Sustainable Language Access Programs For Hospitals and Health Systems

Sustainable language access programs for healthcare systems

It’s well-known that hospitals and healthcare systems must provide interpreting and translation services to patients free of charge to stay in compliance with the federal government, not to mention it’s just the right thing to do.

Picture this:

You’re vacationing with your family in a foreign country. You assume many people speak English but the truth is, it’s a little tough to get by.

One afternoon your child falls and injures themselves – they need medical attention. Wouldn’t you want to be able to effectively communicate with the doctors? How much panic would you feel not being able to communicate?

Totally helpless and out of your control.

You wouldn’t want them to rely on an automated translation tool or Google Translate, would you? How would you feel in that situation?

There are at least 350 languages spoken in U.S. homes and 27% of the population is considered limited English proficient (LEP) speaking English “not well” or “not at all” (2011 Census).

Here’s the bottom line:

Language barriers compromise effective communication, potentially sacrificing the quality of care and patient safety.

If you don’t provide an adequate level of care to your patients, you could end up in Federal court or with the Office of Civil Rights after you.

A 2007 study reported 52% of adverse events that occurred to LEP patients in hospitals were likely the result of communication errors and that nearly half of these events involved some physical harm.

Language access in healthcare systems statistic

Can you afford to compromise the level of care for a large segment of your patient population?

Doesn’t everybody deserve an equal level of care regardless of the language they speak?

The thing is:

Instituting a successful language access program is difficult. It requires a full-scale organizational change. It is a long-term plan and will take time to fully implement.

But, when done correctly, you will:

  • Increase patient satisfaction
  • Decrease readmission rates
  • Retain more patients on a long-term care basis
  • Create a more empathetic workforce which translates directly to the quality of care
  • Create a well-rounded and cost-effective language service plan without sacrificing quality
  • Increase your competitiveness for employees and retention by offering professional development opportunities for bilingual staff through medical interpreter trainings (therefore decreasing your reliance on contractors by building internal capacity to treat LEP patients)

Do you want to rank as a top hospital or healthcare provider in the United States?

Then keep reading because in this article we will discuss:

  • Different types of language solutions + when they are best used
  • How to create a medical interpreter training program for employees
  • How to choose the right language service agency partner
  • How to create a successful implementation plan

Spoken Word Solutions – Interpreter Services

Spoken Word Solutions Interpreter Services

A research study done at two Massachusetts pediatric emergency rooms found that when Spanish speaking families have access to a professional interpreter, critical errors like wrong medication doses decrease significantly.

But mistakes are twice as likely to happen if the interpreter is a family member, bilingual hospital staff member or other non-trained professional.

The study, reported in the Annals of Emergency Medicine, found that using a professional interpreter decreased translation errors (like adding or omitting a word) by 12%. Those errors can have major health consequences.


Let’s discuss your options when it comes to interpreter services.

In person interpreter services logo In Person Interpreter Services 

Without a doubt, in person interpreter services provide the highest level of care. When an interpreter is in the room with the patient, they are better equipped to get a feeling for the appointment, read body language, and most effectively facilitate communication between patient and provider.

When they are in the room, they will be able to tell whether the patient feels uncomfortable or nervous or maybe isn’t truly grasping what is being communicated. When this happens, they can notify the provider and better manage the flow of conversation.

In person interpreters are mostly scheduled through agencies but as hospitals offer medical interpreter training to bilingual staff, you will be able to utilize your own staff.



Over the phone interpreter services logo Over The Phone Interpreter Services

An in person interpreter isn’t always feasible or necessary.

That’s when remote interpreting options like over the phone interpreting (OPI) come in.

Over the phone interpreter services are ideal to support your call center and manage all incoming and outgoing patient calls.

It is not ideal for all in person patient appointments as the interpreter has little to no context to the appointment but in a pinch, it can certainly be a life saver and there are many instances throughout the patient journey where this service is perfectly acceptable.

This is also a great solution for small healthcare clinics who don’t see a lot of LEP patients but need to remain compliant.


Video remote interpreter services logo Video Remote Interpreter Services

A comfortable middle man between in person interpreting and over the phone interpreting is video remote interpreting (VRI).

VRI is an encrypted video chat with an on-demand professional interpreter. You can use a computer, laptop, tablet or dedicated cart for VRI, as many hospitals do.

The benefit of VRI is that you can see the interpreter and the interpreter can see the provider and/or the patient to get a better feel for the atmosphere in the room.

Additionally, VRI is a great solution for deaf and hard of hearing patients as if gives you access to certified American Sign Language interpreters in 30 seconds or less. With the increase in demand for ASL interpreters, it can be tough to get an in person interpreter when you need them. VRI solves that problem for hospitals in both cities and rural areas alike.

Interpretation Levels Chart

American Sign Language Interpreters

While we have focused on LEP populations, it’s important to mention that the same federal regulations apply to the deaf and hard of hearing community. ASL interpreters are provided by most language service companies and as mentioned, VRI is a great solution to provide equal care to this population as well.

American Sign Language Services Logo

All Of The Above

While some modes of interpreting are better suited for certain situations, there is no right or wrong.

In fact, we believe the most successful language access programs are a blend of all of the services listed above supplemented by either staff interpreters and/or bilingual staff who are trained as dual-role interpreters.

By training hospital staff of the importance of interpreter services and when each is best suited for what situation, you will be able to provide equal care to all while better controlling costs.

Building Internal Capacity To Serve A Multilingual Population through Medical Interpreter Certification

Interpreting as a profession needs to be studied and practiced. They are experienced, trained, and hopefully on the road to medical interpreter certification or already certified.

If you want to offer bilingual staff members the opportunity to interpret, it’s important to understand that they will be stepping into a dual-role. Interpreting will be in addition to their current position and it’s a role that must be trained for.

Many bilingual speaking staff get excited for the opportunity to add “medical interpreter” to their toolbox of skills. For employers, this is a great benefit to attract and retain employees.

By empowering employees to become interpreters, you will be able to control your costs to professional companies and increase patient and employee happiness alike.

Have a Spanish speaking patient in the Emergency Room? Instead of going to a phone or video interpreter, you can have an onsite employee interpret in person. It’s a win-win all around.

So, how do you go about implementing such a program?

While there are details specific to each hospital, generally, we recommend the following

  1. Schedule language proficiency tests for interested employees.

Trust but verify. Just because someone says they are bilingual, doesn’t mean they have the level of professional proficiency to become a medical interpreter.

Language proficiency tests are easy to schedule and are done over the phone to accommodate any employee’s schedule.

We consult with hospitals to determine a baseline of acceptable proficiency levels.

Those who pass the test will be qualified to attend a 40-hour medical interpreter training.

  1. Medical Interpreter Training – Requirement for Medical Interpreter Certification

The National Council on Interpreting in Health Care (NCIHC) lists six primary components that are basic requirements for healthcare interpreters:

  • Language skills
  • Knowledge of the medical interpreter Code of Ethics
  • Sensitivity to cultural issues
  • Master of healthcare terminology
  • Integrated interpreting skills
  • Ability to create oral translations, or, where appropriate, brief written translations.

This 40-hour course meets the minimum requirements for national certification and follows a lecture-based and role-play training approach. The format encompasses a variety of interactive exercises and discussions, case study analysis, selected readings, and media including digital, video, and audio technologies.

The training is conducted in English so it is language-neutral. This is a course to prepare individuals to become professional medical interpreters, not to teach them another language. Although, many glossaries and terminology sheets are provided so they can study medical terminology on their own time.

We are flexible with our training schedule to accommodate the hospital and employee’s schedules.

Medical Interpreter Certification

Certification Commission for Healthcare Interpreters CCHI logo The national board of certification for medical interpreters NBCMI logo

Medical Interpreter Certification is controlled on a national level by two national boards:  Certification Commission for Healthcare Interpreters (CCHI) and National Board of Certification for Medical Interpreters (NBCMI). Individuals who complete the 40-hour training and wish to pursue certification will have to go directly through either national board.

The Written Word – Translation Services

Emergency Room sign translated into different languages

Like interpreting, medical translation is a highly specialized field of translation due to the technical and sensitive nature of documents. Another thing we want to make clear is just as a bilingual speaking individual isn’t necessarily qualified to be an interpreter, an interpreter or bilingual individual isn’t qualified to be a translator.

Interpreters and translators are two distinct professions. Interpreters specialize in verbally facilitating conversations while translators are masters of the written word. Very similar to public speakers and writers.

Consider the difference in someone who speaks for a living versus someone who is a writer. One is more creative and outgoing while the other is very technical and detail-oriented.

The medical industry provides a unique challenge for translators, as there are new terms constantly emerging and evolving. Translators must be critical in the use of new terms and synonyms.

Risking patient safety to save a few bucks is not worth it. Imagine the trouble that could happen if you had a bilingual employee hastily translate a script or a legal form. Leave this detailed and important task to professionals.

Getting key documents translated will be the final step in creating a healthcare environment that is all-inclusive. Besides the obvious translation of legal forms, brochures, care instructions, etc. consider translating signage around your hospital.

Implementing Organizational Change

Implementing Organizational Change

Setting up a language service contract won’t be any good if you don’t have an implementation strategy to get everyone in your organization trained on:

  • The importance of language services
  • How to request language services
  • How to best serve LEP patients

Understand that this will be a process that takes time. It may take months to a year to fully implement the language access program you have carefully planned.

Each hospital is different and will require a unique approach but here are some of our top tips that have proven to be successful:

  1. Leadership support to create organizational buy-in

As with any large-scale effort, creating buy-in starts with the leadership team for long-term success. Leaders can show their commitment to language access by promoting policies and procedures and by supporting bilingual staff in their interest in medical interpreter training.

  1. Create a formal language access policy

Put your new policies and procedures into writing. Distribute it to current staff. Talk about it in team huddles and meetings. Include it in new employee training and on-boarding. Include it in staff only emails. Get the word out, you get the picture.

The Department of Health and Human Services has a free Guide to Developing A Language Access Plan which could offer a great starting point.

  1. Ongoing training for staff and providers

Offer continuous education materials whether written articles or in person trainings. There are a wide variety of topics you can cover including federal regulations, working with LEP patients, working with interpreters, etc. Keep the importance of these services top of mind and educate your provider team on how to best serve LEP populations.

  1. Create a language service pack for each department

We’ve seen hospitals dedicate a cart or basket to language services in each department. You can include a dual-handset phone, language service request options, tip sheet for when to use each interpreter service, etc. This is completely customizable and having a go-to spot for quick reference will help providers know exactly where to go when they need linguistic support.

  1. Dedicated champions

Assign a dedicated champion or two in each department to be the go-to resource should anyone have any questions. They can manage the language service pack to make sure it’s being used and returned to the same place and also serve to answer any questions any other staff member may have.

Bringing It All Together

Language services reduce health disparities and improve patient care and satisfaction. As federal and state laws increasingly scrutinize health equity and language access, enhancing services lowers liability risks.

There is no one size fits all language solution for hospitals and healthcare systems. Find a reliable language solution partner that is willing to dig deep into your organization to consult on the best suite of services and implementation plans.

A successful and effective language access plan for hospitals will include a mixture of in person and remote interpreting services, translation services, and a testing and interpreter training program for interested bilingual staff members.

The need for language services isn’t going to go away and federal pressure will always be there. Take a proactive approach today to get your hospital trained and ready to care for any patient, no matter their language or background.

Free Download: Recommendations on how to improve the patient experience using qualified interpreters



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