Q&A on Healthcare Interpreter Certification

Certification Commission for Healthcare InterpretersNational Board of Certification for Medical Interpreters

At CultureSmart, we’ve been thinking about – and preparing for – medical interpreter certification for years. The Q&A in this blog entry offers background on healthcare interpreter certification plus our thoughts on how certification will benefit interpreters, patients, and the health care industry.

What is the status of medical interpreter certification in the U.S.?
National certification is a long way off, but there’s a nation wide wave of interest in certification, thanks to a movement that started several years ago. Currently, the largest impediment to the adoption of certification is that most stakeholders – hospitals, providers, patients, even interpreters – either don’t fully grasp what medical interpreter certification would mean or don’t see justification for it.

In addition, the powers-that-be in health care – decision makers, funders and even, to some extent, regulatory and accreditation agencies – were not or are not completely “on board” with certification. That’s partly because the status quo feels familiar and comfortable, even though it has some problems. We’ve seen similar situations: many providers favor continuing to use ad hoc interpreters, essentially bilingual people who happen to be nearby, rather than qualified interpreters, who must often be booked in advance.

Unless there’s lots of advocacy – as I think we’re seeing now – you won’t get buy-in from stakeholders. The squeaky wheel gets the oil.

Why are there two groups – The Certification Commission for Healthcare Interpreters and The National Board of Certification for Medical Interpreters – working on certification?
The push for certification began as a coalition several years ago but it split because of conflicting approaches. The approach of The National Board of Certification for Medical Interpreters is “Let’s get certification now.” This group believes that, regardless of whether a comprehensive process is in place, it’s best to start certification and let everything else follow.

The Certification Commission for Healthcare Interpreters had the philosophy that the field isn’t yet ready for certification. Interpreter preparedness is uneven and, nationally, most organizations aren’t convinced of the benefits of using screened, trained, qualified interpreters. Another issue is that national standards, though available, aren’t consistently applied. The Certification Commission’s approach was to continue the work started by the National Council on Interpreting in Health Care to methodically develop awareness in the field, gradually disseminate and implement standards nationally, before launching a national certification process.

As a trainer of interpreters who visits many states, I find that many staff members who interpret display little awareness of the interpreter’s role. We usually spend almost four hours in most of our introductory training programs deconstructing the interpreter’s role and dispelling certain myths before we move on to exploring the interpreter’s functions.

I think the Certification Commission’s approach – methodically creating awareness and developing tools, steps, and milestones that will eventually lead to certification – is a sensible, rational approach. In reality, though, the National Board started registering candidates for pilot certification in 2009. Then the Certification Commission followed suit almost immediately in 2010. Today, both approaches are being implemented simultaneously. This is a big development for the field because certification is so important, but I can’t predict how much of an immediate or long-term effect it will have on interpreters’ careers or patients’ lives.

What do you think about medical interpreter certification? Is it necessary?
I think certification is validation for the profession. Having been an interpreter for almost 20 years, I see progress in recognizing the importance of professional interpreters. I think certification is the last challenge to gaining recognition for the profession. I think it could help to standardize interpreters’ work.

In the U.S. there are geographic clusters where national and local standards are often followed. However, if you look at the interpreting profession overall, interpreter preparation and qualifications vary greatly. So do stakeholders’ expectations: they range from expecting family members to interpret to requiring that interpreters have advanced degrees in addition to training. Certification would help eliminate those discrepancies.

I believe that one of our problem is that we’ve become too fixated on the word “certification.” Unfortunately, it has eclipsed our efforts to develop and observe standards and codes. Ten years ago, while I was working at the Massachusetts Department of Public Health’s former Office of Refugee and Immigrant Health, we helped to establish, disseminate and enforce interpreter standards. Today, interpreters in Massachusetts generally abide by the same standards and codes. At CultureSmart, national standards and codes from CHIA, IMIA and NCIHC have always been an integral part of our curriculum.

How will certification change the way medical interpreters work?
I think certified interpreters will work with more confidence. They’ll feel more recognized and more empowered, which will justify their presence and role in the clinical team. Interpreters often work in the shadows, and they don’t always feel empowered to assert themselves as interpreters. I also think the pay of interpreters will rise – interpreters might be most excited about that. Certification will also ensure that interpreters no longer compete with family members and unqualified, untrained, ad hoc interpreters.

How might certification benefit providers, patients and health care facilities?
The biggest way certification will benefit providers is by easing pressure in working with LEP patients. Communication is crucial to providers’ work: if communication is hindered, providers face more risk of making wrong decisions and diagnoses, and arriving at negative outcomes and adverse events. An interpreter can be the weakest or strongest link in the provider-LEP patient relationship. If an interpreter is not screened, trained, and qualified – which certification should ensure – s/he is more likely to convey incorrect information or omit something as this has been shown in several studies.

On the patient’s side, patients’ rights would more likely be fully observed when there’s a certified interpreter present: everything the patient expresses will, presumably, be interpreted exactly as it is said, without any omission, additions or changes of information, thus enabling better communication with their providers. Interpreter certification also means interpreters have demonstrated they possess the necessary vocabulary for interpreting doctor-patient communications.

For healthcare facilities, some of the benefits are the same as for providers: the interpreter is more integrated in the clinical team. That leads to higher efficiency in the delivery of care, which leads to savings in the cost of providing care to an LEP patient. If you look at healthcare facilities’ concerns with risk management and care for LEP patients, you see that the potential for miscommunication exposes facilities and providers to the risk of giving a patient the wrong treatment. When you have certified interpreters, there’s a far greater chance that medical history will be more complete, reducing risks to both the facility and the provider. Certifying interpreters would also shift liability for interpreter errors from the facility and provider to the interpreter, who would be required to purchase insurance, as legal interpreters who work in the federal court system already do.

Are there any downsides to certifying interpreters?
I think it depends on whom you ask. As a trainer and interpreter, I can’t see any downsides to certification. However I think it will take time to become a reality. I believe implementing certification before the field is ready may lead to people rushing or focusing on the word “certification” at the expense of qualifications and standards. It’s taken years for healthcare organizations to universally adopt standards that are already available. A certification test is not a substitute for training or building awareness or getting buy-in from all the stakeholders involved in caring for LEP patients. Moving certification forward too quickly could lead to substantial problems later if the process doesn’t establish a system that provides solid rationale and stable support for national certification. Also, interpreters may become legally liable for their errors and omissions and may be required to carry professional liability insurance. That is a small price to pay for the many benefits that come with the official recognition that certification would bring.

How is CultureSmart getting ready for certification?
CultureSmart has been training interpreting staffs in national standards, national codes of ethics, medical vocabulary and other certification exam topics for 15 years. The topics –especially national standards- function as a common foundation for the profession. In my opinion, only when we all have a common understanding about the role and necessary qualifications of the interpreter can we say, “Okay now we’re going to test to be sure your knowledge and skills meet national standards.”

On Saturday, September 11th, in collaboration with Caritas Christi Health Care System, we launched a first in the nation program designed to prepare interpreters who speak Cape Verdean Creole, Haitian Creole, Portuguese, Russian, Spanish and Vietnamese to prepare for the written and eventual oral portion of the certification exams currently available. Seventy fulltime interpreters working at nine healthcare facilities in greater Boston are attending. The program, called “Pre-Certification Study Group” has a prescribed list of topics to be covered in the span of two months. Average group size is about 10, and the trainees are separated by language, to cover bilingual vocabulary. We’re excited about the course and look forward to hearing from other healthcare institutions that are interested in offering similar training. We will offer this program in the winter of 2011 in other areas and for other languages as well.

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