Language program managers in hospital and clinic systems gain valuable knowledge from forming networks with peers. There is no national professional network of language program managers on the order of those that exist for other health management groups such as nurse managers, radiology managers, or risk management managers. Language program managers come to their work from different pathways, and may have no direct patient care experience, no experience with immigrant communities, or no experience with interpretation or translation. By creating or joining peer networks, they can rapidly ground themselves in the complexities of the work. Language program managers are expected to manage diverse staff, manage outside contracts for language services, manage many technical systems and data, keep the organization in a state of readiness for regulatory review, and interact with a huge variety of clinical providers to assure appropriate language support for patients and families.
Building a peer network can take different forms, depending on the specific patient population that the health organization serves. Children’s hospitals across the country must care for families in a way that other organizations do not. Research protocols for extremely ill children require specially trained interpreters. Navigation programs for families who have trouble managing all of the strands of care for a sick child may fall under the purview of the language support manager.
Likewise, the language program managers for cancer clinics and behavioral health organizations may benefit from forming peer networks with each other, as these organizations face special challenges in providing high quality language support. They may contract with language agencies which provide specialized training for the interpreters and translators and may pay more per hour than other hospitals in the region. Outpatient and inpatient mental health facilities have language support needs in common, particularly for interpreters who are trained in mental health encounter protocols.
Peer networks can greatly benefit facilities operating in one geographical area. Hospitals and clinic systems in one state or county operate in the same environment. Language program managers in one geographical area can share information:
- How are demographics changing in the area, what groups live in which parts of town?
- What are the projections for new immigrant groups coming to the area?
- Which groups no longer need language support?
- What language support companies have qualified sub-contractors in which languages?
- Which local language groups are particularly difficult to find in-person interpreters for?
- Is there a pool of qualified interpreters, translators, and navigators from which to hire staff?
- Is there a local professional organization or college which provides interpreter and translator training?
- What are local norms about developing and paying bilingual staff and providers?
- Which communities have strong advocacy groups?
- What regulatory pings have taken place in this area recently?
Peer networks can be formal or informal. Having even one colleague with similar responsibilities in a different organization can be beneficial. But spreading the peer network across more organizations brings surprisingly powerful benefits, particularly in building professional confidence and competence in this fairly new cadre of language program managers.
It is fascinating to see how differently people from diverse role backgrounds approach language support. For example, language program managers from risk management backgrounds focus on having strong written procedures and performing to those standards. Managers from nursing backgrounds focus on patient outcomes and on whether care teams have the language support they need to provide care. Those from financial backgrounds focus on efficiency of language support through judicious use of interpreter and translation modalities. Those from interpreter or community access backgrounds focus on both the patient experience and on the needs and qualifications of interpreters. All of these backgrounds inform each other through peer networks.
When setting up a peer network of language program managers, consider the following:
Is this particular network open to any language program manager in that geographical area or in that specialty sector? Can people self-refer, or should they be invited by someone who is in the network already? This is less of an issue when meetings are virtual and do not require physical travel to other facilities. Networks that are productive and supportive tend to grow and attract more peers.
Does the network commit to periodic meetings, and if so, will the meetings be online or in-person or a mixture of both? Will there be agendas set ahead of time, and if so, can anyone on the network bring agenda items? Will there be turn-taking to set up the meetings or calls and take minutes? Will there be invited guests to discuss issues of interest such as regulatory rules or special needs of certain populations? Will there be an email roundtable that all members can participate in as they feel warranted, so that peers can submit questions or comments to the group as things come up?
Are language services companies invited to belong to the network? Often only language program managers are invited to join the peer networks. But LSCs are such an important partner that peer networks may ask local or national LSCs to join particular meetings to discuss topics of interest such as use of new technology or coverage for rare languages.
How can the peer network collect and share useful documents such as meeting minutes, examples of policies and procedures, and shared tips from members? Some networks create a drop box-style cloud repository that members have access to, while other networks expect members to keep anything they are interested in their own files. The advantage to having a drop box is that new members can benefit from materials shared before they joined.
What are network norms around when to take discussions offline, around keeping shared materials confidential in the group, and around confidentiality related to any topics discussed in the group?
Topics that are repeatedly brought up within peer networks of language program managers include the following:
- How to balance interpreting and translating budget dollars between internal staff resources and outside language agencies?
- What languages are hard to find right now, and who has a source?
- What training is most needed for the area’s interpreter corps right now, including both ethics topics and medical topics?
- How to support such training by sponsoring classes, providing auditorium space, asking doctors and nurses to provide training?
- What is the trend on hiring and training bilingual staff?
- How are interpreters being assessed for language competence?
- Is there a rising number of heritage speakers, and if so, are they fully competent linguistically and culturally?
- What is Joint Commission focusing on in this region this year?
- What are the latest requirements to notify the public of available language services?
- What documents need to be translated and can hospitals share costs of translations?
- How is parking being subsidized so as to tempt interpreters to take assignments?
- Are new automated methods of posting available interpreter assignments resulting in the best interpreter for the job?
- How are peers dealing with interpreters who are unethical or incompetent?
- Are the HC organizations being responsive to complaints from interpreters about poor working conditions or low wages, particularly related to no-shows and cancelations that are not their fault?
- Are agency interpreters requested to make reminder calls?
- Do peers have navigator programs or do their staff interpreters include navigation in their portfolio? If so, are they paid more for this?
A peer network is SAIL, Seattle Area Interpreter Leadership, organized in Seattle area in 2004 by the language program managers of King County Public Health, University of Washington Medical Center, Harborview Medical Center, and Swedish Medical Center. This group met monthly in-person and slowly grew to include most of the hospitals and clinic systems in the greater Seattle area. By 2010 the participants included language program managers from adjoining counties and even as far afield as Portland, Oregon. Monthly meetings became virtual. Clinic systems with no hospital, such as Seattle Cancer Care Alliance, MultiCare, and Group Health/Kaiser Permanente, are core members. A drop box is used for sharing documents. Only language program managers and their deputies are invited, excluding specifically any private consultants or language services companies. Regulatory specialists, WA State Language Testing Center staff, and advocates from specific patient communities are periodically invited to attend to discuss specific topics. Active email solicitation for advice on specific topics takes place among members between meetings. Peers may request to be included on the network, but must be accepted by SAIL members before they are welcomed to a virtual meeting or given access to the group email list. No commercial use of the email list is permitted.
The Forum on the Coordination of Interpreter Services (FOCIS) developed in 2003 from an initiative of Caritas Christi Health Care (CCHC), the second largest health care system in New England. As a system, the Coordinators of Interpreter Services from all six hospitals were meeting monthly to work collaboratively on interpreter issues and to share resources. The group was approached by interpreter services coordinators from other hospitals who wanted to participate. CCHC recognized the need to develop a separate venue for Coordinators of Interpreter Services and decided to initiate this process by establishing FOCIS. FOCIS is a non-profit corporation within Massachusetts. It provides a venue for coordinators of interpreter services and serves as a resource for coordinators in other states. Supervisors, coordinators, managers, and directors discuss daily operational issues related to running an interpreter services program at FOCIS meetings which are in-person (with the exception of January due to weather) and are held every other month. FOCIS is lead by a Broad of Directors that also meet regularly and are primarily respoinsible for guiding the meetings through well-planned meeting agendas and supervising the focus on the organization’s mission.
- To improve access and the quality of interpreter services for limited English proficient patients receiving medical treatment in the State of Massachusetts. This will be accomplished by sharing information among coordinators of medical interpreter service departments throughout the state to create standards and efficiencies, and to provide technical assistance to departments in various stages of development.
- To work collaboratively with coordinators from states and jurisdictions outside of Massachusetts to facilitate the creation of FOCIS organizations.
- To act as the national headquarters and resource for FOCIS organizations, ensuring sister organizations retain the original vision and purpose of FOCIS/Massachusetts, the founding chapter.