1. Safety Training
   1. All leaders, supervisors, and foremen should at least take an OSHA 30-hour class  
   1. They should receive additional specialized training as appropriate for assigned tasks, including but not limited to:
      1. Permit-Required Confined Space
      1. Excavation and Trenching
      1. Fall Protection
   1. Furthermore, supervisors should obtain a safety-trained supervisor (STS) certification
2. Leadership Skills
   1. Supervisors should participate in leadership training to learn how to effectively:
      1. Convey company safety vision 
      1. Communicate expectations
      1. Listen
      1. Coach workers to craft a robust jobsite safety climate
      1. Provide both positive and negative constructive response
      1. Understand processes and anticipations
3. Finding Root Cause
   1. Train supervisors, foremen, and safety to conduct root cause analyses to examine: committees
      1. Environment
      1. Organization 
      1. Human factors that contribute to site incidents and close calls. 
   1. A process should be developed to share findings from these investigations across the organization
4. Role Model
   1. Educate supervisors on the significance of demonstrating good safety example:
      1. Foremen should always use proper personal protective equipment (PPE)
      1. Insist workers and managers who arrive on site to don PPE 
      1. Maintain accountability expectations
      1. When addressing worker complaints, supervisors should recognize that workers may not have the experience or training to recognize risk as you do
5. Cultural Training
   1. Supervisors must understand and be culturally sensitive to immigrants
      1. Cultural training bridges misunderstanding
      1. Retain interpreter services to insure limited English proficient workers’ comprehension
      1. Select and train promising immigrants for promotions
      1. Solicit services of bilingual, culturally competent safety consultants

Well guess what, normally I move on to the next subject after part 2. However, this time I have a part 3! What steps need to be taken to train workers?

This is the first of a series of articles on safety culture and climate in the workplace. I begin at the top with company leaders!

Years ago, I observed a four-year-old boy using extremely vulgar language! The parents reacted with an extremely shocked look, saying, “Oh my God! I have no idea where he picked that up from!” I had no doubt where he learned those words. That young boy was like a parrot, repeating what was spoken at home. He was reflecting the real language spoken at home.

Likewise, whenever I enter a jobsite and observe the workers performing their duties, I see a reflection of their supervisors! If they are organized, efficient, productive, and safe, I already know that the supervisor is exactly that way. If the workers cut corners, are careless, messy, and disorganized, I will assume they also reflect their supervisor. I’m rarely wrong.

The workforce will always reflect leadership. It doesn’t matter what the leaders say, employees are observing what they do! Actions speak louder than words.  Besides, nobody likes a hypocrite.  Therefore, if a company leader constantly reminds others to be safe but does not himself follow the rules, the employees will notice and often follow suit.

Management’s commitment to keeping employees safe is demonstrated through their speech and deeds. If leaders don’t set a good example, creating and maintaining a positive safety climate is impossible.  Most companies will say, “safety is #1!”  In fact, when you look at most of their websites, they often claim it is a core principle for the company. The fact is that although many companies sing the song, they don’t reflect it in their dance. Employees know that difference and will only take to heart the safety message if management and leadership are practicing it themselves.

Now, let’s add another layer to this discussion. Often, many immigrants in this country view themselves as outsiders. Many believe that the United States community considers them to be a secondary, less important group. They appreciate that a company has a strong safety culture with a lot of training. However, they believe that all that effort is reserved for the “American citizen,” not the immigrant. They hear the message, but somehow think it isn’t for them. For this reason, at the end of this series on safety culture, I will add an additional segment on immigrant culture, beliefs, and its effect on safety culture.

This last segment is important; a company might be doing everything right and still have a problem if they fail to recognize and treat a problem with their immigrant employees. Part 2 will discuss ways for management and leaders to set a good example.

Human beings, however, are far more complex than a simple telephone. To simply view or categorize an interpreter as a conduit of communication would be a mistake. This perspective is limiting and fails to acknowledge that professional interpreters often possess insight and can perceive vital information that the healthcare professional might miss.

The Goal

The goal in the medical setting is for the interpreter to serve as a communication bridge. You want communication to flow as closely and accurately as possible, as if people were speaking to each other in the same language. Obviously, the patient wants to make sure the doctor understands everything he is saying. Likewise, the medical professional wants his message transmitted exactly as he intends it to be said.

Why teach that interpreters are conduits?

As is the case for most professionals, interpreters must also follow a code of ethics. Within that code of ethics, the interpreter is to be unbiased and maintain transparency. Experience has shown that staying unbiased, can be a real challenge for interpreters in a medical setting. When life and death is at stake, emotions can run high. It is natural for an interpreter to empathize with a patient who is suffering grief.

When an interpreter takes on the role of the patient and speaks as if he is the patient, it is common for them to suffer what is known as vicarious trauma. The emotional patient begins to describe his pain and suffering. He describes his terrible traumatic experience and the interpreter is relating all of this as if he is the one that went through that horrible experience. Often this exercise can cause the interpreter to empathize so greatly with the patient that he himself suffers emotional trauma.

 Often when patients are emotional and frustrated, they begin to believe that perhaps they are not getting the best medical treatment. Health care interpreters are not exempt from having their own personal opinions about the quality of care that they might be observing. In highly charged emotional situations, some interpreters had sided with the patient in their defense. Medical interpreters are not professionals and are not qualified to make such judgments. However, it is easy to fall into this trap when emotions are extremely high.

To help interpreters maintain their professionalism and stay unbiased, interpreters are typically encouraged to limit personal time with their patient. Avoid unnecessary chatting. Erect an invisible wall and maintain a business only relationship. Basically, the idea is to turn the interpreter into a machine with no emotions.

By categorizing the role of the interpreter as simply a conduit of information the issue of the interpreter staying unbiased is addressed. However, there are other issues to address if a patient is to receive quality care. The next blog will take a closer look at the role of the professional healthcare interpreter.

In part one, we reviewed communication breakdowns at home and with the first recorded skyscraper in ancient history, the Tower of Babel. We discussed how important communication is and how challenging it is to do well in our own language.  Now grasp the degree of challenge associated with a limited English proficient (LEP), multilingual workforce. Below are steps you can take to foster communication in a healthy safety climate.

1. Safety Materials
   1. Review company safety materials to ensure a consistent positive safety message
   1. Ensure the safety materials are in a language all your employees understand
   1. Utilize both formal and informal communication channels
   1. Don’t damage mutual trust between employees and management with mixed messages about safety and productivity
   1. Actions speak louder than words; leadership deeds and conduct can negate the valued safety message
2. Clearly Communicate Policies and Procedures
   1. State policies and procedures to all employees
   1. Company policies and procedures unrelated to safety should be reviewed to see if a safety component can be added
   1. Ensure policies and procedures are plainly written, available, and understood by all employees, including all non-English speaking employees
   1. Review policies and procedures with all employees:
      1. When hired
      1. Annually or other appropriate occasions
      1. Upon any organizational changes
3. Transparency
   1. Clearly address employee safety concerns
   1. Visibly engage employees in considering related policies and procedures as issues arise
   1. Contemplate developing an online incident reporting system to notify management when close calls occur, or a hazardous condition exists
   1. Conspicuously posting a report on management’s corrective actions to alert employees
4. Create conversation opportunities
   1. Examine ways to directly converse with employees regarding safety
   1. Utilize formal and informal methods to enable honest dialogue about safety among:
      1. Project owners
      1. Management
      1. Employees
   1. Candid discussion helps employees trust that management values safety and empowers them to protect themselves and their co-workers
   1. Project owners should be visible, accessible, and engage in open dialogue
   1. It is critical that management be sensitive to LEP employees to include them in meaningfully safety discussions (professional interpreting services may be needed for these meetings)

Some mechanisms for creating an open dialogue on and off the jobsite include:

1. Joint employee-management committees These distribute power and responsibility for safety-related decision making, which inspires mutual confidence between employees and managementEliminate barriers to employee participation
2. Daily safety conversations provide an excellent opportunity to involve and empower employees in identifying and addressing hazards promptly
   1. Brief – approximately 15 minutes
   1. Part of pre-task planning to reveal possible hazards and how to prevent them
3. Joint site inspection and informal conversations
   1. Joint management-employee walk-arounds help identify and resolve new hazards as they emerge during the day
   1. Informal conversations with employees throughout the day effectively reaffirm safety values and encourage ongoing two-way conversations between employees and management about potential safety concerns

In recent years, there have been many changes in the USA health care sector. We have observed changes in the way doctors practice medicine.  Also, hospitals have been consolidating.

In March of 2010, The Patient Protection and Affordable Care Act, known by most people as Obamacare was enacted into law. As a result, many changes began to occur. Doctors were under obligation to provide complete care. This made it more difficult for individual doctors to manage their own offices. They needed to become part of a larger team who can treat whatever needs the patient might have. As part of complete care, doctors are also now required to provide a medical interpreter if a patient needs one.

Shortly after Obamacare was enacted, doctors began to affiliate themselves with hospitals in order to provide complete care. Most hospitals provide their own interpreters and many of them use telephonic or video interpreters as well.

As part of the hospital policy, many doctors’ offices now found themselves obligated to use telephonic or video interpreters. Many of the health care professionals that I speak to hate using telephonic interpreters. Sometimes the signal is bad or the interpreter isn’t very effective They  can’t always hear and observe everything that is occurring in the visit. 

I have also found that many doctors’ offices and medical groups have found themselves obligated to use telephonic interpreters for their practices in order to comply with Obamacare.  Typically, in-person interpreters are much more effective than those accessed by the telephone. However, national agencies usually charge a premium for them and most small companies cannot afford it.

If you are a medical practice in the State of South Carolina and you have found this to be your frustration, consider Alfonso interpreting. Alfonso interpreting is a Company that provides professional health care interpreters throughout the state of South Carolina. Believe me, we aren’t cheap. Nevertheless, because we are much smaller than national agencies, we can compete on price and availability without sacrificing professionalism.

Why not give us a call and see how we might be able to help you provide quality, ethical interpreting without breaking the bank?