Translation! So much of the United States healthcare system depends on written material. How does your organization triage the need for translation while managing translation costs?
Imagine following a patient through the care pathways he navigates in your institution. What paperwork does he need to fill out at each stage of care? What consents for care and financial agreements does he need to sign? What patient education does he need to read? What written instructions does he need to follow? Are his medications labeled in his language? How does he interact with the patient portal? Can he read the information on the public-facing website? Can he read the signage in the hallways, parking lot, waiting rooms, cafeteria, and urine-collecting station?
How do you decide which documents to translate into which languages? What mix of pre-translated and on-demand translation do you budget for? Do you utilize translations from outside the organization to augment what you develop internally? Do you have a source for Braille translation? How much pressure is placed on interpreters to sight translate documents for patients because there is no translated version available? Does your EMR program include translated versions of discharge instructions?
The regulatory push is to increase the depth and breadth of translation in the healthcare environment, in order to reduce barriers to care. It is important to have a plan for translation that is tailored to the specific patient population served. That requires a firm grasp on patient demographics, which change a lot over time. A clinic or hospital that used to serve Spanish-speaking and Vietnamese-speaking patients may now be serving significant populations of Mandarin- or Somali-speakers as well. The neo-natal unit may be serving a lot of Amharic-speakers, while the oncology units may be serving more Cantonese- and Korean-speakers. The need for translated materials will vary by clinical service.
Translation costs can be managed effectively by using some strong underlying practices.
Separate out the formatting work from the language translation work. Regardless of whether you use internal staff translators or an external translation agency, you want to pay for linguistic expertise rather than for formatting whenever possible. Provide the translator with clean text to translate, and have someone else put the translated text into the formatting. Get a quick check by the translator or an interpreter before publishing to make sure everything got put in the right place. For formal documents you can count on the translation agency to make professionally formatted documents. For languages which read from right-to-left, and for languages which use highly intricate fonts, such as Amharic and Thai, it may be best to send the entire project out.
Template your high-volume documents that are adapted for use for many different patients. Examples of documents which lend themselves to templating: pharmacy medication labels, discharge instructions for high volume conditions, discharge medication lists for intensive medication regimens such as transplant, and care coordination letters to patients. Have the initiating department write out ALL of the common permutations of instructions or content, and pre-translate ALL of these permutations in the high volume languages. Use DUAL language format for these documents so that
Use a consistent source for translation so that dictionaries of preferred usage and translation memories can be utilized to speed up translation and cut down cost. A translator who has translated similar material before does not have to re-translate everything from scratch. Likewise, if a Translation Memory is used, segments that have been previously translated can simply be reviewed to ensure the existing translation is appropriate in context. And you can maintain consistency of terms across all your documents. Example: keeping the Chinese translation of “Physician’s Assistant” the same across documents.
Share and borrow! Utilize translations from inside and outside the organization which serve the purpose, instead of translating new documentation of similar material. Use government and non-profit public documents about specific diseases instead of creating new internal patient education materials. A sister hospital in the same system may have already translated an entire series of documents related to Prenatal Care, or you may have translated them and can share outward. Different hospitals or units can each fund part of a larger translation effort, rather than each undertaking all languages needed.
Making a 3-year plan for translation effort may be a good way to secure internal funding, rather than having to justify translation dollars in every budget cycle.
Not sure where to start?
Start by evaluating what documents may be considered VITAL.
Have additional recommendations or questions? What documents do you translate? Comment below.