Defining and Evaluating Bilingual Hospital Staff and Interpreters

IMG_3830Back when I was supervising my Language Services department, one of my responsibilities was overseeing our bilingual staff and interpreter approval program.  Honestly?  It wasn’t ever anything I wanted to be in charge of.  But I thought it was important.  I think it just made me uneasy in the beginning because I could never really pin anyone down to help guide me and answer my questions: Whose language should we evaluate?  What should we evaluate?  How do we know if they’re “proficient”?  What does that mean?  How do we evaluate language?  Who can be an interpreter?  What’s the difference between interpreters and bilingual staff?  How do we come up with an evaluation process that people will actually use?  Why do we evaluate them?  How do we follow up?  Essentially: How can we make sure that patients are getting what they need through effective communication when they’re being served by interpreters and bilingual staff?

I’ve got some basics here that may be helpful if you’re responsible for these kinds of things, or if you yourself are a bilingual person working in healthcare, wondering what it means to be an interpreter.

What’s the difference between bilingual staff and interpreters?  The former are staff members who are bilingual, but don’t have interpreter training.  Once their language skills are validated, they interact one-on-one with patients in a non-English language, but they don’t interpret.  So for example, a bilingual nurse might go through an admission with a patient in a non-English language, but he wouldn’t interpret for the patient’s doctor.  As for interpreters, in addition to speaking more than one language, they have formal training in ethics, standards, and medical terminology.

What does your hospital policy say?  You first have to define who qualifies as an interpreter, and who qualifies as approved bilingual staff.  In a nutshell, my hospital policy defined what minimum training an interpreter must have, and then goes on to say that anyone who’s serving as an interpreter or bilingual staff must be evaluated (it doesn’t say how, so we have some flexibility there).  The requirement to have formal training in order to serve as an interpreter isn’t popular with many bilingual staff members–especially those who are native speakers of their non-English language–so it’s important to get comfortable with explaining in a direct, succinct way why it’s important to have trained interpreters (effective communication, patient safety, etc).

In my particular situation, we had a couple of sticking points here. First, interpreter training involves a commitment of time and money and the training isn’t available within our healthcare system.  So it’s tough for people to access and work into their schedules, especially without supportive leadership.  Second, bilingual staff don’t want to wait for an interpreter or work with a telephonic interpreter, and so they’re frustrated that although they’re bilingual, clinically-trained professionals, they see it as a hassle to involve an interpreter rather than just doing it themselves.  There’s research you can look into that addresses the benefits of using trained interpreters and the downfalls of using untrained interpreters, so I won’t get into it here.  The important thing is to address these kinds of concerns on a one-on-one basis to see how you can best educate, guide, and provide resources.  In short, you really have to have these things spelled out in your hospital interpreter use policy to have any hope of developing a meaningful language evaluation program.

What kind of test should you use? It’s best to use a test that’s been validated–in short, something that’s undergone a process that shows that the results will be reliable.  The ACTFL OPI is one example of such a test. There are many tests out there, and your first step will be deciding what you want to evaluate–general language proficiency, proficiency and medical terminology, just spoken language, spoken and written language?  Then you will need to decide what level of proficiency you will accept as passing.

During my time at the hospital, we did our language evaluations internally for Spanish (we evaluated for general language proficiency in spoken language only, a decision that was a process over a period of years), and outsourced evaluations for other languages.  While I felt our internal evaluation was a good tool, and I liked doing the evals myself, it’s just not the same as a validated test.  Since I left my job at the hospital, an external, validated test has been implemented and this is really the ideal situation. 

Who should be evaluated?  For language proficiency, only heritage speakers (people who grew up in English-speaking society and received their primary education in English, but spoke another language at home) and non-native speakers (people like me who learned their non-English language as an adult) needed to be evauated, but not native speakers of the non-English language.  To make it crystal clear who falls under which category, we used the ACTFL definitions for native and heritage speakers (this is also spelled out in the hospital policy).  This is a really easy and objective way to determine who needs to be tested.

How do you keep track of everyone? This can be tricky if you’re not conducting the language evaluations internally.  In this case, a centralized language services department can schedule the evaluations and receives the results.  However, there’s a separate issue of follow-up, especially with those who are approved to work as interpreters, but are working in a department where nobody can assess that part of their work.  The fact that we were a very small department managing language services for an enormous city-wide healthcare system created a barrier to us really addressing this issue.

How are you getting the word out? In my department, we looked for opportunities to do in-services, lunch and learns, and get ourselves on the agenda for staff meetings and new employee orientations.  If you have staff interpreters, it’s important that they know how the process works since they are the ones interacting most with healthcare providers who will ask about it.

Although this post is on the long-ish side, this is the super short version of the story.  There are all kind of barriers to accomplishing this kind of work.  How are you handling evaluations for bilingual staff and interpreters in your hospital or clinic?  Feel free to share your experiences in the comments!

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