Healthcare Language Access Case Study:
How UW Health Delivers High Quality Health Care in the Language of their Patients
About UW Health: UW Health (uwhealth.org) is an academic health system associated with the University of Wisconsin-Madison serving a diverse patient population. It encompasses the research, education and patient care activities that take place at the UW School of Medicine and Public Health and within UW Hospitals and Clinics Authority. The health system is home to UW Health at The American Center, American Family Children's Hospital, UW Medical Foundation and UW Carbone Cancer Center. The health system operates 648 beds and employs over 13,000 medical professionals.
UW Health Interpreter Services Staff: Left to right, back: Guadalupe Mangin, CHI, UW Health Staff Spanish Medical Interpreter, Beatriz Fernández-Jordá, CHI, UW Health Staff Spanish Medical Interpreter, Cecilia Pous, CHI, UW Health Staff Spanish Medical Interpreter, Diana Altuzar, CHI, UW Health Staff Spanish Medical Interpreter; Front: Kim Bagley, NIC, UW Health Staff Sign Language Medical Interpreter, Shiva Bidar-Sielaff, CHI-Spanish, UW Health Director of Community Partnerships and Interpreter Services
Known for exceptional patient care, UW Health recognizes the need to communicate and provide services in the language of their patients. Located in the Mid-West, the health system serves a growing diverse patient population, encountering many different languages from patients who do not speak or understand the English language. “Other than English, sixty-percent of the languages spoken by our patients are Spanish, followed by Hmong, Chinese-Mandarin, Korean, and Arabic,” states Shiva Bidar-Sielaff, M.A., CHI™-Spanish, Director of Interpreter Services & Community Partnerships for UW Health.
Bidar, also a professional interpreter in French and Spanish, has been with the provider for over 18 years in their interpreter services department. “Interpreter services is able to support over 23 different languages through different patient encounters. We’re able to interpret from the patient’s native language to English through video meetings, face-to-face encounters, and over the phone situations.”
Bidar is responsible for the management, staffing, and quality assurance of 7 employees and over 80 contractors who help UW Health communicate in the language of their patients. In fact, she was the provider’s first Spanish interpreter in 1997 and has since then helped the health system respond and be pro-active in how they communicate with their limited English proficient (LEP) patient population. “Due to the ability to communicate with patients in so many different languages, UW Health is able to focus on the specific needs of our patients and their families. We are a partner in their health care by overcoming language barriers. It makes a difference in outcome of care the patient receives when you are able to speak their language.”
RECOGNIZING THE NEED FOR STANDARDIZATION & CERTIFICATION FOR HEALTHCARE INTERPRETERS
UW Health knew that they needed to go beyond providing a human voice to interpret between the patient and provider – they needed to ensure all of their medical interpreters were operating at the highest possible standards and regulations for the best level of patient care. “As of January 2013, we required that all of our staff interpreters and contractors are certified healthcare interpreters,” adds Bidar. “We needed a better way to ensure language quality. This was a huge challenge prior to certification.”
Naturally, UW Health turned to the CCHI – the Certification Commission for Healthcare Interpreters - for guidance on national certification of their medical interpreters.
“We selected CCHI because they are the voice of the healthcare interpreting industry,” says Bidar. “It was a very natural move for us. Their thirteen Commissioners are true leaders and innovators in healthcare interpreting, and were instrumental in creating the industry standard healthcare providers trust and rely on when using interpreters. During the certification process, CCHI provided testing and guidance on the reality of day-to-day interpreting and expectations. CCHI is the only national certifying body offering a core-level certification for interpreters of any language, the CoreCHI™ certification, in addition to the language-specific CHI™ certification in Spanish, Arabic and Mandarin. Having these two levels of certification allows us to have certified interpreters of all languages for our patients.”
“UW Health is truly a leader in how they communicate with their LEP patients and support their diverse patient communities,” says Alejandro Maldonado, B.A., CHI™-Spanish, CCHI Chair. “We helped certify all of their interpreter resources and, through our continuing education requirements, provide additional support for the interpreters’ professional development. Their commitment to meeting the national standards in interpreting services ultimately results in improved quality of care for the patient and increased professional accountability of interpreters.”
THE CRITICAL IMPORTANCE FOR HEALTHCARE INTERPRETER CERTIFICATION
Bidar outlined the importance of employing CCHI-certified healthcare interpreters. CCHI certification:
EVALUATING THE CCHI EXPERIENCE AS THE INDUSTRY VOICE
UW Health reported that the transition to CCHI national certification was a smooth process. Specifically, high marks were provided in the following areas:
As LEP patients in UW Health’s market area continue to increase, Bidar stated that the health system has several initiatives within the community to respond for the future need of additional interpreter resources. “We are currently partnering with our local community college on training and developing of future interpreters. Additionally, the health system is constantly monitoring the growth of additional languages we encounter.”
PROVIDER TO PROVIDER ADVICE ON LANGUAGE ACCESS
It’s no doubt that UW Health has had the unique opportunity to grow and respond to their LEP market, emerging from a single interpreter department to one with strategic guidance from a full-time director with resources spanning full-time certified interpreters and contractors.
“Providers need to understand that collaboration is key when creating a pool of professional interpreters,” Bidar says. “Reach out to other providers in your area or network. You may need to explore sharing of resources based on geography or need. We’ve completed this locally and have come together within the healthcare community to provide equal access to health care in the language of the patient. Additionally, quality should lead you directly to certification. The ability to provide a professionally certified healthcare interpreter should be no different when pursuing high quality healthcare standards. It’s really not as hard as it seems when transitioning to certified interpreters. It is such a relief knowing your interpreters have reached such rigorous standards.”
Promoting certification, a South Carolina hospital story:
It's about being the best for our patients
About Lexington: Lexington Medical Center, West Columbia, South Carolina, has been named Columbia’s “Best Place to Have a Baby”, “Best Hospital” and one of the “Top 25 Best Hospitals to Work for in the U.S.” The heart and cancer programs are affiliated with Duke Medicine. Lexington Medical Center’s interpreters are an integral part of the organization’s success.
Lexington Medical Center staff: Left to right, back row: Yolanda Murillo, Mary Ayala, Melinda Soto; Front row: Su Kang, Amanda Elías Vargas, Patricia Buckley, Annette Hilgert, Luz Salazar, Ping Chen, Ana Andrew, Esmeralda Concepción
“We want to be the best versions of ourselves; we don’t want to provide mediocre care to our patients” says Amanda J. Elías Vargas, CHI™-Spanish, Coordinator of Interpreter Services Department at Lexington Medical Center, when I ask her why they support certification of their staff interpreters. “If our physicians and other healthcare professionals seek national certification, then it’s only natural that interpreters should be certified, too. We are members of the care team; we have to have equal credentials."
Amanda started working at Lexington Medical Center six years ago. That’s when the leadership realized that their community had been rapidly changing, with more patients who speak languages other than English seeking help. And to be true to their mission - to provide quality health services that meet the needs of the community – ad hoc lists of bilingual staff needed to be replaced with a sustainable interpreter services program. And Amanda, with the support of Susan Horton, Director of Guest Services and Interpreting Services, had the honor and challenge to develop such a program. “As the interpreter program was developed our goal was to provide the best care for our patients and a big part of that is how we communicate with them,” Susan states. “We made the decision to certify all of our interpreters to ensure the highest quality of care.”
“The first thing I realized was that any person who interprets for us must be trained,” continues Amanda. The hospital paid for her and four other bilingual staff to get the Bridging the Gap (BTG) training from the CCHCP. In 2010, she traveled to Seattle to become a licensed BTG trainer herself so that she could train in-house. Now all newly hired interpreters must complete the BTG course plus a week-long orientation and shadowing before they are allowed to work independently.
“Our goal is by January 2016, to have and hire only certified interpreters,” says Amanda. “I participated in CCHI’s first administration of the certification exams in 2010. I chose to be a CHI™-Spanish certified interpreter because CCHI’s process was more transparent and smooth. And I wasn’t disappointed. Both exams, CoreCHI™ and CHI™, are right on target as for what we are doing on a daily basis. The questions echo what BTG teaches and ascertain that the interpreter not only knows medical terminology but also understands the healthcare setting regulations and can apply the professional code of ethics to specific real-life situations.”
Since 2010, seven staff interpreters became certified through CCHI. One of them is Annette M. Hilgert, CHI™-Spanish, who, at first, worked in an administrative role and became staff interpreter in 2009. “One day I was asked by a physician to help him communicate with a Spanish-speaking patient, which I then learned was interpreting,” starts Annette. “A coworker encouraged me to apply. I finished the BTG training with Amanda and got certified with CCHI. It’s the best job I have ever had. At the end of the day, I know I made a difference in people’s lives.”
Annette strongly believes that CCHI certification confirms the status of a professional interpreter and ensures that interpreters have the proper training and skills to do their job. “Interpreting is not just a job. As Interpreters we have an opportunity to help provide excellent service and access to solutions to the patient’s healthcare concerns. We play an important role in a medical encounter of LEP patients as part of the medical team. Therefore, it is important to continue educating ourselves regarding terminology, diagnosis and procedures in order to do our job seamlessly and allow the provider-patient relationship to develop. It is an honor to be a certified interpreter through CCHI which allows me to serve the LEP patients, their families and colleagues with professionalism and integrity. I’m excited that four more of my coworkers are getting ready to take the exams now.”
In addition to reimbursing the certification expenses, the hospital also strongly supports the interpreters’ continuing professional development by including interpreters in relevant internal continuing education events for nurses, physicians and other healthcare professionals, by giving the interpreters time to take online webinars or attend conferences. And since last year, each staff interpreter gets budgeted dollars for their continuing education. “How can it be otherwise?!” interjects Amanda. “You have to show to employees that you are dedicated to their professional development. Otherwise they are not loyal to you, to your mission, and the cost of turnover is much higher. It’s also important to create the work environment that encourages growth, to be supportive and help them meet the high expectations I set. It’s comfortable to accept mediocrity and convince ourselves that the status quo is ‘good enough’ but it’s rewarding to strive and push toward a goal and then find you’ve surpassed even your own expectations. I think that keeps us sharp and motivated, and as it applies to medical interpreting, allows us to achieve excellence, which we owe to the patients we serve. It’s also important to stay curious! There is always something new in medicine, language and culture. And if we lose interest we’ll lose our interpreting skills.”
Language barriers between healthcare providers and their patients not only cause confusion, but can open to the door to poor quality of clinical care and severe racial and ethnic health disparities. That’s why healthcare providers of all types and sizes rely on the Certification Commission for Healthcare Interpreters (CCHI) as the nationally recognized voice for setting the standard for quality in healthcare interpreting. Requiring your interpreters to obtain a national CCHI certification is a most efficient way to comply with Section 1557 of the Affordable Care Act and The Joint Commission Accreditation requirements.
CCHI invited Mara Youdelman, managing attorney of the National Health Law Program and a founding Commissioner of CCHI, to clarify the meaning of Section 1557 for healthcare administrators and interpreters. She presented the webinar "Implications of Section 1557 of the Affordable Care Act for Provision of Language Assistance to Patients with LEP" on 11/10/2016. To see the webinar slides click here, and to re-play the webinar, click here.
Here’s how we help healthcare providers:
1. National Certification and Standardization of Medical Interpreters
For providers with current or prospective bilingual or multi-lingual staff, we provide national certification of medical interpreters covering areas of managing an interpreting encounter, healthcare terminology, interacting with patients and healthcare professionals, cultural responsiveness and other vital functions throughout the patient-interpreter-provider interaction.
We offer two types of certification:
CoreCHI™: The CoreCHI™ certification is THE one certification every interpreter of any language needs to have and can have today. This certification tests medical interpreters of any language on the core professional knowledge as well as critical thinking, ethical decision-making, and cultural responsiveness skills needed to perform the interpreter's duties in any healthcare setting.
CHI™: Language-specific performance certification for Spanish, Arabic and Mandarin interpreters focusing on testing their interpreting skills and abilities. Additional emphasis is placed on all modes of interpreting in a healthcare encounter, sight translation, and healthcare document translation.
Begin the first steps in national certification for your medical interpreters.
2. Nationally Registry of CCHI Certified Healthcare Interpreters
For hospitals without medical interpreting staff or resources, we can help you find a certified healthcare interpreter. Providers also use this database to verify certification.
The Value of CCHI Certification
Complying with Rules and Regulations Governing Language Access to Health Care
CCHI certifications help ensure that you comply with Title 6, The Joint Commission and other regulatory requirements for providing language access. When you don’t have CCHI certified healthcare interpreters, you risk:
Promoting certification, a Colorado hospital story:
It takes compassion, commitment to patient-centered care, and asking the right questions
About Valley View: Valley View Hospital, Glenwood Springs, Colorado, is a member of the Planetree Alliance and prides itself on providing the best quality of care to their diverse patients.
Valley View Hospital staff: Left to right, top row: Abigail Jones, Luisa Angelica Sanchez, Samantha Valencia (CHI™-Spanish), Tania Cardenas-Portillo, Sandra Elisabet Ursino-Gould; Front row: Stephen Patrick Morris II, Andreia Barros Poston, Maria Selene Lujan, Viviana Nevarez (CHI™-Spanish), Rosa Isela Gonzalez Ortega, Alicia Cabrera
Samantha Valencia has been working in Radiology Department at Valley View Hospital for over 10 years. And from the very beginning, she and her coworker Viviana Nevarez were asked to interpret for Spanish speaking patients. Samantha very quickly realized that for a bilingual employee providing interpreting services it's important to have proper training and qualifications in interpreting. Also, for consistency of services to patients with limited English proficiency, the hospital needs to have an established structure of coordinating interpretation provided by bilingual employees who perform other duties.
She went to the HR department with questions. "When I do my job in Radiology, I'm expected to have certain qualifications. So when I am asked to interpret, shouldn't I possess professional qualifications specific to interpreting? If I'm not certified, how do you know that I can interpret? Doesn't the hospital expose itself to liability if bilinguals whose competency has not been assessed against a valid professional standard are allowed to interpret?"
Valley View Hospital's HR leadership took Samantha's concerns to heart. They understand that patients expect and deserve to have all members of their care team qualified. And interpreters are equal members of the patient care team along with other allied health professionals.
With the hospital's support, Samantha, Viviana and their co-worker Lorena Arroyo got certified by CCHI; they are proud holders of the CHI™-Spanish certification. "We chose CCHI for a number of reasons. CCHI's written exam is very comprehensive; it tests our knowledge of the professional conduct and healthcare settings, in addition to medical terminology. And the simultaneous component of the oral exam is extremely important since this skill is needed to interpret in emergency department and in emotionally-charged situations," said Samantha.
But this is not the end of the story. Daniel Biggs, FACHE, Chief HR Officer, recognized that three certified dual-role interpreters are not able to meet their patients’ needs. And with his support, this spring, Wendy Tennis, Planetree Coordinator, was tasked with identifying and training as interpreters other bilingual staff in the hospital. This HR initiative also received full support from all department managers.
"After we've selected our bilingual staff who were eager to learn the intricacies of the interpreting profession, I went to Beth Shaw of the Colorado Mountain College for advice. We are lucky to have them," says Wendy. "They helped us select an experienced healthcare interpreter trainer, offered their facility for the training, and act as the testing site for the CCHI's written and oral certification exams," continues Wendy.
Wendy concludes, “Our support for the interpreter certification stems from our embracing the Planetree’s philosophy: care should be organized first and foremost around the needs of patients. And if our patients don’t speak English, they deserve to have interpreters whose competency meets the national standards. The best care is possible only when you have a system-wide understanding of what patient-centered care truly means and when you have and nurture the best professionals.”
Hospitals and health systems nationwide recognize the need for a standard policy of healthcare interpreting. These hospitals currently use CCHI certification as an employment requirement or reimburse the cost of interpreter certification to their multi-lingual staff.
CCHI recognizes the following hospitals that either adopted a policy of requiring CCHI certification as employment requirement or reimburse the cost of interpreter certification:
Banner Health (AZ)
Beth Israel Deaconess Medical Center (MA)
Children’s Hospital of Los Angeles (CA)
Cleveland Clinic (OH)
Indiana University Health (Academic Health Center)(Indianapolis, IN)
Lexington Medical Center (SC)
Lurie Children’s Hospital of Chicago (IL)
MD Anderson Cancer Center (TX)
Memorial Sloan Kettering Cancer Center (NY) (See more info here)
Rush University Medical Center (Chicago, IL)
Spectrum Health (MI)
Stanford Health Care (CA)
St. Luke’s Roosevelt Hospital Center (NY)
University Medical Center of Southern Nevada (NV)
University of Wisconsin Hospitals & Clinics (WI)
Valley Children's Hospital (CA)
Valley View Hospital (CO)