Here are several elements to consider for Language Support Programs:
Size of the language access program
How many patients are there who need language support, how many encounters are there requiring support, what percentage of the patient base requires language support? Is the present size of the language support program about right, is it short of what is needed, is it over-funded or over-staffed? Language access managers must look at these questions within their institutions as well as considering what other institutions in the region have. They must defend budget requests not only to assure that they have enough resources for their patients, but to explain why they would be worried to reduce support to levels considered adequate in other institutions.
Complexity of the language access program
Maturity of the program
Organizational attention to patient education
Patient groups requiring higher-than-average resources
Some language groups in which few people are scientifically educated and which therefore have few or no competent medical interpreters are very difficult to provide language support for. The Interpreter Manager needs to inventory how many such patients are seen by the organization in order to plan for an appropriate mix of staff and agency interpreters. It may be worth it to hire a staff interpreter in one of these rarer languages just to make sure the community can receive language support at this facility, even if this interpreter is not kept busy with interpreting all the time.
Room for staff
Room for staff interpreters and translators: In order to use staff interpreters and translators, physical space must be available for them in base areas with room for storing outerwear, doing required computerized administrative tasks, taking breaks, performing translation, and performing phone and video interpretation in booths. Space constraints can fatally crimp the effectiveness and productivity of staff. The manager must also be close to the activities of the staff interpreters and translators to be effective.
HR support for interpreter and translator staff: Once a language support program has hired its first interpreters, translators, schedulers, and managers it is easy to simply adjust the fine points of their job descriptions and the number of staff employed. However, it can take years to create and get administrative support for first setting up the staff components of a language support program. For instance, if some or all staff are unionized, it can be difficult to assign the interpreters, translators, and schedulers to appropriate union staff categories. If union wage levels dictate wages that are too low to attract good candidates from the community, these positions will be very hard to fill because interpreters can make more through agency. This is particularly true for ASL interpreters and for translators, so many programs never include ASL interpreters or foreign language translators on staff.
HR support can make or break a language support program. If HR understands the value of professional interpreters over using ad hoc untrained bilingual staff, they will commit to assuring that staff interpreters have acceptable working conditions, continuing education opportunities, and pathways to higher professional development like other categories of health care staff do. HR recruiters should be mentored by the language access manager to screen for the important factors of proven dual language proficiency, ethical performance, training in interpreter fundamentals, attainment of state or national certification, and experience in many different health settings.
Mix and cost of agency resources available
The local area may have few or many qualified interpreters available to come in-person. Local agencies may be too expensive to use OR there may be a vendor leading a race to the bottom of hourly charges while basing that on the use of untrained and incompetent interpreters. The balance of in-person to remote modalities greatly depends on what languages are available at affordable cost and at high enough quality. As local agency charges rise, organizations shift the balance away from in-person to staff interpreters and remote agency modalities. The balance between using agency or staff can swing back and forth every few years. The interpreter manager must build good relations with contracted agencies so that both organizations can plan their business relationship for the next few years.
Contracting support to achieve suitable contracts with agencies: Some healthcare organizations manage their contracting with vendors through a Contracting department rather than through the Interpreter manager. In some cases, such as with governmental health entities, there is a requirement to contract with the lowest bidder, even when that bidder cannot demonstrate required quality or quantity of performance. This forces the Interpreter manager to use more staff, who can be trained and monitored. Some organizations, however, allow contracting to fully serve language support needs. For example, a large hospital system may need three or four agencies to provide a full mix of the languages needed in-person, as well as several different remote agencies to provide telephonic and video interpretation across the languages needed. Every agency provides a different mix of languages, as well as a different standard of quality. As the demand for more specialized interpreter qualifications grows, some agencies may begin to provide only interpreters with more specialized, and more expensive skills. One or more translation agencies will also be contracted with, based on their ability to perform on healthcare content.