Ensuring Interpreter Qualifications and Standards Through Vendor Contracts

Central Maine Medical Center, Lewiston, Maine

Create and enforce a standardized set of qualifications that each interpreter must meet.

Developed contracts for outside interpreter agencies specifying qualifications and standards for interpreters to work at Central Maine Medical Center (CMMC).

Prior to implementation, anyone who was bilingual was able to serve as an interpreter at the hospital. Now CMMC can ensure that every interpreter providing services has met the standards set.

Central Maine Medical Center
300 Maine Street
Lewiston, ME 04240
Ph: (207) 795-0111

From the Experts:
"It’s hard enough to listen and understand a conversation in English with a doctor, but when you have language as a secondary challenge, making sure whoever is doing the interpreting is qualified and correctly collecting the pertinent information is extremely important. And if they don’t think they have the information, confirming it back to the person who’s made the statement is just as important."

Jeralyn Maurer, M.S.W.
Regional Director, Guest Services

Central Maine Medical Center is licensed for 250 beds, and is a private, non-profit teaching hospital

Clinical areas affected:

  • All hospitals/facilities in the CMMC hospital system.

Staff involved:

  • Medical Staff
  • Administrative staff
  • IT department

Starting with coming up with standards, to having the resources in place for training and testing, then creating a contract and communicating with each interpreting agency or each solo person interpreting, the process took nearly eight months.Part of the challenge was defining the standards. CMMC worked with some the agencies in Maine that work with refugees to define these standards, including refugee and immigration resource agencies.

Jeralyn Maurer, M.S.W.
Regional Director, Guest Services
Central Maine Medical Center
Ph: (207) 795-2398

Innovation Implementation:
In 1999, after years of civil war in Somalia, the U.S. government and the United Nations responded to the refugee crisis by assisting in the relocation of an estimated 12,000 refugees from the persecuted Bantu minority population to cities across the country. Before they knew what happened the Somali immigrant population in Lewiston, Maine exploded and the Central Maine Medical Center found themselves in desperate need of translators and interpreters.

As a solution to meet the demand for language services, CMMC decided to allow interpreters to come in and perform a basic test in order to work at the hospital. The test was for the interpreter to conduct a simple conversation in English and if the hospital staff member thought the interpreter did well enough, they were approved to work in the hospital.

However, it soon became clear that some important information was getting lost in translation. Through regular audits of their language services team, the staff at CMMC realized that the vendors providing language services were not as consistent and effective as they should be—leaving the door open to dangerous lapses in quality and safety for patients with limited English proficiency (LEP). The hospital realized that in order to ensure a high-quality language services staff, a standardized set of qualifications was needed for the contracted interpreters working there.

To develop these standards, CMMC worked with other hospitals and stakeholders to outline the requirements for interpreter vendors and codify them into vendor contracts. The most important change was to require that hospital interpreters undergo a minimum of 20 hours of training through an accredited Interpreter service. This would ensure that they met certain national standards and could be considered a qualified medical interpreter.

The next step was for CMMC to put the new requirements and contracts into action. When it came time to reissue the contracts with interpreters, the hospital included a provision detailing the new requirements and the fact that the interpreters would be held accountable for the costs of the training. If they didn’t fulfill the requirements, they would be unable to work in the hospital.

The result has been that all interpreters working in the hospital are now meeting the training and contract requirements, ensuring that patients are receiving the services of qualified medical interpreters and that only the highest quality and safety of care is being provided at CMMC.

Advice and lessons learned:

  1. Contracts are a good way to enforce standards. It is hard to change an existing professional workforce without some way to hold them responsible. By folding the new requirements into the interpreter vendor contracts, CMMC was able to ensure that anyone who wanted to work with them had to meet the terms of their agreement.
  2. It’s the hospital’s responsibility. It is the hospital’s responsibility to ensure that everyone working in the institution is fully trained and qualified.
  3. Learn from or collaborate with others in your region. Chances are that your peers have had to deal with similar problems from their language services staff so it is useful to ask them for insight on how it was dealt with or collaborate with them on a solution. This will ensure that changes are standardized throughout the system and will serve to raise the professionalism of all interpreters in your area.

Cost/benefit estimate:
There was very little cost associated with creating the standardized qualifications or redoing the interpreter contracts. Since the 100 hour training session for interpreters is not paid for by the hospital, there were also no additional costs there. The result of having guaranteed qualified language services is immeasurable but ensures patients are receiving the highest-quality and safest care possible.