Q&A with HBI Principal Director Tina Williams.
HBI Principal Director, Tina Williams, spent three years overseeing the interpreter services program for a 1,000-bed academic medical center. During that time, she gained significant insight into the pros and cons of outsourced and insourced interpreter service models, owing to the demand for services, the culture of the organization, and its hybrid approach.
HBI: Can you provide your general thoughts on insourcing versus outsourcing, and why a hybrid approach might be more ideal?
Williams: This organization made the decision to use a hybrid model due to the type of care provided by the Level I trauma center and a desire to ensure that each patient and family member understood the care they were agreeing to. Whenever possible, our interpreters provided this service either face to face or virtually, from our call center. Otherwise, we used a vendor. We had a good working relationship with our vendor and knew they held their interpreters to the same standards as ours. The interpreters could come onsite to service the hospitals and clinics, and they were qualified and trustworthy.
However, I don‘t think there is any way to completely insource interpreter services, because you always have more languages than staff and it’s not cost effective to staff 24/7 due to volumes. At my organization, we regularly had patients that spoke six or seven languages. At one point, we had representations for the top five, but, due to budgetary constraints, that has been reduced to the top two languages.
So, if it is one of the top languages, the ideal option is face-to-face interpreting. The second is video, internally, and the third line is a vendor that provides video interpreting. There are many vendors who provide video interpreters, and, if they don‘t have a video interpreter for a specific language or if an interpreter is not available, it goes to a phone interpreter which greatly expands the volume of interpreters. My organization also contracted with a second vendor to serve as a backup to the primary vendor when necessary.
HBI: From our understanding, it is particularly important to have onsite translators in critical areas such as the emergency department. Is that true?
Williams: That’s correct. At my organization, we had interpreters onsite manning the emergency rooms until midnight on weekdays and from 7:00 am to 7:00 pm on weekends. The vendor provided additional 24-hour support.
The operating rooms are another important area. Patients start arriving to the ORs around 6:00 am, so we always staffed interpreters onsite in the ORs from 6:00 am to 2:00 pm. After 2:00 pm, all surgeries for that day had at least started. The OR is one area where you want to make sure the patients clearly understand the procedure, the risks and benefits, and the intended outcome of the surgery.
HBI: What are some of the criteria organizations can use to determine where to place interpreters? Is using demographic information a common approach?
Williams: You can certainly do that. But, because of the number of hospitals and nonhospital locations in the surrounding counties, the organization chose to strategically place interpreters according to the Epic schedule. In the system, you can book an appointment and a resource at the same time, so, based on the patient’s language requirements, we booked the appropriate interpreter as a resource. We were always able to pull up schedules one to three days ahead to know where we needed to deploy staff. It’s more reliable, because a patient could live in one area but see a doctor on other side of the town near where they worked. We used the zip code of the office where the patient was scheduled rather than where they live.
HBI: What role does cost play in determining whether to insource or outsource?
Williams: There are several factors, and cost is definitely one of them. Although, I am not sure that outsourcing is always cheaper, and, from my experience, I am also not sure that outsourcing is always reliable. You have to be sure that your vendor thoroughly screens its applicants and requires high competency levels before allowing interpreters to work in a hospital or clinic setting. After all, the primary mission is to provide patients with quality, informed care and reliable service, so whatever strategy an organization can use to achieve that goal, whether it is outsourcing, insourcing, or a hybrid model, one must always weigh both cost and quality.