Equity in service delivery: When patients don’t speak your language
When I was in third grade, I fell off the jungle gym and cut my chin. I was bleeding a lot, so I was rushed off to the hospital, where they gave me stitches. What was unusual was that we were in Taiwan, in a small town where nobody spoke English. When I got to the hospital, they numbed my chin and then put a sheet over my face so that only the injury was showing. This was terrifying – I had no idea what was being said, what they were doing to me, or what was going to happen next.
Imagine yourself in a similar situation. You need medical attention and are unable to communicate with the providers. Now consider being the medical provider and being unable to obtain or convey information in a critical situation because the patient speaks another language.
While the need to be understood in a medical situation is a basic human desire, in the United States, medical providers are required by law to provide interpreting services for patients. Yet sometimes, the providers don’t have a plan in place to obtain those services.
Develop a Communications Plan
To meet patient and provider needs, here are 12 suggestions for developing a communications plan for patients who don’t speak your language. These steps will help provide equity in service delivery, so you can serve anybody that needs medical care, regardless of what language they speak.
- Get Professional Interpreters
This is perhaps the most important tip. Do not allow the patient’s friends or family members to interpret for them, because you run the risk of incomplete or incorrect information being conveyed to the patient. For example, in some cultures, children will not share all the information being communicated with an elder to protect them or because of cultural norms. The provider needs to be sure that the person interpreting is communicating everything the provider is saying accurately to abide by U.S. law. The best way to do this is by using a professional interpreter.
- Look for Specialized Interpretation Services
When you hire a partner or agency to work with you, make sure it is a reputable agency that offers specialized medical interpretation services. Legal interpreters use different terminology than medical interpreters, medical interpreters use different terminology than technical interpreters, and so forth. Know your interpreter’s specialty.
- Ask for Interpreter Qualifications
The language services provider you choose should train, test, and monitor their interpreters. Feedback should be requested and then conveyed to the interpreter. The goal should be to ensure quality interpretation and continuous improvement of skills and services.
- Ensure HIPAA Compliance
To comply with the Health Insurance Portability and Accountability Act (HIPAA), your language services provider needs to follow HIPAA guidelines as well. Your contract with them should outline the services to be provided and expectations for compliance.
- Provide Feedback
It is important to communicate with your language services provider and share feedback on the interpreters assigned. If there is an interpreter that you really like and you let them know, they can assign that interpreter to you more frequently. Likewise, if there is an interpreter that is not a good fit, share that feedback as well.
- Establish Communication Policy and Procedures
Once you decide on a language services provider, document the steps required for obtaining services. Make sure your communication policy clearly establishes all the procedures involved, and that your staff members know how to implement it.
In that policy, outline the four different modalities of speaking across languages and when to use them:
- Telephone interpreting – to schedule appointments or share results that are not serious.
- Video interpreting – to meet with the patient in person and have an interpreter join the appointment by video call.
- Live interpreting – for delicate or difficult conversations, especially if there might be body language involved.
- Written translation – for information sheets or pamphlets, including pre-surgery instructions, post-surgery follow up instructions, or similar directions.
- Determine Scheduling Procedures
Some of our clients have their receptionist schedule the interpreter as soon as an appointment is made. Other clients have a dedicated interpreter scheduler or department that tracks and manages the scheduling of interpreters for appointments. Once you decide what method works for you, outline the steps in your policy and procedures and train your staff.
- Keep Agency Information Accessible
For telephone interpreting and video interpreting, keep account information accessible near the phones at the nurses’ station or the scheduling desk, so that staff can schedule interpreters quickly and easily. Some providers provide stickers with the contact information and account code for clients to put on the phone for easy reference.
- Use a Language Card
At times it can be challenging for the patient and provider to communicate or identify the language spoken. One solution is to have a language card at the reception desk, so your providers and staff can access it. If you can’t identify the language spoken, show the patient the card. It has instructions in various languages that say, “if you speak this language, point to this.” Then it identifies, in English, what language they speak so you can get the appropriate interpreter.
- Develop a Translation Management Plan
When communicating with patients who do not speak English, it is important to provide written translations for important instructions or medication directions. I heard of a situation where a patient was taking suppositories orally, causing additional medical problems. Or patients taking too many pills each day because they didn’t understand the directions, because they were in English. It is important to ensure that providers share instructions and information in a language patients understand. Develop a plan that identifies what materials would be important to translate to ensure patient safety. Any information that you might provide to your English-speaking patients as a hand-out should be translated and ready to distribute to patients in their native language.
- Remember Your Website
Your website is often the first resource people will go to for information. If you have directions on how to pre-register or pre-appointment instructions on your website, this would be important to provide in languages that your patients speak. The entire website content does not need to be translated; just the information that your patients need to know before their appointments.
- Change Your Mindset
Finally, don’t think of interpretation and translation in terms of an expense. The return on investment (ROI) of interpretation and translation services is a smoother communications process and an increase in the quality of service you provide your patients. Plus, it limits your risk, like an insurance policy.
Getting medical care, whether of a routine or urgent nature, can be stressful for patients at the best of times. When the patient doesn’t speak the language, communication can present an insurmountable obstacle for both the patient and the provider. Removing the language barrier will improve the patient experience and help ensure your patients feel comfortable getting the care they need. Use these twelve tips to develop your communications plan, and you will provide better service and ensure equity in your service delivery.
Photo: gesrey, Getty Images