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Intercultural mediation in healthcare

The more you know about the past, the better you are prepared for the future.”

– Theodore Roosevelt

History of medical interpreting

Medical interpreting within the United States truly formalized in 1986 with the founding of the Massachusetts Medical Interpreting Association (MMIA), which was the first organization representing this specialization worldwide. In 2007, the MMIA expanded and is now the International Medical Interpreters Association (IMIA). Since its inception, the IMIA has pioneered a great many achievements including the first medical interpreter code of ethics and the first medical interpreting standards of practice.

Former IMIA President, Dr. Izabel ET de V Souza, spoke in 2007 about the IMIA expansion:

“We will now be able to join forces with other associations around the world, to help develop an international code of ethics, standards of practice, and quality controls for medical interpreters, and to facilitate the cross-continental exchange of knowledge in the language services industry.”

Over the past decade, Dr. Souza’s comments have certainly rung true. With national chapters in 35 states and international chapters throughout the Americas, Europe, Asia, and Africa, the IMIA is dedicated to ensuring the highest interpreting standards within the medical interpreting field. The United States is growing increasingly more culturally and linguistically diverse, and the need for professionally-trained medical interpreters is growing right alongside.

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A former Executive Director and President of the IMIA, Secretary General of the International Federation of Translators, project leader of Healthcare Interpreting Standard (ISO 21998), and Chair of the National Language Access Coalition Healthcare Committee, Dr. Souza is also the author of Intercultural Mediation in Healthcare, which encompasses the results of her international doctoral study involving well over 400 interpreter practitioners from 25 countries around the world.

With a wealth of knowledge and expertise, Dr. de V Souza offers 10 tips to healthcare practitioners, medical interpreters, and language services providers in order to strengthen language access and narrow the gap on miscommunication:

Tips for interpreters

Tip #1 Consult the IMIA Educational Directory

Frequent the IMIA educational directory which now lists a growing number of university-based programs offering 100, 200, and even more hours of medical interpreting training, as well as continuing education opportunities.

Tip #2 Accreditation vs Certification

Getting certified is the most important step an interpreter must take in order to take advantage of what the profession has to offer. There are three national certification programs for medical interpreters. Familiarize yourself with the National Board of Certification for Medical Interpreters (NBMI), the Certified Commission for Healthcare Interpreters (CCHI), and the Registry for the Deaf (RID). Do your due diligence by going to their websites to see which certification program is right for you.

Accreditation is usually a process for organizations to certify themselves to a higher standard. To receive IMIA accreditation, educational programs that offer 40-hour training are no longer be accepted. Within the next two years, this requirement will increase to 80 hours. So, look for programs that are accredited or that offer at least 60 hours of training. Dr. Souza recommends the longer programs that are university based as these will yield better job opportunities. 

Tip #3 Be assertive

Often, either due to time constraints, lack of awareness, or other challenges, healthcare staff may fail to appropriately introduce interpreters to the patients whom they are serving. Sometimes, physicians will start an examination before the interpreter is even in the room and may even end an over-the-phone interpreting session before the medical evaluation is complete.

If and whenever you find yourself in this position, speak up, articulate your and medical staff’s legal responsibilities to the patient, and ensure that the proper medical interpreting code of ethics is followed.

Tips for healthcare providers

Tip #4 Choose wisely

Look at language access or interpreting organizations that are affiliated with interpreter associations. The IMIA for example, has an extensive list of interpreter service provider members. This shows support for the profession and an eagerness to stay informed. Familiarize yourself with the NBCMI, the CCHI, and the RID.

Tip #5 Maintain accreditation

As an independent, non-profit organization, the Joint Commission now accredits and certifies over 20,000 healthcare organizations and programs within the United States. In order to receive and maintain accreditation, healthcare facilities must ensure that all those hired to work as medical interpreters have the required qualifications. Visit the Joint Commission’s Roadmap for Hospitals for more information.

Tip #6 Choose effective interpreting

Although there are specific guidelines when it comes to the most appropriate use of in-person, over-the-phone, and virtual remote (VIT) interpreting, “… what’s most important is that the person behind the phone or behind the screen or in the room is qualified.” – Dr. Souza

Dr. Souza is currently working on the ISO standards for healthcare interpretation (ISO-21998) which will be ready for release soon.

Tip #7 Hire professional interpreters

“Nowadays, there are very few excuses for ever not using a professional interpreter… volunteers should really never be used.” – Dr. Souza

Patients from linguistically and culturally diverse backgrounds are often unaware of the dangers of using ad hoc interpreters and are generally unaware of their language access rights. Medical staff may also require the expertise of medical interpreters to ensure they are providing the highest quality of care. Dr. Souza does not recommend volunteer or ad hoc interpreters ever. With technology, it is better to call a qualified professional and do it over the phone rather than work with the bilingual individual with no experience or qualifications to interpret medical information.

Tip #8 Document patient languages

Without this step, you will not know whom you are serving. Documenting what language patients speak is an underserved need. When healthcare facilities document the language needs of their patients and share this data with the various departments involved in the patient’s care, language access for patients becomes more readily accessible and efficient, ultimately improving patient outcomes.

Tips for interpreter services providers (ISPs)

Tip #9 Offer competitive pricing and unique services

Price is the number one differentiator, but qualifications and healthcare specializations are also important differentiators. What might really impress healthcare institutions is an LSP’s ability to provide training and customized solutions.

Many healthcare facilities don’t have the manpower to train their staff, so consider offering brown bag sessions and workshops. Visit clinics to demonstrate best practices in how to secure an interpreter. This opens up lines of communication to discuss issues and work out solutions. Also, consider developing customized dashboards that allow facilities to track calls and monitor the overall process.

Tip #10 Offer fill rate excellence

It should come as no surprise that healthcare facilities move at great speed. According to the 2015 National Hospital Ambulatory Medical Care Survey, there were 137 million emergency department (ED) visits in the United States, resulting in 12.3 million hospital admissions. Since approximately 9 percent of the total US population is comprised of residents with limited English proficiency, there may have been well over 12 million LEP patients who presented in EDs this same year, resulting in over 1 million hospital admissions.

If interpreters fail to show up or show up too late, physicians must move on. Strive to provide service excellence by ensuring your interpreters always arrive – and arrive at the scheduled time.

The future of medical interpreting is looking bright

Thanks in large part to Title VI of the Civil Rights Act of 1964, Executive Order 13611, and the CLAS Standards as foundations, the interpreting profession is now in high demand. HHS 1557, a nondiscrimination provision of the Affordable Care Act (ACA), “… extends nondiscrimination protections to individuals participating in:

  • Any health program or activity any part of which received funding from HHS
  • Any health program or activity that HHS itself administers
  • Health Insurance Marketplaces and all plans offered by issuers that participate in those Marketplaces.”

With the dedicated work of professionals within the language services and medical interpreting fields, a patient’s right to language access has continued to improve – but this doesn’t mean there isn’t still work to do.

“Much has happened in [recent] years, which I will call the post-certification era. Yet much work is still needed in the field, and we cannot become complacent.”  – Dr. Izabel Souza

Learn more about intercultural intermediation

Hungry to find out more? Make sure to get a copy of Dr. Souza’s book, “Intercultural Mediation in Healthcare: : From the Professional Medical Interpreters’ Perspective“, which is available on Amazon and other major retailers. 

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