GOOD SYSTEMS CREATE GOOD CARE

There is a saying that bad systems defeat good people every time.  I see the truth in that.  But sometimes, good systems are in place.  And good people can do good work, a good amount of the time, thanks to having processes in place to streamline what we do and how we go about it.

This week, a young person with a congenital health problem that had been managed well for years suddenly died a week after surgery, right when things seemed to be going well.  While the patient didn’t need an interpreter, her family certainly did.  Yet calling for an interpreter is not something every medical center would think of during a “code” situation when staff is busy trying to revive the patient whose heart has stopped.  These situations tend to be chaotic and people naturally feel a certain level of panic, even when they are well-trained.  We likely would not have known it was happening, but for our integrated Interpreter Services that has systems in place to maximize patient coverage.

I was enjoying my lunch at the office with one of our long-time schedulers, when she heard the overhead page for the code team to go to a specific room number.  She quickly checked the Interpreter Services list of in-patients, and discovered that indeed it was a patient with a language need.  She sent me to the room immediately, shortly before I had my next assignment, to offer my services. When I arrived, there were several dozen people, staff and family members, surrounding the patient while chest compression was being applied in an attempt to revive the patient. The immediate family were needing to communicate and negotiate whether they could remain in the room, and to hear enough of the doctor’s talk to understand when the patient was declared deceased. They were able to ask many questions and get answers and comfort right away.

At the first opportunity, I reached out to Interpreter Services and simply stated that I would need my afternoon schedule cleared to stay with this family just for these couple of hours. Our scheduler’s response was to the point: “Done.”  This was not the same scheduler, but she had been updated by her colleague. Other interpreter colleagues covered my remaining jobs so I could stay with this family. Everything was streamlined.

These systems and procedures were put into place by staff and management based on years of experience, good working relations, and commitment to patient care.  And like other good systems, they created the opportunity for a healing experience.  Even for this shocked and grieving family who were literally watching their beloved family member died before their very eyes.  Because we did watch her die, unfortunately.  And there was a need for clear communication with the family throughout this process.

I was able to be present when the surgeon talked to the family about what had happened to likely cause this sudden and unexpected death. I was present and interpreting when the nurse gave her words of comfort and encouraged the family to gather around even as she was cleaning the patient. I was present as family members were offered chairs and water. I interpreted while the hospital obtained permission for a post-mortem blood draw to run studies to protect staff who had been splashed in the eyes with blood during the final event. The social worker was able to hear the family’s immediate concerns about funeral arrangements and grieving support. Other staff came in to offer condolences and information. One brought in a memorial quilt to cover the patient for viewing and when through my interpreting she found out there were several children, she brought in more blankets so each child could have one. Staff came in with tea and coffee, and a tray of snacks, and was able to offer these refreshments in to the family in their language. One of the siblings had me ask staff for a phone charger to borrow while she called family members, and this was found and provided. Another asked for a private location to make some calls and it was found for him.  Someone came from spiritual services and had a good conversation about the family’s needs, and then brought in the specific liturgy that matched the patient’s faith. We were able to pray over the body in the patient’s language and in the patient’s tradition.  This was all of great comfort to the patient’s family at a time of such need. What a positive and supportive outcome for this grieving family.

It is important to note that although there were several family members who were clearly fluent in both English and Spanish, because of our quick response and my ongoing presence, none of them was asked to step up and interpret, not even something non-medical, let alone medical. Imagine requiring a close family member to ask her siblings or parents for a post-mortem blood draw or an autopsy!  Remember that most often, the bilingual family members are the youngest ones, sometimes merely children.  These bilingual family members were allowed to grieve with their family instead of being recruited to “work for free” for the hospital.  When they asked questions of staff and doctors in English, I was nearby to back-interpret into Spanish so the whole family could hear both the questions and answers as they were uttered. These conversations became general, as the non-English speakers were able to hear and participate in the discussions as they took place.  All family members were put on an even footing, and none were burdened with taking on the voice of the hospital.

Thanks to my ongoing presence, none of the staff was tempted to use their varying levels of Spanish either. One of the doctors, the one who was obtaining consent for the autopsy, clearly spoke a lot of Spanish and understood me as I was interpreting.  Her face would light up and she said “yes” several times as she heard my renderings.  But as I was there, she was able to communicate through me, rather than struggling with not quite fluent Spanish.  The doctor ended up being very pleased with the way her words were conveyed, and mentioned that while she had understood what I was saying, she would not have been able to say it as well or so thoughtfully herself.  Thus, the family were able to understand and ultimately decide on the autopsy, as well as ask further questions about the surgery, hospitalization, and final event, in clear language. The family was able to get a lot of closure in the few short hours I was with them.

I feel so grateful to be part of a team where teamwork matters.  Where patient care truly is central.  Where systems are in place so that patients and their families are less likely to fall through the cracks, especially at these critical moments.  This sweet patient was born with a serious health problem, and she had a long-term relationship with the doctors and staff.  But not all of her family had this close and trusting relationship, and they were all in shock.  For them, having clear communication about what was happening,  and getting gentle and respectful support during this time, in their own language, was truly valuable.  It was my honor to interpret for them.  But I wouldn’t have been able to without the systems in place and the excellent scheduling staff that it is my pleasure to work with.