Accreditation & Certification

Stick Out Your Tongues Speaking the Language of International Healthcare

Accreditation & Certification

Health care consumers today can choose their providers from a global marketplace. Whether they are seeking the highest quality of care, the world’s foremost experts in a given area of medicine, or a lower cost than what is available in their home market, patients can quickly and easily find countless facilities and practitioners competing for their business. How can hospitals and health care service providers rise to the top of the international medical tourism marketplace?

The search for health care services begins (and possibly ends) with something called “language access.” In other words, how accessible are your services – and even the information on how to obtain them – to patients who speak other languages? This is an issue that touches every part of a health care organization – from its compliance department, to its IT/web services group all the way to its front-line staff. This article presents key considerations for helping your organization reach patients across borders of language and culture.

Create a Multilingual and Culturally Appropriate Web Presence

How are your patients finding you? Increasingly, individuals will conduct online searches or visit your website to obtain more information. If your goal is to reach more patients that speak a given language or reside in a specific country, both your website and your search engine marketing must be optimized for this purpose. You’ll want to make sure that your website is localized into the languages that your patients speak, and that the content is appealing to them.

In order to do this, you’ll need more than just technical expertise – your team will need to ensure that the images, text, and even the navigation elements are appropriate for the culture and language in question. This doesn’t mean that you will need to translate every single page of your website, but you do need to make sure that you give patients access to the most important and commonly requested information in their native tongues.

For example, the Mayo Clinic has localized some of its website for Arabic-speaking patients (see Figure 1) Instead of having the navigation appear on the left, as it does for most English sites, the menu items are listed on the right instead, since Arabic reads from right to left. Also, the image that was chosen shows a culturally appropriate interaction between a female patient and a female physician. Not all of the information is available in Arabic – some text still appears in English – but many of the essential questions that a patient might ask are answered here.

Figure 1: Language and Culture-Specific Web Content for Arabic-Speaking Patients. Source: Mayo Clinic

However, having culturally and linguistically targeted content is just one piece of the multilingual web puzzle. You will need to make sure that your website is optimized for discovery in online search queries, so that your organization appears among the first few search results for given words and phrases – in all of the languages that your patients may speak. And, you’ll also need to make sure that individuals can find content in their languages quickly and easily.

Hygeia Healthcare has done a good job with its search engine optimization for knee surgery. A patient in the United States who searches for “Thailand knee surgery” will find Hygeia Healthcare’s English language website as the very first result that appears. However, while the organization appears at the top of the search results, its website’s language display is lacking. The languages appear in a dropdown menu on the right side of the page, with an instruction that says “select language” in English (see Figure 2). If the health care consumer speaks German, one of the languages available on the site, he or she might not think to click on the drop-down menu, and even so, the language names are written in English.

Figure 2: While English Content is Easy to Find, Other Languages Prove Difficult to Access. Source: Hygeia Healthcare

A better way to guide visitors to language-specific content is to simply put the name of the language – written in that language – at the top of the website in a visible place with a hyperlink to the appropriate content. Avoid using flags – contrary to widespread use, this is not the best way to direct individuals to content in their languages. Many flags resemble each other, images are slower to load than text, and flags are simply unnecessary when targeting individuals from many countries who speak the same language. Also, a given country might have a linguistically diverse population – for example, India is home to several hundred different languages, making it difficult to equate the nation’s flag with a single tongue.

If you target patients in multiple countries, you may also want to purchase relevant international domain names for your organization. Web properties are available today not just with country-specific extensions (such as .fr for France and .uk for the United Kingdom), but in non-Latin scripts for languages such as Arabic and Chinese.

Using Multilingual Staff Wisely – and Carefully

If you are advertising that you provide services in other languages, how well does your staff truly communicate in those tongues? The language skills of your staff are important – if patients have an easy time asking questions and understanding instructions, it not only improves the quality of their experience, but makes them more likely to refer other patients to your facility. It is not sufficient to state that you provide services in a given language. After all, how do you know that the nurse speaks perfect English if she has never had her language skills professionally evaluated? Having health care professionals make medical decisions based on conversations that take place in another language can be risky if their skill levels are unknown.

Organizations such as Language Testing International offer phone-based and computer-based language testing in more than 60 languages. Tests are essential to evaluate the language proficiency of everyone who communicates with patients in other languages. For example, a registration clerk might only require a basic level of fluency, while a nurse who provides patients with discharge instructions might need to have a higher level of skill.

Many facilities overlook the chance to use their multilingualism as a marketing tool. For example, many health plans market to the Spanish-speaking population in the United States. Imagine being able to say not just, “Some of the physicians in our network speak Spanish,” but “All of our Spanish-speaking physicians have been tested for language proficiency.” The latter statement shows a recognition of the fact that patients don’t want to be treated by a doctor who took just a couple of years of Spanish in high school, but someone who can truly communicate in detail about health care matters.

Taking Advantage of Strategic Language Partners

A recent study from market research firm Common Sense Advisory reveals that the global market for outsourced translation, interpreting, and localization services is worth US$26.327 billion in 2010 and consists of 23,380 vendors throughout the world. Yet, many health care facilities continue to try to do things the hard way – asking their bilingual health care staff to spend time translating materials or interpreting. Asking staff to carry out language-related tasks is a poor use of their time and expertise. Even if they speak two languages fluently, they are unlikely to have the proper credentials to translate written documents or provide professional medical interpreting services – let alone localize your web content. These are jobs best left to language professionals.

Thankfully, finding a vendor is not difficult – a simple web search for “translation agencies” or “interpreting companies” will help you find plenty of options. Printed business directories and phone books also have many listings for language service providers. Better yet, get recommendations or referrals for vendors from other health care organizations. If they have experience working directly with medical content, chances are they will be a better fit.

If you are looking for a company with cultural expertise as well as linguistic know-how, ask if they offer “transcreation,” a service which relates not just to the direct translation of words from one language into another, but involves developing or customizing content for a specific target audience or culture. Transcreation ensures that your messages will resonate more genuinely with your intended market. For example, a dietary information sheet produced for English-speaking patients at Harborview Medical Center in Washington shows a plate, fork, knife, and spoon. The Vietnamese version depicts chopsticks and a bowl instead. The foods listed are also targeted to the culture in question. The transcreation process enables health care organizations to provide content to different populations while still making sure that messages are relevant and easily understood.

Figure 3: Transcreation Makes Culturally and Linguistically Relevant Content a Reality. Source: Harborview Medical Center

Also, consider connecting with a telephone interpreting firm – these companies offer medical interpreters in more than 150 languages on a 24 by 7 basis. Conferencing in a telephone interpreter can be a lifesaver for a patient who needs to describe a critical symptom, especially when no one else is available who speaks the language in question. Every phone at your facility can be easily programmed to connect to an interpreter instantly, and this feature gives your organization the ability to instantly make use of the fact that you can communicate in more than one hundred languages – an impressive but important point that you can include in your marketing messages for international patients.

Most importantly, by using strategic partners for language services instead of relying exclusively on internal resources, you can slowly increase your organization’s level of language access over time. Perhaps right now your budget will allow you to translate only a set number of materials or just a few pages of your website, but that’s an important start. Over time, as you track your web traffic and see it result in more business from international markets, you can justify increasing your spending on language services.

A Truly International Facility Speaks the Language(s) of the Patient

Your facility’s linguistic capacity is not just a marketing gimmick or a “nice-to-have” feature – it’s an essential differentiator in today’s global health care market. The organizations that invest in strengthening their language access early on have a clear competitive advantage – not only in attracting more customers, but in retaining them. Health care decision-making is highly personal in nature, and patients want confidence that they can trust their providers – especially when they are traveling to another country to seek care. Stick out your tongue – or better yet, put forth your messages in every tongue that your patients happen to speak – in order to build trust and enhance your organization’s reputation as a leading international provider of health care services.

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About The Author

Nataly Kelly is an analyst with Common Sense Advisory, a market research firm that specializes in the language services industry. She is the author of Telephone Interpreting, the first-ever book on the topic of phone-based language interpretation. A former Fulbright scholar in sociolinguistics, Ms. Kelly has formerly served as a board member of the National Council on Interpreting in Health Care, and is an invited member of the National Project Advisory Committee for a web-based training program for culturally and linguistically appropriate services offered through the U.S. Department of Health and Human Services – Office of Minority Health. Contact:

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