Here are three simple things you can do to invest in the continued professional development of your team of healthcare interpreters:

Block Time

Interpreters have very busy schedules. Departments need to run as efficiently and cost effectively as possible. A lot of time that means doing more with less and running as many appointments as you can with as few interpreters as possible. Still, interpreters need time for continued learning as part of the performance of their duties. It is an expectation in the interpreter code of ethics. It might even be written into the job description. Opportunity for continuous learning is quite probably part of what your interpreters love about their job and what keeps them energized about the work they do. Block time in your interpreters’ schedule that is reserved for study and professional development.

Give Tools

Interpreters need materials and tools that will facilitate their continued learning. A place to study and a computer with good internet access whose firewall allows reasonable freedom to conduct searches is a good start. Compile a “favorites” list of valuable websites so other team members can more efficiently research information. Start collection of multimedia resources for your department. Collaborate with your hospital’s library to take advantage of existing resources and grow its collection to include items of value to interpreters. Perhaps most importantly, ask the interpreters what tools they need to foster their continued learning.

Show Interest

Show an interest in your interpreters’ continued learning, and encourage them in their continued learning, not as an afterthought, but as a routine part of the workday. Take a few minutes to chat with your interpreters about what new things they’ve learned lately. Ask if they have the time and tools they need to grow their skills and knowledge. If someone on your staff attends a third party training event, provide an outlet for the interpreter to share the learning experience with the entire department. Acknowledge the professional growth that interpreters achieve as a result of their efforts to always learn more.

Interpreter Managers/Many Other Roles, invest in your interpreters’ professional development and you’ll have a team of interpreters that is invested in the work of your department.

 Erin Rosales

Director of Interpreter Development

1. Expect neutrality.

Neutrality is accomplished by the interpreter transmitting exactly what has been said from one language to another. This exactness of message assures that both parties understand each other. When an interpreter remains in a neutral position, the physician and patient can feel at ease communicating directly. The relationship should be established between the physician and patient – not physician and interpreter or patient and interpreter. This neutrality allows the physician and patient to remain in control of the care given and received. When a professional interpreter does their job correctly, it will be as if you are speaking with your patient in his or her native language. There should be nothing said that you don’t immediately hear in your understood language.

2. Expect empowerment.

Communicate the same as you would with a native English speaker. Engage. Clarify. Assure understanding. Expect the interpreter to empower you and the LEP patient to communicate directly with one another. This direct communication will allow you the ability to clearly diagnose and understand the patient’s symptoms and needs, and assure the patient understands your suggested care plan.

3. Expect confidentiality.

Professional interpreters abide by a strict Code of Ethics forbidding them to break any level of confidentiality. Utilizing professional interpreters will assure that all private matters remain private. Professional interpreters also allow you to see your patients in strict confidence, without being forced to involve children, family members, neighbors or friends.

4. Expect professionalism.

Broadly speaking, professional interpreters are not trained social workers, educators, doctors or nurses. They are bilingual professionals who understand cultural differences and possess the breadth of vocabulary fitting the situations they are in. Interpreters will not give advice about the situation, but will adapt their skills to the needs of each unique encounter according to the guidelines of the profession and assure the parties involved overcome the language barriers that impede their ability to communicate directly and effectively with one another.

In summary, expect professional medical interpreters to represent you and your practice’s brand transparently and allow you the ability to establish a direct relationship with your patient. You should leave the interpreted encounter confident that you and your LEP patient have communicated in such a way that you have heard everything the patient said, and the patient has been allowed to make a proper, sound, educated decision based on the information and suggestions you provided.

Kyle Werych

Head of Business Development

Maybe it’s because I would like to do everything for free.  Maybe it’s because I don’t look like I could have the experience to be of value to an organization.  Or maybe, and most likely, I don’t give myself enough credit.

Familiar environments can make a big difference.  I remember growing up and spending a lot of time at a roller skating rink.  I tended to be quite shy with people I didn’t know.  But when I was with people and in a location that I knew well and trusted, watch out!  I was unstoppable!

I think many people have the same feelings I do.  Recently, a colleague went to visit a customer and asked for a testimonial. The customer agreed to offer a testimonial but clarified that she was a “terrible writer.”  Someone in a senior level position in a large healthcare system says she’s a terrible writer!  It made me feel more at ease with myself.

Communicating with others can be very difficult for some.  I do well with large groups, but struggle terribly one on one.  Whether we’re looking to advance our career or see a movie with a friend, we must all communicate with our recipient in a confident, compassionate and understanding way.

I don’t know about you, but I’d rather have a meaningful dialogue with a vendor than be talked at by someone who thinks they know what my business needs better than I do!

Rashelle LeCaptain

President

It seems however there is yet another factor hindering efficient patient and provider communications. Drum roll please….physicians. Really? The Palo Alto Medical Research Institute conducted focus groups in the San Francisco Bay Area and found that, “even relatively affluent and well-educated patients feel compelled to conform to socially sanctioned roles and defer to physicians during clinical consultations; that physicians can be authoritarian; and that the fear of being categorized as ‘difficult’ prevents patients from participating more fully in their own health care.”²

Add cultural and language barriers to this, and the interpersonal dynamics of a family member or child acting as a patient’s interpreter and we’re potentially a long way from transparent communications. None of these risks can be completely mitigated, but using an unbiased, professional health care interpreter will significantly improve the odds of comfortable and transparent communications.

 Kyle Werych

Head of Business Development

As of this posting, I can readily name five events that I’d love to attend but will not due to a variety of the aforementioned Conflicts. I know that I’m not alone in this predicament, so I’m happy to share this blog post from David Kelly on How to Learn from a Conference You Aren’t Attending in which he gives advice on using Twitter as a way to tap into the event from afar. Although it doesn’t replace the richness of attending the event, it is a viable way to stay engaged with the important goings-on in the industries that drive your professional practice.

As for me, all I have to do is master Twitter, which should be quite a bit easier than mastering the art of bilocation and winning the lottery.

Erin Rosales

Director of Interpreter Development

At this price point, I will have to sacrifice certain features. Some are tangible, such as gas mileage, while others are intangible.  I may have to think twice about taking a job with a lot of travel in the $3,000 car while the new Ford Taurus would make this a non-issue.  Both will get me from point A to point B, but I’ll end up putting more money into the budget car when it requires repairs and maintenance.

It’s more difficult to make the same distinction with professional services.  As a business owner I’ve learned a lot about purchasing such services.  Most often I’ve tried to do things on my own first, only to realize that I wasted precious time better spent elsewhere.  I was trying to figure something out that someone else could do so much more efficiently.  Even though I have to pay for the service, I benefit because my problem is solved in a much more timely fashion and I am able to focus on my area of expertise.

I get frustrated when language services are referenced as a horrible injustice to health care.  “The costs are too high.”  “We can’t afford to hire interpreters.”  “We’re losing money already and language services make it worse.”  Poor communication affects so much more that the price of language services.  Organizations must look at the intangible costs related to poor communication as much as they do the cost of interpreters.

Recently the (http://www.healthcarepayernews.com/content/nqf-endorses-all-cause-unplanned-readmissions-measures) National Quality Forum released a press release stating that readmissions cost $15 billion annually.  The cause of some readmissions was adherence to treatment plans, patient health literacy and language barriers.

When health care has an opportunity to reduce a $15 billion dollar waste, I’d ask what are language services that improve communication worth?

Rashelle LeCaptain

President

While it is typically good when nothing extreme is going on to warrant an urgent communication, not having regular contact can prevent the language services provider from leveraging their full potential for the health care organization. On both sides, operational processes can change; systems are enhanced; employees move; new services are unveiled. No news may mean everything is on track and proceeding as planned, or it might not.

Engage in the relationship. Keep each other abreast of upcoming needs and interests. Measure performance levels at appropriate intervals. These actions assure language services are being provided to the health care system in their most efficient manner.

Kyle Werych

Head of Business Development

Introduce Yourself

Anytime you have an initial contact with someone, whether in person or on the phone, always introduce yourself first and then move on to the business at hand. This is especially important when you are initiating the communication. If a stranger calls my house and asks to speak with so-and-so without first stating who they are or why they are calling, I will be very guarded and much more likely to abruptly end the communication than if the caller takes a moment to state who they are first and then ask me to reveal information. So, when I make contact with someone who doesn’t know who I am or what my purpose is, I need to remember to extend the courtesy of identifying myself first and then moving on to the purpose of the communication. After all, why should I expect anybody to tell me anything unless I’ve told them who I am first?

Address People by Name

People have names, and those names are important. Dale Carnegie said, “If you remember my name, you pay me a subtle compliment; you indicate that I have made an impression on you. Remember my name and you add to my feeling of importance.” I can extend a kindness and compliment to someone without even having to know their personal skills and talents. All I have to do is address someone by their name. While there is nothing inherently wrong or offensive about referring to someone as the “nurse” or “patient” or “interpreter,” learning someone’s name moves the interaction beyond the generic and impersonal. It acknowledges the individual person, which is a key component to building rapport.

Speak with Sincerity

It isn’t enough to mindlessly rattle off the words and go through the motions. You must show that you are fully invested in the task and people at hand. Put the electronic communication devices aside, make eye contact (or other culturally appropriate body language), and speak kindly.  Set aside all temptations toward inattentiveness in order to avoid projecting an attitude of indifference toward the individual or situation. When you speak with sincerity, you show others that you are fully engaged in the concerns of the moment and in them as valuable individuals.

What are you doing to build rapport and drive customer service?

Leave a comment and continue the discussion!

Erin Rosales

Director of Interpreter Development

Think, for a moment, and answer the following questions:

What business will you be forever loyal to?  Why is that?

Why did you choose these clothes today?

Why will you never be going to return to that restaurant again?

I’d bet you even frequent the same grocery store week after week.

Businesses, good ones, know that their customers have choices.  They design their services according to the experiences they hope will keep customers coming back time and time again.  Everyone has choices and those choices dictate the experiences we’ll have.

Health care is a business and their programs are designed around a very purposeful experience, knowing most people would rather be anywhere else but at a health care facility.  The outcome of the experience depends on pleasant people and relaxing environments, like entryways and waiting rooms.  Positive experiences affect satisfaction ratings, the success of preventative medicine and tenured employees that are engaged.

Health care organizations are successful because they deliver experiences that are not only positive, but memorable.  Employees and service providers, including language services, are responsible for making sure the organization’s vision is fulfilled.  Language access programs fail because they do not deliver the experience that customers expect.    Predictable language access resources build trust because they create a positive and memorable experience for organizations and their employees.

The choices we make depend on the predictability of an experience.  Sometimes they are our own and other times we make choices based on the experiences of a trusted friend.  Positive experiences build trust and trust builds loyalty.

What experiences will your employees have with language services today?

Rashelle LeCaptain
President

Health care interpreters new to the field might find themselves in a similar situation. They have diligently studied interpreting theory, performed a number of role plays, and had hours of field observation. Yet, when the time comes to interpret a live medical encounter, sometimes it’s not as easy as it all seemed up to that point. There’s just no shortcut around experience.

Whether you have one month or one decade of interpreting in the health care field, it’s valuable to use your experiences as a way to grow. There are many ways to achieve this. I will suggest two.

First, discuss your experiences with others who understand, and maybe have
experience in, the interpreter role. Even someone with less familiarity can
serve as a sounding board. Doing so will:

1. help you realize that you are not alone in your struggles and triumphs – others are walking the walk right along with you.

2. be an opportunity to gain outside perspective and learn to approach things in different and more effective ways.

3. result in discovering best practices that can be replicated by more interpreters.

Second, track and review your experiences. It isn’t enough just to have the
experience and move on – experiences tend to lose their value if they are soon
forgotten. By documenting the experiences you’ll:

1. more clearly see areas for growth, be better encouraged by how far you’ve come, and be fueled to continue on the journey.

2. see that what was challenging six months ago is now a cake walk. (Consider sectioning off a spot in your personal glossary and dedicating it specifically to “other” things learned.)

3. be able to review these experiences at a later time and refresh the lessons learned.

How do you use your experiences to grow professionally?

Erin Rosales

Director of Interpreter Development

How should the interpreter respond?

If the complaint is made while actively interpreting Patient<>Provider communication it would be best to table the comment until there is an appropriate time to address it, such as after the appointment. In the moment the interpreter could briefly acknowledge the comment and let the individual know that he or she would like to address the comment after the encounter is over. This will alert the concerned individual to the desire to address the comment while keeping the communication from being derailed by a side comment not relevant to the current situation.

If the timing allows for the complaint to be aired, it is important for the interpreter to respond in a way that is within his or her authority. This will vary depending on whether or not the interpreter is self-employed, represents an agency, or works directly for the health care facility. (If the interpreter works for an agency or health care facility, the interpreter should follow the guidelines of that institution.)

As a general rule of thumb, the interpreter should avoid judgment either in support of or against the complaint. Instead, he or she should acknowledge the complaint and address it objectively. In this way the interpreter avoids projecting bias regarding the situation and avoids promising a particular resolution, which the interpreter might not have authority to provide. The interpreter should tell the individual that he or she will bring the concern to the attention of the supervisor, and ask if the supervisor could call the individual to discuss the matter directly.

By taking this approach, the interpreter acknowledges the individual’s concern and ensures that the situation is addressed in the appropriate way and through the appropriate individuals. It is important for interpreters to be prepared to respond well to complaints about interpreter services so that problems can be identified, corrected, and prevented from occurring again. This will strengthen the services provided and build rapport with those who rely on interpreter services.

How do you respond in this type of situation?

Leave a comment to tell us about your experience and continue the
discussion!

Erin Rosales

Director of Interpreter Development

Like the bookcase-assembly metaphor, I would think it difficult and frustrating for, say, a doctor to work with an interpreter if the doctor is basing his/her approach on a “How-to” guide that doesn’t correspond to the professional practice of that particular interpreter. I imagine the same could be said for the interpreter working with the doctor in such a scenario.

I mention this because I recently came across different “How-to” guides for working with interpreters. For the most part, the information was quite useful. That is good. Unfortunately, some of the tips were arguably wrong insofar as they contradicted ethical standards for health care interpreters. That is bad.

As I reflected on what could have led to these erroneous tips I concluded that one possible reason for these discrepancies is that the role of the health care interpreter varies from place to place. It is understandable, then, that the authors of one “How-to” guide would create tips that are accurate for the interpreters in that particular place but that would not be applicable to interpreters elsewhere.

As long as there are inconsistencies regarding the role and function of the interpreter, it will be difficult to write a universal guide that instructs others on how to work effectively with interpreters. In spite of this, the work of the health care interpreter must continue, and in this environment, “How-to” guides are helpful because at the very least they indicate that there are techniques and strategies to working with interpreters, despite discrepancies from one “How-to” guide to another.

Will techniques on working with an interpreter ever reach the level of robotic execution and strategy? “I stand here. You stand there.” I suspect – and hope -not. The work of the health care interpreter is inevitably and necessarily dynamic. Nevertheless, the greater consistency there is from interpreter to interpreter, organization to organization and region to region, the easier it will be to write         “How to Work With the Health Care Interpreter” guides that are more universally applicable.

With that achieved, applying the tips and strategies laid out in the interpreter “How-to” guides will make working with interpreters more like learning how to dance with a new partner – awkward at first, but graceful with practice – and less like trying to assemble a bookcase with an inaccurate manual.

These industries, products and services were readily understood by the market place. They were also regulated for education, execution and quality. Oh no, I was venturing into a market and business model that I had to generate on my own. I knew what I didn’t want to do so I had to create what I did want to do.

Healthcare organizations are finding themselves in the same boat I was in so many years ago. There is a need to provide language services and that need must be filled. To make matters worse, unlike accountants and lawyers, massage therapists and hair stylists, there just aren’t many options for language services.

And like any other business, bottom line is king. While most would be willing to give away their services to help others, the reality is that we all need to make a living to survive. Without revenue, organizations fail and people lose their jobs.

Everyone is trying to create ways to save money and still comply with language access regulations. Unfortunately, this can be like buying a luxury car for $3,000. It will get you where you want to go, but you will probably end up at the shop fixing that car and spending a lot more than the original $3,000.

Quint Studer

Ask anyone:  Managing is HARD work.  Tasks, people, issues, demands, budgets, compliance…the list goes on.  You’re managing all of these things, all the while your direct reports are assuming you’re not working as hard as they are.  Many of us have a hard time balancing the fine line between each of these responsibilities.  All are important, but which is the most urgent?

Priorities

Tasks tend to jump to the top of the list.  They are urgent, neatly listed on your to-do page and don’t need the participation of anyone else.  You can just sit down and get them done.  Putting out “fires” usually comes second.

Problems, conflicts, emergencies; they all fall into our laps and pound on our doors every day.  They can’t wait and have to get done immediately.  Then there are the meetings.  Our schedules are cram packed with meetings with managers, supervisors, departments throughout the organization, volunteering.

The list is all consuming.  Problems and meetings take time from our day, therefore our tasks aren’t completed.  All, or any, of the extra time we have is spent on getting our tasks done.  Besides, if these aren’t finished they will be the most noticed by our supervisor, right?

If they’d just…

Many of our problems or emergencies have to do with people.  An interpreter didn’t show up on time to an appointment, or not at all!  A different interpreter didn’t provide the necessary documentation for the encounter.  There is a disagreement between a few people in your department and they’re bringing their problem to you.  You’ve asked someone to do something repeatedly and they’re still not doing it.  Someone else needs you to show them how to do something, AGAIN!

Your resources are limited and time is of the essence.  You see how process and procedure are affecting productivity and increasing chaos.  In an effort to control them you seek out the problems and address them with the right people.  It’s addressed with frustration, quickly, directly and often without an established relationship that creates a coaching opportunity.  Once this is done we move on to the next urgent item.

Food for thought

Whew!  That’s a lot of hard work!

• When was the last time someone told you something positive about the work you’re doing?
• Was the comment heart felt or was it just a cookie cutter response?
• How should/could someone make you feel like you’re doing a good job and recognize your contribution?

If you were able to answer these questions positively and receive this kind of appreciation regularly from your supervisor and/or peers, then  you are a lucky duck!

If you couldn’t answer positively, how nice would it be to have someone show their appreciation and gratitude for your hard work you do?   Would it make you feel differently about your job?

Before we move on let me just say, from one hard worker to another, you are a rock star!

Now what?

Repeat those same questions and ask them from the perspective of your staff members.  Managers would like to think that their staff would answer positively to these questions.  It is important to be realistic in your evaluation and put yourselves in the other persons’ shoes.  If you can’t, then maybe it’s time to ask.

List one thing you will do differently this week to show your appreciation to your direct reports.  What barriers exist to accomplish this goal?  What will you do to remove the barrier?  How will this one thing make a difference to you and your team?

Managing is a hard job.  Be sure to focus on your people and don’t get lost in the tasks.  If you support your staff so they are successful, they will look good.  And if they look good, then you, your team, and your organization will look even better!

Rashelle LeCaptain
President

My Motto:  Together Everyone Achieves More

More specifically, a tiered process will save time and money by eliminating candidates that aren’t qualified early on in the process.  There’s nothing more frustrating than spending a chunk of your time with a candidate and learning that they simply don’t meet the requirements.  Or even worse, hiring someone and because of limited screening to quickly find that they cannot perform the job.

When a process is established, each new hire will have passed the screening and will feel that they are very qualified to do the job.  The existing staff will feel the same.  This creates a level of trust within the department or team.  All of the interpreters will feel confident in each other’s abilities to care for the needs of the medical staff.  The trust will minimize the “fight” for appointments or an interpreter demanding continuous interaction with any one particular patient.  These scenarios can wreak havoc when managing the logistics of an active department.

There have been many times when we’ve had volume demand and I’ve pressed our operations team to fill the void as quickly as possible.  They are quick to tell me when they’ve yet to screen a successful candidate for the job.  While I might feel that a candidate can be developed into the position, our operations and training team are very aware of the basic required skills needed to be successful.  Anything less costs more time and money and exacerbates our existing challenges.

Business demands must be in balance with the standards for service delivery.  If top performing interpreters work with underperforming co-workers, what drive do they have to keep up their performance?  It would be obvious to them that, as an organization or management team, no one cares what their skill or performance level is.  This depletes morale, challenges an organization, is expensive and, ultimately, harms the medical staff and their patients.

An even playing field starts with similarly skilled team members.  Developing a high performing interpreter team requires consistent screening, training and execution.  Managers and organizations must work together to balance demand with available resources to reap the benefits of successful interpreting.

Rashelle LeCaptain
President

It is with that in mind that I say to the title question, “Yes!”

The trainer/instructor should be involved at least in establishing criteria for hire/admission to health care interpreter departments/programs.  Trainers bring a different perspective than, say, a hiring manager because they are looking not only at the candidate’s experience and ability to do the job.  They are also looking for evidence that the candidate has the knowledge, skills and attitude (KSA) to successfully complete the training program/period.  Can an admissions officer or a hiring manager do the same? Certainly, but a quick consult with the learning professional to determine how to measure the candidate’s likelihood for KSA success will make the screening process all the more effective when it comes to outcomes.

Ideally the trainer (or one of the trainers in a team environment) will have the opportunity to participate directly at some point during the interview/admissions process.  This can be accomplished through any number of creative ways that can be as formal as conducting a sit-down interview or a 10 minute phone call. The benefit is twofold.  It gives the trainer opportunity to assess the individual in areas specific to training (such as readiness to learn new information/skills) and it gives the candidate opportunity to gain insight into the organization’s commitment to and expectations of the students’/employee’s professional development.

Whether the circumstance is that of a student paying tuition and an academic instructor looking to have a strong graduating class, or that of an individual counting on an income and an organization looking to strengthen the workforce, both parties are making an investment. Taking steps to ensure the best possible outcome early on pays off in the short and long run.

So, all you trainer-types and hiring manager-types, set a date and integrate! (Couldn’t resist the rhyme.)  For those who are already doing this, you know what I’m talking about – I can see the nodding heads.

Erin Rosales
Director of Interpreter Development