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Triple Aim: 3 Ways to Better Care and Lower Cost with Language Services


Aligning medical interpretation services with Donald Berwick’s “Triple Aim.” The Triple Aim framework was developed by the Institute for Healthcare Improvement in Cambridge, Massachusetts (


Listening to former CMS Administrator Donald Berwick at this year’s American Hospital Association Leadership Summit got me thinking about how the “Triple Aim” process relates to interpreting services.  Triple Aim consists of three elements: better health outcomes, better care, and lower costs, and the framework needed to improve all three elements at the same time.

Interpretation services are a core component in achieving the “Triple Aim” for the Limited English Patient population.  The majority of hospitals today are providing language services in one form or another, but research indicates that there are many opportunities for improvement.

Better Health

It’s simple – the use of professional interpreters improves clinical care.[i] Even with this data, physicians still regularly use family members to interpret healthcare sessions, under-using professional interpreters. [ii]

Why? One answer is that physicians are almost always pressed for time.[iii] Using a family member already in the room seems quick and easy. Getting a professional interpreter is difficult and takes time, right?

Not necessarily. A professional remote interpreter can be accessed within seconds.  Smartphones, web browsers, desk phones or tablet computers – all are perfect devices to get connected to an interpreter in no time and ensure better health outcomes. If physicians are aware that a professional, medical interpreter is a click away, would they use it more?

Technology makes interpreters more accessible, but that might not help much if physicians think they can get by without an interpreter, as one study suggests.[iv] Therefore, training is another essential component: TeamSTEPPS is an ideal framework to provide ready-to-use materials.[v]

Better Care

Professional interpreters improve patient satisfaction, irrespective of modality (in-person, telephone, video). [vi]

52.4% of adverse health events for Limited English Proficient patients are due to communication errors, compared to 35.9% for English speakers.

Innovative systems stratify their HCAHPS scores by language and can improve overall satisfaction by improving the scores for the LEP demographic.[vii]

Lower Costs

Cash-strapped hospitals may be tempted to cut back on interpreter services to save money, even at the risk of lowering healthcare outcomes for Limited English Proficient patients. This would be a big mistake. There are plenty of better ways to save money on interpreter services.

As with other hospital programs, eliminating inefficiencies can both lower costs and expand the service.  Keep in mind that while there are situations where professional on-site interpreters are indispensable, for most other cases, the use of a remote interpreter is more cost effective.

One example of this is Cambridge Health Alliance, that developed an innovative system that increases the amount of time an interpreter is actually interpreting, while at the same time eliminating costs from wait times, travels, and transitions that are unavoidable in an in-person delivery model. [viii]

How is your facility following the Triple Aim process? Feel free to leave comments below.







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