Table 3.

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

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’)