Lost in Translation

The Hospitalist. 2006 November;2006(11):

November 1, 2006 | The Hospitalist

According to Cynthia Roat, MPH, a national consultant on language access in healthcare, the two major restrictions hindering the implementation of professional linguistic access programs in hospitals today are:

Lack of funding and
Lack of qualified interpreters.

“Fortunately the latter problem is being addressed,” she says. “We have established standards of practice for professional competence, and there are training programs for medical interpreters as well as for clinical staff who use interpreters.”

For example, the National Council on Interpreting in Health Care (NCIHC), a leading advocate of medical interpreting, has developed national standards to improve communication between the LEP patient and the healthcare provider. In addition, many technical and community colleges now offer medical interpreting classes, and some medical schools are beginning to offer seminars and courses designed to train clinical staff to work with interpreters. “Working with interpreters is a concrete, clinical skill,” says Roat.

Still, finding the money for this type of program can have a financial impact on healthcare organizations. Adding to that, accreditation agencies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance (NCQA) have set compliance standards for language access in terms of its contribution to quality care and patient safety. These compliance standards can also have a financial impact on healthcare organizations.

Medical Students Take Initiative

Led by Yan Tomas Ortiz-Pomales, a fourth-year medical student starting his residency at the end of 2006 as an officer in the U.S. Navy, a group of medical students at Georgetown Medical Center in Washington, D.C., has begun a Medical Translation Program through Patient Advocacy. Offering translation services in Spanish, French, Russian, Vietnamese, Mandarin, Italian, and Arabic, the group volunteers to help the Patient Advocacy Department fulfill its mission of making Georgetown Medical Center welcoming for patients of different ethnic backgrounds.

Formed in 2004, the group was originally intended to help medical students learn Spanish in an effort to prepare them to serve Spanish-speaking communities. Eventually, the students decided to become volunteer translators in the clinical setting. Each student may work as a translator for one or two hours a week on an as-needed basis (although every effort is made to allow a student who has worked once with a patient to continue serving that patient on follow-up visits).

The medical center has been enthusiastic and willing to work with the students—even accommodating their schedules. But because the hospital must place patients’ needs above the students’ availability, the students may not always volunteer as many hours as they’d like. Nevertheless, the program continues to survive and grow, and its future seems secure.

“I am passing down the torch and all the information to some interested first-year students,” says Ortiz-Pomales. “We are all trying to reach out as much as we can. We know it’s needed—in all specialties, not just the ones we’re going into.”—AK

An even more significant effect may result from the federal government’s mandate to provide language services to LEP individuals. Specifically, Executive Order 13166, “Improving Access to Services for Persons with Limited English Proficiency,” stipulates that hospital and healthcare organizations receiving federal funds are required to provide interpretation services under Title VI of the Civil Rights Act of 1964. Denial of interpreter services to LEP patients is considered a form of discrimination.

In addition, the Office of Minority Health (OMH) within the U.S. Department of Health and Human Services has specified 14 National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) that direct healthcare organizations to make their practices more culturally and linguistically accessible. CLAS standards are organized by themes: Culturally Competent Care, Language Access, and Organizational Support for Cultural Competence. Within this framework, there are three types of obligation: mandates, guidelines, and recommendations. Mandates are current federal requirements for all recipients of federal funds; guidelines are activities recommended by OMH for adoption as mandates by accrediting agencies; and recommendations are standards suggested by OMH for voluntary adoption by healthcare organizations.