Don’t Get Disconnected: 10 Steps to Bridge the Language Divide

By Jeanette Anders, for HealthLeaders News, September 5, 2006

As the country’s linguistic makeup continues to evolve, hospitals are struggling to evolve with it. Many facilities are moving to offer formal language access services, hiring in-house interpreters and partnering with over-the-phone and video interpretation services. The goal, of course, is to ensure diagnostic accuracy, improve overall quality of care across the patient population, and ultimately increase the hospital’s effectiveness on a human, financial and regulatory scale. While structured interpretation programs are a first step toward better communication, good implementation is key to their success. The fact is, without cooperation from all sides of the communication equation--patient, interpreter and medical team--a great deal of potential benefit can be lost in translation.

In the medical setting, speed and accuracy are fundamental to success, but as is often the case, the drive for speed and the need for accuracy are not always in harmony. By following a strict formula for working with limited English proficiency (LEP) patients and with interpreters, physicians and nurses can greatly increase the value of their efforts to bridge the language gap.

When it comes to over-the-phone interpretation in particular, where background discussion is often limited and telling gestures are hidden from the interpreter, implementation and procedure matter greatly. These 10 steps will help to ensure that phone interpretation sessions in your hospital are fast and on-target:

1. Start off on the right foot – When working with an over-the-phone interpreter, the medical staff should first clearly identify the name of their hospital to the interpreter, then provide specific instructions about what needs to be done or obtained during the call. The interpreter can assist staff members in getting the call off to a good start by introducing the physician and facility, and then relaying an initial question.



2. Speak directly and clearly to the patient – The physician or nurse and the patient can communicate directly with each other as if the interpreter were not there. The interpreter will relay the information, and then communicate the patient’s response directly back to the medical team on the call. Also, it is important to speak naturally (not louder) and at a normal pace (not slower). The physician or nurse should also speak in one sentence or two short sentences at a time, while pausing to make sure the interpreter has time to deliver the message. If a communication is unclear or overly long, the interpreter may ask for a complete or partial repetition of what was said, or may ask to clarify what was meant by the statement.



3. Gauge the patient’s understanding – It is important for the medical staff not to assume that the LEP patient understands a communication even after interpretation. In some cultures a person may say “yes” as during a conversation, but it doesn’t necessarily mean that they understand. It may just mean they want you to keep talking because they are trying to follow the conversation.



4. Keep opinions out of the equation – The medical staff should avoid asking the interpreter for opinions or comments. The interpreter’s job is to convey the meaning of the source language and not allow personal opinion to influence the interpretation.



5. Say only what you mean to say – Physicians and nurses in an interpretation setting should avoid private conversations with colleagues. Whatever the interpreter hears will be interpreted.



6. Avoid tech speak – To improve patient and interpreter understanding, medical staff members should avoid using industry jargon, slang, idioms, acronyms or technical terms. Vocabulary that is unique to the situation should be clarified, and examples should be offered as often as possible.



7. Understand the limits of interpretation – The medical team should remember that many concepts expressed during a session may have no equivalent in other languages. The interpreter may have to describe or paraphrase terms that are used. As a result, an interpretation might take twice as long as a conversation carried on in English only.



8. Read scripts thoughtfully – Although we may not notice it, we often talk more quickly when reading a script. When reading a script, a prepared text or a disclosure, slow down to give the interpreter a chance to keep up with the pace.



9. Consider the culture – Professional interpreters are familiar with the culture and customs of the LEP speaker. During the interpretation session, the interpreter might identify a cultural issue that may be important to the situation. Also, if the interpreter feels that a particular question is culturally inappropriate, he or she may ask for a rephrasing.



10. Closing the call – The interpreter will wait for the medical staff to initiate the closing of the call. When appropriate, the interpreter will offer further assistance and will be the last to disconnect from the call.

Good communication requires a bit of preparation and a great deal of consistency along the way, and every party involved bears some responsibility. When it comes to communicating via phone with LEP patients, physicians and nurses--as the medical decision-makers--should work to direct the conversation and maximize its efficiency, while trained and certified interpreters are tasked with the job of ensuring accuracy, developing strong understanding and gauging the effectiveness of the call.

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Jeanette Anders is healthcare director with Monterey, Calif.-based language service provider, Language Line Services. She may be contacted at janders@languageline.com.