ISO 21998:2020 Interpreting services – Healthcare interpreting – Requirements and recommendations

Published on 03.03.2022

Industry Standards Demystified – Part 7

By: Monika Popiolek, ATA TCD Newsletter and Blog contributor and ISO/CEN industry standards expert

ISO 21998:2020 specifies requirements and recommendations for healthcare interpreting services in spoken and signed communication. It is applicable to all situations requiring healthcare interpreting, where the parties involved need to communicate using spoken or signed language in the context of a health-related issue. The document is intended for interpreting service providers (ISPs) and individual healthcare interpreters who can generally use it as a source of information and benchmark for best practice. In particular, the standard specifies requirements for the competences and qualifications of healthcare interpreters and other factors directly affecting the quality and delivery of these services. It also sets requirements and provides recommendations on core processes, training, technical, ethical as well as other aspects of healthcare interpreting services.

Interpreting service providers (ISPs) can also certify in order to demonstrate their conformity to this ISO standard. From the practical and certification point of view, fulfilment of all the requirements set out in ISO 21998 allows the healthcare ISP to demonstrate conformity of their services to this document and their capability to maintain a level of quality in healthcare interpreting services that will meet the client’s and other applicable specifications. Healthcare interpreting is also often referred to as medical interpreting.

Restrictions in the application of this standard are as follows:

  1. the standard does not apply to translation services;
  2. the standard clearly states that it is intended for both institutional ISPs as well as individual healthcare interpreters but the certification of individuals is a complex process governed by different regulations and rules so certification of individuals under this standard may not be possible at this time.

It needs to be noted that ISO 18841:2018 is a generalist interpreting standard while ISO 21998:2020 was developed as a specialist standard which is complementary to ISO 18841.
As stated in the introduction to ISO 21998, the reasoning behind the document is that
healthcare interpreting services enable safe communication mainly between healthcare providers and patients and provide linguistic access to healthcare services.
ISO 21998 was developed in response to a worldwide growing demand to accommodate the interpreting needs of patients accessing healthcare services and healthcare professionals, such as physicians, nurses, and healthcare administrative staff, as well as to promote patient safety, wellbeing, and dignity during interactions related to the provision of healthcare-related services. In those countries that do not have any recognized healthcare interpreting education in place, this document can serve as a guideline and basis for setting up a suitable legal, administrative and educational system for all healthcare interpreting stakeholders.

The document clearly states why healthcare interpreting is distinct from medical or healthcare-related translation. Translation involves the rendering of various forms of content into another language in written form, requiring a process and the allocation of a certain period of time for the task. Interpreting involves rendering spoken or signed messages from one language to another, either face-to-face or via distance interpreting. Some healthcare interpreters are qualified to provide medical translation while others are not. Likewise, some medical translators may or may not be qualified to provide healthcare interpreting services, as these activities require different skill sets. When documents are not translated, healthcare interpreters sight translate the document into the other language.
The document specifies that healthcare interpreting normally takes place between three or more participants:

  1. speaker(s) or signer(s) of a language other than the language the healthcare provider speaks or signs;
  2. healthcare providers or staff;
  3. healthcare interpreter(s).

Healthcare organizations procure interpreting services directly or via an interpreting service provider (ISP). Healthcare interpreters, who come into a healthcare organization to interpret for a particular case, whether face-to-face or via distance interpreting, limit themselves to engaging in the communicative events that require their services. Healthcare interpreters who work in an interpreter services department within a healthcare organization perform tasks and take on responsibilities beyond the act of interpreting in communicative events. These tasks can be related to bridging the cultural and linguistic gaps of the healthcare community, can involve intercultural inquiry, cultural or linguistic education of other healthcare staff, contacting patients, written translations, or addressing matters related to the administration and quality assurance of the interpreting department in question, or comply with patient safety responsibilities as required by their employer. Healthcare interpreters follow standards of practice (see relevant codes of ethics).

Apart from listing specific requirements and recommendations, ISO 21998 also aims to:

  • to promote market transparency in the field of healthcare interpreting;
  • to provide information and clarification for users of healthcare interpreting services;
  • to establish professional working conditions for healthcare interpreters.

Taking the above into account as well as the fact that there were previously no specialist international standards in this area, ISO 21998 was developed in response to an evident market need.

The following stakeholders have been identified in the context of healthcare interpreting:

  • healthcare interpreters;
  • interpreting service providers;
  • patients and accompanying persons;
  • interpreter departments in healthcare organizations;
  • government agencies;
  • non-profit organizations;
  • community organizations that provide interpreting services;
  • employees that provide interpreting services;
  • professional associations;
  • healthcare organizations;
  • educators and researchers;
  • healthcare providers and staff;
  • healthcare policy writers.

Apart from the requirements, recommendations and background information, ISO 20998 defines some key healthcare interpreting terms, such as ‘ healthcare interpreter/medical interpreter’, ‘interpreting service provider (ISP)’, ‘healthcare interpreting’, ‘patient safety’, and this information is an important industry resource in itself.

Healthcare interpreter competences
Under ISO 21998, section 4, healthcare interpreters are required to have the following competences:
1 Patient safety competence
2 Linguistic proficiency competence
3 Intercultural competence
4 Interpersonal competence
5 Technical competence
6 Competence in health-related terminological research
7 Healthcare related competence
8 Communicative competence
9 Interpreting competence
10 Entrepreneurial competence

Healthcare interpreter qualifications
Under ISO 21998, section 5, a healthcare interpreter shall keep on file, and produce upon request, evidence that attests to their qualifications (as appropriate under national rules or legislation which govern healthcare interpreting), such as one of the qualifications below:
a) official certification in healthcare interpreting; or
b) a recognized degree in healthcare interpreting from an institution of post-secondary education; or
c) a recognized degree in interpreting, linguistics, or language studies, which includes at least one year of healthcare interpreting training from an institution of post-secondary education; or
d) a recognized degree in any other field from an institution of post-secondary education, obtained at any time, and two years of continuous experience in healthcare interpreting, in the last ten years, in cases where a) to c) cannot be met (e.g. in a country where healthcare interpreting is just emerging). In the case where only a diploma from an institution of post-secondary education and experience are provided, interpreting service providers and healthcare organizations are recommended to document third-party testing to ensure healthcare interpreting competences, in order to decrease liability and to protect patients from risk.

The main premise of ISO 21998 is that healthcare interpreting should always be performed by suitably qualified and competent healthcare interpreters. The reason that ISO 21998 is considered to be an important specialist industry standard is because it is the first standard that describes the best practice and many core professional requirements and recommendations for specialist professional healthcare interpreting and related professional considerations, such as authorization as healthcare interpreter, professional development — continuing education, and the professional responsibilities of interpreting service providers and interpreters.

ISO 21998 has three informative Annexes:
Annex A – Selection of the interpreting mode
Annex B – Selection of the interpreting modality
Annex C – Self-care and vicarious trauma


Author information: Monika Popiolek has an MA in English, an Executive MBA and is a graduate of a PhD Management Programme. She has been a specialist translator and interpreter for over thirty years and is also an authorised certified legal translator, CEO of MAart Agency Ltd. since 1991, President of the Polish Association of Translation Companies (PSBT) since 2009, Head of National Delegation and Chair of the ISO TC 37 Mirror Committee at PKN, OASIS, ISO and CEN expert since 2007, the EUATC Liaison Rep. to ISO TC 37, member of ATA, and many other organisations. Monika is the author of many publications, member of the editorial board of the JIAL journal (John Benjamins Publishing Company) and has presented at more than 25 international conferences. Her research specializations are: quality management, translation quality assurance, specialist translation and standards (particularly ISO 17100, ISO 9001, ISO/IEC 82079-1, ISO 27001, ISO 21998). She was one of the editors for the ISO 17100 (Translation services – Requirements), Project Leader for two ISO standards (ISO 21998 and ISO 21999), and is the manager of the ISO TC 37 LinkedIn Industry Standards Group.
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