For patients who do not speak English as their primary language, communication and understanding in a healthcare setting can prove difficult, leading to worse health outcomes. National standards for healthcare interpreters can ensure consistency and quality in language access.
Standards of Practice
Laws like the Civil Rights Act of 1964, which prohibits discrimination on the basis of national origin, and Executive Order 13166, signed in 2000, require healthcare facilities to provide professional interpreters. Despite these legal requirements, many healthcare providers still relied on untrained interpreters to communicate with limited-English proficient (LEP) patients, even as recently as the early 2000s.
The level of access and professionalism in interpreting services could vary greatly from one organization to another. Therefore, in 2004, the National Council on Interpreting in Health Care (NCIHC) published the first National Code of Ethics for Interpreters as a comprehensive guide on how to measure the quality of interpreting services.
They got input from American Sign Language (ASL) interpreters, as well as state interpreting associations from California and Massachusetts. The result is a definitive guide of what interpreters do and how they are expected to perform while providing medical interpreting services for patients in their native language.
The guide includes nine standards, all "guided by ethical principles" to help interpreters and healthcare organizations determine what is appropriate in the context of an interpreter-patient-provider relationship.
Accuracy in healthcare interpreting means that both parties’ messages are conveyed just as they were expressed – completely and with all components, including tone, register, and cultural context. It often requires knowledge of the native speaker's culture to put all the information into proper perspective.
Convey all the information from one person to the other in its entirety, without any additions or omissions
Try to match the style and tone of the original speaker much as possible
Avoid rephrasing or trying to explain information that is technical or complex; instead, they should ask the speaker to rephrase the information and interpret that exactly as it is described
Correct any errors during translation as they become aware of them
Be clear about when they (as the interpreter) require clarification or have a question
As with all aspects of healthcare, confidentiality is critical. The information that is shared between a healthcare professional and a patient is personal and private and should remain that way even when a third-party interpreter is present. Interpreters are bound by HIPAA laws to safeguard any protected health information (PHI), including written and verbal information, that they encounter during their interactions.
Confidentiality also extends to other family members who are not present during the interaction. An interpreter should not share any information without the express consent of the patient.
An interpreter who is involved in a patient care situation is simply there to translate the words that each party says. They should never interject their own advice or counseling. They should also be aware of their own biases or personal feelings and take great care to avoid conveying that information during interpretation.
Another important ethical consideration for interpreters is to disclose conflicts of interest and withdraw from interpreting in situations where they may not be able to remain impartial. For example, a professional interpreter should not be involved in medical care for a family member, even if they are qualified to do so.
All patients deserve respect in their encounters with care providers and facilities. In addition to being respectful of the language and communication style, a professional interpreter should also have an understanding of the patient's native culture and how to show respect in culturally appropriate ways. Providing patient-centered care is the goal — keeping patients at the center of the interaction and ensuring that the treatment meets their needs, preferences, and values.
Spoken language is important to understand, but much of what we communicate and understand goes beyond just the words that people say. Within each culture, there are different traditions, customs, and behaviors that have meaning.
An interpreter must be culturally competent, taking the time to learn more than just the right words to help people speak to each other, but also a high level of awareness of the person's culture. That awareness ensures that the interpreter is aware of potential conflicts or misunderstandings that might arise even with correct and accurate translation.
An interpreter is a third party whose role is simply to convey information in a language that the patient is comfortable speaking. The interpreter is not a care provider (even if they have training in a medical profession) and should never provide medical advice or information that does not come directly from the provider.
As with any profession, the interpreter must also understand and respect personal boundaries. A translator should not share their own personal information or story and should not request that information from a patient unless it is relevant to the healthcare situation.
Professionalism is important in any job, but for medical interpreters, it is crucial. Healthcare is a basic human right, and getting the right care can improve the quality of life and longevity of a patient. On the other hand, getting the wrong care can have very serious negative consequences.
To remain professional, interpreters must:
Be honest and ethical in all their interactions with patients, providers, and family members
Come prepared for each assignment, understanding all the important terminology for a medical specialty or treatment
Let everyone know if they have limitations that might prevent them from understanding highly technical or complex information
Limit errors, and make appropriate corrections when they make an error
Avoid translation or interpreting that goes beyond their training and skills
Arrive on time, dress appropriately for the situation, and be respectful to everyone involved in the patient-provider interaction
Medical interpreting is a complex and technical field that requires very specific skills and training. Interpreters should proactively seek out professional development and training opportunities to expand their skills through interpreter associations or the Accreditation Commission for Health Care (ACHC). Additionally, interpreters should remain up to date on medical terminology, cultural intricacies, local slang, and customs that could influence patients' understanding in healthcare situations.
While we often focus on the importance of remaining impartial, there are some situations where an interpreter has a duty to advocate for a patient and should speak up. For example, interpreters would be well within their ethical boundaries to point out an error in a medical treatment that could negatively impact a patient's outcome, such as a serious allergy or a potential medication interaction. Interpreters should strive to ensure the highest level of dignity and respect for each patient and speak out in any situation where they feel that is not happening.
Talk to GLOBO Today About Language Access
GLOBO is a leading provider of language services in healthcare settings. Our qualified medical interpreters adhere to the highest ethical and professional standards to ensure that everyone gets the care they need and deserve. To learn more about working with an interpreter, download our free guide: Best Practices for Working with an Interpreter.
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