By Rachel Showstack, Paul Spacek & Sarah Hoy
Healthcare administrators often find themselves between a rock and a hard place when it comes to providing language access for Kansas’s linguistically diverse communities. On one hand, they know that to comply with federal regulations and avoid the risk of a malpractice lawsuit, not to mention ensuring safe and ethical care, they must provide qualified language access services, including interpreting services. On the other hand, the quality of and level of qualification of the interpreting services they can provide depends on many different factors, some of which may seem to be beyond their control.
The Alce su Voz Hospital and Clinic Engagement Team has been meeting with Kansas healthcare administrators over the past two years as part of our Promoting Equitable Access to Language Services (PEALS) award from the Office of Minority Health of the U.S. Department of Health and Human Services. We have engaged in numerous conversations with healthcare leaders about the challenges of providing language access services and the kinds of support that would allow them to improve their care for patients with non-English language preference (NELP).
This blog post is for all the healthcare administrators who find themselves struggling to serve minoritized language communities. We have identified three things you may not know that could help you to improve your services and advocate for resources.
First, the federal requirements for provision of language access services have just been expanded. In April of this year the Biden Administration approved a new rule that strengthens the civil rights protections under Section 1557 of the Affordable Care Act. Regulations implementing Section 1557 require qualified interpreters and prohibit the use of minors as interpreters, except in an emergency, adult and family friends as interpreters, except in an emergency or unless the patient refuses a professional interpreter, and bilingual staff, unless interpreting is part of their current job responsibilities, and they have demonstrated qualification. This means that in nearly all healthcare institutions, failing to provide qualified language access services is against the law. The new rule requires covered entities to post notices to inform individuals of their rights and train staff who interact with the public on the provision of language access services. It also requires covered entities to create their own policies and procedures regarding Section 1557, designate a Section 1557 coordinator (if the entity has 15 or more employees), and ensure that interpreters, translators, and bilingual staff providing language access services are qualified. Additionally, the new rule requires a notice of availability of language assistance services to accompany a range of different types of electronic or written documents, including complaint forms; therefore, it is important that your institution have a system for submitting grievances that is in line with your accreditation standards and is accessible in the top fifteen languages of your region.
All these requirements are in place to ensure that you provide the same high level of care for all who walk through your doors. Following best practices in health care language access results in a more accurate and thorough exchange of information and better interpersonal communication between healthcare workers and patients, which can lead to improved accuracy of diagnosis, appropriate treatment, and patient adherence to the plan of care. Avoiding misdiagnosis of patients, like when the appendicitis of Veronica Mireles’s son was left untreated in a Wichita hospital several years ago, resulting in a burst appendix, can also save the patient and the provider from the unnecessary expenditure of resources and funds by avoiding preventable poor health outcomes.
The second thing you should know is that there are steps you can take to ensure that individuals providing language access services at your institution are qualified. It is important that the skills of staff interpreters and bilingual staff are assessed and evaluated, and assessing language proficiency for direct patient care is different from assessing medical interpreting skills. The new Final Rule on Section 1557 requires that bilingual staff providing care in a language other than English demonstrate qualification. For the assessment of bilingual clinicians and non-clinical staff, there are several different options. One option is Alta’s Clinician Cultural and Linguistic Assessment, which is designed to determine a physician’s level of proficiency in the target language. Alce su Voz’s training videos on Clinician Language Proficiency Testing and Clinician Language Proficiency Self-Assessment can provide you and your bilingual clinicians with more information about options for assessing their skills.
Although there is no federal baseline requirement for interpreter training, the typical industry standard is that to be considered qualified, a medical interpreter must have completed at minimum a 40-hour medical interpreter training program and demonstrate language and interpreting skills needed for the specific type of healthcare context where they will be providing services. The two certifying bodies for medical interpreters are: the Certification Commission for Healthcare Interpreting (CCHI) https://cchicertification.org/, and the National Board of Certification for Medical Interpreters (NBCMI) https://www.certifiedmedicalinterpreters.org/. Certified medical interpreters are required to complete continuing education credits to maintain their certification and stay up to date with the latest developments in medicine and the field of interpreting. While national certification has not yet attained a high level of prevalence in the field, it is a valuable way to differentiate highly qualified interpreters. Whenever you are hiring somebody that will be using a second language as part of their job responsibilities, either as an interpreter or other bilingual staff, it is recommended to assess that person’s verbal and/or written skills in the second language through an independent, validated instrument through a vendor such as Alta. If you contract with a language service provider, it is not safe to just assume that the provider will take care of quality control; you should develop a way to check the quality of the services that you are receiving.
Finally, language access plans are one of the best ways that you can prepare your institution and your staff to offer equitable care for NELP patients. The Sedgwick County Health Department (SCHD) is setting an example for the state of Kansas by spearheading an initiative to support language access planning in certain zip codes with high NELP populations. It is our hope that other county health departments will follow SCHD’s example. At minimum, to comply with Section 1557’s new final rule, it is important that you develop language access policies and procedures that are available to your employees. This course can help you learn about the development and implementation of language access plans. One of the components of a language access plan is a description of how your organization will train its staff on the policies and procedures for providing language services. The Alce su Voz training video Bridging Language Barriers: Best Practices for the Care of Linguistically Diverse Patients provides a valuable training opportunity for your clinicians.
Kansas is beginning to make strides to support healthcare language access in compliance with federal regulations. You may know that Kansas Medicaid Managed Care Organizations (MCOs, currently Sunflower, Aetna, and United HealthCare) are required to provide interpreting services for the NELP patients they cover. You or your patients can call the MCO providing coverage to request interpreting services. In addition to working with interpreters provided by the MCOs, hospitals, county health departments and health clinics generally contract with interpreting agencies and may also offer in-house interpreters for the most common languages of the region. While remote (video or over-the-phone) interpreting services are important for less common languages and smaller or more rural healthcare entities, we recommend that hospitals employ a combination of both remote and in-person interpreting modalities to provide the best quality of services possible. Some hospitals have in-house interpreters and/or qualified bilingual staff for the most common language needed, and local interpreting agencies can also provide contracted services for the languages that are the most common in your region. Thanks to Alce su Voz and other emerging initiatives, there is a growing number of qualified Spanish and Indigenous language interpreters in Kansas, and to support the local economy it is important to hire local talent.
Even with the range of resources currently available, there are still many challenges that come with providing equitable language access services for all NELP patients. One of these challenges is finding reliable interpreting services for less common languages, such as Indigenous languages. For example, in Coffeyville, Kansas, there is a sizeable population of speakers of the Mayan language Akateko. Like other national agencies, the remote interpreting agency contracted by the Coffeyville Regional Medical Center cannot guarantee to have Akateko interpreters available for patients who present unscheduled. Indigenous interpreting comes with additional challenges, such as the lack of direct equivalencies of certain cultural concepts in Indigenous languages and the need for relay interpreting, the practice of interpreting from one language to another through a third language (e.g., Spanish for Mesoamerican Indigenous languages to English). Fortunately, there are national organizations that have been advancing the field of Indigenous interpreting in the US, such as Pueblo Unido PDX in Portland, OR. In Kansas, Alce su Voz is collaborating with Indigenous communities and healthcare institutions to begin to explore ways to improve Indigenous interpreting in the state.
Alce su Voz is here to support you. Please reach out to our team if you have requests for assistance or concerns about the availability of resources. Alce su Voz is currently finalizing a white paper with recommendations for the state of Kansas on improving healthcare language policy. Please stay up to date on our accomplishments through our social media and by joining our email list and attending our events.
Rachel Showstack, Ph.D., is Associate Professor of Spanish at Wichita State and Founding Director of Alce su Voz. Paul Spacek is the Education and Development Program Manager for Language Services at Children’s Mercy Hospital in Kansas City. Sarah Hoy is the Chief Nursing Officer of Coffeyville Regional Medical Center in Coffeyville, KS.
Alce su voz is a community-based initiative of Wichita State University whose mission is to improve health equity for Spanish speakers and speakers of Indigenous languages in the United States, with a focus on Kansas and the Midwest. For more information or to get involved, please send an email to alcesuvoz@wichita.edu. You can also join our email list and follow us on Facebook, Instagram, and LinkedIn.
This blog post is supported by Health and Human Services (HHS) as part of a financial assistance award totaling $375,000 by the Office of Minority Health (OMH) of the U.S. Department of Health with 100 percent funded by OMH/OASH/HHS. The contents are those of the authors and do not necessarily represent the official views of, nor endorsement by OMH/OASH/HHS, or the U.S. Government. For more information, please visit https://www.minorityhealth.hhs.gov/