This section offers resources to help health care providers identify the linguistic needs of their Limited English Proficient (LEP) patients and strategies to meet their communication needs.
Research indicates that LEP patients face linguistic barriers when accessing health care services. These barriers have a negative impact on patient satisfaction and knowledge of diagnosis and treatment. Patients with linguistic barriers are less likely to seek treatment and preventive services. This leads to poor health outcomes and longer hospital stays.
This section contains useful tips and ready-to-use tools to help remove the linguistic barriers and improve the linguistic competence of health care providers. The tools are intended to assist health care providers in delivering appropriate and effective linguistic services, which leads to:
- Increased patient health knowledge and compliance with treatment
- Decreased problems with patient-provider encounters and increased patient satisfaction
- Increased appropriate utilization of health care services by patients
- Potential reduction in liability from medical errors
The following materials are available in this section:
This tool is designed for office staff to assist in basic entry- level communication with Limited English Proficient (LEP) patients. Point to the sentence you wish to communicate and your LEP patient may read it in his/her language of preference. The patient can then point to the next message.
Click here to download the Common Sentences Card
Tips for Communicating Across Language Barriers
Limited English Proficient (LEP) patients are faced with language barriers that undermine their ability to understand information given by healthcare providers as well as instructions on prescriptions and medication bottles, appointment slips, medical education brochures, doctor’s directions, and consent forms. They experience more difficulty (than other patients) processing information necessary to care for themselves and others.
Tips to Identify a Patient’s Preferred Language •Ask the patient for their preferred spoken and written language.
- Display a poster of common languages spoken by patients; ask them to point to their language of preference.
- Post information relative to the availability of interpreter services.
- Make available and encourage patients to carry “I speak….” or “Language ID” cards.
- (Note: Many phone interpreter companies provide language posters and cards at no charge.)
Tips to Assessing which Type of Interpreter to Use
- Telephone interpreter services are easily accessed and available for short conversations or unusual language requests.
- Face-to-face interpreters provide the best communication for sensitive, legal or long communications.
- Trained bilingual staff provide consistent patient interactions for a large number of patients.
- For reliable patient communication, avoid using minors and family members.
Tips to Overcome Language Barriers
- Use simple words; avoid jargon and acronyms.
- Limit/avoid technical language.
- Speak slowly (don’t shout).
- Articulate words completely.
- Repeat important information.
- Provide educational material in the languages your patients read.
- Use pictures, demonstrations, video or audiotapes to increase understanding.
- Give information in small chunks and verify comprehension before going on.
- Always confirm patient’s understanding of the information - patient’s logic may be different from yours. " "Employee Language Skills
The attached self-assessment tool can assist you in identifying language skills and resources existing in your health care setting. This simple tool will provide a basic and subjective idea of the bilingual capabilities of your staff.
We recommend that you distribute the tool to all your clinical and non-clinical employees using their non-English language skills in the workplace. The information collected may be used as a first step to improve communication with your diverse patient base.
You may wish to write an introductory note along the following lines:
We are committed to maintaining our readiness to serve the needs of our patients. Many of our employees could use their skills in languages other than English.
We are compiling information about resources available within our work force. Please complete and return this survey to no later than…
This survey will not affect your performance evaluation. It is just a way for us to improve our customer service, and to make you part of such efforts.
Thank you for your assistance.
Once bilingual staff have been identified, they should be referred to professional assessment agencies to evaluate the level of proficiency. There are many sources that will help you assess the bilingual capacity of staff.
Depending on their level of confirmed fluency, your practice would be able to make use of this added value to help your practice better communicate with your patients in the client’s language of preference.
Language Identification Flashcards
The sheets in this tool can be used to assist the office staff or physician in identifying the language that your patient is speaking. Pass the sheets to the patient and point to the English statement. Motion to the patient to read the other languages and to point to the language that the patient prefers. (Conservative gestures can communicate this.) Record the patient’s language preference in their medical record.
The Language Identification Flashcards were developed by the U.S. Census Department and can be used to identify most languages that are spoken in the United States."
Click here to download the Language Identification Flashcards
Tips for Locating Interpreter Services
First, assess the oral linguistic needs of your Limited English Proficient (LEP) patients. Second, assess the services available to meet these needs.
Assess the language capability of your staff (See Employee Language Skills Self-Assessment)
- Keep a list of available bilingual staff who can assist with LEP patients on-site.
- Assess services available through patient health plans
- Ask all health plans you work with if and when they provide interpreter services, including American Sign Language interpreters, as a covered benefit for their members.
- Identify the policies and procedures in place to access interpreter services for each plan you work with.
- Keep an updated list of specific telephone numbers and health plan contacts for language services.
- Ask the agency providing the interpreter for their training standards and methods of assessing interpreter quality.
- Don’t forget to inquire about Telecommunication Device for the Deaf (TDD) services for the hard of hearing/deaf. If services are covered, identify the appropriate contact and request the health plan’s process to access services.
- Determine if face-to-face and/or telephone interpreters are covered.
- If face-to-face interpreters are covered, have the following information ready before requesting the interpreter: gender, age, language needed, date/time of appointment, type of visit, and office specialty.
- Remember to follow all HIPAA regulations when transmitting any patient-identifiable information to parties outside your office.
- If telephone interpreters are covered, relay the pertinent patient information which will help the interpreter better serve the needs of the patient and the provider.
- If interpreter services are NOT covered by the patient’s health plan, find other resources to meet the linguistic needs of your LEP patients.
- Use trained/capable internal staff.
- Contract with a telephonic interpreting company. (See Telephonic Interpreting Companies.) It is recommended that you assess the quality of the services provided by these vendors.
- Check for services available through Community Based Organizations. Some provide free face-to-face interpreter services for the community or they may offer low fees.
- Depending on the linguistic needs of your LEP population, you may have to consider hiring a professional interpreter.
- For further information, you may contact the National Council on Interpretation in Health Care, the Society of American Interpreters, the Translators & Interpreters Guild, the American Translators Association, or any local Health Care Interpreters association in your area.
Telephonic Interpreting Companies
Price per Minute: Prices may range from $1.25 to $4.50 per minute. Some companies charge different rates depending on the language requested. Other companies charge the same rate regardless of language. Most rates are negotiable depending on volume.
Start-up Costs: There might be a $150 set-up charge and a $50 monthly service fee, but often these costs are waived.
Staff Training: On-site and teleconferencing training on how to use telephonic interpretation is available.
Connection Time: Connection times range from 30 to 60 seconds.
Other Services: All companies have training materials, custom reports and equipment available. Some have dual handset telephones available.
This list is intended to give you a sample of vendors that offer telephone interpretation services, and is not an endorsement or a recommendation. You should conduct your own research to assess the quality of the services provided by these vendors.
Industry Specialization Standards for Interpreters
Standards for Interpreters
Completion of the CyraCom Interpreter Qualification Process
7330 N. Oracle Rd.
Tucson, AZ 85704
Interpreting Services International, Inc. (ISI)
Completion of the ISI Interpreter Training and Assessment Program (ITAP)
6180 Laurel Canyon Blvd.
North Hollywood, CA 91606
Language Line Services (LLS)
Completion of the Language Line Medical Certification Program
One Lower Ragsdale Dr.
Monterey, CA 93940
Network Omni Services
1329 E. Thousand Oaks Blvd., 2nd Floor
Thousand Oaks, CA 91362
Two years of college education
Formal training as interpreter
Professional certification Active membership in a professional organization
One SW Columbia, Ste. 1950
Portland, OR 97258
Medical Legal Insurance
Primarily recruit from interpretation schools
447 W. Burchett St., 2nd Floor
Glendale, CA 91203
10 Tips for Working with Interpreters
1. Choose an interpreter who meets the needs of the patient, considering age, sex and background.
A patient might be reluctant to disclose personal and sensitive information, for example, in front of an interpreter of a different sex.
2. Hold a brief introductory discussion with the interpreter.
If it is your first time working with a professional interpreter, briefly meet with the interpreter first to agree on basic interpretation protocols. Let the interpreter brief the patient on the interpreter’s role.
3. Allow enough time for the interpreted sessions.
Remember that an interpreted conversation requires more time. What can be said in a few words in one language may require a lengthy paraphrase in another.
4. Speak in a normal voice, clearly, and not too fast or too loudly.
It is usually easier for the interpreter to understand speech produced at normal speed and with normal rhythms, than artificially slow speech.
5. Avoid acronyms, jargon, and technical terms.
Avoid idioms, technical words, or cultural references that might be difficult to translate. Some concepts may be easy for the interpreter to understand but extremely difficult to translate (i.e. positive test results).
6. Face the patient and talk to the patient directly. Be brief, explicit and basic.
Remember that you are communicating with the patient through an interpreter. Pause after a full thought for the interpretation to be accurate and complete. If you speak too long, the interpreter may not remember and miss what was said.
7. Don’t ask or say anything that you don’t want the patient to hear.
Expect everything you say to be interpreted, and everything the patient and their family says.
8. Be patient and avoid interrupting during interpretation.
Allow the interpreter as much time as necessary to ask questions, for repeats, and for clarification. Be prepared to repeat yourself in different words if your message is not understood. Professional interpreters do not translate word-for-word but rather concept-by-concept. Also remember that English is a direct language, and may need to be relayed into complex grammar and a different communication pattern.
9. Be sensitive to appropriate communication standards.
Different cultures have different protocols to discuss sensitive topics and to address physicians. Many ideas taken for granted in America do not exist in the patient’s culture and may need detailed explanation in another language. Take advantage of your interpreter’s insight and let the interpreter be your “Cultural Broker.”
10. Read body language in the cultural context.
Watch the patient’s eyes, facial expression, or body language when you speak and when the interpreter speaks. Look for signs of comprehension, confusion, agreement, or disagreement.