Medical explanations and care instructions can be difficult enough for patients who use English as their native language; for those with limited language proficiency, the chance for misunderstanding between caregiver and patient becomes much greater ― as does the chance for potentially serious errors.
To combat this issue, interpreters have been used in the medical arena for years, with mixed results. Now health officials are recognizing that accurate communication is part art and part science — in other words, just any interpreter won’t do. In fact, the field of healthcare interpretation/translation is beginning a new era of professionalism, thanks to recent attention from The Joint Commission, the American Hospital Association, and the launch of a new, national certification commission.
The 2005-2007 American Community Survey conducted by the U.S. Census Bureau found 19.5 percent of the population five years and older speak a language other than English at home and 8.6 percent indicate that they speak English less than “very well.” These numbers indicate an increase from the 2000 Census.
This growth has been noticed in healthcare organizations. The American Hospital Association’s (AHA) Health Research and Educational Trust (HRET) research found that 80 percent of hospitals frequently encounter patients with limited English proficiency; 43 percent reported daily encounters; 20 percent weekly; and 17 percent monthly.
This population is referred to as persons with limited English proficiency (LEP). An LEP patient requires an interpreter to translate to and from the person’s primary language to meet the legal and ethical requirements for healthcare providers to deliver culturally competent care.
In addition to spoken language interpreters, federal laws prohibit discrimination against persons with disabilities, and require healthcare organizations to provide effective communication for persons who are deaf or hard of hearing.
The American Hospital Association provides resources, examples and tools for hospitals to assist in eliminating disparities in health outcomes. The Registry for Interpreters for the Deaf provides information about using a Certified Interpreter for the Deaf.
The spoken encounter is just one part of the communication challenge. “Hospitals are also generally required to translate their standard documents into a patient’s native language, including consent forms, patient instruction sheets and patient rights statements,” said Elizabeth Zurek, JD, a healthcare attorney in private practice in Oak Park, Ill.
In addition to current standards addressed at respecting the patient’s right to receive information in a manner he or she understands, The Joint Commission, with funding from The Commonwealth Fund, is developing proposed accreditation requirements for hospitals to advance effective communication, cultural competence, and patient-centered care.
“The professional trained medical interpreter has been an integral part of the health care team,” explained Lois Wessel, RN, CFNP, associate director for programs at the Association of Clinicians for the Underserved (ACU). “With ever-changing culturally diverse patient populations, clinicians need to understand the nuances of a patient’s personal story, and patients need to be clear on the plans and messages from the providers.”
“Whenever possible, do not use family members,” added Zurek. “You want an interpreter that will not change the words, the meaning, the tone, but rather provide an exact translation to the patient’s native language.”
How can healthcare providers ensure that they are delivering appropriate and accurate interpreter services? Beginning in the fall of 2010, they will be able to look for persons with earned qualifications to be offered through the new Certification Commission for Healthcare Interpreters (CCHI), which was incorporated in July 2009.
CCHI is working to assure competency in language interactions in healthcare settings. According to the description on their web site, “CCHI is the only certification body created by interpreters, for interpreters and the public good, and will involve thousands of interpreters and users of interpreter services in defining their future and the credentials by which they will be known and respected.”
Certification programs testing knowledge, skills, and performance will be based on data from the field, not on a particular training program or vendor’s services package.
“Without certified interpreters, both patients and providers become frustrated and health outcomes are poor,” stated Wessel. “With certified interpreters, everyone’s needs are met and there is assurance that patients know how to implement the plans set forth by the providers, and providers understand the patients’ issues.”