We in the healthcare sector have come far in the last few years, actively discussing what is adequate performance in terms of a qualified interpreter or translator and language support programs. Let’s look at all the different stakeholders and see how their expectations have matured. And then let’s look at how these changing expectations impact the role of the language program manager.
Licensed professionals who care for patients, such as physicians, nurses, pharmacists, and therapists, have consistently raised the bar on what they expect from medical interpreters. These providers expect interpreters to understand the subject matter and to be able to perform at high register. They expect interpreters to partner with them in approaching difficult encounters so that communication is effective and therapeutic. They expect interpreters to maintain professional ethics boundaries rather than using an informal approach to their role. Providers frequently make appropriate requests to interpreters to improve their performance, while also complimenting interpreters when they contribute to successful encounters. Providers complain to the language program manager when they are not satisfied with the skill and knowledge of interpreters, rather than complaining only when an interpreter fails to show up.
Patients and families are now making themselves heard as educated clients of interpreter services. In years past people would gossip about which interpreters are “nice” to them and which interpreters were from acceptable ethnic and religious sub-groups. Today, patients and family members frequently describe specific aspects of practice such as knowledge about medical topics, skill in interpreting accurately and completely, and professional/ethical attention to the patient. Broader use of remote interpreting modalities has exposed patients to many more individual interpreters than formerly, which in itself changes patients’ focus toward skill and knowledge and away from whether the interpreter has a pleasing personality.
Regulatory bodies such as Joint Commission and Department of Justice have been very active in laying out details about what constitutes effective communication and qualified interpretation. These agents have driven change because they address not only the interpreter’s competence but whether he is achieving effective communication at the moment of the encounter. What is the clinical picture at the moment, and which modalities of interpretation would be suitable? Which patients should have round-the-clock interpreters? Also, regulatory bodies have elevated language support to the same level as other aspects of care provided to patients: If language support is not documented, it might as well not have happened, and the care team can be held responsible for not having done what was needed. As regulatory bodies look at sentinel events (mistakes and failures of care), they include a review of language support provided. Did these particular language need patients suffer because of poor language support?
Interpreters themselves have become a driving force for improved skill and knowledge. There are several aspects to this drive. Skilled interpreters wish to be acknowledged and paid well for their expertise and effort. Community interpreters want to provide good service for their clients, plus they want to disprove accusations that they are simply making money off of the system by showing up. And all medical interpreters strive to strengthen their earning power in the same way that court interpreters have been able to do, so they acknowledge the need to continuously improve their skill and knowledge.
All of the stakeholders mentioned above are raising the bar of health interpreter performance. The only countervailing force, driving against improvement of interpreter competence, is the financial pressure from healthcare organizations to reduce remuneration for interpreters. There is a race to the bottom in contract negotiations which only results in driving good interpreters out of the field and in attracting less capable interpreters in their place. Language program managers should interest themselves in raising the quality of language services for their patients, rather than signing off on requests from administrators to go with the cheapest contract.
Many organizations are responsive to demand from providers, patients, regulatory bodies, and interpreters for competent language support. Language program managers in these organizations have the happy challenge of how to best support their staff and agency interpreters in continuous improvement.
One of the best ways to boost interpreter competence is to recommend or require national certification. National testing and certification carries with it the requirement to study hard for the exam, to prove linguistic competence in both languages, and to maintain the credential with continuing education units after certification. Another way to build interpreter competence is to collaborate with other healthcare organizations and with language service companies in the area to sponsor interpreter classes open to all interpreters. This benefits all interpreters, all agencies, and all healthcare organizations which use interpreters. A third way to promote high interpreter performance is to conduct positive public relations around the interpreter role with the providers, encouraging the providers to nurture interpreters as part of their care team. This partnership rapidly builds interpreter competence in specific disciplines.