Recommendations from the Roadmap
By David Fetterolf, Stratus Video President
"A Roadmap for Hospitals" was developed by the Joint Commission as a guide to encourage healthcare organizations to integrate effective communication, cultural competence and patient and family centered care into their overall care delivery. The guide provides recommendations to best meet patient needs as well as Joint Commission standards, including implementation examples and best practice tips. Similar to the standards, much of the roadmap applies to language access services. Below are recommendations from the roadmap on how to best serve the limited English proficient (LEP) and Deaf/Hard of Hearing (HoH) patient population.
Recommendations from the Roadmap
Develop a system to provide language services. There are several factors to consider when strategizing a comprehensive language access solution, including language needs, facility size, interpretation modes and cost effectiveness. To ensure a language access plan is effective, the language needs of the community must first be identified. This can be accomplished by looking at the top foreign languages, the percentage of limited English proficient (LEP) people in the area, the number of encounters the facility has had with LEP patients, the number of languages encountered and any recent increase in interpreter requests.
Determine the types of services needed. Hospitals establish and follow guidelines as to when each mode of interpretation is most appropriate.
- Video remote interpretation is ideal for situations where an interpreter is needed immediately and visual cues are vital to the conversation.
- Onsite interpreting is best suited for more delicate discussions such as mental health, informed consent, new diagnoses and end of life conversations, when an onsite presence is needed or by patient preference.
- Over-the-phone interpreting is essential to reach languages of lesser diffusion that may not be available in person or over video. It is also commonly used for conversations that do not require visual cues such as appointment settings and/or follow up calls.
Common deciding factors include the LEP patient population, frequency of encounters, length of the interpretation session, nature of the conversation, patient preference, immediacy and ease of accessibility.
Offer a mixture of language services to ensure coverage. Effective language access plans typically include a combination of the three with guidelines on when and how to use each mode. While common language requests are often fulfilled by onsite and video remote interpreters, less common language needs are more easily met over the phone. By having access to all three, providers can ensure coverage no matter the language or time.
Train staff on how to access language services and work with interpreters. Most interpretation providers offer tools and training resources to hospitals and health systems as part of implementation and ongoing support. There are several actions that healthcare providers can take to more effectively work as a team with medical interpreters. Top tips include preparing the interpreter for the session, speaking directly to the patient, speaking simply and checking for understanding. Most important of all, healthcare providers must use a qualified medical interpreter to ensure the message is being conveyed accurately and completely.
Note the use of language services in the medical record. The information obtained is vital to the development and optimization of a successful comprehensive language access plan.
Provide translated written documents for frequently encountered languages. Vital documents must be translated into most frequently encountered languages. Vital documents include informed consent documents, complaint forms, information about free language assistance programs and notices or eligibility criteria for benefits.