Leadership in Nursing - Essay Example

Leadership in Nursing Contents Summary 2 Introduction 3 Literature Review 4 Change Proposal 9 References 16 Summary With the advent of globalization the movements of people across borders have increased and so have increased the no. of patients seeking healthcare in a foreign country. There has been simultaneous rise of a particular problem associated with this phenomenon. That is the problem of language barrier. It is a common knowledge in the medical profession that delivery of treatment and preoperative care becomes far better if it is delivered in the native language of the patient. To facilitate communication between the patient community and health practitioners the use of interpreters is recommended. However the physical presence of interpreters is not always possible and there is reluctance on the part of hospital authorities to employ the services of an interpreter. In view of this peculiar problem facing the healthcare industry, several alternatives have been suggested. Many such alternatives eliminate the need of keeping interpreters by making the patients proficient in the language of the health service provider. Other probable alternatives require the use of technology in use of services such as video remote interpreting (VRI) and telephone interpreting. However implementing any alternative practices requires changes to occur. In order to manage that change two particular models namely kotler’s 8 step model and NHS change model have been suggested. Introduction Increased globalization has resulted into challenges in context of providing safe and accessible healthcare. The percentage of individuals who can make best use of health services gradually declines if they are not fluent in English. Language barriers are usually witnessed by many health professionals. In this study various mechanisms shall be analyzed that can bring forth changes in health organizations. Change is an essential component that facilitates achievement of organizational goals. This change is highly dependent on nature of business and future objectives. Medical care of high quality basically requires effective communication between health professional and patient. Patients should be able to understand their health issues well and treatment that would be undertaken. It often becomes difficult to carry forward medical treatment when patient is not able to communicate well with medical representatives. There are certain existing services that help to eliminate such language barriers. Telephone interpreting services or face to face interpretation are common techniques that are incorporated to remove such language barriers. However in this proposal other measures shall be outlined such as telephone interpreting and video remote interpreting. These aspects would be cantered towards creating change within health organizations. Linguistic diversity is highlighted within this report and it is evaluated in relation to doctors working for primary care. The need of language translation is a must for health professionals who are practicing overseas. To be more precise these skills support health professionals to efficiently handle diverse cultural background patients. These professionals even share knowledge and understanding of health expectations and beliefs. However there is a high need for change since interpretation skills at times might not deliver appropriate results. On the other hand, modern techniques have to be incorporated so as to meet common goals or objectives. This study would even analyze effectiveness of organizational change in relation to certain theoretical frameworks. Literature Review According to Gill, Beavan, Calvert and Freemantle (2011), clear communication has always been recognized as an integral component of high quality medical care. Physicians often come across such problems where establishing effective communication is a difficult task. This is mainly observed when patients and physicians do not communicate in same language which is known as language discordance. Globalization has eventually led to human migration and this result into multilingual aspect within countries. There are many cities across the globe that is a home for new immigrants and physicians are bound to encounter patients who are unaware of dominant language. This form of language barrier results into health disparity comprising of differential mortality rates (Gill, Beavan, Calvert and Freemantle, 2011). As per Parsons, Baker and Smith (2014), language barriers at times yields certain negative outcomes like impair patient comprehension, affect satisfaction level, appears as a barrier to accessing care and drastic impact on treatment adherence. Communication barriers are greatly linked with length of stay in hospital and reduced health status. Physicians and patients not communicating in a common language or social structural features are able to compound a medical situation. The rapid growth of modern clinical practice appears to be a challenge for effective communication. This is mainly because decisions need to be taken quickly and are dependent on history (Parsons, Baker and Smith, 2014). Szczepura (2005) in his studies stated that there is generally less research conducted regarding experience of physicians in terms of language discordance. Physicians should possess knowledge regarding such language disability as it results into negative health outcomes. LEP or limited English proficiency is a major problem which is witnessed in patients and this leads to high demand for translators. LEP is basically used for those individuals who are not comfortable in speaking English language. This creates a lot of problems for health professionals as they are not able to communicate properly regarding health issues. In such circumstances physicians usually get help or get by in order to communicate with patients (Szczepura, 2005). As per Wilson, Chen, Grumbach, Wang and Fernandez (2005), cultural diversity plays a significant role in giving rise to linguistic barriers. Population diversity is greatly observed in United Kingdom and comprises of individuals from Caribbean origin, Africans, Asian, Arabs, Chinese and even other mixed cultural backgrounds. This culture is highly reflected in languages spoken and communication between individuals. Linguistic competency is usually achieved when an individual is comfortable in all languages. This aspect is essential during foreign language interpretation (Wilson, Chen, Grumbach, Wang and Fernandez, 2005). As stated by Hudelson and Vilpert (2009), patients possessing linguistic competency is able to analyze their health issues well and adopt best possible measures. On the other hand, cultural competency encompasses cultural dimensions such as patients’ wellness, health and healing belief systems, ways in which wellness is perceived, behaviour of patients or their attitude towards health care providers, values and views of those individuals who are providing health care. The major barrier to medical comprehension is limited English proficiency. Patients who are unable to understand language of their doctors cannot be attended appropriately. In order to solve such problems interpreters are used and they at times alter overall meaning of a discussion. This kind of limited proficiency is not only a barrier but even is the root cause for adverse medication reaction (Hudelson and Vilpert, 2009). According to Dickover and Bot (2007), increasing accessibility to physicians of language concordance mitigates to great extent language barriers but does not eliminate it completely. Availability of interpreter services holds a lot of importance for hospital clinical staff. Well trained interpreters are likely to deliver patient safety and quality care. Proper analysis of hospital variations in practices and attitudes contribute towards predicting factors that facilitate better services. In hospitals there exists wide array of departments and each of them has certain set of attitudes or practices that affects task of interpreters. These factors even cause an impact on LFP patients across hospital departments and varying departments. Implementation of institution wide culture will require development of service level activities and hospital wide policy. This policy reinforcement shall facilitate easy communication with LFP patients (Dickover and Bot, 2007). As stated by Masland, Lou and Snowden (2010), language service providers are also associated with certain barriers such as shortage of expertise personnel and costs. However these barriers can easily be overcome through advanced technologies like video conferencing, Internet, call centers that enables resource sharing across organization’s and provider’s network. These technologies can be used enhanced through foundation and government support. For health care organizations these technologies play a vital role along with training of professionals on linguistic abilities. There is great of deal of involvement in information sharing networks, participation in communication and training program development (Masland, Lou and Snowden, 2010). According to Pitkin and Baker (2000), with the influx of different people to different countries in the context of increased globalization the people needs to get admitted to the hospitals of different countries. A particular problem that health care industry faces in this respect is the communication problem. Since persons belonging to different countries speak different languages, so when those persons come down to have preliminary health checkups or surgeries the particular problem that they feel is the communication problem. It has been established through study that migrant patients need to visit primary health care facilities more often than the local people do. However it is also found that these foreign patients were less likely to receive appointments for follow up treatment, and were less likely to comply with the instructions given in the prescription (Pitkin and Baker, 2000). As per Bischoff, Perneger, Bovier, Loutan, and Stalder (2003), studies have shown that while reviewing the appropriateness of medical treatments and their patient centeredness the review given by the foreign patients tends to be ignored. Language barriers have been identified as the leading cause behind foreign patient’s reluctance to self monitoring of blood glucose, low levels of patient satisfactions, lower adherence to examination for checking of breast cancer. Interpreters in this respect play a key role in improving these conditions. In a particular case it was witnessed that after the introduction of interpreters the uptake of preventive measures by foreign language patients increased significantly. However it must be noted that the introduction of interpreters in health services does not only require the training of the interpreters but the training of health professionals also who work with them (Bischoff, Perneger, Bovier, Loutan, and Stalder, 2003). As stated by Jacobs, Lauderdale, Meltzer, Shorey, Levinson, and Thsted (2001), it has long been recognized by the medical community that the communication between health professionals and physicians is of primary importance for health care to be effective and efficient. However many patients are not able to benefit from this because of the language barrier that exists between foreign patients and medical professionals. Several studies conducted over the years have found out that the non English speaking patients are more likely to receive less than optimal health care and are thus more prone to the risk of not receiving optimal preventive measures to prevent the onset the onset of any disease (Jacobs, Lauderdale, Meltzer, Shorey, Levinson, and Thsted, 2001). According to Woloshin, Schwartz, Katz and Welch (1997), in their study found out that woman of Canada whose native language is not English were less likely to receive preventive and diagnostic measures that prevent and detect breast cancer than their other English speaking counterparts (Woloshin, Schwartz, Katz and Welch, 1997).In regards of who is to be chosen as interpreter, there is a deviation commonly found in what is practiced and what is preached. It is normally recommended widely by the professional interpreters and linguists that bilingual family members should not be used as interpreters by the family members since they are most likely to commit errors (Flores, 2006). However, most hospitals and medical institutions are reluctant to provide interpreter services (Weisskirch, 2007.). In such as case the bilingual family members do the job of interpreters for the ill family members (Meyer, Pawlack, and Kliche, 2010). According to Downing, and Roat (2002), to aid in communication between the patients and health care providers several models have been provided and developed over the years. One such model known as the bilingual patient model aims to train the non English patient in English language making the need of interpreters unnecessary. If the patients are themselves able to communicate in English with the healthcare providers there is no need of the interpreters (Downing, and Roat, 2002). As per Hudelson and Vilpert (2009), the ability of being able to speak in English provides other advantages as well. Another model is the bilingual workforce model where two or more types of medical professionals are recruited who can speak different languages proficiently thus removing the need for any interpreter. A study in this field has found out that use of the available interpreter services by hospital staff is often not to the standards despite evidence connecting to the fact that availability of trained interpreters helps in improving quality of healthcare provided (Hudelson and Vilpert, 2009). Change Proposal A saying that is true for all time irrespective of culture, creed, and socio-political environment is the concept of change. Heraclitus a Greek philosopher had once remarked that change is the only constant thing in the world. The saying is true even today after 2000 years and will be true till the earth or human civilization exists. We live in a world that is changing very rapidly. The writing on the wall is pretty simple that is to exist you have to change with changing times. Irrespective of the industry in which a company operates, it has to embrace change. For a company which does not embrace change is thrown out of business. An example in this case is KODAK. KODAK was once a market leader but it failed to embrace change at the right time and had to go bankrupt. We live in a world where business means change. In this scenario the case in point is the change in the nursing care and improving communication with non English speaking customers. However no matter how common or inevitable change is, there is an inherent lack or willingness of people to go for change. There are many theories on how to make people ready for accepting change. One of the several theories is Kotler’s 8 step model. Kotler’s 8 step model Step 1 Kotler believes that for change to occur the first thing that needs to happen be people should vote for and want change (Cameron and Green, 2004). They need to feel the urgency of going in for change. The leadership must be able to create urgency in the minds of people in order to make them ready to embrace change. The urgency can be created by showing ground realities and possible scenario if the company does not go in for change. Step 2 To lead change the next important task is to build a coalition or team of effective and influential people. This team plays a major influential role in the organization. The job of the leader is to convince theses people. If this core group is motivated and they are ready to accept change, the core group will then influence others to go for change. Step 3 When an organization plans to go in for change there are many ideas that float around. The organization should devise a comprehensive vision incorporating all the ideas (Biech, 2007). The vision statement for change should be made such that it is easily graspable by the people and is almost accepted as a mantra. A clear vision helps leader to motivate people regarding why they should go for Change. Step 4 After the vision has been developed the next step is to communicate it effectively within the organization. How effectively the vision is communicated, determines if the vision will be able to generate some success and whether change will be accepted by the different people in the organization. The vision needs to be communicated to the people as frequently as is possible so that it always stays at the top of their minds. It is also important that the leaders practice what they preach. To make the organization members accept and go for change, the leader should first himself practice what he is preaching. Step 5 When the vision and strategy for change is communicated through the ranks and levels of organization, there should be some obstacles and some people who will resist the change. The job of the leader over here is to remove the obstacles Step 6 The long term goal of the overall strategy for change is broken down into smaller goals that are easily measurable and achievable (Sabri, Gupta and Beitler, 2006). By breaking down long term goals into smaller short term achievable goals, the leader may create a sense of achievement among the people whenever they achieve a short term goal. The short term wins motivates the people to go for long term strategic goal for change and deter the critics and negative thinkers. Step 7 Change is a continuous and long term process. There is no quick, short and simple fix by which the company will go for change today and will be getting the results in a year’s time or so. It is a long process. If the company gets quick success after implementing change it does and should not mean that the process should end at that point of time. Rather it is a motivation to continue on the good work. Step 8 The change should be incorporated in the corporate culture. The corporate culture plays a major role in determining what actually gets done in an organization. So if the change and the vision of change are incorporated in the corporate culture it actually gets implemented. Another model of change that is particular to the hospitality industry is the NHS change model. There are 8 steps to the model. NHS change model (Source: Broadvision inc., 2013) Shared purpose The first step that is fundamental to the change process is the shared values that are at the core of any hospitality organization. The central point of shared value is connected to all other parts of the overall change model. Engagement to mobilize The next important step to identify in the change management process is who the stakeholders are likely to be affected by change. It is not enough to just list their names but it is also essential to identify the values that they share and the factor that motivates them for change. Leadership for change The role of the leader is supreme for any change to take place. A good and effective leader should be able to motivate people of the organization to accept change. The leader who is most likely to be successful in this particular case is he who vouches for team work and collaborative spirit within the organization. Spread of innovation The change culture and innovative spirit should be spread across the organization. The spread of any change and adoption of new policies is facilitated by resources, risk taking, tools, relationships information, and rewards. Improvement methodology Improvement methodology refers to the overall game plan for implementing change. For changes that affect the entire organization and bigger change management needs to be divided into smaller plans. Rigorous delivery The change management should be implemented by devising a proper planning that addresses every step of the process. The strategic planning, the financial planning, monitoring the progress, clarifying objectives are some of the steps. Transparent measurement Transparent measurement of the accrued benefits and cost of the change is important. In this case return of investment of the amount invested in the change process is important to evaluate. System drivers What are the factors in the systems that facilitate change? These system drivers help in creating the broad conditions necessary for change. It needs to be considered whether these system drivers are in line with the change initiative and whether they can be lined up. References Biech, E., 2007. Thriving through change: a leader’s practical guide to change mastery. NY: American Society for Training and Development Bischoff, A., Perneger, T. V., Bovier, P. A., Loutan, L. and Stalder, H. 2003. Improving communication between physicians and patients who speak a foreign language. British Journal of General Practice. 53(1). pp. 541-546. Broadvision inc., 2013. An introduction to the nhs change model, [pdf.] Available at http://www.changemodel.nhs.uk/dl/cv_content/66078 [Accessed on 22nd December 2014] Cameron, E. and Green, M. 2004. Making sense of change management: a complete guide to the models, tools & techniques of organizational change.London: Kogan cage publisher Dickover, D. W., and Bot, H., 2007. Patterns of communication through interpreters. J Gen Intern Med, 22(6), p. 896. Downing, B., and Roat, C. E., 2002. Models for the provision of language access in health care settings. [pdf] Available at. http://www.hablamosjuntos.org/pdf_files/Models_for_the_Provision_of_Language_Access_final_.pdf [Accessed on 22nd December 2014] Flores, G. 2006. Language Barriers to Health Care in the United States, The New England Journal of Medicine. 355(3). pp. 229-231. Gill, P. S., Beavan, J., Calvert, M., and Freemantle, N., 2011. The unmet need for interpreting provision in uk primary care. PLoS ONE, 6(6), pp. 2-6. Hudelson, P. and Vilpert, S. 2009. Overcoming language barriers with foreign-language speaking patients: a survey to investigate intra-hospital variation in attitudes and practices. BMC Health Services Research. 9(187). [Accessed on 22nd December 2014] Hudelson, P., and Vilpert, S., 2009. Overcoming language barriers with foreign-language speaking patients: a survey to investigate intra-hospital variation in attitudes and practices. BMC Health Services Research, 187 (1), pp. 1-9. Jacobs, E. A., Lauderdale, D.S., Meltzer, D. Shorey, J. M., Levinson, W. and Thsted, R. A., 2001. Inpact of interpreter services on delivery of health care to limited English proficient patients. JGIM. 16(1). pp. 468-474. Masland, M. C., Lou, C., and Snowden, L., 2010. Use of communication technologies to cost-effectively increase the availability of interpretation services in healthcare settings. TELEMEDICINE and e-HEALTH, 16 (6), pp. 739-743. Meyer, B., Pawlack, B., and Kliche O.,2010. Family interpreters in hospitals: Good reasons for bad practice? [pdf] Available at. http://www.mediazioni.sitlec.unibo.it/index.php/no-10-special-issue-2010/166-family-interpreters-in-hospitals-good-reasons-for-bad-practice.html [Accessed on 22nd December 2014] Parsons, J. A., Baker, N. A., and Smith, G. T., 2014. To ‘Get by’ or ‘get help’? A qualitative study of physicians’ challenges and dilemmas when patients have limited English proficiency. BMJ Open, 4 (1), pp. 1-9. Pitkin, K and Baker, D. W., 2000. Limited English proficiency and Latinos’ use of physician services. Med Care Res Rev. 57(1). pp.76-91. Sabri, E. H., Gupta, A. P. and Beitler, M. A. 2006. Purchase order management best practices: process, technology, and change management. NY: J. Ross Publishing Szczepura, A., 2005. Access to health care for ethnic minority populations. Postgrad Med J, 81(1), pp. 141–147. Weisskirch, R.S., 2007. Feelings about language brokering and family relations among Mexican American early adolescents. The journal of early adolescence. 27(4).pp.545-561. Wilson, E., Chen, A. H., Grumbach, K., Wang, F., and Fernandez, A., 2005. Effects of limited english proficiency and physician language on health care comprehension. California: University of California. Woloshin, S., Schwartz, L., Katz,S and Welch, H., 1997. Is language a barrier to the use of preventive services? J gen intern med. 12(1). pp. 472-477. Read More