Are You Ready for the Challenges of Tomorrow?


Mary Longe
Director, AHA Solutions, Inc.
An American Hospital Association Company

When a candidate for ambulatory care with Limited English Proficiency walks in to an emergency department because he was unable to make an appointment over the phone, capacity is threatened. When a patient leaves an acute or an ambulatory setting not understanding discharge instructions, her likelihood for readmission or a preventable admission is heightened and the organization is in financial risk. When a hearing challenged patient who speaks a language other than English has no one to interpret for them an individual’s life may be at risk as well as the organization’s safety and reputation.

Real-life scenarios like these require organizations to provide appropriate communication from a care perspective and appropriate language services from an operational perspective. Offering language services is critical to care, quality, efficiency and the organization’s bottom line. It is an important element in an organization for the future of health care delivery.

So what’s your road map for transforming your organization to meet of today’s healthcare needs?

What’s clear is the increase in pressure for quality care and efficiencies across health care organizations is not stopping.  Each organization must decide how they will participate in the future of the healthcare delivery system.

Whether you can make good decisions for the direction of your future depends on three things. No matter if it’s a transformation in care, business, or leadership practices, quality decisions depend on how well your organization understands your current situation, whether your vision guides you to where your organization intends to go, and what elements you must change to get you there.

The landscape of healthcare is changing fast and so are many communities. You can find information on this website and others about how hospitals need language services to address the changing demographics. Not long ago, language services often were the domain of the patient advocate. Now it’s about the care, quality, efficiency, and financial responsibility of the hospital. Is your organization ready to handle these new challenges in the future?

What do you think? Leave us a comment in the section below.

Enforcement of Title VI – Voluntary Resolution Agreements

Recently, two medical facilities took action to improve their language assistance services after being investigated by the Office for Civil Rights in regards to Title VI of the Civil Rights Act of 1964. Shenandoah Memorial Hospital in Virginia and Memorial Health System in Colorado Springs signed a Voluntary Resolution Agreement to provide meaningful access to their Limited English Proficient (LEP) patients.

In the Voluntary Resolution Agreements, each facility outlines specific plans to provide meaningful access to LEP patients through language services. Such plans include:

• Appointing a language assistance coordinator
• Development of an LEP policy
• Assessment of linguistic needs
• Notification to LEP population of free language services
• Complaint procedure development
• Employee training
• Outreach

Title VI of the Civil Rights Act of 1964 prohibits discrimination in federally funded government agencies on the ground of race, color, and national origin. Title VI keeps federally funded agencies and activities accountable to provide committed and meaningful access to individuals including LEP persons.

Meaningful access may have different connotations to each facility. It is essential for facilities to evaluate their current resources to determine the appropriate measures taken to comply with Title VI and to improve accommodations for LEP populations.
Information on how to implement a strategic plan may be found at

“New” Joint Commission Standards for Health Care Interpreting: Myths and Truths

By Amy Wilson-Stronks, MPP, CPHQ

In January 2010, The Joint Commission, the primary accrediting body for the majority of US hospitals, released a set of new and revised standards for patient-centered communication. I experienced the pleasure and pain of leading the development of these standards while serving as Project Director for Health Disparities at The Joint Commission. This blog post will share my perspectives on this experience and hopefully dispel some myths about the “new” standards.

Myth #1: The Joint Commission requirement to provide interpreter services is new.

Fact: The Joint Commission has had standards requiring the provision of interpretation and translation services for more than 15 years. Surprised? Well, these standards were created in the early 90’s as part of The Joint Commission’s Patient’s Rights. One of the requirements outlined in the standards is the patient’s right for effective communication. Interpretation and translation services were identified as one of the means to support that right.

So, what is new about the “new” standards? Well, now the standards include specific language that requires interpreters to be qualified.

Myth #2: The Joint Commission requires hospitals to do one of the following:

  • Hire in-person interpreters
  • Use telephone interpreters
  • Use video remote interpretation

Fact: The Joint Commission does not specify what type of interpretation service a hospital provides. The intent of the “new” standards for patient-centered communication is to support “effective communication” between patients and providers. As we know, some means for providing interpretation are better suited for certain situations than others. For example, the use of phone or video interpretation during labor and delivery may not be as effective as having an in-person interpreter for obvious reasons. However, some languages may not have in-person interpreters available due to the infrequency of the language or other factors. In this situation, phone or video interpretation is the best option. The intent of the standard goes back to what is most effective for the patient in each situation, given the resources available.

Myth #3: The Joint Commission requires interpreters to be certified.

Fact: The Joint Commission does NOT require that hospitals use certified interpreters. The standards were clarified to set the expectation that interpreters are qualified and competent to perform the service of interpretation. Qualifications and competencies can be met in a variety of ways (not simply through certification), and The Joint Commission references several options for meeting the requirements for qualified interpreters, such as:

  • Language proficiency testing
  • Training in the practice of interpreting
  • Interpreting experience in a health care setting
  • Knowledge of medical terminology

Myth #4: Every patient, no matter what language, must be given translated discharge instructions in his or her language.

Fact: This is impossible in today’s environment with the limited resources we have available. The art and science of translating written materials is complex and cannot be done effectively in an ad-hoc manner. Translation takes time and follows a process of review and revision that does not lend itself to the quick turn around that would be needed for a hospital to accommodate every possible language that is encountered. It is expected that vital documents are translated into the languages most commonly encountered. It should also be expected that these documents are translated using qualified translators. This will help ensure accuracy and readability, thus supporting effective patient-provider communication.

Additional Facts
There are too many nuances to cover in one blog post, but I am compelled to share some additional facts that may be of help. These served as the basis of thought as we developed and revised The Joint Commission standards to better support effective patient-provider communication.

Fact: Each hospital’s accreditation survey may approach the evaluation of language and interpretation services differently. However, at the core of the evaluation will be whether or not staff have followed the hospital’s policy. Of course, it will also be important that your policy reflects the current professional practice standards for the provision of language services. Remember that the interpretation and translation industries are complex; surveyors may have varying degrees of familiarity with state of the art language services.

Fact: Your surveyor may ask to review your contracts with language service providers. Several standards support the provision of services through contractual arrangement. Without getting too technical, these standards essentially require that any service provided through a contract is monitored and held accountable to hospital policies and procedures as if the service were provided directly. For this reason, it is important to be sure that your contracted language service provider has included processes for delivering, monitoring, and evaluating the provision of services. Given the increased emphasis on interpreter qualifications, it is also important that the process for qualifying interpreters by the contracted organization is outlined in your contract. Language service companies should be prepared for random audits by customers who want to validate competencies and qualifications of the interpreters used at their organization.

Fact: The new Joint Commission standard on effective communication is found within the set of standards that relate to Provision of Care, Treatment, and Services. This is significant as it emphasizes that effective communication is not simply a patient’s right, but an essential component of safe, effective, high quality care.

Importantly, the new standard does not only address communication as it relates to the provision of interpreter services. The new standard sets forth the expectation that needs of each patient are 1) identified and 2) addressed. These needs may be the need for large print materials, the need to have glasses, hearing aids, or other assistive devices available to support communication. It could also mean that effective communication with the patient will require the use of interpreter services in the case of LEP patients and patients who are deaf.

In Summary
There are several areas covered by the “new” Joint Commission standards. The “new” standards are designed to help give greater emphasis to what language access advocates have been communicating for years: Quality of care is compromised when patients and providers do not have access to resources that facilitate patient-provider communication. These resources need to be those which are effective, and in the case of interpreters, are qualified to interpret health care information.

About Amy Wilson-Stronks
An independent advocate, consultant, and researcher, Amy’s primary area of focus is system building to effect positive change at both the micro and macro levels in the care for vulnerable populations. Her clients include large hospital systems, small practices, advocacy and professional organizations, and vendors of products and services that support effective patient- provider communication and health equity. She is the author of several reports and papers on the challenges and benefits of incorporating cultural competence and language access into patient care, including: Advancing Effective Communication, Cultural Competence, and Patient-and Family-centered Care: A Roadmap for Hospitals, published in 2010, One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations, published in the spring of 2008, and Exploring Culturally and Linguistically Appropriate Services in the Nation’s Hospitals: A Report of Findings, spring 2007.

Amy is a sought after advisor working with organizations to help advance health equity and patient-centered care. She serves on the boards of the National Council on Interpreting in Healthcare, the Voice of Love ( ), and the Gay and Lesbian Medical Association ( ). She also serves as a member of the Advisory Council for the Certification Commission for Healthcare Interpreters ( and The Advisory Board of PULSE NY(, a grass roots patient advocacy organization dedicated to arming patients and families with tools and resources for positive health outcomes.

More information about Amy and her work can be found at

AHA Re-endorsement of CyraCom

– Susan Simpson, Senior Field Representative AHA Solutions, Inc.  

We are pleased to contribute a post to the CyraCom blog.

After a six month evaluation of the language services industry, through AHA Signature Due Diligence Process,  Interpretation and Translation Services from CyraCom have earned an extension of the AHA Endorsement originally awarded in 2008. Health care focus, training in medical terminology and comprehensive service offerings in over 170 languages continue to demonstrate CyraCom’s commitment to safe, quality care for limited English proficiency (LEP) patients.

AHA Solutions, Inc., a subsidiary of the AHA, conducts extensive field research for products and services that align with our Mission: To foster the operational excellence in hospitals. A solution bearing the exclusive AHA Endorsement Seal instills the confidence and prestige of having met the highest standards of the leading national advocate for the nation’s hospitals.

Want to learn more? Watch this video to hear Anthony J. Burke, President and CEO of AHA Solutions, Inc., discuss why the AHA chose to partner with CyraCom.

Then visit us at Booth #409 during the ASHRM Annual Conference to learn more about AHA Solutions and all the resources we offer to advance AHA member hospitals.


Susan P. Simpson

Industry Update: A National Certification Program for Healthcare Interpreters

The Certification for Healthcare Interpreter (CCHI) received an accreditation from the National Commission for Certifying Agencies (NCCA).

The CCHI is a professional certification organization acting in the public interest by establishing and enforcing education, examination, experience and ethics requirements for certification. The NCCA recognized and accredited the CCHI’s Spanish Healthcare Interpreter Certification for a five-year period. 

“NCCA Accreditation awarded to CCHI is an outstanding achievement, plus strong and clear recognition of CCHI’s leadership and a strong sense of equity in health care for all we are privileged to serve,” said Fred Hobby, CEO, Institute for Diversity in Health Management, and CCHI Commissioner from 2009 to 2011. He continued, “…CCHI is now the gold standard by which all other interpreter services programs will be measured.”

CCHI is the first organization certifying healthcare interpreters to receive NCCA accreditation.  The NCCA accredits certifying programs based on the highest quality standards in professional certification.  A valid and credible certification is an important milestone in the continued development of the language services industry.  We are excited to observe how these new standards will enhance the initiative to help bridge the language gap between individuals. 

Achieving Service Excellence: CyraCom and Medical City Dallas

Helping healthcare organizations achieve service and operational excellence is one of our main goals as a language services provider. So we were really pleased to speak with Casey Pederson, Nurse Manager at Medical City Dallas, about how CyraCom has helped their organization achieve success in these areas.

For many years, Medical City utilized another interpretation service provider. However, the service was often insufficient for meeting the needs of patients and staff. “There were a few issues with our previous provider,” said Pederson. “The interpreters weren’t medically trained, we were only supplied with one phone per unit, and we couldn’t track our language usage. Because of these factors we decided to explore other options.”

Eventually, the hospital decided to try CyraCom’s interpretation services, due in part to the company’s exclusive endorsement by the American Hospital Association for its interpretation and translation solutions.  After an initial evaluation in its cardiovascular unit, a full service rollout for the organization was planned.

“The CyraCom team went into every unit of the facility, doing installations and rounding with our telecom specialist,“ explained Pederson. “The service went live on schedule – it was phenomenal work.”

Since the implementation, Medical City has been more than pleased with the service. The staff, in particular, appreciates how accessible the service is:

“If there’s a patient who doesn’t speak English, a doctor or nurse will pull out the phone, give one handset to the patient and use the other handset for themselves, push the button, and be on their way,” said Pederson. “Everyone’s busy, so when our lives are made easier it means the world. We are thrilled with the service’s convenience and ease of use.”

Another plus, Pederson explains, is the fact that CyraCom’s interpreters are trained in medical terminology: “You can tell there’s a difference in CyraCom’s level of service, and you can be confident that their interpreters are giving patients the right information, which really does give you peace of mind,” says Pederson.

Overall, the organization is excited with what CyraCom has done and will do for them in the future. Medical City recently reapplied for ANCC Magnet Designation and believes that CyraCom’s Over-the-Phone Interpretation will play an important role in helping them achieve the award. “As a Magnet facility, we are recognized for our quality patient care, nursing excellence, and innovations in professional nursing practice,” explains Pederson. “And we believe that because CyraCom’s interpretation service helps us better reach these high-level goals, particularly when dealing with our non-English speaking patients, we will again achieve Magnet recognition.”

“Our future looks really bright with CyraCom,” she added.

Thanks for the compliments Casey. We’re glad to be assisting Medical City Dallas in providing high quality healthcare to all of its patients.


* To learn more about Medical City Dallas’ experience with CyraCom, download the case study, Achieving Service Excellence 

CyraCom’s interpretation and translation solutions are exclusively endorsed by the American Hospital Association. With ISO 9001:2008 certified quality processes, US-based medically-trained interpreters, and a dedicated account management team, we are equipped to meet your patients’ language needs.

CyraCom Launches Video Remote Interpretation Service for 11 Popular Languages

CyraCom International, Inc. today announced the release of its new on-demand Video Remote Interpretation (VRI) service, available to clients in 11 high-demand languages, including American Sign Language (ASL).

CyraCom clients can instantly connect to a qualified medical interpreter by using any web browser to access its high-quality video conferences. The benefits of CyraCom’s VRI solution include:

  • Having 24/7 access to nationally certified (RID) ASL interpreters with 5+ years of interpreting experience
  • Visually connecting with spoken-language interpreters enabling them to see non-verbal communication cues
  • Improving access to healthcare for non-English speaking patients especially in remote areas
  • Providing video access through a secured, encrypted connection
  • Meeting HIPAA compliance, as calls are handled in secure contact centers
  • Potential cost-savings when used instead of an on-site interpreter

“Today’s healthcare organizations are viewing language services as an essential part of the patient care process,” said Jeremy Woan, Chairman and CEO of CyraCom International, Inc. “Video Remote Interpretation effectively combines technology with interpretation to provide an efficient and cost-effective service.”

As an established Over-the-Phone Interpretation provider operating US-based contact centers, CyraCom International has been able to train its current interpreter employees for video interpretation in house, maintaining quality standards and maximizing efficiency.

About CyraCom

CyraCom provides innovative language solutions for healthcare, including Over-the-Phone Interpretation, Video Remote Interpretation, Translation and Localization, and On-Site Interpretation to over 1,800 healthcare clients. The company is exclusively endorsed by the American Hospital Association for its interpretation and translation solutions and is ISO 9001:2008 quality certified.

For more information, visit or call (800) 713-4950 ext. 1.

Video Blog: “Reducing Recidivism with non-English Speakers” – a conversation with Jonathan Levy, CyraCom’s Director of Language Services

Starting October 2012, Medicare will cut hospitals’ funding by up to 1% if they have higher-than-expected 30-day readmission rates for patients with heart attack, heart failure, or pneumonia.[1]

In this video blog, Jonathan Levy, CyraCom’s Director of Language Services, discusses the challenges hospitals are facing concerning reducing readmissions rates for non-English speakers and proposes solutions for improvement.


[1] Patient Protection and Affordable Care Act, sections 3025 and 10309

CyraCom’s interpretation and translation solutions are exclusively endorsed by the American Hospital Association. With ISO 9001:2008 certified quality processes, US-based medically-trained interpreters, and a dedicated account management team, we are equipped to meet your patients’ language needs. 

Are your souls and livestock well? Idioms: Translating the Untranslatable

One of the difficulties in interpreting and translating is conveying culturally bound idioms from one language and culture into another. CyraCom International’s Akmaral Mukan is part of our Language Services Department, which oversees the training and development of CyraCom’s interpreters. She is also an applied linguist who recently developed a leading guide to Kazakh idioms.

CyraCom is the healthcare servicing brand of CyraCom International, Inc. CyraCom’s interpretation and translation solutions are exclusively endorsed by the American Hospital Association. With ISO 9001:2008 certified quality processes, US-based medically-trained interpreters, and a dedicated account management team, we are equipped to meet your patients’ language needs. 


A Kazakh man greets his neighbor: Малжан аман ба?Are your souls and livestock well?”

The neighbor replies: Аман. Қара домалақтарың тәуір ме?Well. Are your black spheres feeling better?

This seemingly simple conversation, somewhat incomprehensible when literally translated, illustrates how challenging it is to convey culturally bound concepts from one language and culture into another. How do you best translate or interpret the Kazakh greeting into English effectively and efficiently? Obviously, it is more than just saying “How are you doing?” Where would livestock, something so important in the Kazakh culture, find its reflection in the English greeting? And why do we refer to small, cute children as black spheres?

The other day, I heard my son’s daycare teacher say ‘hold your horses’ to one of the impatient babies. I immediately wondered how this English idiom would translate.  Would it retain its full flavor in Kazakh, the language of people historically known as horse-riders?  No, not only does it not translate literally, it also does not have a close equivalent involving any type of livestock.

Finding solutions to these types of challenges was one of the reasons I began to compile a dictionary of Kazakh idioms. My goal was to take language learners from everyday vocabulary to complex cultural concepts embedded in simple words. I organized the idioms into cultural categories such as color, number, livestock, clothing, food, nature, etc. so users could see the cultural connection between the idioms. I also provided literal translations which will undoubtedly amuse or baffle my readers, but are very helpful in retaining the idioms in memory. After all, how can one forget ‘a black sphere’ as a reference to a child?


* To learn more, please check out my recently published A Learner’s Dictionary of Kazakh Idioms:

Webinar: Using Language Services as a Risk-Reduction Strategy, featuring speakers from Banner Health

Register Now

Learn how Banner Health, a multi-state, 23 hospital system mitigates risk by using language services. Talking points include how Banner Health:

  • Developed a  comprehensive language services program to address The Joint Commission’s standards for patient-centered communication
  • Trained bilingual staff to become qualified interpreters through its Banner Spanish Language Academy
  • Used language services to reduce miscommunication risk, decrease expenses, and improve satisfaction among patients, staff, and physicians
Language Services as a Risk Reduction Strategy
Webinar from Banner HealthTuesday May 1st, 2012

Liz Swan, RN, MBA, CPHRM – RN Risk Management Consultant
Marisa Hernandez, BS – Interpreter Educator


CyraCom’s interpretation and translation solutions are exclusively endorsed by the American Hospital Association. With ISO 9001:2008 certified quality processes, US-based medically-trained interpreters, and a dedicated account management team, we are equipped to meet your patients’ language needs.