Bilingual staff valuable in healthcare, but lack of training is liability

By Oscar Arocha
01:56 PM

This is the third post in a multi-part series about the new Joint Commission standards on language access requirements for limited English proficient patients.
Bilingual staff have become a valuable asset to healthcare organizations. They’re often pulled from their daily responsibilities to assist nurses, physicians, techs and other support staff in communicating with limited English proficient (LEP) patients. As language barriers persist, “helping” is the word commonly used to describe the role these bilingual employees have assumed as they attempt to facilitate the communication between patients and providers who do not share a common language.

These requests sometimes are extended to bilingual family members and even strangers nearby who want to “help.” The issue is regardless how much they would like to help, most have little or no training in medical interpreting or the importance of accurate communication in the prevention of adverse health outcomes.

There is very little understanding of the potential harm when there are misunderstandings of symptoms, the care plan, follow up and discharge instructions that specify correct medication dosage or usage. Going through a consent process usually involves a conversation with technically challenging medical information that non-medical staff are simply not equipped to explain. In order to be qualified, bilingual staff  must be trained in medical terminology, a variety of specialties, interpreting modes, standards, ethics and/or be certified.

The accrediting bodies and regulatory agencies that oversee the healthcare industry have been working to raise the requirements for language access programs. Standards and expectations now exist and will be closely monitored by organizations such as the various Departments of Public Health and The Joint Commission (TJC), which this past January launched its New Standards on Patient-Centered Communication. The new standards take full effect next January upon completion of a one-year pilot.

TJC utilizes the patient tracer method during unannounced surveys. Patient medical charts are picked for review. Healthcare organizations must document on patient charts how the language need was met. Surveyors are able to ask for the personnel file of the interpreter listed on the chart to ensure proper qualifications, such as their education, tests, organizational assessment, continuing education records, up-to-date performance reviews, safety and infection control trainings, HIPAA training, immunization records and any other information deemed necessary of all healthcare workers.

Some organizations recognize the valuable secondary role of bilingual staff and include the interpreting tasks in employee job descriptions, with key parameters and measures to monitor quality and additional compensation in some instances. Those organizations are the exception. The others face a number of often unanswerable questions: Who is covering for the bilingual staff when they go interpret? Who will train, test and then monitor their linguistic skills? What support will these individuals receive? How will they be compensated for these additional responsibilities?

There is no question that bilingual staff can be a great asset. At the same time, if they are to provide interpretations in addition to their main function, healthcare organizations need to understand the steps necessary to protect themselves from possible liability. Given the ongoing need and continued investment required, having an interpreter training program that can keep up with employee turnover is extremely important.

The program should include third-party assessment of bilingual staff, interpreter knowledge and skills training, medical terminology training in both English and target languages, an interpreter skills test and on-going training every year. There is no alternative. The risks are simply too high for healthcare organizations not to pay close attention to what could potentially harm their patients.


Oscar Arocha is Senior Executive, Global Strategic Initiatives for Language Line Services. He is one of a number of language access subject matter experts who speak through The Language Access Center for Excellence on a variety of related topics. Speakers are available to Language Line Services customers, government agencies, industry conferences, not-for-profit organizations and other stakeholders, typically at no charge. For more information visit

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