The Language Barriers Between Akan-Speaking Patients and Health Professionals

Introduction

It is important to note that communication between a patient and healthcare professional is integral to the healthcare delivery process. An unhindered flow of information determines and affects the quality of care, effectiveness of treatment, and adherence. The primary purpose of the given evidence-based practice project proposal is to evaluate the effectiveness of written treatment education materials for Akan-speaking patients. PICOT statement is as follows: Adult hypertensive patients whose language is Akan, an African language. (P) Could providing written treatment education materials in their primary language Akan (I), be more effective than using an interpreter, (C) Leading to improved controlled blood pressure (O) and avoiding possible complications associated with the disease progression and preventing mistrust between healthcare providers and patients (T) over a period of 4 months. The key organization of main interest is Montefiore Medical Center, which has a sufficient amount of resources and readiness for organizational and procedural changes. The lack of full and comprehensive understanding between Akan-speaking patients and healthcare professionals manifests in a reduced level of trust, poor adherence to the treatment, and lower quality of care delivered by the center.

Problem Statement

The core problem statement results in the fact that mistrust and miscommunication are created as an outcome of the language barriers between Akan-speaking patients and health professionals since interpreters are either inaccessible or show poor performance. Such issues tend to have a major negative effect on the patients of a medical center. A problematic aspect is the reduced overall quality of care and increased patient dissatisfaction with healthcare services. Therefore, addressing the problem requires a highly effective and evidence-based intervention. The written treatment format is developed and designed to reduce or eliminate the Akan language barriers to enhance the safety and quality of care at the center. In other words, the communication and language issues are addressed not through oral delivery of the information but rather through writing, enabling less reliance on an interpreter and time needed to explain the measures.

It is important to state that effective treatment and care delivery processes directly depend on a health professional’s ability to communicate critical and essential knowledge to a patient. The implication of the problem statement manifests in an organizational change in terms of new procedural arrangements made to enhance the comprehension of the treatments provided by healthcare professionals. Implementing any form of change meant to improve an organization cannot be done without ensuring that the shift will be welcomed and can be integrated.

Organizational Culture and Readiness

Organizational Culture

When it comes to organizational culture, the latter plays a major role in determining the effectiveness of change. It is reported that “change-oriented leadership has a positive and significant direct effect on planned change and a positive and significant but indirect effect on planned change and emergent change” (Al-Ali et al., 2017, p. 723). In other words, change is primarily initiated and sustained by an establishment of proper form and style of leadership. Considering the fact that the organization’s leadership is proactive and transformational, it is evident that its organizational culture is flexible enough for appropriate shifts in the work processes and goals. A medical center’s leaders need to be proactive in the implementation of a major organizational change by supporting and promoting procedural transitions. The mission and values embrace continuous quality improvement since patient satisfaction lies at the core of the strategy. The latter is reflected in team engagement, communication, and employee perception.

Organizational Readiness Tool and Readiness Assessment

One of the positive aspects of the medical center is that its culture is supportive of changes due to its leadership and management. It is a strong indicator of willingness for new and effective measures to improve the quality of care delivered to patients. However, it is important to know whether or not the organization is ready for shifts since willingness does not equate to readiness. In order to assess the stated factors, a tool will be utilized, which is called the Organizational Readiness for Implementing Change or ORIC. It was found that the ORIC framework “measures if organizational members are confident in their collective commitment towards and ability (efficacy) to implement organizational change” (Storkholm et al., 2018, p. 1). The organization’s strength reveals a moderate level of commitment with high efficacy for change. In other words, the latter indicates readiness, and the former reveals willingness.

Thus, there is a form of mismatch between willingness and readiness, which can be interpreted as a significant barrier to change but a weakness of the evaluation since they use overlapping inputs. The subsequent efforts require a stronger emphasis on accurate assessments of organizational readiness. It becomes evident that it has a high-level readiness when the medical center is evaluated in accordance with the ORIC tool. It is suggested that when a leader uses ORIC, it allows him or her “to gain a deeper understanding of the organization’s current perceived culture and … pivotal in identifying the culture gap in moving toward a preferred culture over an 18-month period” (Davis & Cates, 2018, p. 71). In other words, the medical center’s leadership needs to have an insight into how the employees perceive a change in order to avoid resistance to the proposed plan and procedural shifts.

It is critical for change implementation that ORIC demonstrates the dimensional states of the medical center since culture, leadership, and readiness are intertwined. In other words, the latter statement indicates that the leader, patients, and staff are key stakeholders. The primary reason includes a transformational leader who supports and encourages proactive action and improvement. The healthcare staff needs a clear objective and explicit policies to follow and leadership support and assistance. In addition, the organization needs to have a strong change embracing culture, which should be used as the main resource.

Literature Review

Whenever a major endeavor manifested in an organization change is being considered, planned for, and incorporated, the proposed solutions must be based on evidence. The literature provides a substantial body of knowledge in regards to the project. It additionally reveals insight into potential barriers and underlying measures to be implemented. One study states that “an individual leader among the group needs to view the present situation as being sustained by forces and behaviors from within the group to initiate change” (Abd el–shafy et al., 2019, p. 84). Therefore, the shifts and transitions must be perceived not as something external but rather internal, which is initiated, led, and sustained by the leader himself or herself.

Another piece of research further substantiates the previously mentioned point. It reports that “change is a process that helps leaders, as change agents, to establish relationships with employees that enable and facilitate the change process, thereby ensuring that the change is effectively managed” (Al-Ali et al., 2017, p. 725). In other words, despite the fact that the core problem is about communication challenges between patients and healthcare professionals, the same barrier needs to be overcome by the leaders as well. Similar observations can be noted in regards to leadership support. It is stated: that “the relatively strong associations linking both change commitment and efficacy with supportive leadership and nursing foundation for quality of care shows that a positive work environment is an important precondition for change” (Sharma et al., 2018, p. 2808). Both leaders and managers must be willing to create a change-receptive environment by being proactive, reciprocal, and supportive.

The implementation aspect of the project proposal can be intuitive, quantitative, qualitative, or mixed. A healthcare organization deals with high-risk issues daily, meaning that precision and objectivity are of paramount relevance. Although it might be difficult to integrate quantitative measures into healthcare practice and process, they can be useful in ensuring continuous improvement. A critical review highlights that quantitative research, project, or plan is the most consistent, valid, and reliable way to introduce the quality of care enhancements (Bressan et al., 2017). Thus, such a design should lie at the project’s core to ensure that Akan-speaking patients are receiving their treatments without any mistrust and miscommunication.

Organizational change is about introducing new policies and protocols coupled with novel skills, knowledge, and competencies. The human resource aspect primarily challenges the transitional force within the given process. According to Benner’s novice to expert theory, fundamental understanding of patient care and acquisition of essential skills are driven not only by the educational foundation but additionally work experience (Moore, 2021). Thus, nursing foundation-based formats can be potent at enabling a swift provision of knowledge and skills to healthcare professionals without failing to incorporate the experiential aspect (Daniels & Jooste, 2018). Unlike traditional medical education, training an already experienced medical professional needs to be quick and efficient since they are likely to be occupied with other responsibilities.

For the subject of interprofessional cooperation issues, the medical center’s management can face significant challenges in combatting interprofessional conflicts. It is stated that these issues can be overcome “by bridging professional, social, physical and task-related gaps, by negotiating overlaps in roles and tasks, and by creating spaces to be able to do so” (Schot et al., 2019, p. 332). In addition, it is suggested that the patients are more likely to adhere to the functional status factors and recommended practices due to interprofessional strategy (Reeves et al., 2017). In other words, better adherence is ensured through such effort. The latter statement is substantiated by the notion that these challenges will be overcome by using an interprofessional collaborative approach focused on organizing their input in a structured format (Al Shamsi et al., 2020). Since healthcare providers in the experimental group must stick to the written treatment educational resource, the literature-based observations are essential. Another critical part is to minimize unnecessary interactions between various health experts involved in the project to eliminate potential points of conflict, which means that conflict avoidance is appropriate in this case. Thus, the strategies are interprofessional collaboration when avoidance is impossible.

Change Model, or Framework

Any organizational change involving major procedural and culture changes must adhere to a specific and evidence-based framework. The selected format is Lewin’s change model, which focuses on three phases such as unfreezing, changing, and freezing (Abd el–shafy et al., 2019). The first phase requires ensuring the readiness of the organization and the involvement of all stakeholders. The key reason is that unfreezing all already established patterns and rules of operations need to be made more receptive to novel introductions and alterations. The second phase is focused on incorporating and integrating the written statements as a core aspect of the practice. In other words, as soon as the medical center makes the necessary preparation for new procedural directions, the intervention needs to be incorporated quickly and effectively. Any delays in the integration process can cause unnecessary confusion among employees and patients, damaging organizational performance and quality of care.

The third phase is designed to solidify the changes by turning them into the center’s protocols of care and organizational policies. In short, the novel interventions and transitions in how the medical center operates must become a new norm with no unaccounted drawbacks. The key target improvement healthcare process and systems changes revolve around introducing the Akan language to improve communication, patient satisfaction, safety, quality of care, and cost-effectiveness. The framework is based on a targeted improvement of the healthcare process and system changes. These revolve around the introduction of the Akan language to improve communication, patient satisfaction, safety, quality of care, and cost-effectiveness. It is reported that “language barriers in healthcare lead to miscommunication between the medical professional and patient, reducing both parties’ satisfaction and decreasing the quality of healthcare delivery and patient safety” (Al Shamsi et al., 2020, p. 1). In other words, the leadership and managers need to be aware of the potential ramifications of failing to address the underlying problems in the healthcare delivery process to the target population.

Therefore, the recommendation is to hire language experts and healthcare professionals with knowledge of the Akan language. The required shifts need to be systematic and comprehensive without causing excessive confusion among healthcare workers. The mere reduction of the communication barrier will improve the quality and safety of care. However, the medical center might need to bolster its existing team with new experts who can help properly develop the written treatment instruments. For the cost-effectiveness, hiring a medical professional with Akan language knowledge can be the best option since his or her skills will be valuable for non-Akan-speaking patients as well.

Implementation Plan

Implementation and Leadership

In the case of the plan implementation, the medical center’s leadership must show proactivity and reciprocity about the proposed organizational change. It is clear that culture and leadership play a significant role in facilitating implementation at the center. In other words, the top-down approach is to be utilized to ensure the effectiveness and efficiency of the intervention. However, when it comes to informing and prompting the leaders to undertake such an endeavor, the strategy might exclude these elements since they are already properly adjusted and positively tuned for change. The medical center’s ORIC revealed that its leadership is interested in addressing the problem among Akan-speaking patients. Thus, the direct focus and resources need to be directed at preparing the healthcare workers and service delivery procedures for the shift.

Since the latter statements mean that the leaders and managers are supportive of the proposed measures for improvements, the culture can be sufficiently primed for the continuous increase in quality of care. It is suggested that “nursing foundation for quality of care and supportive leadership was positively associated with readiness, change commitment and change efficacy. However, staffing and resource adequacy was positively associated only with change efficacy” (Sharma et al., 2018, p. 2798). In other words, establishing a nursing foundation for quality of care can be a highly effective facilitator for improving the readiness and willingness factors. It is a form of program which can be utilized in both educational and training settings in order to quickly equip the healthcare professional with the necessary skills and knowledge (Daniels & Jooste, 2018). Since nursing specialists will provide the core support and hands-on care for patients, the method is relevant and plausible, but it does not exclude other medical doctors. Thus, the strategy should include supportive leadership, patient-centered culture, and a nursing foundation for quality of care.

Implementation Design

Any form of implementation and integration plan needs to be properly designed in accordance with organizational needs and specificities. The implementation design for the proposed project plan is to be calculated, precise, and quantitative. The underlying reason is that the comparison mandates precise measurements, and then these can be conducted through blood pressure values and trust level scores. An intervention affecting the procedural processes as well as organizational policies needs an explicit framework to measure how it impacted the core problem. In the case of nursing-related studies, it is reported that “the guidance provided by current mixed-methods research is inconsistent and incomplete, and this compounds the lack of available direction” (Bressan et al., 2017, p. 2878). In other words, the qualitative aspect might prove to be a hindrance resulting in an inefficiency, where costs and efforts no longer justify the means. Such evaluation and progress monitoring measures should either choose qualitative or quantitative designs, and the comparison will be more accurate with numerical data.

The design of the intervention additionally provides an opportunity to apply statistical measurements of the variables of interest. Both blood pressure values and trust level scores can be comparatively assessed for statistically significant shifts before and after the written treatment instruments are provided to Akan-speaking patients. The use of one-way analysis of variance or ANOVA can prove to be useful to objectively confirm whether or not the health outcomes and quality of care are improved (Shrestha et al., 2019). In other words, the effectiveness is to be evaluated with a one-way analysis of variance, which is useful in determining the substantiality of differences (Moore, 2021). It should be noted that these assessments will be conducted by the main project manager of the project plan accompanied by the center’s managers.

Stakeholders

In order to ensure that plan is realizable and practiced, all involved parties need to be outlined. The key stakeholders include the chief manager of the medical center, head nurse, nursing staff, doctors, and healthcare managers or administrators. Although the intervention is designed for Akan-speaking patients only, the organizational shift project is systematic. The main reason is that the target population can have needs, which include the mentioned stakeholders. In addition, it is important to note that the patients themselves are not included since they will not be actively involved in the change process but will be impacted by it positively.

However, they should be categorized as passive stakeholders of the plan. The chief manager and the administrative staff, including managers, will be tasked with incorporating a more supportive leadership style into the organization. As was stated above, the top-down approach will be utilized in order to ensure organizational readiness and willingness for these changes. They will need to establish a nursing foundation for quality of care to improve readiness and willingness for change. The latter means allocation of resources towards the program and provision of an environment for accelerated learning and training.

At the core of the plan lie medical professionals, such as doctors and nurses. They will be responsible for carrying out and practically implementing the new guidelines and protocols of care. Significant resistance to these novel measures is not to be expected since the written treatment instruments are designed to lessen the time spent on the patients. In other words, they will no longer spend a significant portion of their time overcoming communication barriers since all essential information will be present in the treatment descriptions and details. Their collective efforts will determine the overall organizational culture, which is critical for change as well. However, the changes do not mean that Akan-speaking patients are given the written instrument without an explanation, which still necessitates the use of an interpreter of the medical center. Therefore, the nursing staff is the most vital group since they are the ones interacting with the patients the most, which is why the foundation is designed to support them alongside the management. The provision of care and delivery of healthcare services are primarily made by nursing professionals, who will additionally engage the interpreter if needed.

When it comes to other important stakeholders, the team will include the cardiologist, interpreter, physician, Akan expert, and researcher. Interprofessional collaboration will be at the center of organizational change since each professional has expertise and competence in a particular domain. Connecting and cooperating with them will require significant input and direction from the medical center’s leadership. The beneficiaries of the project will be the center, patients, and healthcare professionals, where improved patient outcomes will directly benefit the former two, and the latter will obtain a more effective method of communication.

Timeline and Delivery

Access will be provided after the consent form is signed by the participants, as shown in the Consent Form of the Appendix. The latter is necessary because patients’ personal health data will be used to make the comparative measurements between the efficacy of the written treatment education material and interpreter on the basis of blood pressure and level of trust. Firstly, the managers will need to find the relevant professionals to design and improve the tool to make it applicable to the medical center. Secondly, the digital healthcare translator will be installed on the work computers of each doctor to automatically translate English treatment writings into Akan ones. Thirdly, since there are not many Akan-speaking doctors available, one interpreter will be hired to assist the medical staff with treatment writing. The timeline will be comprised of five consecutive steps, and the entirety of the project will be completed in five months as listed below:

1. Obtaining consent from the participants by informing them about the risks, benefits, and need for personal health data on blood pressure, as well as surveying them about trust in the initial week;
2. Providing the written treatment education materials to healthcare providers in order to ensure the equal use of an interpreter in both predetermined groups the following week;
3. Collecting the data about the current level of trust in healthcare providers among patients and blood pressure measurements during the next week;
4. Enabling the observation of subjects across a four-month period;
5. Gathering data about two measurement metrics with subsequent comparative analysis a week after the observation.

Since the written treatment education material will be a novelty within the care provision protocol, it is vital to provide a brief training session for the healthcare workers. Therefore, the process of delivering the intervention is to be conducted within the fourth and second steps of the schedule. The second group will work with an interpreter, and the first group of Akan-speaking subjects must be given the written form of treatment. The core addition will be the written treatment education material. During the last stages, the center is to provide its services in an established and regular fashion.

Budget and Resources Needed

A fiscal expense unrelated to human resources and only written treatment education materials will be needed since the medical center already has interpreters. A cardiologist will be hired as well to conduct the measurements of blood pressure, whereas an Akan expert will be hired for the whole duration of the project. In addition, a physician’s involvement will be necessary. The need for such a professional will be in the assessment in order to provide extra information in regards to the patients’ severity of hypertension. Essential equipment and supplies are to be provided by the healthcare center. This step is to be achieved after the administration gives an officially signed permission to incorporate them within an outlined plan. The estimation is that the intervention will require $6000, but the written treatment itself and related education material are to be developed by both an Akan expert and a physician accompanied by the cardiologist.

Moreover, the phase of the creation of the easy-to-use hardcopy in regards to the final material will likely cost $3500. In other words, it should be noted that the majority of costs will be distributed to involve the professionals. Detailed budgeting and resourcing details, as well as core financial and resource allocation elements, are shown in Table 1 of the Appendix. The project manager is to be occupied with the majority of analytical and presentation-related endeavors, and thus, the subsequent compensation is to be approximately $10000. The medical center’s interpreters are to be involved in participating in the project proposal plan with a sum of $5000 as a standard control group factor. A cardiologist is to engage in two instances for $10000 at the beginning and the end of the observation to conduct the blood pressure measurements. Lastly, a physician is to be tasked to assist in the initial and final assessment as well as the development of the written treatment material on three separate occasions for $5000. Thus, the budget allocations can be considered fair and reasonable for the scale and importance of the proposal plan to address the communication problems among Akan-speaking patients.

Evaluation Plan

The entire process will be evaluated on the basis of physical improvements as well as direct feedback from the target patient group. The evaluative framework will involve the measurement of blood pressure with a sphygmomanometer, which will be provided by the cardiologist. The level of trust of patients towards their healthcare providers will be analyzed with the use of a simple questionnaire, as shown in Table 2 of the Appendix. Healthcare work is most often done by highly motivated people who have a strong interest in the work itself in a quality value structure. At the same time, at the present stage, the resource factor exerting pressure on resistance to change is increasingly influencing. It is important to note that it is expedient to provide employees with the opportunity to participate in the planning of organizational changes in order to freely express their attitude towards innovations.

The support of management in a situation of change and the perception of the realism and feasibility of changes in their own activities and the activities of the center are determined by the presence of clear goals. This applies to the ability to manage a professional environment and build positive relationships with people. Motivation is a powerful incentive tool for the effective operation of a team or organization. The differences between initial and final measurements will be compared by the use of a one-way analysis of variance. In addition, it is necessary to create a sense of belonging to potential problems and changes. The latter is done in order to level the resistance to changes on the part of the staff due to the specifics of their work. Thus, the proposed solution will be monitored through these two metrics.

The proposed plan is feasible as long as the medical center agrees to make the necessary arrangements. Since the health experts and Akan experts will be compensated, their engagement is likely, and the latter is true for the center due to their interest in providing better care. As a result, this will increase the level of understanding and acceptance of the change. Due to the specific motivational features of healthcare teams, additionally competent motivational support for the process of introducing changes is necessary. However, the certainty of the plan can be impacted by low participation by Akan-speaking patients because they already comprise a rather small portion of the total patient base.

Conclusion

In conclusion, the lack of full and comprehensive understanding between Akan-speaking patients and healthcare professionals results in a reduced level of trust, poor adherence to the treatment, and lower quality of care delivered by the center. The feasibility of change and the support of the management of the center in the implementation of organizational changes among medical professionals have similar connections and structures in the context of cooperation. The evaluation will be precise and quantitative in order to direct and accurately observe the improvements. The patient feedback and blood pressure changes will be used as comparative metrics to make objective assessments of the plan implementation. The plausibility of changes and the support of the leadership are determined by the severity of all components, except for the autonomy component. The adult Akan-speaking hypertensive patients will be provided with written treatment education materials. These efforts will prevent and eliminate mistrust between healthcare providers and patients over a period of 4 months. Lewin’s change model will be the core framework, where the written treatments in the Akan language will be provided to Akan-speaking patients.

References

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Al-Ali, A. A., Singh, S. K., Al-Nahyan, M., & Sohal, A. S. (2017). Change management through leadership: The mediating role of organizational culture. International Journal of Organizational Analysis, 25(4), 723-739. Web.

Bressan, V., Bagnasco, A., Aleo, G., Timmins, F., Barisone, M., Bianchi, M., Pellegrini, R., & Sasso, L. (2017). Mixed-methods research in nursing – A critical review. Journal of Clinical Nursing, 26(19-20), 2878–2890. Web.

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Sharma, N., Herrnschmidt, J., Claes, V., Bachnick, S., De Geest, S., & Simon, M. (2018). Organizational readiness for implementing change in acute care hospitals: An analysis of a cross-sectional, multicentre study. Journal of Advanced Nursing, 74(12), 2798-2808. Web.

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Appendix

Consent Form

Name_____________________________________

“Improving The Quality of Care and Health Outcomes for Akan-Speaking Patients”

1. I confirm that I have read and understood the information provided about the project in the Information Sheet for Participants. Date:
2. I confirm that I had the opportunity to request additional information about the research’s risks, benefits, and personal health data from the researcher.
3. I confirm that all my questions were answered extensively and in-depth with no confusion and misunderstanding, and the responses and clarifications were satisfactory.
4. I fully understand that my participation is voluntary and not forced. I am free to withdraw from the project at any moment and time without providing any reasons.
5. I understand that I can withdraw my personal health data from the project at any time and moment.

Participant’s signature ______________________________ Date __________

Investigator’s signature _____________________________ Date __________

Participant’s Initials: ________

Table 1

Table 2

Final Revisions

• Lewin model change
• Leadership use change
• Organizational culture detail additions
• Literature review additions
• Stakeholder role changes
• Motivational elements inclusion in the evaluation plan
• Expanded readiness assessment
• Elaborated problem statement

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