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ABSTRACT
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The typical Canadian or American health
care organization accepts as the norm compromised communication between English-speaking
practitioners and non-English-speaking (NES) or Limited-English Proficient
(LEP) patients. Professional health care interpreting is still in the early
stages of acceptance in health care settings within the United States and Canada, and uniform standards of practice for health care interpreters
are in development. The provision of professional interpreters is still a
controversial issue within health organizations lacking such services. For
example, the American Medical Association currently opposes existing U.S.
civil rights legislation requiring physicians to use qualified interpreters.
This interdisciplinary, qualitative, grounded theory, research developed
theoretical frameworks about the necessary organizational contexts and
decision-making processes leading to the creation of professional health care
interpreter services from a convenience sampling of health care organizations
in Canada and the United States. The stories told by health care executives
and managers, health care practitioners, and health interpreting experts in
14 health organizations, about the development of interpreter services in
their sites, were audio taped in on-site interviews, and then transcribed and
examined. A complex variety of compelling reasons for establishing dedicated
interpreter services were found across the sites. Details differed among
sites, particularly between Canada
and the U.S.A., but common patterns of obstacles, challenges, essential
prerequisite conditions, and catalysts, were identified. These catalysts
appear to have created the necessary initial momentum for the organization to
launch an interpreter service. The elements determining the course of the
change process in the health organizations occur within a matrix of at least
5 structural and contextual domain layers. A 4-stage model of interpreter
services development emerged from participants' stories. Development
typically moved from a stage of “making do” without interpreters, to a
“launch” stage, followed by a longer period of “normative growth and
maturation.” A number of interpreter services included in this study appeared
to be highly successful in their organizations. These services were located
in sites where the organization's executive team championed their work.
Interpreter services in these organizations led the entire organization
toward what appears to be a fourth stage of “culturally and linguistically
appropriate health care,” characterized by a number of indicators.
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