In Part 1 of this blog series, we discussed National CLAS Standard 5: Offer Communication and Language Assistance and learned that, at its heart, this standard requires offering interpreters and translated documents to Limited English Proficient and sensory impaired patients and caregivers. In Part 2, we examined Standard 6: Inform Individuals of the Availability of Language Assistance and learned the importance of both verbal and written notification of language services. In Part 3, we will discuss Standard 7:
Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.
Before July 18, 2016, the effective date of the Section 1557 regulations, authorities in healthcare language services weren’t very clear on what it meant to provide interpreting services. The Section 1557 regulations finally offered some details on what it means to be a “professional,” or, in their terms, “qualified” medical interpreter:
A qualified interpreter means an interpreter who:
- Adheres to generally accepted interpreter ethics principles, including client confidentiality; and
- [For spoken languages] has demonstrated proficiency in speaking and understanding both spoken English and at least one other spoken language; and
- Is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary, terminology, and phraseology.[1]
The definition is certainly helpful, but still lacks detail on practical steps healthcare providers should take to ensure the interpreters helping with their patients “adhere to interpreter ethics principles, including confidentiality,” and are “able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary, terminology and phraseology.”
So, what should you look for to ensure that the professional medical interpreters working with you are qualified? Let’s break down the standard and find out.
- Ethical: How does anyone prove that they “adhere” to ethics principles? As with any profession that centers around maintaining confidentiality, a great way to show commitment to ethics is through annual training and attestation. Ask your language solutions provider for evidence that interpreters have been trained regarding interpreter ethics principles as well as HIPAA and patient confidentiality, and that they have committed to compliance through attestation.
- Competent: We all know that it takes much more than being bilingual to be a competent medical interpreter. Key to ensuring competence is assessment. The National Health Law Program[2] identified the below list of skills and qualifications to consider:
- Active listening skills
- Message conversion skills
- Clear and understandable speech delivery
- Familiarity with regionalisms and slang in both languages
- Ability to identify differences in meaning due to dialects or regionalisms to ensure effective and accurate message conversion
- Ability to communicate in all registers and at varying levels of formality
- Understanding of colloquialisms and idiomatic expressions in all working languages
- Working knowledge of anatomy and physiology
- Extensive knowledge of the vocabulary and terminology related to diagnosis, prevention, treatment, and management of illness and disease
- Understanding of key concepts in health care, such as confidentiality, informed consent, and patients’ rights
- Command of the vocabulary related to the provision of health care in both languages
Don’t know whether your in-house and/or contracted interpreters have been assessed for competence? Don’t be afraid to ask! If you don’t, there’s a good chance the Joint Commission or a plaintiff’s lawyer will.
The second part of CLAS Standard 7 instructs us to “avoid the use of untrained individuals and/or minors as interpreters.” On this topic, Section 1557 goes much further and is extremely clear: don’t do it! Except in limited circumstances (like emergencies), Section 1557 prohibits the use of minors or untrained adults as interpreters. In the real world, this is often easier said than done. Let’s take a look at the two main hurdles to complying with this standard:
- Medical Staff: Getting medical staff to use your Language Access Program and bring in a qualified interpreter means confronting the reasons they don’t do it in the first place. The most common reasons given for using a friend or family member include “it’s faster,” “it’s more convenient,” and “it doesn’t cost anything.” Challenge medical staff objections with a few, pointed questions:
- Is it really “faster” if the untrained person doesn’t understand medical terminology, requiring numerous back-and-forth exchanges before understanding is reached?
- Is it really faster, more convenient or less expensive if a misdiagnosis due to ineffective communication causes a lengthened stay, unnecessary testing, or readmission?
- How does that cost savings look compared to a medical malpractice claim or discrimination lawsuit?
The bottom line is family and friends need to be in a support (and sometimes advocate) role, not assuming the burden and risk of a misinterpretation.
- Persistent Patients: Let’s face it. Some patients or caregivers want what they want and won’t take no for an answer. While Section 1557 provides a limited out for adult patients who really want to use an adult friend or family member as an interpreter, in most cases, a qualified interpreter is required. Helping patients and their caregivers understand why using a qualified medical interpreter is so important means helping them overcome their concerns:
- “I don’t want a stranger knowing my personal business!” Healthcare is a private, personal matter. When patients see professional interpreters as “outsiders” or “strangers,” instead of an integral part of the healthcare team, they may feel uncomfortable. Combat this by always treating interpreters like the healthcare staff they are.
- “But the interpreter is a [man/woman!]!” Whether for cultural or religious reasons, or just personal discomfort, some patients prefer not to have members of the opposite gender in the room during medical treatment. Especially for rare languages, accommodating gender preferences can be difficult (and, in some cases, violate anti-discrimination laws). Much as the privacy issue addressed above, dealing with this concern starts with treating medical interpreters as a valued part of the medical team. Build on this by explaining or asking the interpreter to explain his/her commitment to privacy and confidentiality, and the positioning techniques that he/she will use to see only the patient’s face. Or, where appropriate, use over-the-phone interpreting to eliminate the issue altogether.
- “But I want my loved one involved!” Patients often want their loved ones there to help in medical decisions or coping with medical problems. This can lead to the false conclusion that using a loved one as an interpreter is the best way to go. Counter this by explaining to patients that the qualified medical interpreter is there to allow their friends and family to focus on them; to act as a support or advocate or shoulder to cry on – not the person worrying about whether they know how the Spanish/Arabic/Russian/Etc. words for “cardiologist,” “appendicitis,” or “thrombosis.”
When it comes to providing qualified medical interpreters, Vocalink Global has you covered. Our interpreters are assessed for language proficiency and trained on interpreter ethics, HIPAA, and patient confidentiality. Better yet, our UCheck Interpreter Compliance Portal provides 24/7/365 on-demand access to on-site interpreter compliance reports and supporting documentation.
For more information, check out www.thinkculturalhealth.hhs.gov and watch for the next installment in this blog series where we’ll discuss ensuring the competence of individuals providing language assistance.
[1] Paraphrased from 45 CFR §92.4’s definitions of “Qualified interpreter for an individual with a disability,” and “Qualified interpreter for an individual with limited English proficiency.”