Managing the switch from on-site to remote interpreter services: Lessons learned from the hospital.
What do you think about telephonic interpreter services? Video remote interpreter services? Yeah, I know. Everyone wants an on-site interpreter. Any time I see an article about remote interpreter services, and I read the comments, I cringe. People are super mad about integrating the use of remote interpreter services into patient care. And I mean, all people. I’m disappointed that those people include interpreters. On-site interpreters are mad because they see the remote interpreter as a threat to their livelihood: The more work that goes to remote interpreters, they think (I think?), the less work will go to on-site interpreters. I have seen on-site interpreters leave some really, really angry, and even unprofessional comments trashing remote interpreter services. Guys, come on. These are our colleagues we’re talking about.
I know from experience that it’s common to arrive on-site to an interpreting assignment and immediately hear something like this from the medical staff: “Oh, thank god you’re here, we had to use the phone [or video] interpreter, and it was just awful.” Or maybe, “This hospital doesn’t care about patients. Why can’t we get interpreters anymore?” Or they’ll just come out and say, “We hate the phone interpreter.” Really? You HATE the phone interpreter?
I know, it’s easier to give in and jump on that bandwagon of trashing remote interpreter services. And usually I have a very laid-back, you-do-it-your-way-and-I’ll-do-it-mine, we-all-have-our-own-experiences kind of approach to most things. But let me be clear here: If you are jumping on that trashing-remote-interpreter-services bandwagon, you are not only part of the problem, you are making it worse. Please, know how to redirect people who have complaints so that they can be addressed.
Two years ago, half of my staff interpreters were laid off, and the hospital went from providing 80% on-site interpreter services, to 20% on-site interpreter services. Overnight. It was a painful experience for many people, including me. I heard every complaint you can think of. The funny thing is, you would not believe the number of complaints I got about on-site interpreters before they all disappeared! For a long time, and even still, a lot of people demanded that we bring them back. Friends, they’re not coming back.
Awareness surrounding effective communication and working with interpreters is on the rise, which is great! So is the demand for interpreters. And in a Language Services program that offers all on-site interpreter services, it’s a bubble that will pop when an administrator says, “We can’t pay for this any more”, and when that happens, you have to know how to manage the change, which will likely include integrating remote interpreter services into the mix so that the services can remain accessible. In my case, the best we could do was to advocate for on-site interpreters for certain cases (we wrote guidelines into our hospital interpreter use policy), help people understand how to work with remote interpreters, and consistently re-evaluate our plan and how it was working (or not working).
Here are my tips in the first of a two-part post on effectively managing a switch from on-site interpreter services to remote interpreter services.
It’s the way we talk about it: I’m careful to talk about an on-site interpreter as “on-site”, and not a “live” interpreter. I would not believe this had I not experienced it, but some people who use interpreter services reject the “phone interpreter” or the “video interpreter” and insist on a “live” interpreter because they think that the interpretation delivered by phone or video is like an app, or some kind of machine translation, while really, it’s the same trained, “live” interpreter, who just happens to be on the other end of the phone or video screen.
I get the confusion. There are plenty of apps and services that deliver machine interpretation or translation. I mean, a “phone interpreter” that is not really an interpreter, this thing exists. If people have gotten the message, “Don’t use machine translation in the hospital.” and then their very own language services department is asking them to use something that sounds like machine translation, well, that’s confusing. And they might be so confused that they don’t even know what questions to ask and they end up refusing to use those services. I think it’s our job as language professionals to make sure that we’re all talking about the same thing when we talk about on-site, telephonic, and video interpreters.
It’s not the technology: When hospital staff have trouble with telephonic or video remote interpreter services, consider what the real difficulty is. A phone is not some kind of new-fangled technology. And lots of people are familiar with some kind of platform that lets you see someone on a phone or tablet while you’re talking to them. The issue is probably just getting used to something new after years of using only on-site interpreters. And when we’re getting used to something new, we can imagine all kinds of insurmountable barriers to the new thing actually working, and so-and-so said that they used a phone interpreter at another hospital and it was awful, and I heard this other hospital uses video interpreters and it’s a joke, and suddenly we’ve decided it can’t be done before we’ve even tried. You can always start out by saying to the struggling staff member “Tell me about the difficulties you have when you use the phone/video interpreter service.” Don’t be surprised when you learn that they haven’t actually used the service.
When hospital staff really dig in their heels and insist on having an on-site interpreter, you can usually get them to agree to having a staff interpreter on-site for that visit to help them get set up with the phone or video, and then the on-site interpreter is there to offer support. I did this myself, and it really went a long way in understanding how I could help them effectively work with a remote interpreter, or sometimes, it helped me understand why this area really did need an on-site interpreter.
That might seem like a lot of hand-holding to some folks, but hospital staff have a lot to deal with and their processes and procedures get changed all the time. If we don’t help them adapt to new ways to work with interpreters, language services will just get lost in the shuffle and in the end, patients get the short end of that stick.
But sometimes, it’s the technology: If a clinic or unit is set up to use telephonic interpreter services with wireless phones, and the wireless connection is choppy and unreliable, well then that is a tech problem or an equipment problem or however you want to look at it, that creates a barrier to using that service. Again, a simple, “Tell me about the connectivity when you use the service” will get you enough of a scoop to get started.
You can help places that have complained about connectivity by actually going there and trying out their phone or video unit in every single area they see patients. When you understand what the issues are, you can begin to work towards a solution. And as an added bonus when you go on-site to help staff work out their issues, you get to meet them in person, develop a nice little working relationship and they’ll be more likely to continue to work with you, rather than just ditching interpreter services in the future when they run into an obstacle. Again, in the latter scenario it’s the patients who lose.
These are the three most common barriers in my experience. There are obvious points I could make about how good leadership, good planning, and lots of hands-on work is necessary, but those points are, well, obvious. Again, the interpreters on the other end of the phone or video screen are our colleagues. What if, instead of widening the divide, any time we hear some version of “I hate the phone interpreter”, we take that as an invitation to start a dialogue? What if all interpreters support each other, and encourage each other? If I, as an interpreter, see that there’s an issue with the way other interpreters (on-site or remote) get treated, or get paid, or get training, what if I try and find a way to make that better?
I know it’s easy for me to say, since I don’t have a vested interest in on-site versus remote interpreter services in the hospital anymore. I don’t plan to go back to healthcare interpreting, and I don’t plan on working for a vendor that sells remote interpreter services. But the one thing we should all have a vested interest in is patients’ access to their healthcare. As soon as we can all get on board with that, we can start working towards change.