Like language policy, translation policy is a complex adaptive phenomenon where multiple agents interact dynamically at diverse levels and affect how principles such as equality, inclusion, and non-discrimination are implemented at concrete, structural levels. While a fair amount of work has been done on top-down and bottom-up translation policy, more research about meso-level translation policy is needed to better understand this topic. This study thus seeks to show how meso-level agency needs to be taken into consideration; in particular, the complex interplays between meso-level agency and structural factors in policymaking and appropriation processes. Taking two Toronto hospitals as examples, this study demonstrates how hospitals can be conceptualised at a meso-level as collective agents. It examines the complexity of their agentive roles and elucidates their exertion of agentive power in order to explore meso complexity, and to assess the subsequent impact on both policy outcomes and people’s lives. To do so, a framework of parameters influencing, if not determining, the effectiveness of public service translation and interpreting provision is proposed. It is then used in combination with an existing tripartite framework of translation policy to develop a more fine-grained and holistic understanding of translation policy in public service settings.