Table 4.

Mapping the four circles of the Bilingual Health Communication Model to the Geneva experience

	What happened?	What could have been done?	Suggestions for optimal approach
Communicative goals	Doctors were trained on how to work with interpreters [77]; interpreters were recruited and trained to work in healthcare settings; Learning materials (leaflets, brochures) [150] were prepared, for both health staff and interpreters [98]. In response to increasing arrival of refugees, health care provision for these was adapted; interpreter services offered them the opportunity to communicate their needs [93] Thanks to refugees an awareness to cultural issues among staff was triggered [151] The arrival of high numbers of Albanian immigrants triggered the Geneva government to finance interpreters in all departments [80]	A clear shift from a narrow bio-medical focus in health care towards a culturally sensitive one A clear shift from the paradigm of a conference interpreting towards community interpreting A clear shift from ‘cultural boxification’ (stereotyping) [152] towards a transcultural approach	Three shifts Targeted healthcare for asylum and refugees, that include interpreter service Training Recruitment of interpreters
Individual agency	Interpreters were involved in navigating patients in health facilities People with language skills, communication skills and interpreting skills (especially languages spoken by refugees) were identified and trained to work with refugee patients [58]. The concept of mediation (as opposed to so-called verbatim translation) was introduced [153].	Involve (migrant) patients in the planning of interpreter services A shift from dual communication (provider–patient) towards triadic communication (‘trialogue’) should have been operated in a more systematic way; The fact that the three ‘agents’ in the bilingual interview have competing interests should have been recognised. An explicit shift away from the black box or conduit model should have operated. A shift away from a ‘Swisso-centric’ view on health care should have been operated.	User involvement Expanded interpreter roles (broader scope); while at the same time, interpreter should not become mini-doctors Develop framework where different types of interpreters Develop triadic concept, ‘trialogue’
System norms	The term interpreter has been successfully advocated, instead of the misleading and ‘narrow’ term of the translator [92, 122] Different roles of interpreting were identified and developed [154] Pragmatic approach regarding the question whether only formal interpreters should be used or also informal interpreters [99] There has been progress on language policy; the term allophone is now widely used [126] The use of informal interpreters has not been banned, but the advantages of both basic types (formal interpreters vs. informal interpreters) have been spelt out. [155] Ethical guidelines were elaborated that justified and even required the use of interpreters [139]	The right to health (of migrants) should be clearly spelt out [156] The right to have an interpreter should be warranted and be known to health professionals Insurance companies should have been convinced that interpreter provision is to be reimbursed.	Right to health Right to have an interpreter Ethical committee Integration of bilingual health staff Health insurance covering interpreter expenses
Quality and equality of care (QEC)	The early awareness that there is a need to provide quality of care for migrants as good as for Swiss patients was a decisive factor to provide interpreter services [157] The use of research ‘disguised’ in quality-of-care projects helped to propel the introduction of interpreters [78] Because of the high number of refugees with PTSD, interpreter provision was accelerated [79] Thanks to coordinated national efforts interpreters were certified [82, 158]. H4E, migrant-friendly hospitals provided a framework that allowed introducing healthcare packages tuned towards migrants and refugees; one of them being interpreting [125]	There has been no pro-active policy development regarding health care interpreting Despite research findings showing interpreters’ cost-effectiveness, there has been no acceptance of financing interpreters by administration of hospital departments Inclusion of healthcare interpreting as an essential in programmes, including chronic disease management, health promotion and prevention, patient-centred care and integrated medicine. Telephone interpreting to be rolled out [107] (national efforts (Federal Office of Public Health) Responses to the global pandemic of chronic diseases have so far not addressed language barriers and interpreter support	Focus on quality of care, including research, including monitoring Context-sensitive interpreting (mental health, PTSD) Telephone interpreting Broad framework, whereby health care interpreting package Costing of interpreter services (to show that not using interpreters is too expensive) Comprehensive chronic disease programmes in which interpreters have their place