Guidelines for "interpreting remotely in the healthcare setting" for interpreters

The following provides some insights, guidance, and training to support our interpreters to provide more effective remote interpreting services in the healthcare setting (click the headings for more information):

When interpreting in the healthcare setting, we expect professional interpreters to be:

  • [Conduit] to process the spoken language, with meaning, so that the exact equivalent is provided in the target language, with no omissions, additions or editing.
  • [Clarifier] to interpret the underlying and metaphorical meanings within the cultural context. NB: interpreters need to alert practitioners when interpreting metaphors literally and then provide the meanings within the cultural context.
  • [Cultural clarifier] to provide a necessary framework for the message being interpreted. As part of the cultural clarifier role, interpreters need to inform either party (practitioner or patient) about relevant cultural practices and expectations, ethics and etiquette when there is either apparent or potential misunderstanding and assist in maintaining a good relationship with better understanding and respect.

For remote interpreting via telephone or video conference the following competencies are expected:

  • consecutive interpreting
  • sight translation

 NOTE: 

  • Simultaneous interpreting modality is not expected for telephone or video conference interpreting. Most patients and practitioners are not familiar with this interpreting mode.
  • Sign-language interpreter can only be delivered via video conferencing.

Other essential competencies include:

  • Culturally competent
  • Extensive health knowledge
  • Extensive medical terminology
  • Contextual and semantic interpreting skills

The following standards are expected from interpreters: 

  • Accuracy – interprets accurately and faithfully.
  • Confidentiality – all information shall remain strictly confidential.
  • Impartiality – interprets without bias.
  • Standard of conduct – complies with lawful requirements.
  • Conflict of interest – declares a conflict of interest.
  • Professional courtesy – acts appropriately and tactfully.
  • Declining works – declines if beyond own capability.
  • Contractual obligations – maintain integrity.

Here are some remote interpreting scenarios which explain what you need to know and consider.

(1) Connecting to multiple remote parties 

This scenario involves a health practitioner, who is on his own, connecting the phone/video conference system to a remote patient, a remote interpreter (and others). Everyone is joining the session remotely.

  • For telephone interpreting, you are on your own, and:
    • you are either connecting to the health practitioner via your phone or
    • you are connected by the health practitioner via your phone.
  • For video conference interpreting, you are you your own, and:
    • you are either connecting to the health practitioner via your smartphone, device, tablet or PC or
    • you are connected by the health practitioner via your smartphone, device, tablet or PC.
  • For both telephone and video conference interpreting:
    • you need to make sure you are in a private space to ensure confidentiality and a quiet space to avoid noise disturbance.
    • NB: this type of scenario will be the commonly used approach during a pandemic (eg COVID-19) to reduce close contacts.  

 (2) When 1-1 connects to a remote interpreter 

This scenario involves a health practitioner with an in-person patient in a clinic space or a hospital bed, connecting to a remote interpreter by phone/video conferencing system: 

  • For both telephone and video conference interpreting:
    • you need to make sure you are in a private space to ensure confidentiality and a quiet space to avoid noise disturbance.
    • NB: this type of scenario will be reduced and limited for crucial cases during a pandemic, (eg COVID-1) to reduce close contacts.

(3) When a group is connecting to multiple in-person parties 

This scenario involves a health practitioner with a patient and family in a meeting room, connecting to a remote interpreter via phone/video conferencing:

  • For both telephone and video conference interpreting:
    • you need to make sure you are in a private space to ensure confidentiality and a quiet space to avoid noise disturbance.
    • NB: this type of scenario will be reduced and limited to special cases during a pandemic, (eg COVID-1) to reduce close contacts.

Reminder: interpreters must have the following to be able to provide video conference interpreting service:

  • access via a desktop computer (PC) or laptop or tablet or smartphone
  • have access to internet with good quality wifi, with at least 25 Mbps or above to support streaming activity
  • access to a headphone for privacy.

Be aware that, in face-to-face communication, the majority of the information we convey to others is through non-verbal communication and tone of voice (ie intonation, accent, stress, pitch, speed, and volume). For telephone interpreting, there are no visual cues, it depends on the quality of voice, and it can be quite stressful for the interpreter when multiple parties are involved.

The following factors may reduce the effectiveness of the provision of telephone interpreting services:

  • poor quality connection 
  • you have a heavy foreign accent (will need to speak slightly louder and slower)
  • when the interpreting session involves more than 3 parties and the health practitioner is not familiar with how to manage the interpreting session.
  • accent (will need to speak slightly louder and slower)
  • when involving more than 3 parties, and the health practitioner is not familiar with how to manage the interpreting session.

The following factors may reduce the effectiveness of the provision of telephone interpreting service, that is:

  • you are not familiar with how to connect to the video session
  • you are familiar with the use of the video conference facility eg Zoom
  • the internet is not stable throughout the session for one or more parties involved.
  • you have a heavy foreign accent (will need to speak slightly louder and slower)
  • when the interpreting session involves more than 3 parties, and the health practitioner is not familiar how to manage the interpreting session.

NB: The first two points need to be resolved by ensuring you are familiar with how to connect via the zoom/video conferencing system. The third point is more difficult to resolve because it is about broadband speed. For the last point, there is a course on "how to work with remote interpreters" for health practitioners who are not familiar with managing the interpreting process.

The guidelines provide essential advice for interpreters to enhance their service provision through a better understanding of how to work with the health practitioners who could be offering them:

  • a pre-brief before the session
  • a session structuring with all parties at the start of the session
  • a session structuring with all parties during the session
  • a debriefing after the session.

 The knowledge of these guidelines will enable interpreters to: 

  • establish an alliance with the health practitioner and to agree on the interpreting process
  • be guided by the health practitioners during the session
  • minimise the frustration of having unwarranted expectations from patients or other parties involved.
  • achieve a better interpreting outcome and experience.

Before the session (pre-brief with the health practitioner)

The purpose of a pre-brief is to establish a good working relationship with the health practitioner and to agree on the interpreting process.

During the pre-brief interpreters could:

  • find out what is the purpose and objectives of the session
  • confirm you are in a quiet and confidential space (this is very assuring for the patient)
  • identify who is leading the session if multiple parties are involved in the telephone session. NB. The role of the leader is to help to facilitate the interpreting process eg manage conversation pauses to allow the interpreter to interpret
  • confirm the use of consecutive interpreting (avoid making an assumption)
  • establish a cue to pause the session (eg if the session is too overwhelming)
  • establish how best to interpret if the client has a cognitive or mental illness such as thought disorder (eg to summarise the information or interpret literally with meaning or without meaning)
  • explain any cultural issues or protocols if needed.

At the start of the session (structuring the session with the patient and others involved):

The purpose of structuring the session at the start of the session is to help the patient and others involved in the interpreting session to understand how to work together. A set of guidelines is provided to health practitioners to: 

  • explain that everything said in the session will be interpreted, ie there are not to be private discussions between parties during the session
  • assure the client that the rule of confidentiality applies to both the practitioner(s) and the interpreter
  • explain the use of consecutive interpreting mode and the interpreting process, eg the need to pause for the interpreter to interpret after two-three sentences.

NB: By setting these rules at the beginning, the health practitioners will be able to remind everyone about the rules again if the interpreting process is affected.  

During the session (communication protocols):

We have provided the following protocols to guide health practitioners on how to work with you during the session.

Health practitioners are recommended to: 

  • use the first person singular when communicating via the interpreter, eg “Mrs. Wong, how are you feeling today” and not “Please ask Mrs. Wong how she feels today”
  • direct the questions/statements to the client or family, and not directly to the interpreter
  • avoid entering into direct conversation with the interpreter except for cultural or process clarification and then let the patient knows what you were talking about (ie never exclude the client)
  • pause after 2-3 sentences to allow the interpreter to interpret
  • allow enough time for the interpreter to convey information (it may only take three words to explain but it may take more time for the interpreter to convey the information in their language)
  • for video conferencing, politely signal to the patient/others involved, if you need them to pause for the interpreter to interpret (a hand gesture or ask for a pause)
  • for telephone interpreting, ask the patient/others to pause for the interpreter to interpret.
  • use simple and succinct language
  • explain concepts or medical terminologies using simple English
  • avoid using jargon, idiom, colloquial language, metaphors, or double negatives
  • avoid asking more than one question at a time
  • reframe questions if the responses from the patient are not what you expected, eg you could ask specifically "When was the last time this symptom occurred i.e. 1 month, 2 months or more?" instead of an open-ended question
  • watch the speed of conversation to minimise accent and pronunciation issues
  • speak clearly and loudly but do not rush and talk over each other
  • manage the situation if the interpreter is emotionally affected by the discussion

NB: Being aware of these protocols, you will be able to be guided by the health practitioners throughout the session. However not all health practitioners are trained on the guidelines as yet. Some may not be familiar with working with interpreters.

After the session (debrief the interpreter, if needed)

You could ask for a debrief with the health practitioner, or the health practitioner could ask for a debrief. For telephone and video conference interpreting, you could stay behind for the debrief session.  Our guidelines for health practitioners is to provide a debrief if they need to: 

  • summarise the session and identify any issues meeting the objectives.
  • clarify any interpreting or cultural issues if:
    • they are concerns or are unsure about contradictory, negative (non-verbal or verbal), unexpected responses, or lack of response, from the patient.
    • they felt that at some point that the translation of information did not correspond with the responses from the patients.
    • they wish to clarify any cultural meanings of some of the words, concepts or responses.
  • check you (the interpreter) is feeling
    • assess whether the interpreter is affected by the content of session and address if necessary.
  • check for transference issues, please be aware that it is not uncommon for interpreters to experience distress in response to patients' experiences.
    • if you feel emotionally affected and distressed by the session:
      • if the health practitioner has time, you could talk about how you feel before concluding the de-brief
      • if the health practitioner doesn’t have, you must make sure you know how to access supervision or counseling support or to contact the interpreting service provider for such support.

NB:

  • Interpreters move from one interpreting session to another. You may bring your transference issues to another emotional session. Self-care is of utmost importance
  • It would be useful to have at least a five minutes pre-brief and five minutes debrief. The amount of time for de-brief is dependent on what is involved.

The following course is available for professionally trained interpreters which experience and knowledge working in the healthcare setting.

Course name: "Module 201: Interpreting remotely in the healthcare setting”

This course aims to provide the essential knowledge and skills to help interpreters proivde more effective remote interpreting services in the healthcare setting.

Participants after completing the course will:

  • gain an understanding of service expectations from interpreters: roles, competencies, and code of ethics
  • gain knowledge of common issues in interpreting, that could impact on poor patient outcome
  • become aware of the different remote interpreting scenarios: equipment and limitations
  • gain an understanding of your rights and responsibilities when providing remote interpreting, eg pre-briefing, structuring, and debriefing.

For more information about this course and a list of available training dates, click here.

  • Duration: 1 hour
  • Delivered: via zoom video conferencing.
  • Enrolled via eCALD.com website Login page.