Lynette Reep has a very interesting, very busy, and very important job at the UVM Medical Center. She helps us provide a service that’s largely invisible — unless you need it. She is the Interpreter Coordinator and makes it possible for people who are deaf, deaf-blind, or who have limited ability to speak English get the same quality of care that everyone else does.
Listen to an interview with Lynette to find out how she make this possible at the UVM Medical Center. Learn more about Interpreting and Translation Services at the UVM Medical Center.
UVM Medical Center: Lynette Reep is with us today on HealthSource to tell us about how all of this happens, and I think you’re a very fascinating part of healthcare. Thanks for coming.
Lynette Reep: Thank you.
UVM Medical Center: First, tell us about the program at UVM Medical Center.
Lynette Reep: Well, I’d like to say that the position is actually housed in the department of case management and social work, and there are a team of people that make all of this happen. My manager is Susan Onderwyzer and we work for Tara Pacy, she’s our director. Mary Gordon is actually the scheduler for our department, she is the person who for many years now has been taking the requests from the departments and the clinics for interpreting coverage and making sure that interpreters are available for those appointments. We also have folks who take care of billing and take care of other aspects of paperwork, so it’s kind of a team effort. I wanted to say that first.
The job itself has been something of a work in progress and that I think people had some ideas about what the position might cover but that’s evolved somewhat over time. There are what I think of a several different branches to the job. The central part of the job, the part that I think people would immediately think of in terms of an interpreter coordinator position is ensuring that interpreting services and translation services are available for patients, and families, and providers and staff as well.
UVM Medical Center: Let me stop you there. What’s the difference between interpreter services and translation services?
Lynette Reep: Yes, that’s a great question. I think for lay people the term “translation” is often used to cover both, but there’s actually a difference. Interpreting services mean through the air language. When I say “through the air,” that means spoken language and it also means signed languages. Anytime you’re right there on the spot, typically without a tremendous amount of preparation facilitating communication between two or more people, that’s interpreting. Translation generally involves the written word often between what’s written in one language being translated into another language, or occasionally from a written document into a spoken or a signed language or vice versa. So little bit different skillsets with some overlap.
That’s one piece of the job and we’re doing some interesting work around that including working on getting our translated documents of which we have quite a number into a more searchable format in a shared space so that everybody, all of the providers and staff and all of the staff as well will be able to access the documents we’ve already translated. We’ve got a lot of going on in that area.
Another primary area is education training and outreach for our staff and our providers, which means that I go to staff meetings or do presentations formally, informally anywhere from five minutes during a staff meeting to … I’ve done a nursing ground rounds and longer presentations about what is interpreting services, what does it mean to work with an interpreter, how do I do that, things to watch out for. For instance, why do we not want to use what we call ad hoc interpreters, friends or family, why does that raise some concerns? So doing some education and outreach around those issues.
The third branch of the job is really kind of looking at the system, the organization as a whole. Are there pieces that we may be are missing or that we could do better? We have a telephonic interpreting service in place so that anybody who works at the hospital can pick up a phone anywhere in the facility, in any of our facilities here in Burlington and make a phone call via interpreter to a patient who doesn’t speak English.
What we don’t have is a really efficient system for doing that in reverse. We have a way, if a patient who doesn’t speak English calls in, they can be put on hold, we can get an interpreter on another line, but it’s not very user-friendly. So we’re working on getting a system in place where patients can just call one number, dedicated phone number where an interpreter in their language which will come on the line and facilitate communication. That’s an example of the kind of systems wide projects that I’m looking at as well.
UVM Medical Center: Walk us through how this happens. Say, a provider has got a patient, maybe even unexpected, doesn’t speak English well at all, how does this all work?
Lynette Reep: It depends a little bit on whether this is inpatient or outpatient, whether it’s a planned appointment or whether it’s last minute, unexpected. Generally speaking, for outpatient ambulatory care, requests come to our department specifically to Mary Gordon from the departments from the clinics. What we’ve asked people to do if it’s not a last minute request is just to email us a screenshot of the appointment so that all of the information is already on the screen: the patient’s medical record number, the date and time of the appointment, the patient’s name, the concern.
All of that is there, it doesn’t have to be retyped, there’s less risk of errors, plus the people who are receiving the request on our end, Mary and the people who work with her can look at that quickly and know where they’re looking on the screen to find the name, and the MRN and so forth. That’s a fairly straightforward process. That request then depending on the language, so if it’s an American Sign Language or a signed language, we also provide some Nepali sign language, that request goes directly to an interpreter because all of our sign language interpreters are in private practice, they are contractors with us directly with the hospital.
If it’s a spoken language, I should preface this by saying this is for in-person request, for an in-person interpreter because we do have other modalities which I’ll get to. But if they’re reaching out to us to request an in-person interpreter, if it’s for a spoken language we work with two wonderful local agencies, the Vermont Refugee Resettlement Program and the Association of Africans Living in Vermont. Both VRRP and AALV have interpreter agencies as a part of their organizations and they provide us with spoken language, in-person spoken language interpreters from the local community.
There’s also the option at any time to use remote modalities, interpreting services via remote modality and one of those is on a tablet or iPad. We have a contract with a company that provides us with about 15 languages in video format, so this is a live, real interpreter who’s at a remote location. The interpreter and the patient and the provider can all see each other via screen and hear each other. That same company also offers a large number about 200 languages that are audio only, so they don’t always have access to someone in an audio/visual environment but can offer that same basic service audio only.
We also have contracts with two different strictly telephonic interpreting services. Those services can be used just as I’ve described, in an appointment between a provider and a patient using a dual handset phone or a speaker phone. Those telephonic services can also be used for a provider or a staff person who needs to call a patient at home. They dial that same phone number, say the language that they need and get an interpreter on the line and can call a patient that way.
UVM Medical Center: That’s amazing, and it happens pretty quickly.
Lynette Reep: Yes, it happens quite quickly. Of course on the inpatient side it depends how much we know in advance. Some people come in through the emergency department, we may not know immediately that there’s a need. The remote modalities are especially helpful when we don’t have a lot of lead time, you can imagine it can be difficult to get an in-person interpreter in very quickly, but we do attempt to do that when the need is there. We have after hours call lists for the emergency department.
We don’t actually have interpreters on-call literally speaking, we don’t have people who have committed to being available overnight. We do have people who are willing to be called. It’s an option to attempt to fill the need that way. We can’t always do that but we do have those remote modalities available as well.
UVM Medical Center: You mentioned something briefly that I think would be interesting for people to learn more about which is why a family member or some other person close to the patient is not a good choice even though they would obviously be totally expert in that particular dialect or whatever it is. Why is that?
Lynette Reep: I won’t make you do this, but when I do trainings in the departments I actually kind of put it back on the providers to say, “What reasons do you think there might be?” and immediately there’s always a flurry of hands, people have a lot of sense of that from having been on the floor with families and with patients. There are a number of concerns, one of them is family dynamics are very diverse and it’s not really within our immediate capability to judge whether a family’s dynamics are healthy or not healthy for a given patient, we certainly don’t assume that anything untoward is happening in anyone’s family, but we just don’t know that.
Just as when patients come in to the ED they are always asked, “Are you safe at home?” That’s a question that’s asked directly of a patient, it’s not asked through a family member. When you think about why we do that in a similar vein we want to make sure that we’re communicating directly with the patient to be sure, we’re not missing some kind of concern of that sort. That’s one piece, obviously that’s not going to be a problem in most cases at all.
There are other issues in that, we are not really able to judge the language expertise of someone who’s coming in who’s not a professional interpreter, we don’t know how well they understand medical terminology in their first or second language, or in English whether that’s their second, third, fourth language. Also, family members for the best of reasons may have their own agenda when a patient comes in. They may hear news that they don’t want to share either for a personal or cultural reasons, they may not want to pass on bad news. That means that the patient is not getting the information that the provider thinks that she’s getting or he’s getting. There are a number of reason why that might be concerning.
UVM Medical Center: Medical knowledge is an interesting point, too. The folks that we use through these services and that we have relationships, they do have some level of certification in proficiency in medical terminology and so forth?
Lynette Reep: Yes. Certification can be a confusing term. In the interpreting field, certification actually means something very specific; it means that you’ve taken a validated national level exam to prove your skills. Certification for spoken language interpreters in this country is quite rare. If you work at the UN, if you work in a conference setting, that’s a whole different ball game and people in those settings are typically certified. In this kind of community setting, what people get is medically specific training and they might get a certificate of completion that says they’ve had a certain level of training. They may or may not have been tested in a certain way for that training because we work with agencies who are training their own spoken language interpreters to work with us, they take care of the training and the assessing. That’s an understanding in our contract.
It’s a little bit different with the American Sign Language interpreters because that certification is definitely an expectation in the field. The field of American Sign Language interpreting has been professionalized longer than the field of community spoken language interpreting. It’s interesting. Obviously, interpreting has been around as long as there’s been any kind of language contact and of course people have been interpreting at the community level in all kinds of language for many, many years.
In this country, it just so happens that American Sign Language interpreters in community settings were professionalized earlier and so there are some very specific expectations for ASL interpreters including national certification, including continuing professional development or in continuing ED units and that sort of thing. That system is not quite in place in the same way for spoken language interpreters so our expectations are a little different.
UVM Medical Center: In your day to day basis, you’re called in putting out fires I’m sure, what are some of the common things you have to deal with?
Lynette Reep: Absolutely the number issue is family members being asked to interpret or being expected to interpret or coming in expecting to interpret. One particular variation on that that can be challenging for staff and for providers is the family member who says, “This is my job, I interpret for my mother” for instance. I see this very often with women who are the grown daughter of an elderly parent from many different cultural backgrounds. It’s typical for offspring of patients to say, “I am the family interpreter.”
The way that I like to respond to that to avoid unintentionally offending or alienating patients or families is to really reinforce the importance of that family member’s role at that appointment, that we want that family member to feel like they’re a part of the appointment, can ask questions of the provider, can take notes, can disagree, can have a conversation and not feel the burden of have the sort of neutral ongoing role of interpreting at the same time. It’s not really possible to do both well and we really want them there as family members.
I really like to emphasize the importance of their participation and also to emphasize that we will always provide interpreting services that are confidential and at no cost at any time to the patient. That’s really important for people to understand.
UVM Medical Center: As I said in the beginning, really interesting and critically important as you know well. It’s a huge contributor to the quality of care because it can reduce medical errors and length of stay and all the rest of it. In terms of patient care it’s really important to not only to just the comfort that people have, I would think that they know they’re being understood.
Lynette Reep: Definitely. I think it makes a huge difference for the provider, too. Without training or experience, providers may feel that when there’s an interpreter in the room or there’s a family member interpreting, they may feel sort of barrier with their patient. It’s really important to me that the providers see the patients as their patient just as they would with any other patient and have an opportunity to make that really human connection. I think when you have a professional interpreter as a part of that triadic communication, it really makes a difference. It allows not only the patients to feel safer and more comfortable, but I think it makes the provider’s job more successful and more enjoyable too.
UVM Medical Center: That’s Lynette Reep, she’s the Interpreter Coordinator at the UVM Medical Center. I want to thank you very much for being with us.
Lynette Reep: Thank you.