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Table 3 From muddling through to institutional approaches to health care interpreting: five phases

From: The evolution of a healthcare interpreting service mapped against the bilingual health communication model: a historical qualitative case study

Phase

Main characteristics

Main challenges

Political and policy context factors

Phase 1: 1992–1995

 Patchy appearance of healthcare interpreting

Emerging interpreter services

Languages of asylum seekers

Few departments use interpreters

Wide array of different interpreter types

No tradition of using interpreters at all

What should the profile of a health care interpreter be?

Migration pressure and sharp increase of asylum seekers and refugees ‘to do something’ in terms of language access

Up to now policy of assimilation

Phase 2: 1995–1999

 First formalised interpreter services for asylum seekers and refugees

Refugees from the Balkan and Africa and Middle-East

Many traumatised people

Special programme of providing Albanian-speaking interpreters to Kosovo refugees, sensitising all medical departments for interpreting

War, political unrest in countries that make people flee

Effect on interpreters interpreting for traumatised people

Different services asking for different interpreter services

Migration and mobility as a consequence of globalisation âž” changing demographics and therefore changing patient population patterns

Phase 3: 1999–2003

 Healthcare interpreting provision is an quality of care issue

Research shows, using interpreters can improve quality of care for allophone patients

Trainings for interpreters and training health professionals on how to work with interpreters

Clinical ethics committee issues advice on the use of interpreters

Service agreement with interpreter service

How normative should the hospital be regarding the use of ad hoc vs. professional interpreters?

Health professionals use interpreters, and costs increase

Multicultural acceptance increases, multiculturalism instead of assimilation policy

Health services become aware that they are to cater for new patient populations

Phase 4: 2004–2010

 Towards institutionalised interpreter services

Clarification on different interpreter roles

Coordinated efforts at the national level (cantons, other university hospitals) and international level (Migrant-Friendly Hospital initiative

Increasingly important role of Interpret’ (the Swiss interpreter association)

Costing studies into language barriers appear in Switzerland

Who should fulfil the interpreter roles, and what interpreter roles are called for by health professionals

Autonomy of interpreters; they should get organised, they should have their rights addressed

Integration policy instead of assimilation policy

Diversity mainstreaming as a health policy approach

Phase 5: 2011–2016

 Towards equity

Health care interpreting—a transcultural approach, interventions that target vulnerable groups

Interpreting embedded in a package that aims at improving the quality of care of minority groups

Hospitals for Equity

A right to have an interpreter?

In the area of the epidemic of chronic diseases, there is a need to develop language-accessible chronic disease management programmes

Health care interpreting—an element of global public health?

At the same time: resurgence of assimilation politics (‘those migrants just have to learn our language’)