Risk Management of the LEP Patient and Effective Language Access Plans for 2012: Problems and Solutions to Reach
Compliance With The Joint Commission Standards
Presented by:Armando Ezquerra Hasbun, Director of Programs, LSA
Shiva Bidar-Sielaff, CCHI Commissioner
LSA Company Overview
About LSA
Founded in 1991 by Laura K.T. SchriverHorsham, PA headquartersA network of more than 5,000 Independently Contracted global LinguistsRecently named to Common Sense Advisory’s list of “Top Global Language Services Providers” for the second consecutive yearOver 200 language offerings100% privately ownedCertified Diversity Enterprise (WMBE)
LSA Company Overview
LSA is proud to offer a full range of language translation services and language interpreter services:
Webinar Objectives
Discuss the current regulatory requirements governing Language Access Plans for LEP populations in healthcare settingsLearn more about the problems healthcare providers and administrators typically encounter when implementing an effective Language Access PlanReview the recommended options, strategies and solutions to meet Joint Commission Standards, with the ultimate goal of achieving optimal outcomes for allUnderstand the importance of using certified and credentialed medical interpreters when caring for an LEP patient, and what certification and credentialing means to The Joint Commission
You are invited to share your experiences, in terms of challenges and successes, at the end of the Webinar during the Q&A session.
The Joint Commission (TJC)
The Joint Commission is an independent, not-for-profit organization that accredits and certifies more than 19,000 health care
organizations and programs in the United States. A majority of state governments recognize Joint Commission accreditation as a
condition of licensure and the receipt of Medicaid reimbursement.
Surveys (inspections) typically follow a triennial cycle, with findings made available to the public in an accreditation quality report.
The declared mission of the organization is:"To continuously improve health care for the public, in
collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and
effective care of the highest quality and value.”
Key Guidelines Regarding Equal Language Access Standards
PC.02.01.21: The hospital effectively communicates with patients when providing care, treatment and services.EP 1: The hospital identifies the patient’s oral and written communication needs, including the patient’s preferred language for discussing health care.EP 2: The hospital communicates with the patient during the provision of care, treatment and services in a manner that meets the patient’s oral and written communication needs.Title VI of the Civil Rights Act of 1964 prohibits discrimination based on “national origin,” which includes language.The Americans with Disabilities Act of 1990Section 504 of the Rehabilitation Act of 1973
How Are Health Care Providers Responding?
Some of the larger providers are at the vanguard, and are setting an example on how to successfully achieve equal language access; on the other hand, the majority of smaller providers are finding themselves in one of the positions listed below:
Rushing to try and meet compliance deadlinesTrying to make sense of guidelines that are not explicit Struggling for funding that has not been budgeted for At a loss as to how well their language needs are being metHaving to design, document and perfect their response
The Language Access Plan
The first step to achieving equal language access is to create, develop, apply and continuously supervise your institution’s Language Access PlanA Language Access Plan is the roadmap that is created to reflect:
The linguistic needs of the community your institution servesYour arrangements for meeting those needsYour system for the provision of interpretation services:
Staff face-to-face interpretersPer-diem face-to-face interpreters contracted directlyPer-diem face-to-face interpreters from agenciesRemote interpreters from provider poolsRemote telephonic interpreters from language services providersRemote VRI interpreters from language services providers
Language Access Plan on Interpretation
HR.01.02.01:It is not appropriate to rely on untrained individuals as the primarysource for bridging communication barriers during medical encounters with individuals who are deaf or speak a language otherthan English. Requirement HR. 01.02.01, EP1 requires hospitals todefine staff qualifications specific to job responsibilities.
Note 4 in EP 1 requires hospitals to specifically ensure thatindividuals who provide interpreting and translation services in thehospital have defined qualifications and competencies.
Language Access Plan on the Use of Untrained Interpreters
Untrained individuals – including family members, friends, otherpatients and / or untrained bilingual staff – should not be used toprovide language access services during medical encounters.
Standard HR.01.02.01: The hospital defines staff qualifications“Qualifications for language interpreters and translators may be met through language proficiency assessment, education,training and experience.”
Problems and Possibilities
Lack of Institutional SupportMy institution doesn’t budget for contracting language servicesMy institution doesn’t have policies in place regarding the proper use of interpretersMy institution relies on bilinguals and doesn’t see the need to do it any other way
Lack of Trained InterpretersOur in-house team has never been trainedOur bilingual personnel has not been testedWe cannot possibly provide interpreters:
In all the languages that show upIn all the medical subspecialties neededAt all hours of the day and night
We cannot be sure how our team performs
Problems and Possibilities
Multiple Solutions but No AccountabilityHow can we test for language skills? How can we determine interpreting ability?We can’t tell how well an interpreter performsConflicts of interest and ethical dilemmasCorrect language but much misunderstandingCan we rely on “Certified” interpreters?
Trained, Qualified, Certified?The 40-hour specialized training courseThe ‘Training the Trainer’ courseThe National Certification options availableHealth Care Interpreter QualificationContinued Education and Remote LearningEnglish and Languages of Limited Diffusion
Problems and Possibilities
Opposition From All Sides: A Shift in Perception and Attitude Is NeededProviders see the process as cumbersome; causes delaysBilingual providers use their own language skillsPatients rely on their own family and friendsDual-role employees have extra duties and no pay differentialRemote interpreting has major limitationsTechnophobes tend to under use available services
Problems and Possibilities
Understanding Professional InterpretersKnowledge, skills and abilityTraining, testing and acquisition of credentialsApplied ethicsProtocol and common standards of practice Protocol and best practicesLinguistic limitations – consulting the dictionaryRoles and what an Interpreter cannot doA typical day in the life of a healthcare Interpreter
Problems and Possibilities
Sources of Recurrent ProblemsSudden re-scheduling and cancellationsReported times and billing reconciliationHow to manage the INFORMED CONSENT FORMErrors, inaccuracies and incomplete interpretationThe interpreter takes over control of the sessionSide conversations in the foreign languageCannot hear well; disconnectionsThe interpreter is argumentative or impolite
How LSA Can Help
LSA supports you in your mission by:Helping providers assess their bilingual dual-role staffProviding training courses to help make interpreters qualified to sit in for the certification examinationOffering continuing education educational sessions on specialized topics for your interpreter corpsTraining your providers on how to work with interpretersDelivering a full range of services to help providers achieve their goals of better outcomes, while meeting all specifications of a Language Access Plan; LSA’s full suite of services includes:
Translation & LocalizationVideo Remote InterpretingInterpreting by TelephoneFace-to-Face InterpretingAmerican Sign LanguageIntercultural Consulting
Healthcare Interpreter Certification
A Piece of the Compliance Puzzle: Healthcare Interpreter Certification
Shiva Bidar-Sielaff
CCHI Commissioner
Why is Credentialing Important?
No federal regulations for the healthcare interpreting profession exist
Very few state regulations exist
Major organizations understand importance of competent interpreters:
Office for Civil Rights
Office of Minority Health
The Joint Commission
New Joint Commission Standards
The patient-centered communication standards, approved in December 2009 and released in January 2010, became effective on July 1st, 2012:
HR.01.02.01., EP 1: Individuals providing interpreting or translation services have defined qualifications or competenciesQualifications for language interpreters may be met through
Assessment (AHI and CHI tests)Education (U.S. High School or equivalent)Training (Minimum of 40 hours & Continuing Education)Experience
Certification Commission for Healthcare Interpreters
CCHI (Certification Commission for Healthcare Interpreters) – “One Voice”
One set of industry-formed standardsAssurance of competency
Professional certification programInvolving
InterpretersEmployees and independent contractorsUsers of interpreter services
Bringing together the necessary stakeholders through a non-profit organization
Why CCHI Credentials?
The AHITM and CHITM examinations follow the blueprint created by the Job Task Analysis (JTA)Exams were developed according to NCCA Standards, under direct oversight of CCHICCHI exams have been psychometrically validatedOver 1,250 applicants since testing began509 interpreters nationwide have already earned their CCHI credentials – 165 AHITM and 344 CHITM
Test Development Supporters
Note: The participation by supporters does not constitute ultimate endorsement of CCHI’s certification program.
CCHI Current Credentials
Associate Healthcare InterpreterTM Credential (AHITM)Available to all interpreters except Spanish-, Arabic- and Mandarin-speaking interpreters
Certified Healthcare InterpreterTM Certification (CHITM)Currently available to Spanish-, Arabic- and Mandarin-speaking interpreters
What Is the Associate Healthcare InterpreterTM (AHITM) Credential?
Available to interpreters in ALL languagesEntry point into professional certificationTwo-hour, computer-based, 100 question, multiple choice exam in EnglishTests the basics of health care interpretingPreliminary results are immediate at test centerCredential awarded upon successful completion of the written examination (except for Interpreters who are eligible for CHITM)
The AHITM Examination
Managing an Interpreting Encounter 30% - 35%Healthcare Terminology 22% - 25%Interacting With Other Healthcare Professionals 20% - 24%Preparing for an Interpreting Encounter 16% - 20%Demonstrating Cultural Responsiveness 3% - 6%
What is the Certified Healthcare InterpreterTM (CHITM) Certification?
Currently available in Spanish, Arabic and Mandarin; other languages will continue to be developedTests the basics of health care interpreting plus interpreting skills and abilitiesAHITM examination + computer-based oral performance examination (takes one hour to complete) = Certification
The CHITM Examination
Knowledge required of health care interpreters (same as AHITM credential)Interpreting in a health care environment: accurately and completely within a cultural and environmental context:
Interpret consecutively 75 – 80%Interpret simultaneously 10 – 15% Sight translate and translate healthcare documents 10 – 15%
Fees
Application: $30 (non-refundable)AHITM: $175CHITM: $250
$455 total for Spanish-, Mandarin- and Arabic-speaking interpreters$205 for all other interpretersAll fees are non-refundable
This is for one examination administration
Credential / Certification Maintenance
CHITM certification and AHITM credential are valid for four yearsMaintenance Requirements
32 hours total Continuing Education = 16 hours (classroom or contact) in years 1 & 2, 16 hours in years 3 & 440 hours of work experience = 20 hours in years 1 & 2, 20 hours in years 3 & 4
CCHI
Certification Commission for Healthcare Interpreters
www.healthcareinterpretercertification.org
Thank You!
Armando Ezquerra HasbunDirector of Programs, [email protected] www.lsaweb.com
Shiva Bidar-SielaffCCHI Commissioner [email protected] www.healthcareinterpretercertification.org
Translation and Localization
Face-to-Face Interpreting Video Remote Interpreting (VRI)
American Sign Language (ASL) Intercultural Consulting
Q&A Session
