A Guide for Medical Providers and how to best partner with interpreters for encounters with LEP patients.

1. WORKING WITH INTERPRETERS
FOR HEALTHCARE PROVIDERS
2018
Presented by Eliana Lobo of Lobo Language Access

2. TODAY’S GOAL:
LEARN HOW TO MAKE YOUR
INTERPRETED COMMUNICATIONS
MORE EFFECTIVE AND EFFICIENT

3. AT THE CONCLUSION OF THIS PROGRAM YOU WILL
BE ABLE TO:
• Identify the multiple roles of an interpreter
• Structure an interpreted encounter
• Identify best practices
• Identify behaviors to avoid in interpreted
encounters
• Know where to seek cultural consultation

4. WHO SHOULD INTERPRET?
 An interpreter, NOT a family member
 An interpreter, NOT a co-worker
 Medical interpreters should be trained and certified
 National certification insures quality interpretation
 WA state requires interpreters to take the DSHS medical
interpreter exam, which tests language proficiency, ethical
knowledge and standards of practice
 If you receive Federal funds, you are mandated by Title VI
to provide meaningful language access
 If you receive Federal funds, and you practice in WA, you
may only use the services of DSHS certified or authorized
interpreters

5. BEING BILINGUAL DOES NOT GUARANTEE
INTERPRETING SKILL!
“Generic bilingualism” is not enough because interpreting
is not a generic activity. Interpreters work in specific
contexts and use specific vocabularies whose meanings
and usage change from context to context, both between
subject areas (medical, legal, etc.) and within subject areas
(folk medicine, advanced cancer treatment, etc.).”
http://www.atanet.org/chronicle/3707_22_johnson.pdf

6. IT GOES BEYOND HAVING TERMINOLOGY
EQUIVALENTS!
“Even the acquisition of vocabulary and cultural
understanding is not enough because bilingualism alone
does not address communication between languages.
Bilingualism is usually defined in terms of communication in
two languages, not as the ability to communicate between
two languages.”
http://www.atanet.org/chronicle/3707_22_johnson.pdf

7. THE EIGHT STEPS OF SPEECH PRODUCTION
(IN A SINGLE LANGUAGE)
For someone speaking a single language, it looks like this:
1. Speech sounds and other stimuli are received by your ear or hearing aid
2. These sounds are converted to bioelectric signals within the human ear, or
within the hearing aid device.
3. These electric impulses are then transported through specific ganglial
structures, ending up in the primary auditory cortex, on both hemispheres
of the brain. Interestingly, each hemisphere treats this input differently
4. The left side recognizes distinctive parts such as phonemes or basic sounds
of speech, whereas the right side takes over melodic/prosodic
characteristics
5. The input then moves through the following areas in the brain that process
6. speech perception
7. semantic association, and only then does it move to
8. speech production
Only EIGHT steps!
prosodic features in the English Language include stress, pitch, intonation, pauses,
loudness and pace, paralinguistic features and vocal effects

8. 11 STEPS TO SPEECH PRODUCTION
(IN TWO LANGUAGES)
• When we move from communicating in a single
language to interpreting, we add the following tasks
to the mix:
• Memory
• Conversion
• Iteration
• The interpreter’s brain is now handling ALL of the
prior tasks, plus three new tasks. Essentially adding
3 balls to the 8 balls already being juggled!

9. BEING BILINGUAL DOES NOT GUARANTEE
INTERPRETING SKILL!
“The ability to take another person’s ideas, which
are expressed in that person’s own idiolect, and
transfer those ideas to another language while
faithfully communicating the message in all its
aspects is the crucial element that
separates translation and interpreting skills from
mere bilingual skills.”
http://www.atanet.org/chronicle/3707_22_johnson.pdf

10. WHY INTERPRETERS?
Clear communication is an essential tool for diagnosis,
treatment and compliance
• Safety issues
• Liability issues
• The law requires it:
 Title VI of the 1964 Civil Rights Act
 The Americans with Disabilities Act 1990
 DSHS Guidance of August 2000
• CLAS Standards
• Joint Commission standards beginning in 2004

11. WHY INTERPRETERS?
AHIT-Texas Association of Healthcare Interpreters and Translators-PSA

12. BEFORE WE DIVE IN,
• Do you know how to schedule an interpreter in
advance of the appointment date?
 EPIC uses Cadence for this, what does your hospital
use?
• Do you know how to reach a telephonic interpreter?
• If your hospital or medical center contracts with a
video vendor, do you know where the cart is and how
to use it?
Malpractice insurance will NOT cover you for
mistakes in this area, (provision of language
access). Failing to offer an interpreter to a
patient who needs one is legally considered to
be a CIVIL RIGHTS VIOLATION, and
malpractice insurance does not cover that!

13. DOCUMENTING INTERPRETER NEED
• EPIC users
 Registration: during registration (in the demographics
section), and prior to the scheduling of any
appointments, the Patient Services Specialist enters
the preferred language & indicates "Yes" in the in
needs interpreter field
 there are some documentation comments required
 Out-patient appointments:
This presentation assumes that you, or your
facility, knows how to do the above. Today,
we will focus on how to best partner with an
interpreter for good clear communication,
and improved health outcomes.

14. WHAT DO INTERPRETERS DO?
• Transmit meaning from one language to another

15. MODES OF INTERPRETATION
• Consecutive
 Interpreting after the speaker or signer has completed
one or more ideas in the source language and paused,
allowing the interpreter to transmit the information
 Most often used in community and health interpreting
• Simultaneous
 Interpreting into the target language at nearly the
same time as the source language is being delivered
 Most often used in court interpreting
• Sight Translation
 Oral translation of written text

16. WHAT ARE THE ROLES OF AN INTERPRETER?
• Conduit
transmitting everything
• Clarifier
changing the form of the message, in order
to preserve the intent and meaning of the
message

17. INTERPRETER ROLES
• Cultural broker
providing the necessary framework for
understanding the message being
transmitted
• Advocate
taking action on behalf of either the patient
or the provider outside the bounds of the
interpreted encounter

18. STRUCTURING THE INTERPRETED ENCOUNTER
• Pre-session
 Check that interpreter is wearing a badge with photo
 Verify patient’s language preference
 Record the name of the language
 Record the name of the interpreter
• Introductions
• Encounter
• Post-conference

19. INTERPRETER BADGES
National certification Agency sub-contractor

20. ALWAYS ASK YOUR INTERPRETER ABOUT
THEIR CERTIFICATION STATUS
• Who certifies healthcare interpreters nationally?
• RID, (Registry of Interpreters for the Deaf) certifies ASL interpreters,
however, RID does not offer a healthcare specialization
• CCHI, (Certification Commission for Healthcare Interpreters) an
accredited body, certifies spoken language healthcare interpreters in all
languages as well as ASL interpreters
• NBCMI, (National Board of Certification for Medical Interpreters)
a non-accredited body, certifies spoken language medical interpreters in
Spanish, Russian, Mandarin, Cantonese, Korean,
and Vietnamese
Not using certified interpreters has long-term negative consequences
for patient safety, quality of care, hospital liability, health outcomes,
as well as compliance with Federal laws and regulations.

21. THE PRE-SESSION
• Introduction
 What are the time constraints?
 Names
 How would you prefer to be addressed?
 Establish the context, nature and goal of visit
 Is there cultural information that would be
helpful in this encounter?
• Encourage the interpreter to ask for
clarification if something you say isn’t clear
• It isn’t just the interpreter who may pronounce English
with a regional or national accent!

22. POSITIONING DURING THE ENCOUNTER
• Be aware of positioning and audio clarity
 Room sizes and configurations vary, but try to position
yourself where the patient and interpreter can both see and
hear you as well as each other, for all clinical appointments
 For in-patients in recovery or critical care, have the
interpreter stand on the same side of the bed as you, to
avoid creating a tennis match viewpoint for the patient
 For remote situations (telephone or video) make sure
everyone can hear what is being said. Often, video remote
interpreters can raise or lower volumes at both ends, but
phone interpreters can only control their end. Sometimes
you need to make adjustments on your own phone set-up
• Look at the patient while they are speaking!
 Match the interpreted content to what you just observed

23. NOTE INTERPRETER NAME IN THE EMR
• Confirm language preference with patient, then
compare with language indicated in EMR
• Ask the patient if they understand the interpreter
• If you are not a native speaker of English, ask they
interpreter if they understand you
• Note the language and any other relevant details
(specific dialect for example) in the EMR

24. THE THREE MAJOR ELECTRONIC MEDICAL
RECORD APPLICATIONS
• EPIC
• In-Patient: Language preference should appear in
PRELUDE, the registrations module within EPIC
• Out-Patient: Language preference should appear in
CADENCE, the scheduling module within EPIC
• Note language details (such as dialect) that become
apparent during the encounter, on the patient
education/hands-on teaching page
• CERNER
• SORIAN

25. THE ENCOUNTER
ONCE YOU HAVE ESTABLISHED GOOD POSITIONING
• Remember to LOOK at the patient while they
are speaking
• Match interpreted content to what you just watched
• Establish that anything that anyone says will be
interpreted and kept confidential
then, and only then do you
• Speak to the patient, not the interpreter
• Speak in first person
• Speak in relatively short segments
• Pause frequently

26. HARBORVIEW MEDICAL CENTER ENCOUNTER
FEATURING REMOTE VIDEO INTERPRETATION

27. CONSENTS & HIPAA
• Take the time to explain about privacy laws and HIPAA prior to
beginning the consent process
• HIPAA does not exist outside the U.S.
• Explain that all manner of risk, side effects and potential
outcomes are standard when explaining a procedure or
surgery to patients so they can be fully informed
• Otherwise, you risk frightening the patient into postponing treatment

28. POST-CONFERENCE
• Is there additional cultural information that
will help me to care for this patient?
• Is there anything I could have done
differently to facilitate your interpretation?
• After a difficult or traumatic session,
“How are you doing?”
Standard questions to ask the interpreter:

29. DO’S AND DON’T’S
• You’ve set the stage by
• Confirming language preference
• Positioning yourself correctly
• Introducing yourself
• What are some other things you can do to control
or enhance clearer communication?

30. AVOID
• Idiomatic speech or slang
• E.g., “you’re out of the woods”, “feeling blue”.
Better to be boring and direct in your speech
• Using ACRONYMS
• Interrupts the interpreter’s internal flow and can really slow down
communication
• Complicated sentence structure, particularly when ideas
change mid-sentence
• Collect and order your thoughts first, then speak clearly,
pausing often
• Asking more than one question at a time
• GENDER MIS-MATCH (between provider and patient)
• A match facilitates obtaining intimate personal information or choice

31. WHEN YOU WORK WITH A QUALIFIED AND
CERTIFIED INTERPRETER YOU HELP
• Reduce overutilization of the Emergency Dept. as the locus
for primary care
• You reduce the number of medication errors that occur
• You improve LEP patients’ adherence to their care plans
• You shorten LOS for LEP patients
• You reduce readmission rates for LEP
• You help reduce health disparities!

32. REMEMBER
• Concepts, diagnoses and treatments that can be
expressed briefly in English, may have no linguistic
equivalent in the target language.
• This often leads to the use of:
 Descriptions
 Word pictures
 Much lengthier exchanges

33. CULTURALLY COMPETENT RESOURCES
FOR YOU TO LEARN MORE ABOUT YOUR REFUGEE & IMMIGRANT PATIENT POPULATION
• WWW.ETHNOMED.ORG
• WWW.DIGITALLITERACY.GOV/HEALTHY-ROADS-MEDIA
• WWW.STORE.HEALTHYROADSMEDIA.ORG
• WWW.HABLAMOSJUNTOS.ORG
• WWW.HHS.GOV/CIVIL-RIGHTS/FOR-
INDIVIDUALS/SPECIAL-TOPICS/LIMITED-ENGLISH-
PROFICIENCY/INDEX.HTML

34. QUESTIONS?
Contact: Eliana Lobo
Director
InterpreterTrainer@outlook.com
Lobo Language Access