A language access program manager may be called upon to assist the organization in designing and managing a bilingual staff and provider program. Here we present some of the key elements to consider.
First, a definition of bilingual staff and providers:
We are referring to healthcare staff who are proficient in a second foreign language or ASL, and who take direct care of their OWN patients using their language and cultural skills. We are NOT referring to dual-role staff who are called away from their own assigned job to interpret as needed for colleagues. That is a topic for another day.
The advantages to a health care organization of a bilingual staff and provider program include:
Better quality of care based on the cultural competence of the bilingual staff and providers.
Cost savings from not having to pay as many interpreters.
Protection against liability arising from communication barriers.
The cadre of a hospital or clinic system may mirror the ethnic makeup of its patient community, or it may not. Furthermore, while some organizations serve one or two major ethnic communities, other organizations serve ten to twenty large, disparate ethnic groups as well as many other smaller groups. It is easier to manage a bilingual staff and provider program if there is just one major community to serve (immigrant or Deaf), but it can really pay off to have even one bilingual staff person or provider for smaller language communities. For example, having a clinical social worker proficient in ASL on the evening shift in the Emergency Department allows for timely and sensitive intake of patients.
The usefulness of bilingual/bicultural providers and staff depends on the strategic goals of the organization, and on its targeted client base.
Administrators need to consider these questions to design an effective role for bilingual staff and providers:
What is the target client base for the organization? Does it have a strong primary and family care component? Is it a trauma center that serves a large catchment area? Does it provide mostly specialty services to a carefully nourished referral base? Does it have strong ties with specific ethnic communities or the Deaf community? Does it market to international clients for cancer care or other specialty care?
The organization should be able to quantify both its targeted and its actual client base in terms of what languages are needed in each service line. For example, obstetric services see patients of child-bearing age, so which communities are having children? Orthopedics sees patients who were injured on the job, so what languages do the local blue collar workers speak? International clients might come for cancer, orthopedic, or transplant services. The organization may focus its bilingual staff programs on those clinical units which see the most patients who speak a foreign language or ASL.
How strong is the institutional culture of appreciation for diversity and community? Would staff and providers be proud to wear badges identifying them as bilingual? Are staff and providers “’allowed” or encouraged– or discouraged –from speaking to each other or to patients in a foreign language? Is HR on board with creating and maintaining the bilingual staff program? Is the Medical Staff office supportive of the bilingual provider program? Does the strategic plan support publicity around multiculturalism through the marketing department?
Labor competition between staff interpreters and bilingual staff/ bilingual providers. Dedicated staff interpreters may resist the concept of using bilingual staff and providers, thinking that this might reduce demand for their own services. They may be quite critical of any bilingual staff or providers whose language and terminology proficiency is not proven.
How are staff and providers assessed or tested for proficiency in the language? Are non-native speakers considered for participation in the program, given fewer bicultural skills? Are heritage speakers who learned the foreign language from their parents considered, given probably lower language proficiency? Who pays for the language proficiency assessment? Is the assessment portable if the staff person or provider moves on to a different company? Can a staff person or provider avoid the proficiency assessment by documenting educational or professional achievement in the foreign language?
Are qualified bilingual staff or providers compensated extra for their bilingual/bicultural skills? Is the extra compensation applied to all hours worked? If compensated, what languages and what threshold? Language need profiles vary between clinical units. For Spanish or Mandarin bilingual staff on the perinatal or cancer units, where there is high demand for their languages, will they still be compensated for their bilingual skills when they transfer to units such as Ortho, where demand is lower? Is the extra pay portable to other positions in the company when a staff person moves into management, for example? Are bilingual staff and providers solicited for all languages (for example, a nurse speaks Tamil), or just for languages which exceed a certain level of demand, such as 20 appointments, admissions, or phone calls per week in Vietnamese?
Is the bilingual staff person on a clinical unit assigned all of the patients needing language support? For example, are all Spanish-speaking patients to the GI Clinic assigned to the one doctor who speaks Spanish? This can be resented by both the staff and patients, if patients do not prefer that staff person or provider or if the professionals desire a more varied patient base. For example, a patient family complained that it was assigned to a bilingual doctor even though they wanted to join the panel of a different doctor. A medical assistant who enjoyed caring for patients from many backgrounds found that she did not at all enjoy just taking care of patients from her own immigrant community.
To summarize this quick review of elements to consider in building a bilingual staff and provider program: There are many strategic elements as well as many practical elements to plan for. But to see a well-oiled community clinic bilingual staff and provider program is to see a thing of beauty.