Providing interpreter services in a hospital or healthcare system isn’t simply a matter of having interpreters available. The real challenge is making sure providers can quickly access a qualified interpreter through the right interpreting modality for the situation.
For most healthcare organizations, that means taking a hybrid approach that combines in-person interpreting, video remote interpreting (VRI), and over-the-phone interpreting (OPI) based on the needs of each encounter.
A routine scheduling call may be perfectly suited for a telephone interpreter. An ER visit may benefit from video. A complex behavioral health or end-of-life discussion may call for an interpreter in the room.
The goal isn’t to choose one “best” method of interpreting. It’s to give staff the tools and guidance to choose the right one when it matters.
Addressing Communication Gaps in Healthcare
Language barriers can affect communication throughout the patient experience — from taking a medical history to explaining medications, obtaining informed consent, or providing discharge instructions.
And those communication gaps can become patient-safety issues.
The Agency for Healthcare Research and Quality (AHRQ) identifies language barriers as a patient-safety concern and notes that communication problems involving patients with a non-English language preference (NELP) can contribute to medical errors and adverse events.
Research also supports the use of professional interpreters. A systematic review published in Health Services Research found that professional interpreters were associated with improvements in areas including communication, utilization, clinical outcomes, and patient satisfaction compared with ad hoc interpreting.
How Can a Hospital Provide Interpreters for Patients with a Non-English Language Preference?
Hospitals can provide interpreter access through a combination of:
- Staff or contracted in-person interpreters
- Video remote interpreting (VRI)
- Over-the-phone interpreting (OPI)
- Qualified bilingual healthcare professionals, when the organization has appropriately assessed their language proficiency for direct patient communication
Using multiple options allows hospitals to provide language access across different departments, shifts, languages, and clinical situations.
But simply having those options available isn’t enough.
Healthcare organizations also need clear procedures for when to use each modality, how staff access interpreters, where interpreting equipment is located, how language needs are documented, and what staff should do when their first-choice modality isn’t available.
Choosing the Right Interpreting Modality
There is no single interpreting modality that is best for every healthcare encounter.
To help illustrate how hospitals can approach modality selection, we worked with Debbie Lesser, RID-Certified ASL Healthcare Interpreter and Language Access Consultant, to develop a practical framework for matching interpreting modalities to different healthcare situations.
CLI Expert Perspective — Debbie Lesser, RID-Certified Healthcare Interpreter & Language Access Consultant
Effective language access in healthcare prioritizes the communication and clinical needs of the encounter — not convenience or cost alone.
Interpreter Modality Selection at a Glance
| In-Person | Video Remote (VRI) | Over-the-phone (OPI) | |
| Often Best For… | Complex or extended medical discussions; behavioral health; end-of-life conversations; group settings; encounters involving physical demonstrations; ASL | Emergency department encounters; telemedicine; ICU consultations; visual assessments | Scheduling; prescription clarification; routine follow-ups; insurance questions; brief clinical updates; after-hours support |
| Visual Communication | Full view of body language, facial expressions, physical symptoms, room dynamics, and participants | Facial expressions and some body language are visible; field of view depends on camera placement | Audio only; relies on verbal communication and tone |
| Availability | Usually requires scheduling; availability may be limited for less common languages | On-demand access for many commonly requested languages | Typically offers the broadest on-demand language coverage |
| Technology Needed | None | Tablet, computer, VRI cart, or other video-enabled device with reliable connectivity | Telephone, speakerphone, or dual-handset phone |
| Particularly Useful When… | The encounter is lengthy, highly sensitive, complex, or involves multiple participants | Visual information adds meaningful context | Speed, simplicity, or access to a less commonly requested language is especially important |
These aren’t hard-and-fast rules. Clinical circumstances, patient preferences, language availability, disability-related communication needs, technology, and interpreter availability can all affect the appropriate choice.
The important thing is to give staff a framework for making that choice rather than expecting one modality to work for everything.
When In-Person Interpreting May Be the Better Choice
An interpreter in the room has access to the full environment: body language, facial expressions, physical movement, room dynamics, and interactions among multiple participants.
That can make in-person interpreting particularly valuable for:
- Complex or lengthy conversations
- Behavioral and mental health encounters
- End-of-life discussions
- Family or group therapy
- Certain pediatric encounters
- Physical therapy or encounters requiring physical demonstrations
- Complex surgical consultations
- American Sign Language (ASL)
Group behavioral health encounters deserve particular attention. Remote interpreters may have difficulty seeing or hearing every participant or following interactions occurring outside the camera’s field of view. When those group dynamics are clinically meaningful, an in-person interpreter may provide substantially better access to the entire encounter.
When Video Remote Interpreting May Be the Better Choice
VRI can provide much of the visual connection of an in-person encounter without requiring an interpreter to be physically present.
It can be particularly useful for:
- Emergency department encounters
- Telehealth visits
- Psychiatric evaluations
- ICU consultations
- Dermatology and wound-care encounters
- Conversations where facial expressions and visual cues matter
- ASL and other signed-language interpreting, when deemed effective per the ADA
Video can also provide a valuable middle ground when an in-person interpreter isn’t immediately available but visual communication would improve the encounter.
When Over-the-Phone Interpreting May Be the Better Choice
OPI is often the simplest way to provide rapid language access across a hospital or healthcare system.
It works particularly well for:
- Appointment scheduling
- Prescription clarification
- Routine follow-ups
- Insurance verification
- Brief clinical updates
- After-hours communication
- Situations where visual information isn’t necessary
- Less commonly requested languages that may not be readily available through other modalities
Telephone interpreting can also serve as an important backup when video technology fails or an appropriate in-person or video interpreter isn’t available.
Don’t Just Offer Interpreter Services — Make Them Easy to Use
Making sure thousands of employees across different departments and shifts know how and when to use interpreting services is one of the biggest challenges in a hospital.
A language access program can be well designed on paper and still fail if a nurse at 2 a.m. doesn’t know how to connect to an interpreter or where the VRI device is located.
Healthcare organizations can reduce that problem by making language access instructions easy to find at the point of care.
That might include:
- A one-page modality decision chart
- Interpreter access numbers posted at nursing stations
- Instructions attached directly to VRI carts or devices
- Short videos showing staff how to connect to VRI or OPI
- Department-specific workflows for the ED, ICU, behavioral health, and outpatient clinics
- Clearly identified after-hours support and escalation contacts
- Interpreter and preferred-language information documented in the EHR
- Automated EHR prompts when language services may be needed
The easier the process is, the less likely staff are to improvise when a language barrier arises.
Train Staff on Language Access — Not Just Once
Healthcare systems face constant staff turnover. That makes a single annual email or training session unlikely to be enough.
Instead, language access should be reinforced through several channels.
A hospital might include a short language access module in new-hire orientation, identify department-level language access champions, provide quick-reference materials at the point of care, incorporate language access into annual competencies, and periodically review challenging cases or updated procedures with staff.
Training should answer three very practical questions:
- Why does language access matter?
- How do I get an interpreter?
- Which interpreting option should I use?
If frontline staff can’t answer those questions quickly, the language access program probably isn’t as accessible as it needs to be.
Use Qualified Healthcare Interpreters
Being bilingual and being qualified to interpret in a medical setting are not the same thing.
Healthcare interpreters need the language proficiency and interpreting skills necessary to communicate effectively, accurately, and impartially. They also need familiarity with specialized healthcare vocabulary and professional interpreting ethics.
National certification can be one way to demonstrate expertise, but qualified and certified do not mean the same thing. National healthcare interpreter certification is available in only a limited number of languages, which means hospitals and language service providers also need reliable processes for assessing qualified interpreters in languages where national certification isn’t available.
Avoid Making Family Members the Default Interpreter
When a professional interpreter isn’t immediately visible or available, asking a family member, friend, or bilingual employee to step in can seem faster.
But asking a bilingual individual to interpret doesn’t necessarily mean the patient will receive effective communication.
Untrained interpreters may not understand medical terminology or professional interpreting protocols. They may inadvertently omit, summarize, add to, or change what was said. Patients may also be uncomfortable discussing sensitive medical information through someone they know.
AHRQ identifies failure to use qualified medical interpreters as a potential patient safety concern and highlights high-risk situations such as medication reconciliation, informed consent, emergency care, surgical care, and discharge where effective communication is particularly important.
In addition, working with ad hoc interpreters is prohibited by Section 1557 of the Affordable Care Act (ACA) except in certain circumstances.
Measure Whether Your Language Access Program Is Working
Interpreter utilization data can tell healthcare organizations much more than how many minutes of interpretation they used.
Hospitals can track measures such as:
- Interpreter usage by department and language
- OPI, VRI, and in-person utilization
- Connection and wait times
- Patient feedback
- Staff confidence using each modality
- Cost by modality or encounter
- Quality concerns and interpreter feedback
- Situations where an inappropriate modality was used
Those patterns can reveal opportunities for improvement.
If one department rarely uses interpreter services despite serving a significant NELP population, for example, the issue may not be demand. Staff may not know how to access the service.
If VRI utilization is low, the problem may be device availability, connectivity, training, or simply where the equipment is stored.
Data can help language access teams move from asking “How much interpreting are we using?” to “Is our language access program working the way we intended?”
Your Language Service Provider Should Be Part of the Solution
A language service provider’s job shouldn’t end when an interpreter joins the call.
Hospitals should look for a language service provider (LSP) that can help support the broader language access program through:
- Usage reporting and analytics
- Interpreter quality monitoring
- Staff education
- Implementation support
- Customized quick-reference materials
- Department-specific workflows
- Troubleshooting and escalation support
- Proactive account management
- Guidance on OPI and VRI utilization
A strong provider relationship can also help language access teams identify patterns they may not see from inside the organization.
For example: Are certain departments relying heavily on OPI when VRI might be more appropriate? Are connection times increasing for particular languages? Are staff reporting the same technology issue repeatedly?
Those conversations turn an LSP from an interpreter supplier into a language access partner.
Organizations evaluating their current provider — or considering a new one — can also review our Buyer’s Guide to the Top Telephone and Video Interpretation Companies in the U.S. for additional questions and comparison criteria.
Building a Stronger Language Access Program
The strongest programs use the resources available to them strategically — combining in-person, video, and telephone interpreters and matching those options to the needs of individual patients and clinical encounters.
They also make interpreter access easy for staff, train employees to use it and why it’s important, measure what’s working, and adjust as patient populations, technology, and clinical needs change.
That’s the real advantage of a hybrid approach:
The right modality, at the right time, for the right encounter.
How CLI Supports Healthcare Language Access
Certified Languages International’s healthcare interpreting services help hospitals and healthcare systems make professional interpreter access part of everyday clinical workflows.
CLI provides:
- 24/7 over-the-phone interpretation in 230+ languages
- Video remote interpreting through the MERFi® platform
- Qualified healthcare interpreters
- ASL interpretation
- Language access reporting and analytics
- Implementation and account support
- Flexible solutions designed around healthcare workflows
Whether you’re strengthening an existing language access program or expanding access to telephone and video interpretation, the goal is the same: make it easier for your staff and patients to communicate when it matters most.
