Hiring properly trained interpreters and testing their skills improves quality
Harborview Medical Center in Seattle had more than 100,000 interpreted encounters in 80 languages last year. To meet this demand, the medical center has created a well-developed interpreter service with 50 interpreters on staff. However, whether you have one interpreter on staff or 50, it is important to establish guidelines for hiring.
"As with any profession, there are people who do the job poorly, those who just do the job, and those who do the job in such a way it is clear that interpreting is an art," says Bria Chakofsky-Lewy, RN, supervisor of caseworker/cultural mediators and interpreters for Community House Calls Interpreter Services at Harborview Medical Center.
There are certain basic skills interpreters should have, says Andrea Henry, coordinator of Multicultural Translation Services at Children’s Healthcare of Atlanta.
An interpreter must be proficient in both English and the target language. A good memory also is a must because interpreters need to repeat what the patient and health care provider said without eliminating or embellishing the information.
A good way to determine if interpreters have the appropriate skills is to have them take a test, says Henry. She recommends the tests provided by Language Line, a telephonic interpreting service, which tests for language proficiency and interpreting skills. The company also has a medical certification test that is very difficult; however, the simpler tests are adequate to provide quality assurance when hiring, says Henry.
Erika Shell Castro, manager of Interpretive Services at Grant/Riverside Hospitals in Columbus, OH, says part of the hiring process at her institution is for interpreters to pass the Language Line skills test with a score of 80% or higher and to have no more than three significant errors on the test. The cost of the test is $125 per person.
To make sure interpreters are qualified, training at the University of Texas M.D. Anderson Cancer Center in Houston lasts from one to three months. In addition to receiving a training manual that includes consent forms and medical center policy, newly hired interpreters are assigned to a mentor so they can observe the process until they are ready to interpret on their own. When the new interpreter is ready for an encounter, the senior interpreter observes the session and provides feedback, explains Cecilia Garcia, manager of Language Assistance at M.D. Anderson Cancer Center.
A good knowledge of medical terminology in the environment in which an interpreter works also is important. For example, if the interpreter works in the diabetes center, he or she needs to be familiar with medical terms pertaining to this disease. In addition, interpreters must have an understanding of the western medical model as well as physiology and anatomy, says Henry.
At M.D. Anderson Cancer Center, interpreters must pass an online medical terminology test within 60 days of being hired. In addition, each clinic specializing in a particular cancer has a manual and glossary of medical terms that are given to interpreters. "Our interpreters have to be fully knowledgeable of the terminology used in the various clinics," says Garcia.
In addition, ongoing training takes place so, when there is a new treatment available to patients, an inservice is scheduled for the departmental meeting.
Knowledge of ethics a must
Knowledge of the ethical standards for an interpreter is extremely important, says Henry. "Most people who receive training learn the ethics of the role. These are the parameters that keep us from doing things that would negatively impact the encounter," she explains. For example, interpreters must remain neutral at all times. Also, they must never make assumptions. If something that is said is unclear, they must ask for an explanation.
While patients may ask a medical interpreter to accompany them to an appointment outside the medical center, the national code of ethics for interpreters prohibits such an action. The patient should be referred to the social work department instead.
The principle of medical confidentiality needs to be stated at the beginning of every medical encounter, says Chakofsky-Lewy. In addition, patients need to know that everything said in the room will be interpreted. This way, patients will understand that they cannot provide information to the interpreter in confidence, and any discussion between the interpreter and medical staff will also be interpreted for the patient.
"It is important to remember that two people need training — the interpreter and also the person who is working with the interpreter. It’s not rocket science, but a little bit of instruction on how to do it is very helpful," says Chakofsky-Lewy.
Each institution sets policies for hiring interpreters, and some criteria is unique to that facility. At M.D. Anderson, people who have had a formal education are preferred because they have a better understanding of the language and the culture, says Garcia.
Completion of Bridging the Gap, a training program offered by Cross-Cultural Healthcare, is required at Harborview Medical Center. (For information on this training program and others, see resources at end of article.)
In Columbus, the community standard for interpreter skill training is 24 hours; therefore, that is the minimum required by Grant/Riverside Hospitals. In addition to a certificate of completion of a training course, interpreters must have one-year of professional experience. Volunteer work at free clinics in the area counts as experience, says Shell Castro. A person can have knowledge but not be able to put into practice what they know, she says.
While having interpreters on staff is ideal, it is impossible for health care facilities to have an interpreter for every language needed. In rural areas, it may be difficult to find a skilled interpreter for even the dominant foreign language spoken.
Many facilities contract with telephonic language lines that provide medical interpretation. However, when using a telephone interpreter, it is best to use a speakerphone to create the atmosphere of having a person in the room, says Henry.
If a rural health care facility had enough language needs to actually have a full-time interpreter, administrators might consider recruiting nationally. "The outcome of using interpreters can be so positive for the family and organization. It is worth having people on site; but if there isn’t a large enough population for a skilled interpreter in a particular language, then use phone interpreters," advises Henry.
In large metropolitan areas, some health care facilities use local agencies to supplement their in-house interpreting staff as well.
No matter the size of the facility, it is important to use trained interpreters, says Shell Castro. It is not appropriate to use family members because they do not know medical vocabulary and often summarize and edit information, she explains. Contacting a telephonic interpreting service is a quick way to get a trained interpreter.
When patients insist on using a family member or friend to interpret, Grant/Riverside Hospitals has the patient sign a liability release. "We reserve the right to have an interpreter present if we think it is necessary; and nine times out of 10, we do that. The interpreter only intervenes if information is inaccurate or incomplete. He or she is listening for us so we know what is being said," explains Shell Castro.
Resources
- Center for Cross-Cultural Health — Information resource on cultural competency. Web site: www.crosshealth.com.
- Cross-Cultural Health Care Program — Helps bridge communities and health care institutions to ensure culturally and linguistically appropriate health care. www.xculture.org.
- Ethnomed — Information about cultural beliefs, medical, and other related issues. Web site: www.ethnomed.org.
Sources
For more information about obtaining qualified medical interpreters, contact:
- Bria Chakofsky-Lewy, RN, Supervisor, Caseworker/ Cultural Mediators and Interpreters, Community House calls, Interpreter Services, Harborview Medical Center, Mailbox 359977, 325 Ninth Ave., Seattle, WA 98104. E-mail: [email protected].
- Cecilia Garcia, Manager, Language Assistance, University of Texas M.D. Anderson Cancer Center, 1515 Holcomb, Box 32, Houston, TX 77030. E-mail: [email protected].
- Andrea Henry, Coordinator, Multi-Cultural Translation Services, Children’s Healthcare of Atlanta, 1001 Johnson Ferry Road, Atlanta, GA 30342. E-mail: [email protected].
- Erika Shell Castro, Manager, Interpretive Services, Grant/Riverside Hospitals, 3545 Olentangy River Road, Suite 001 Ground Floor, North Medical Building, Columbus, OH 43214. E-mail: [email protected].
Harborview Medical Center in Seattle had more than 100,000 interpreted encounters in 80 languages last year. To meet this demand, the medical center has created a well-developed interpreter service with 50 interpreters on staff.
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