As an organization, Connecting Cultures is constantly self-critiqueing — What are we doing right? Where could we improve? How can we codify what's been done right so we can replicate that success in the future?
This process results in a lot of writing. A LOT of writing. Occasionally, we'll collect these ideas more formally and publish them as white papers.
We think it's a well-considered look at a process that Healthcare Organizations and Language Access Providers alike can use in assessing their language access needs, and the considerations that go into delivering on those needs.
Above all, we want to get people asking the right questions!
Take a look, and let us know what you think.
I recently visited Oakland, California to attend Diversity Rx's Eighth National Conference on Quality Health Care for Culturally Diverse Populations (more on that in a moment). When traveling, I like to treat my tastebuds to new experiences, so I popped into a Japanese restaurant, seated myself at a table by the window, and tried to order a simple glass of water.
The conversation went something like this:
Waitress: "What would you like to drink?"
Waitress: "You want tea?"
Erin: "No, just water."
Waitress: "Hot water?"
Erin: "No, just plain water, please."
Waitress: (Probably thinking: 'There's something this lady isn't understanding about my question.') "Maybe you would like a cup of tea?"
Erin: (Thinking: 'I must not be communicating clearly. The words I'm using to describe the picture of 'water' I have in my head are not creating the same picture of 'water' in the waitress's head. I need to describe my picture better…') "No tea. Just a cup of water with ice, please."
Bingo! "Ohhh! Okay!" the waitress affirmed with a smile.
The waitress relaxed, I relaxed. A moment later she brought be a lovely cup of tea. Just kidding! It was a tall glass of perfectly iced water.
There's more to communicating across cultures than finding a shared language (or interpreter). It is also necessary to develop skills and strategies that allow you to communicate effectively across cultures.
The Diversity Rx Conference offered workshops focused on developing skills to communicate effectively in cross-cultural encounters. One of these workshops was "Using a Skill-Based Approach to Get the Most Out Of Cultural Competence: The ASCN Model (Ask, Share, Compare, Negotiate)" (presented by John Bormanis, PhD, and Randa Hutob, MD, MPH.) As stated in the session description:
"The main premise of the ASCN model is that you only understand a patient's culture if you ask about it; futhermore, unless you have a great deal of self-knowledge about your own culture(s), you are less likely to be able to deliver culturally competent care."
The ASCN Model is one communication model that promotes effective communication between providers and their patients:
- Ask the patient about his or her health beliefs and behaviors
- Share your medical view
- Compare both views
- Negotiate a treatment plan
By using the ASCN Model, you have the opportunity to better understand the patient's perspective regarding the health concerns. You are able to establish rapport by showing interest in and respect for the patient's experience. You can take waht you learn about the patient's perspective, share your medical perspective, make recommendations and negotiate a plan of action.
Just to clarify: "negotiating" doesn't mean acting in a way that would jeopardize a license to practice medicine or the patient's wellbeing. On the contrary; it is about communicating with patients in a way that builds relationships and fosters exchange of information, which, in turn, allows the theraputic relationship to work toward the best possible outcome. Or, as one of the session participants put it:
"Instead of me (doctor) fixing you (patient), we work together to fight diabetes."
Wouldn't it be so much easier to jsut tell the patient what to do and be done with it? Yes. Would it be effective? Almost certainly not.
The aforementioned waitress could have brushed off my desire for ice water and simply brought be tea. She even could have explained that it was a tasty beverage that would complement my meal well and facilitate proper digestion. I would have agreed with her completely, yet left the tea untouched.
You see, I do enjoy tea and would have very much liked to have drunk tea with my meal, but it was the Lenten Season, and I had made a commitment to abstain from tea as part of my observance of Lent.
To the waitress, I might have seemed like a picky customer. To me, I was just trying to practice my faith, in a way that is common in my culture. Without effective communication, though, there was no way to for the waitress to know the underlying forces that were driving my actions (or inactions, in this case).
How often could simple cultural misunderstandings lead to patient non-compliance,or a medical provider missing the reason behind, for example, a dietary change?
Understanding that these cultural differences exist is the basis for a more thorough and mutually-beneficial conversation between provider and patient, which, in turn, leads to better healthcare outcomes.
Interested in learning more about communication models that help facilitate effective cross-cultural communication?
What successes have you had in communicating within culturally diverse communities?
Are there other communication models / techniques that you have found to be effective?
As medical interpreters, our days are inherently prone to "fire drills". They're last-minute, always urgent, and have the potential to cause real damage if unchecked.
As I see it, there are three ways to approach a fire drill:
1) Do nothing.
Though not usually the best option, this is an option. Depending on your role the situation, this may be worthy of consideration.
Yep. I can run in circles proclaiming all the woes and intensify the frustration in me and everyone around me. Been there. Done that. But it only makes the challenge that much bigger and scarier, so all it really accomplishes is an uptick in the anxiety level of everyone around me.
3) Act calmly, with a sense of purpose.
This is so much easier said than done, I know. But we can't expect to do more than our personal best with the information and tools we have in the moment, so there's no use in getting worked up about it. Or, as the Marines say:
"Slow is smooth. Smooth is fast."
If we keep a balanced perspective of people and business, we can arrive confidently at the right decision. That confidence in our purpose will bring order to those around us.
Our sustained effort to hone our craft leaves us with the tools we need to stay calm and purposeful during our fire drills. Use those tools, stay calm, and make your next fire drill a success!
Consistency makes each day manageable. I know that I'm going to see my family every evening at the dinner table. My kids know what they need to do to get ready for school each morning. There is a sense of security in knowing that you have a job, and it allows us to do our jobs better.
Internal consistency is the cornerstone of our success at Connecting Cultures, because it brings with it an external predictability -- the kind of reliable foundation on which a working relationship can be built.
Over the years, Connecting Cultures has developed internal processes and standards to handle everything from time logging, to appointment confirming, to patient reminder calls, and interpreter training. These reliable touchpoints are built around the internal needs of our customers, allowing us to support their established processes (scheduling, accounts payable, patient reminders) with our own (appointment taking, invoicing, facilitating patient reminder calls). To say nothing of the quality of our interpreters (which we ensure through intensive and continuous training), we are set apart as a language services provider by the ways in which we work with our healthcare providers on an administrative level. The consistency we bring to the relationship pays dividends for our customers by taking the guesswork out of language services and allowing them to focus on providing value in their own work.
Some organizations run into the challenge of staff not wanting to use language services -- typically because their vendor is hard to work with, unpredictable or unnerving. Our job is to make access to language services easy for our clients and their customers. I'm not just talking about picking up the phone to request an interpreter; I'm talking about the confidence given to the services provided to the health care team and to the overall management that will assure standards are met each and every time.
There are many different views about what health care interpreting looks like. Many are trying to create a professional standard. But in order to make this complete, healthcare interpreters need consistency in how they're utilized, managed and trained.
I recently had a conversation with a healthcare provider (we'll call her "Joanne"). Joanne had a friend who was finishing her bachelor's degree with a major in a foreign language, and that friend was thinking about interpreting as a way to make some secondary income.
As our conversation progressed, the topic of "qualifications" came up; Joanne was surprised to hear that, as an industry, healthcare interpreters have no established professional standards (as Joanne, a healthcare professional, had come to expect in her own industry).
My conversation with Joanne brought up two long-standing frustrations I have with the interpreting industry at large:
1) The common view of healthcare interpreting as a secondary income source.
Interpreting is a career choice worthy of your full time and attention! Approaching it as a once-in-a-while job, though well-intended, can do more harm than good — we've all heard stories of underqualified or less-experienced interpreters neglecting important portions of a health care conversation, leading to a botched diagnosis or ineffective treatment.
The ability to confidently navigate the nuances of a healthcare interpreting encounter is something that only comes with training and practice. It truly is a craft, and, as such, is worthy of an interpreter's continued pursuit of mastery.
2) The tarnished reputation of healthcare interpreters, as professional service providers.
The act of interpreting aside, interpreters who don't view it as their life's work are less inclined to approach their job with a sense of professionalism. Is the interpreter available when he/she is needed? Once committed to an appointment, does he/she arrive to the encounter on time? Does the interpreter have a system in place for reliably planning, fulfilling and invoicing their interpreting time? Is the interpreter appropriately dressed for the appointment purpose and setting?
Healthcare providers are consummate professionals, and they should be able to expect the same of their interpreter counterparts in any given encounter.
Given these frequent shortcomings, then, is it any wonder that healthcare providers and administrators don't often view interpreters as necessary elements in their treatment teams?
If we — as an industry of professionals — expect to be taken seriously, it's important that we act professionally, and make our services reliable and consistent, taking into consideration the organizational and administrative needs of our healthcare provider customers.
Just as a healthcare provider needs to be confident in the tools of her trade, she should be confident in the skills and professionalism of her interpreter.
Only then will interpreters be able to consistently demonstrate our true value, and gain consideration in the healthcare process beyond that of a regulatory compliance.
In part one of our Q&A series, we covered the need to have a working agreement in place when working with an agency.
In this edition, we'll cover in more detail one important aspect of that agreement: compensation.
Broadly speaking, medical interpreters are inclined to think of their service in terms of the good it does for the patient and provider, not in terms of the monetary value of that "good".
But it's a safe bet that the agency you're negotiating with has a handle on the dollars and cents of that encounter; both the fees they can charge for it, and the costs they incur in facilitating it (i.e. administrative overhead).
To have an effective and mutually beneficial negotiation, there are several points to consider:
1) What value do you bring to the table?
- Why are you a good fit for the agency?
- What extra value can you bring to the agency's customers?
2) What is the full scope of your compensation?
- As a freelancer, will include only hourly pay and possibly mileage
- As an employee, may include benefits such as health insurance or 401K contributions (typically, at a lower rate of base pay)
3) What are the terms of payment?
- How quickly will you be paid? Will you get a check in 7 days? 10 days? 30 days? As a freelancer, you have to think of yourself as a small business, and in small businesses, cash flow matters!
4) In what ways could you work differently to earn more?
- If an agency can reliably offer you more total billable hours of work per week, then it might be worth accepting a slightly lower hourly rate than you would if the the volume of billable hours was lower.
- If you're willing to accept appointments during unpopular hours, willing to work on short notice ("on call"), or are, generally, more reliably and quickly available to the agency's clients, then you can make a good case for better compensation. That increased availability, after all, will reflect well on the agency's reputation, and they can leverage that reputation to negotiate better fees from their customers.
On the whole, be thinking in terms of demonstrable value. The better-equipped you are to talk about your real value to the agency, the better you will fare at the negotiating table.
Professionalism goes a long way. Do your homework about the agency and their clients. If your experience and skills are a good fit, then be confident in your position.
And never forget: you're not required to accept an agency's offer. If they're not a fit (because of anything from compensation, to culture, to time demands, etc.), know that you can say "no".
Experienced free agents: what have you found helpful in negotions with agencies?
Note: This is the second of a series of posts on the practicalities of working as a freelance interpreter. If you have a question for Rashelle, or any of our experienced interpreters or trainers, email it to firstname.lastname@example.org with the subject line "Freelancer Questions".
Healthcare interpreters are expected to be life-long learners. Fortunately, we interpreters tend to be a knowledge-hungry people, meaning continuing education turns out to be more of a professional perk than a chore. But if you're working alone, good reference materials may not be enough to keep you "in the know".
Back in my college days (suffice it to say that this was pre-Facebook), I had a professor — a life-long learner himself — who often gave examples of things he had learned from his "friends". He'd then go on to reveal his "friend" to be someone who had lived in the second century, or on the other side of the planet.
As a result of that professor's anecdotes, I widened my definition of "friend" to "anyone who inspires or supports you" — whether or not you've actually met this person.
When it comes to professional development, it's important to be connected to the ideas of others if you want to grow — to cast a wider net for those sources of inspiration and support.
In the Facebook / Skype / LinkedIn / Twitter era, there is no shortage of ways to discover and connect with like-minded individuals or professional groups. It's important, though, to distinguish between the medium (online networks, professional organizations, etc.) and the connections you're trying to make with real human beings. In this case, the networks themselves are just tools for connecting; it's still up to you to make and define those connections on a human-to-human level.
As you build your circle of friends, do consider including people and perspectives that forster development in skills and competencies which are less obvious, but still of general value to professionals — such as leadership, customer service, speaking, communication, or time management.
It can also be helpful to diversify in another direction: those who share your role in other industries.
For instance: individuals involved in the training and development of healthcare interpreters will also benefit from extending their circle of professional friends to include sales trainers, or manufacturing trainers. In my own experience wearing my "trainer hat", this circle of friends has provided valuable insights, resources, and tools — all of which have expanded and reinforced my own professional development as a learning and performance practitioner. And since we share a common interest in learning about learning, we have a base level on which we can naturally interact and exchange useful insights from our very different industries.
Here's a peek at a few of my own learning and performance "friends":
As a healthcare interpreter, who are your professional "friends", and how are they helping you to grow?
As medical interpreters, we are driven by our desire to help others and work in a dynamic environment. Given this motivation, we rarely think of ourselves as a business, so drafting and discussing contract terms can be uncomfortable.
But, official "contract" or not, it is essential that you go through the process of identifying your work requirements/terms, and balancing those expectations in writing with the expectations of the hiring agency. This is commonly referred to as a "working agreement".
Think of your working agreement as framework for answering the following:
- What do you expect from the agency?
- What can the agency expect from you as a freelancer? ("agreement"" is a two-way street, after all)
A few items to consider putting into your written agreement:
- Your negotiated hourly rate, and what "counts" as billable time
- Billing terms (i.e. When and how often do you expect to receive payment?)
- Your criteria for accepting a given job
- Circumstances under which you will decline a job
Good business practices suggest that the terms of your working relationship be clear in the beginning. In this sense, the agreement is a way of ensuring this conversation takes place, and that both parties are satisfied with the outcome of that discussion (put down in writing).
It's important to know that, ultimately, an agency has no obligation to sign or commit to any type of working agreement, and they will likely have existing practices they'll want you to adhere to. But, if you’ve taken the time to think about yourself as a business and define what you see as an acceptable working relationship with the agency, you will have demonstrated your competency as a freelancer, and will be in a much better position to make the right decisions about your working relationships with agencies.
Note: This is the first of a series of posts on the practicalities of working as a freelance interpreter. If you have a question for Rashelle, or any of our experienced interpreters or trainers, email it to email@example.com with the subject line "Freelancer Questions".
Have you ever wished for a particular superpower to help you better handle interpreting encounters? I know I have.
It might seem silly to daydream about having superpowers. However, accepting that I don’t have superpowers helps me to have more realistic expectations of myself and others. It also serves as a motivator to uncover superpower alternatives that are realistic and produce the desired outcome — even if it does take a bit more effort.
Here are the top four superpowers on my wish list, along with their more attainable alternatives:
bi-location (n.) The ability to be in two different places at the same time.
Why? Even the most carefully planned day can get off track. A 30 minute clinic appointment might run two hours longer than expected. On some days it might not matter if the planned appointment runs long; other days, this will cause serious complications to meeting the needs of others and fulfilling commitments.
Alternative for non-supers: Develop a logistical contingency plan to fall back on when unplanned events prevent you from sticking to the schedule. Be sure to collaborate with your team members when developing the plan. This includes fellow interpreters, interpreter schedulers, and the healthcare team.
Here are some questions to consider when developing a logistical contingency plan:
+ Who must initiate the communication?
+ Who needs to receive the communication?
+ What do they need to know?
+ By when do they need to know it?
+ How must it be communicated to them?
mindreading (n.) The ability to know exactly what the speaker means, and have access to the full context of the message.
Why? Words don’t always translate neatly, and individuals don’t always speak clearly. Some messages remain unclear even when spoken with a reasonable amount of clarity and context, such as words that have multiple definitions like “buckle” and “tough”.
Alternative for non-supers: Clarify messages before delivering the interpretation, and correct interpretation errors when they happen. I’m much more likely to trust an interpreter who is more concerned with communicating the messages accurately, than an interpreter who is more concerned with “looking good” while delivering seemingly flawless messages. Also, develop a strong working knowledge of the subject matter (i.e. healthcare) to better understand the context of the spoken message.
antigravity (n.) The ability to float or hover above everyone and everything in the immediate environment.
Why? Most hospital and clinic facilities were not designed with interpreters in mind. Sometimes it’s impossible to be in an ideal position to facilitate communication and stay out of the way of medical equipment and personnel.
Alternative for non-supers: Install hammocks on exam room ceilings (just kidding — that would probably creep the patient out, and it wouldn’t be safe).
Work with the medical personnel to select the best place for you to be. Learn from “mistakes” and make better decisions the next time. Remember that you are a very important person in the encounter, but you are not the most important person in the encounter. Make the best of the situation you have.
Energizer Bunny (n.) The ability to keep going and going and going... (Okay, not really a superpower, but indulge me on this one...)
Why? Many interpreters work unusual hours and have unpredictable schedules. Meal and sleep routines get interrupted or delayed, which inevitably impacts the human body’s ability to keep going and diminishes brain power.
Alternative for non-supers: Be aware of your own physical needs, and respond to them. Don’t ignore that you’re hungry, thirsty, tired, or have to go to the bathroom. Do what you can to anticipate your physical needs. The C-section might only last 45 minutes, but you’re going to be very busy for that duration and a period of time thereafter. Grab a quick snack or hydrate before going into the operating room.
As an interpreter, what other superpowers would you like to have? What other superpower alternatives do you recommend?
P.S. If you are reading this and have developed any of these superpowers, please contact me. I'd love to talk.
As healthcare interpreters, we might not consider ourselves to be protagonists in the events and environment that we experience on a daily basis, but we are, nevertheless, affected by them.
Prior to becoming a healthcare interpreter, I was informed of the many challenges that healthcare interpreters face in their field — the emotionally charged encounters; the unpleasant sights, sounds and smells; the odd hours and long shifts.
I knew of all these and other challenges ahead of time, and, as such, was able to identify and respond to them reasonably well.
I also knew that working in the field of healthcare would have an impact on me personally, but I was a little surprised about the self-discoveries I made.
For example: I discovered after years of interpreting that I had developed an increasingly diminished ability form and express my own thoughts. Turns out, while I was spending all day expressing other people’s thoughts and words, I was losing the skill of forming and expressing my own. This has caused me to be more intentional about taking time to engage in activities that give me a chance to speak in my own voice.
I also discovered that it really doesn’t bother me at all to see other people get poked with needles — but when I am the patient getting poked, I get a little lightheaded at the sight of the needle entering my arm. This has made me more sensitive to the emotional stress that patients might be feeling when in the doctor’s office, even if they don’t express it in any external way.
For better or worse, we are impacted by what we experience and by what we do. Through it all, it is important that we take care of ourselves. One way to do that is to take time to acknowledge the impact your work as a healthcare interpreter is having on you as a person.
How has interpreting in healthcare affected you personally?
Let's face it—not all teachers have what it takes to handle Kindergarten, and not all nurses have what it takes to handle the ICU. The same can be said for interpreters in high-stakes, challenging areas like international affairs or healthcare.
With that in mind, I posed the following scenario to the healthcare interpreters at Connecting Cultures:
Imagine you just met someone who has been an interpreter at the United Nations for three years. She says she really enjoys interpreting and does it well, but is not finding "life at the UN" to be all she had hoped for. She has been thinking about making a switch to interpreting in the healthcare field.
What would you do or say to help her decide whether healthcare is a good fit for her?
Here are a few of the interpreters' responses:
- "I would ask her if she's okay with seeing needles, blood, etc. It's not good to be in a medical setting if you know you'll be squeamish."
- "Above all, I think she should make sure she feels comfortable with and is able to follow the Code of Ethics for Interpreters in Healthcare."
- "I would mention that each day is likely to be different from the last."
- "I would mention that in the medical setting, it is very important to be a patient person."
- "Medical interpreting requires the individual to have a very broad vocabulary and the flexibility to jump from one scenario to the next without becoming personally involved."
- "Depending on where you will work, if there is a big population of the ethnic group you will be working with, expect to be recognized everywhere you go."
Are you a healthcare interpreter? What advice would you have for someone considering entering the field?
Healthcare interpreting can be hazardous, especially for interpreters who work onsite at hospitals and other healthcare facilities. Interpreters need to be aware of potential health and safety hazards and take the appropriate measures to minimize or eliminate the risks.
Keep your hands clean.
Healthcare facilities have signs all over the place reminding and instructing people to cleanse their hands. Hand sanitizer stations are posted every three feet. (Okay, slight exaggeration, but you get the idea.) The CDC has even produced a fun, self-guided, interactive tutorial on the subject. Take a look and share it with others.
Use appropriate Personal Protective Equipment (PPE).
Use it in the appropriate way, at the appropriate time. It’s about protecting yourself. General rule of thumb - if the medical personnel wear it, you wear it. It’s about preventing the spread of illness to others. The little ones in the NICU have enough to battle without adding preventable infections to their list of troubles. A quick search of the CDC website will provide you with more specifics on using PPE in the healthcare environment, including this handy poster on donning and removing PPE.
Continue to learn more on how to protect yourself from medical environmental hazards, and put these tips into action because – let’s face it – the medical staff is plenty busy with the patients they already have, and interpreters are scarce enough without lessening availability due to illness.
What else are you doing to take precautions in the medical environment?
As field observation becomes a standard part of interpreter training programs and employee evaluations, the need to conduct effective post-session debriefs (a.k.a. performance feedback) grows. Facilitating a good debrief session requires preparation and skill, just as interpreting itself does.
Here are a few tips to consider when facilitating a field observation debrief:
Establish a structure for the debrief discussion.
Pre-plan discussion topics. This might be as broad as asking “What went well? What needs improvement?” or as detailed as focusing on each tenet of the ethics (accuracy, impartiality, etc.) or interpreting protocols (room positioning, pre-session, etc.).
Focus on the most critical components – this includes positive things to reinforce and areas to improve – to avoid a debrief that drags on ad tedium. You don’t want the performer walking away thinking “I don’t remember much about the appointment, but I know the debrief was grueling.”
Always conduct the debrief in a confidential area.
Given HIPAA and interpreting industry expectations regarding confidentiality, this is (hopefully) a no-brainer. Additionally, the individual in the hot seat will be more receptive to feedback if there is not a fear that “others” are privy to the details of their performance. Praise publicly, correct privately.
Listen first, speak later.
Always insist that the performer evaluate his or her performance first. Then offer feedback and coaching tips afterward. The performer will likely be eager to “unload” at this time, and allowing them to set the stage allows for a more engagement during the discussion. This also is a way to verify that they are able to accurately evaluate their performance when not being observed, an important skill to develop.
Conduct the debrief immediately after the encounter (and have a backup plan if that’s not possible).
The more time that elapses between encounter and debrief, the fuzzier (and less valuable) the debrief becomes. If it is impossible to debrief immediately after the encounter, create a simple self-evaluation form that the performer can fill out in lieu of a formal discussion. This allows the performer to capture important details and decompress after the encounter. Do set a time for a debrief discussion as soon thereafter as possible.
Give meaningful feedback, positively.
This is a big topic unto itself, but for the sake of brevity, make sure the feedback (positive or corrective) focuses on a behavior. “You did really well” is nice to hear, but doesn’t tell the performer what behavior to repeat. Alternatively, “You did a really good job discretely repositioning yourself when it became difficult to hear” names a repeatable behavior. If something in particular didn’t go well, emphasize the performer’s ability to improve and create a plan to help the individual to improve.
An effective debrief leads to better performance. Better performance leads to a stronger health care interpreter workforce. A stronger health care interpreter workforce leads to improved communication between health care providers and the communities they serve through interpreters.
Interpreters and Interpreter Trainers: What other tips do you have to make the most of performance evaluation discussions?
When I was new to interpreting, I often found myself listening to the patient's symptoms and making determinations (to myself, of course) as to what the diagnosis would be.
Fever, pain with swallowing - strep throat!
Abdominal pain, worse after eating - gallstones!
Pain in feet, worse when walking barefoot - flat feet!
Not surprisingly, my diagnoses were frequently wrong, and so I came to realize that while I might know a lot of medical terms and concepts, I had no business trying to apply that knowledge beyond the accurate conversion of messages between languages.
Any lingering delusions I had about my "medical abilities" dissipated one night at the Emergency Department. Long story short, the ED was arranging for the patient, a toddler, to be airlifted to a different hospital. In the meantime, the on-call pediatrician came to the ED for evaluation and consult. The pediatrician determined that the "abnormality" that alarmed the ED physician was not an abnormality after all. My lesson learned: I am infinitely less qualified to make a diagnosis (or treatment recommendation, or referral, or testing recommendation) than a credentialed ED physician.
So, if an ED doc can get it wrong, I have no chance. And I need to remember that.
As interpreters, we learn a lot about biomedicine. It is a requirement expressed in the code of ethics because it supports our ability to interpret accurately and heightens our memory capacity. Still, I need to be careful to limit my application of medical knowledge to the communication of medical information and leave the diagnosing to the doctors. This boundary is also expressed in the interpreter's ethic—and for good reason.
So, hats off to the medical professionals and support staff who use their hard-earned skills and knowledge to the benefit of their patients and their patients' families. As an interpreter, it's a humble honor to use my skills so that they can use theirs.
In working with health care organizations on language access planning, it is generally assumed that operating an in-house team of language professionals is less expensive than contracting with vendors. While each organization is unique, this can be a dangerous, and often inaccurate assumption.
The U.S. Department of Labor Bureau of Labor Statistics recently released data showing Hospitals pay nearly $13.00 USD per hour for employee benefits alone. From paid time off to insurance to other legally required benefits, these embedded employment costs are often overlooked when considering the total cost of adding an employee to staff. And this $13 is just the beginning. In the case of health care interpreters, professional liability insurance should be considered – not to mention the auxiliary support needed to manage and schedule the interpreter.
Is a language services manager needed – or can this oversight be absorbed by an existing team? What training is needed to teach the manager how to manage interpreter services efficiently? How will the interpreter’s day be scheduled? Is software needed? What about after-hour and/or telephone coverage? Document translations? When determining what interpreter to hire – how will language and cultural proficiency be determined and who will need to be responsible for the hiring and interviewing process? Retaining this professional will be important, so what continuing education will be available for professional development? Wherever there may be gaps – what vendor support may still be needed? How will internal and external language services work together to prevent overlaps or service inconsistencies to your patients and providers? If any of these elements are not properly accounted for and monitored, what will lost productivity, turnover, inconsistent service delivery, or at worst, litigation, cost? All this and we haven’t even factored in the interpreter’s hourly wage!
Each health care system has a unique patient demographic and a unique business structure, and language services can come in any number of packages. Before rushing to start or grow an internal language access department, it may be worth taking another look at the obvious and less-obvious costs associated with your language access plan. After everything has been assessed, the numbers may surprise you.
True story. Long before life brought me into the medical interpreting field, I had occasion to seek medical attention from a doctor in Central America. The doctor immediately recognized that I was an American, and so he began speaking to me in English. The trouble was that his English was so heavily accented and broken that I could only understand part of what he was saying. I was fully capable of communicating in Spanish, and so it seemed that the doctor was looking at this consult as an opportunity to practice his English skills. I just wanted medical attention, but found myself in a communication quandary. I didn’t want to offend the doctor or damage his ego. First, it wouldn’t be polite. Second, this was the person I was relying on for medical advice and treatment, so staying on his good side seemed to be in my best interest. Fortunately, I was accompanied by a non-English speaker, who served as a scapegoat as I asked that we communicate in Spanish so that my companion could also understand. In reality, I wanted to communicate in Spanish so I could understand.
Fast forward years later to today, and I find myself observing similar situations in which individuals are eager to “try out” their foreign language skills at medical appointments in the U.S. Sometimes this means patients fumbling through broken English. Sometimes this means medical staff fumbling through broken Spanish. Often the result is a varying degree of uncertainty on the part of the listener. At best, the listener understood the meaning in spite of an awkward pronunciation or use of terminology. At worst the listener misunderstood the meaning all together and felt embarrassed or offended.
Health care interpreters are present to lift the burden of language disparities so that medical personnel can do what they do best and patients can be patients. Allowing the interpreter to do what he or she does best allows both parties to “be themselves” as they engage in topics from the casual to the complex.
I attended an industry conference recently and struck up a conversation with a staff interpreter at a well-known hospital and we crossed the topic of data tracking for the health care interpreting profession. As an employee of a language access company, one that believes strongly in continuous learning and process improvement, I was somewhat surprised to hear this tenured interpreter tell me their hospital did little by way of activity or time tracking. It was also this interpreter’s belief, after we explored our differing opinions, that staff interpreters simply work differently than agency interpreters, and therefore don’t have to track or monitor the same information. To this I ask…why not?
A discussion paper was published by members of the Institute of Medicine, offering a ten-item checklist for CEO’s to follow in delivering high-value health care. Resource Utilization was one of the ten. On page 14 the authors write, “Structured analysis of daily work can eliminate inefficiencies, increase value-added time spent with patients, reduce staff stress, and optimize the use of supplies and other resources.” In the case of health care interpreters, this would suggest there should be metrics in place to evaluate interpreting activities. A few examples might include: interpreting time vs. wait time, travel time, or time by location and department. With this information better documented, language access professionals can see more clearly how and where interpreting resources are being utilized and take action to drive out waste and increase productivity and workplace satisfaction.
Surely there are differences between the demands on staff and agency interpreters in health care; however, the pursuit of continuous process improvement goes beyond these differences. Professional health care interpreters are valuable resources, and structured analysis of daily interpreting activities can be leveraged to increase process efficiency – no matter how or where you work.
I was recently one of the first people to respond to the scene of a motor vehicle accident. The car was upside down, and the occupant was still inside the vehicle. There were about 7 of us regular civilians responding the best way we could. Then the officer arrived on the scene and immediately took charge of the situation instructing the rest of us according to our abilities to help or get out of the way.
When the officer arrived he didn’t have to introduce himself or explain his role. Why? Because he was clearly identifiable by his uniform. This saved time. It created instant trust and rapport with everyone at the scene – he’s earned the uniform and knows what he’s doing. It alleviated some of the stress of the situation – finally someone was there who could actually help.
Like the officer in the scenario, health care interpreters can also benefit by wearing a uniform or other apparel that clearly identifies him or her as the interpreter.
It makes the interpreter visible and distinguishes him or her from other individuals in the encounter, like family or members of the nursing team. It is a good first step toward creating awareness of role boundaries and role differentiation. For interpreters who work collaboratively (a team of staff interpreters, for example), uniformity in apparel can serve as a way to establish trust and rapport with individuals who are working with an unfamiliar interpreter, but who have had excellent experiences with other interpreters on the team.
Unlike police officers, health care interpreters will never be so identifiable by their uniform that they will never have to explain who they are or what their role is. Still, being identifiable presents significant benefits for interpreters and those who rely on them.
Interpreters, what are you doing to be clearly identifiable in your interpreted encounters?
The role and successful utilization of health care interpreting is best described as being in the eye of the beholder. Professional expectations are accepted across the much of the US and the world by practicing health care interpreters. However, the lack of operational standards minimizes the effectiveness of these same professional guidelines.
I recently spoke with a health care professional. We’ll call her Joanne. Joanne was calling to inquire about information regarding health care interpreting because she has a friend that is finishing her bachelors degree with a major in a foreign language. The friend was interested in interpreting as a way to make a secondary income. As my conversation progressed with Joanne we got to the topic of qualifications. Joanne was under the assumption that health care interpreting was a field that had accepted professional standards that were universal, similar to any other health care professional.
Joanne was a very nice woman and our conversation brought up long standing frustrations of mine. The first is that health care interpreting is a job that can bring in secondary income. As a health care professional interpreting is a career choice. Interpreting on occasion, while well intended, can easily cause harm to others. Over and over we hear horror stories of interpreters leaving out portions of a message. They didn’t remember, hear or think it important. In any such case, the people interpreters seek to help the most are put in danger by a lack of consistent expectations and management.
Secondly, interpreting is still struggling to establish a reputation as a valued health care professional. Existing guidelines are the result of passionate and highly educated individuals that want to see equality for everyone needing health care! These guidelines were established as a way to improve interpreting via the interpreter for the benefit of the patient.
But health care itself does not actively recognize interpreting as a necessary addition to their treatment teams. Is it because there is little to no operational standards to establish valued language access programs? Health care has check lists and definitions of how to hire or implement a program, but how can they act upon them?
Until consistent expectations are established and executed by the health care industry, they will continue to work with individual interpreters that operate based on their own perceptions of professional and quality. Is this good or bad? You decide.
Consistency makes each day manageable. I know that I’m going to see my family every evening at the dinner table. My kids know what they need to do to get ready for school each morning. There is a sense of security knowing that you have a job. Connecting Cultures would not be successful without internal consistency because this is what leads to external predictability.
Some organizations run into the challenge of staff not wanting to use language services. Usually it is because they’re hard to work with, unpredictable and unnerving because there is too much unknown. Our job is to make access to language services easy for our clients and their customers. I’m not just talking about picking up the phone to request an interpreter. I’m talking about the confidence given to the services provided to the health care team and to the overall management that will assure standards are met each and every time.
There are many different views about what health care interpreting looks like. Many are trying to create a professional standard. But to make this complete, health care interpreters need consistency. They need consistency in how they’re utilized, managed and trained. If this doesn’t exist, then health care works with a pool of individuals that operate according to their own perception and application of the industry’s professional guidelines.