Standardizing Interpreting Services

May 5, 2017   |  Tags: Blog   |  Tags: Portland , Access , Patient Experience , Interpreting Services
Felicity Ratway, MA, CMI & Sara Jade Webb, MS

The Wallace Medical Concern  provides low cost medical and dental services in Southeast Portland and Gresham, Oregon. Around 47% of their patient population needs interpretation services, with Spanish being the language in which services are most often needed. With a mission to provide an open door to exceptional health services and connections that support individuals and their families in healthy living, it’s no wonder The Wallace Medical Concern is leading the charge in developing robust policies and procedures for interpreting services. Felicity Ratway, Interpreter and Sara Jade Webb, Data and Quality Manager are eager to share about the clinic’s work, including some fantastic templates (attached below the post).

What did interpreting services look like before this change?

Wallace was founded in 1984 as an all-volunteer medical provider clinic and became a Federally Qualified Heath Center in 2012. Over time our organization has grown and changed in many ways including how we provide interpreting services. We currently have two certified Spanish interpreters on staff and are able to schedule outside interpreters to come into our clinic when needed, offer telephonic interpreting, and use a tablet for video interpreting. To make sure everything runs smoothly we needed to develop a clear scheduling process for engaging interpreters. We had some providers who did not have experience working with interpreters – for example, they would talk to the interpreter instead of talking to the patient. Some clinicians and staff were not sure how to get interpreters on the phone to schedule a lab review appointment. That is why we developed the orientation materials [See documents below] to give providers and other staff information about what to expect when working with an interpreter.

Tell me a little bit about your interpreting services process, including the development of your policies and workflows:

We are a smaller organization, but we are growing. We now have two medical clinics, a mobile medical clinic, and a dental clinic that opened last year. When we had just one location, communication was much easier as the staff person you needed was often sitting right next to you or in the next room. Opening a second location made us recognize how important it was to develop workflows and orientation materials for providers and clinic staff. We have also contracted with a project manager who helps with legal terminology for our documents.

One of the resources we developed was an Interpreter Refusal Form [See document below]. This is a form for patients to sign that allows them to use family members. The form documents the fact that we took time to offer them a certified or qualified interpreter. It says “I was offered and I understand the risk associated with using a family member and I still feel more comfortable using a family member.” So there’s still patient choice.

What are your goals to continue improving your interpreting services?

We’d like to take a closer look at the interpretation needs of our patient population, and provide more outreach and services to smaller language groups in our community. We’ve always had staff at our clinic who speak Spanish, as we see many Spanish-speakers. We knew this was our biggest population, so that is why we have staff members for are who interpreters for Spanish-speaking patients. We have other languages represented in our patient population and offer, when possible, in-person interpreting. If it is a very uncommon language, there are fewer in-person options, so we offer telephonic or video services.

What were your most significant barriers to implementing this process?

Staffing transitions were a barrier –new staff members, or staff taking on new roles. We had to communicate expectations with clinicians and staff, to streamline the process as much as possible, and ensure everyone understood the purpose. Another barrier was getting appropriate data. Our clinic conducts an annual needs and capacity assessment to make sure we’re serving the language needs in our population. We struggled to find the data we needed to make sure we understood the needs of our community.

What were some of the most notable improvements to your practice that resulted from adopting this process, and what is your plan for continuing to make improvements?

One of the improvements we have noticed is higher utilization of the tablet, which we use for less common languages– some of our providers were not aware this resource existed. Many providers are on board with this new streamlined process, and happy with using the tablet to access interpreters when we have walk-ins, so we don’t have to schedule a patient for a different day. In that way, we have been able to improve access for our patients. Additionally, I’ve heard patients say they are happy that I’m there as an interpreter every time instead of having a different interpreter every time so they have continuity.

What advice would you share with other clinics looking to develop their own interpreting services?

  1. Familiarize yourself with legislation surrounding language access.
  2. Prioritize – look and see what you’re already doing well and identify areas you need to improve. It’s something that happens in phases. We have an entire language access plan, but we haven’t implemented everything yet. We are looking forward to getting patient feedback in the near future. We do an annual survey of patients and we’re trying to incorporate questions on interpretation service access and quality to see what improvements we can make.
  3. Prioritize what you can do immediately and hold on what can wait. What’s the bare minimum and then what’s the icing on the cake something that we’d like to do but isn’t as high a priority?

What are the benefits to a comprehensive language services plan?

Some clinics find it a challenge financially, but we think it’s worth the investment and in some cases you’ll earn that money back because you’re having providers spend less time with follow-up because of improper communication and needs not being addressed. Let’s say you’re going to invest in some translated forms, then eventually you don’t need an interpreter to sit with them to fill out that form – so that will save money in the long run. Also, when patients have a good experience they will tell their friends – word of mouth.  It also expands your reach in your community and expands the services you can offer.

If you have questions for or would like to discuss, you can contact Sara Jade Webb or Felicity Ratway at:

Sara Jade Webb, MS

Data and Quality Manager | 503-489-1760 ext 450

Sara Jade has been The Wallace Medical Concern's Data and Quality Manager since 2016. She uses healthcare quality methods and data analysis to help the organization measure and produce desired quality and process improvement outcomes. Sara Jade has held data analysis and management positions in nonprofit organizations and universities. Most recently she was a Research Associate in The Regional Research Institute at Portland State University; she was previously employed by the Oregon Social Learning Center and the University of Oregon. Sara Jade holds a Master of Science degree from the University of Oregon. The Wallace Medical Concern is a short walk from Sara Jade's house and she feels privileged to have found a position in which she can use her data skills to serve her community.

Felicity Ratway, MA, CMI (Spanish),

Interpreter│ 503-489-1760 ext 762

Felicity Ratway works for The Wallace Medical Concern, a federally qualified health center in Portland, OR, where she interprets for patients and providers, translates documents, and oversees the organization’s language access program. Felicity received a Master’s degree in Interpreting and Translation Studies from Wake Forest University in Winston-Salem, NC, and has been working in health care ever since.  She holds a national certification as a medical interpreter through the National Board of Certification for Medical Interpreters and state qualification through the Oregon Health Authority.  Felicity previously worked as an interpreter for Mosaic Medical, another federally qualified health center with locations throughout Central Oregon, and is excited to be taking on a more active role in the development and implementation of a language access plan through her position at The Wallace Medical Concern.