Language program managers must manage complaints about language support, as well as monitor performance of contracts. Let’s take a pro-active look at both of these responsibilities and offer some suggestions for presenting information to regulatory reviewers and to Risk Management.
Complaints take many forms
Providers complain about the quality of specific interpreters as well as about the modalities of interpretation available to them. Complaints about quality include tardiness and poor phone etiquette. Complaints about linguistic proficiency include the interpreter not understanding the content of the discussion and not interpreting fully or accurately. Complaints about interpreter role include the interpreter not being in step with the provider’s agenda, which might be to insist that the patient stop damaging behavior or come to terms with the fact that he is dying. With respect to modality, some providers get upset if they are expected to use remote modalities when they have been accustomed to having an in-person interpreter for all encounters.
Staff complain about the behavior of interpreters include tardiness, leaving before the encounter is over, perceived rudeness, and conversing in a non-transparent manner with the patient. They complain about having to maintain and set up phones and video screens to bring remote modalities online. And they complain when their routine workflow for managing patients must be adjusted for patients with language support needs. It can be a very heavy lift for the language program manager to impress staff with the fact that personnel at the point of care are responsible for consistently and responsibly providing language support according to protocols.
Patients and families complain about linguistic competence and about interpreter behavior. They complain if they are not provided with an interpreter, or about the modality of interpreting. Many family members complain that the interpreter interferes with family control of the encounter.
The complaints may arrive in angry phone messages, emails, drop-in visits to the department, pages from the Administrator-on-Call, letters through the mail, or the organization’s clinical mistake database system.
Health care regulations require that all of the types of complaints mentioned above must be gathered, documented, and responded to by the organization. Some of these fall into the patient safety category, others fall into the categories of equal access to care, disability accommodation, and patient satisfaction. The language program manager is usually responsible for managing all categories of complaints, including advising administrative staff on how to navigate regulatory inquiries related to language support.
Complaints are unpleasant to deal with.
They take time to resolve, and they require keeping one’s temper and braving the negativity. But complaints also uncover gaps in protocols, technology, and resources. Complaints uncover need for improvement in both interpreters and in clinical staff treating language need patients. Complaints provide a great excuse to go to the clinical units and in-service staff and providers.
Regulatory reviewers are favorably impressed to see that complaints have been logged, analyzed, and resolved. Keep good documentation of all complaints, preferably in a data base that allows you to sort by different characteristics such as unit, staff person or provider, interpreter, language, situation, etc. Use documented complaints to present reviewers with the actions taken to improve language support across the organization. Maintain this documentation accessibly for the same length of time as medical records are maintained at the hospital, as these materials may be called for again many years later.
Monitoring contract performance is another regulatory requirement of language program managers. They need to do an annual evaluation of contract performance for each agency contracted with. This set of evaluations is kept with the Joint Commission readiness binder for the organization. The JCAHO reviewer will invariably ask to see these contract evaluations, as well as copies of every contract with a language support provider.
These are the questions related to each agency for the past year:
Has the agency responded to requests in a timely manner, per contract? What are the details of fill rate by language, time of day, holiday and after-hours? Have there been give-backs or unacceptable substitutions after confirmation? Have there been disputes about improper billing?
Have there been complaints about any aspect of agency performance or interpreter performance from hospital staff, providers, or patients? These need to be characterized or summarized in terms of seriousness. Documentation of how any serious complaints were resolved should be referred to.
Has the agency performed well on compliance with contractual requirements to maintain needed background check, immunization, and proficiency info on their contracted interpreters? Have they followed proper Business Associate guidelines for HIPAA compliance?
Cost of service may also be an important factor in assessing contract compliance, not because the agency billed higher than the contract allowed, but whether the expense of the contract can be justified for the service it provides.
The final question on these annual evaluation concerns whether this contract is a good value to the organization and whether it should be continued.