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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 ➔ 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’)