Investing in Language Access to Optimize Health System Performance (Research Snapshot)

This report examines systemic impacts of language barriers in Canadian healthcare and the benefits of professional interpreting services.  

Equitable access to high-quality health care is one of the fundamental principles of our Canadian health care system. However, many Canadians who are not proficient in English or French face substantial health inequities due to language barriers.  

Providing professional interpreting services is critical to overcoming linguistic barriers in health care. These services improve the health of patients, enhance the experience of care for both service users and providers, and reduce the costs of health care. 

What is this research about? 

This research aims to build a business case for investing in professional language interpreter services in Canadian healthcare by analyzing the costs of language barriers and documenting the benefits of coordinated language access plans. It updates a 2009 review on the costs of not providing language support.  

Guiding questions:  

• What are the health and economic impacts of language barriers in healthcare? 
• How do professional interpreting services address these challenges? 

What you need to know 

This research positions language access as a foundational element of healthcare equity, with measurable benefits across clinical, experiential, and financial dimensions.  

The research is particularly relevant given that Canada lacks enforceable national standards for interpreting services in healthcare, falling behind other jurisdictions like the US, UK and Australia. The system for delivering medical interpreting in Canada is described as “haphazard and inconsistent.” 21% of Canadians speak a non-official language at home, yet Canada lacks enforceable national standards for medical interpreting. Language barriers result in 34% longer hospital stays for limited English/French proficiency (LEP/LFP) patients and 2x higher risk of medical errors compared to English-proficient patients. 

What the researchers found 

This review analyzes over 120 sources using the Quadruple Aim framework: Better Health Outcomes, Improved Patient Experience, Improved Staff Experience, and Lower Cost of Care.  

Better Health Outcomes:  

• Patients with language barriers are less likely to receive effective, evidence-based treatment. 
• Language barriers contribute to preventable morbidity and mortality. 
• Professional interpreters improve patient safety and clinical outcomes. 
• Diagnostic accuracy for chronic conditions (e.g., diabetes, chronic obstructive pulmonary disease [COPD] and heart failure) 
• Professional interpreters reduced clinically significant errors (12% vs. 22% with ad hoc interpreters) 
• Decreased medication errors by 50% 

Improved Patient Experience:  

• Non-English speakers report lower satisfaction with medical treatment. 
• Language barriers lead to problems with access to and coordination of care. Francophone patients reported misdiagnoses due to language gaps during pain descriptions. 
• Patient satisfaction scores increased by 40% when professional interpreters were used. 
• Professional interpreters improved understanding of diagnoses and follow-up care compliance. 

Improved Staff Experience:  

• Provider satisfaction is higher when professional language services are available, with lower provider burnout. 
• 78% of physicians reported interpreters reduced total care time per patient. 
• Healthcare providers face frequent difficulties communicating with non-English proficient patients. 

Lower Cost of Care:  

• Language barriers decrease healthcare system efficiency and increase costs 
• Professional interpreting services lead to:  
• Reduced emergency department use 
• More efficient use of staff time 
• Lower readmission rates 

The table below demonstrates how investments in language access in general, and professional interpreting in particular, contribute to a higher performing health system. 

Recommendations 

1. Mandate education for all health system employees – from leadership to front line – on the costs and risks of failing to address language barriers and the rationale for investing in interpreting services.  
2. Integrate language access into the standards of practice and policies of Canadian health care institutions, and performance measures of the health system. 
3. Establish core government funding for health care institutions to ensure that interpreting services are included in standard budget lines. 
4. Call on research institutions to develop reliable ways to quantify the costs and benefits associated with investing in language support within the health care system. 

What the researchers did 

Methodology:  

• Literature review of 120+ sources (50+ post-2010) from Canada, the U.S., and globally, including grey literature such as government and institutional reports and demonstration projects. 
• Environmental scan including interviews with healthcare administrators and analysis of hospital utilization data, including research that reviewed hospital records, pediatric ED visits, long-term data on chronic condition management,  

How you can use this research 

For healthcare institutions: 

• Replace ad-hoc interpreters (family/untrained staff) with professional services, reducing liability risks. 
• Mandate interpreter training for healthcare staff. 
• Include language access in health system performance metrics. 
• Adopt remote interpreting technologies (video/phone) to cut costs by $0.75/minute. 

For policymakers: 

• Provide core funding for interpreter services in health budgets. 
• Implement national training standards for medical interpreters. 

Study authors 

Authors: Ilene Hyman and SN Management. Additional content and editing contributions made by Grace Eagan, Bopha Ong, Parul Sharma, Leo Sedevich, and Noa Benishai. 

 

Related Access Alliance Activities & Products 

“When I’m sick, I’m not bilingual” – Language Support is Health Equity
Language can be a significant barrier to accessing healthcare and achieving desired health outcomes. We know what the solutions are, and we know how to make them work. Reframing language access as part of health equity can help ensure that newcomers, and others, have better healthcare experiences and improved health outcomes. What if instead of just thinking about individuals as having a degree of limited English proficiency, we repositioned our perspective to focus on a language of comfort? Language access initiatives can ensure that all individuals have equitable access to high-quality care, information, and services regardless of the language they speak or sign.

Medical Interpreting Services for Refugees in Canada: Current State of Practice and Considerations in Promoting this Essential Human Right for All 
This research examines the current state of medical interpreting services for refugees in Canada. Limited English or French language proficiency can create significant barriers to healthcare access and quality.  The authors make the case that these services are an essential human right while analyzing implementation challenges and opportunities across different jurisdictions.   

RIOMIX Multilingual Information Library  
A collaborative, centralized and accessible repository of translated materials and multilingual websites relating to health and community care and support. The library can be searched by language, topic, category and keyword. Items in the library include the English source and information about the publication (e.g., author, date, translation methodology).  

Access Alliance Language Services  
Established in 1990, Access Alliance Language Services (AALS) delivers high quality language access services to Access Alliance and a diverse range of health, social, and public sector organizations. We provide a wide range of services including interpreting (on-site and remote), translation, audio/video language recordings, interpreter professional development training, and consulting and training services to support organizations achieve their language access goals and meet the language needs of the individuals, families, and communities they serve.  

Community Interpreting in Canada: An Information Session for Afghan Interpreters and Language Assistants  
Presentation slides from 2021 providing information about interpreter accreditation and certification
organizations, interpreting initiatives happening across Canada, and an overview of college language interpreter training programs. 

For more info contact: research@accessalliance.ca