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.
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.
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 (www.volinterpreting.org ), and the Gay and Lesbian Medical Association (www.glma.org ). She also serves as a member of the Advisory Council for the Certification Commission for Healthcare Interpreters (www.healthcareinterpretercertification.org) and The Advisory Board of PULSE NY(www.pulseofny.org), 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 www.wilson-stronks.com.