Medical interpreters key to patient communication, safety
Learn from one hospital's program
According to Joint Commission standards and federal law, patients have the right to effective communication, including access to interpretation and translation services. It's easy to understand why. Effective communication with a patient is a critical component of patient safety, education, and informed consent.
"It makes people very nervous when someone comes in the room and starts speaking a different language that he or she doesn't understand," says Sherry Mazer, regulatory officer at Temple University Hospital in Philadelphia. "Imagine you're in the hospital, you're sick, you don't know what's wrong with you, and you can't understand what anyone is saying. How would you feel?"
Mazer, who oversees the Linguistic and Cultural Services Department at Temple, says there's a lot to consider with language interpretation. You have to take into account all of the patient's needs, including whether your language interpretation service is up to par.
Temple uses three kinds of interpretation services, all accepted by The Joint Commission: in-house staff Spanish interpreters, dual-role interpreters, and a vendor telephone service. The combination of services helps meet the specific needs of Temple's patient population, says Mazer. Spanish is the most widely spoken language in the service area other than English, so the in-house interpreters are most useful.
Temple also follows the National Standards on Culturally and Linguistically Appropriate Services (CLAS), provided by the U.S. Department of Health and Human Services (see p. 10 sidebar), which Mazer says are great guidelines to follow to help ensure effective communication and better patient care.
In-house interpreters are subject to Temple's credentialing program, which begins at hire. The interview is conducted in Spanish, and then the interpreters undergo a series of tests.
"Just because you can speak Spanish doesn't mean you can interpret," says Mazer. A program that emphasizes quality helps ensure that everyone is qualified, whether they are native speakers, speak Spanish in cultural settings but use English as a primary language, or have learned Spanish as a second language, she says.
"Medical interpretation is different," Mazer notes. "There can be a big difference between ‘structure' and ‘stricture.' "
The interpreters' final oral exam is conducted through a vendor, and they are retested annually. The vendor sends the hospital the results, broken down by different areas of competency, such as accuracy and customer serivce. If interpreters do not pass a certain level, they must follow a remediation plan and retest. If the retest results are not satisfactory, the interpreters go through another remediation phase with the understanding that their employment may be in jeopardy.
Once hired, the length of orientation varies as needed, from one month to six months. If an interpreter still needs training after six months, Mazer says the hospital considers letting the person go. Strict standards are critical to ensure patient safety and good care, she says.
"If you have to listen to someone speaking in English and repeat the same thing back in English, you'd probably not repeat what was just said 100%. And that's just English to English, never mind between languages or with medical terminology," says Mazer.
She says the job is also difficult because the interpreter must understand the need for impartiality and to not assume what either party "meant to say," including common phrases that might not translate well. He or she must translate the speaker's exact words, only clarifying through further questioning.
The nature of the conversation is also important, which is why interpreters meet with the provider who called for an interpreter before having the conversation with the patient. It's a good idea for the interpreter to understand whether he or she is delivering bad news, explaining a procedure or discharge instructions, and so forth.
"They need to understand the level of conversation they're going to have with the patient," says Mazer-especially since the patient will likely have questions for the provider.
Dual-role interpreters are hospital staff members who work for the hospital in a primary role-such as a pharmacist, physician, or x-ray technician-but speak another language and provide interpreter services when needed. Mazer stresses that this position isn't just filled by someone who happens to speak a given language. Temple's dual-role interpreters undergo the same credentialing process as the in-house Spanish interpreters, and they have to be cleared by a supervisor before they can interpret on the job. Dual-role interpreters are observed through a vendor agency to ensure quality. They also wear a sticker on their ID badges to identify them as interpreters. Finally, a list is kept on the hospital intranet of who speaks what language.
Under Joint Commission standards, hospitals must also evaluate the vendors used for language interpretation, such as telephone services. Human resources must know what kind of testing the vendor uses, what qualifies as a passing grade, and whether staff are passing said tests. Response time is also important because the services should not delay patient care.
"We've changed vendors over the years because of response time," says Mazer. "Language services are really resource-intensive." But she stresses that those resources are indispensable because the stakes are high. A failure to meet a patient's communication needs could result in a lawsuit and patient harm.