Obstacles And Implementation In Healthcare Discussion Help Implementation__ :
you can use different sources to provide the cost and the required information.
__Includes the cost of the project from start to finish with specific numbers and an explanation of how those numbers were arrived at (ideally, based on research of similar projects). [4-5 sentences]
__Includes a list of actual people or titles of individuals who will be responsible for implementing the project and an explanation of what duties they will perform. [4-5 sentences]
__Includes an explanation of how the project will be implemented with attention to possible concerns the employer may have about the process. What steps are needed to make your project become a reality? [4-5 sentences]
__ Includes a timeline of when the steps of the project will take place (this can be combined with the above point, if you wish.)
__Includes a list explaining the materials and labor needed to make this project a reality. [3-4 sentences]
__ Uses 3 database sources ( I will include 3 pdf files to take quotes)
__ At least 300 words
this section needs to be filled with thoughtful and precise details that reveal the amount of research and time you invested in this project. Locating a similar or related project could be very helpful in this section of the report. Other research may be required, as well. Do not be vague – be specific. Topics that must be addressed are:
The cost of the project from start to finish with specific numbers and an explanation of how those numbers were arrived at (ideally, based on research of similar projects). [4-5 sentences]
Do not claim that the project will cost nothing; everything will cost something (for example, consider that employee hours are a cost, as are refreshments, office supplies, guest speakers, etc.).
Do not throw out a random number, such as “this project should cost $34,000” – you must explain how that number was calculated.
A list of actual people or titles of individuals who will be responsible for implementing the project and an explanation of what duties they will have to perform. [4-5 sentences]
If you don’t know enough about the organization to complete this section effectively, simply put in a phone call to the organization. Their website could be an excellent resource, as well.
An explanation of how the project will be implemented with attention to possible concerns the employer may have about the process. What steps are needed to make your project become a reality? Remember to be logical and realistic. [4-5 sentences]
A timeline of when the steps of the project will take place (this can be combined with the above point, if you wish.)
A list explaining the materials and labor needed to make this project a reality. [3-4 sentences]
__ 3 separate paragraphs and minimum of 12 sentences
__ Obstacle #1 & how obstacle will be overcome
__ Obstacle #2 & how obstacle will be overcome
__ Obstacle #3 & how obstacle will be overcome
I will include a background information to be able to focus on specific implementation such as hiring interpreters and it will be for health departments.
Development and growth will open a new path towards people taking actions and moving to different countries around the world looking forward to better improvement in their life including education and work environment. “English has long been the lingua franca of scientists,” (Adams, P. Fleck, F. 2015). The first thing that comes to people’s mind is to look for connections around the area to make it easier for them to communicate. Indeed, if people don’t have connection; language barrier will be the first thing that comes to their mind. “Language can be a barrier to accessing relevant and high-quality health information and delivering appropriate health care – an unmet need that is amplified on a global scale.” (Adams, P. Fleck, F. 2015). It will also affect their ability to have education and job. Booking appointments and going to healthcare departments is going to be the most challenging concept, according to Schyve, “First, the language differences themselves are a barrier to effective communication.” It will cause people to avoid going to the healthcare departments because of the lack in their language, it could lead to cause more health concerns and more error towards the patient’s health results, as Schyve mentioned, “In the absence of comprehension, effective communication does not occur; when effective communication is absent, the provision of health care ends—or proceeds only with errors, poor quality, and risks to patient safety.” Healthcare providers can manage this issue by providing interpreters, “For example, it is more effective to incorporate a language interpretation service (an evidenced-based practice) into redesigned work processes int he emergency department (a subsystem in a hospital), rather than to simply graft it onto the department’s current system of operations and expect it to integrate itself smoothly and efficiently without interfering with other work processes.” (Schyve, 2007). Another factor that could minimize language barrier as it was mentioned in the world health organization bulletin, “In addition, some United States based websites provide multilingual health information, such as the Health Information Translations collaboration and the National Network of Libraries of Medicine.”
Adams, P., & Fleck, F. (2015). Bridging the language divide in health. World Health Organization.Bulletin of the World Health Organization, 93(6), 365-366. doi:http://dx.doi.org/10.2471/BLT.15.020615
Schyve, P. M. (2007). Language differences as a barrier to quality and safety in health care: the Joint Commission perspective. Journal of general internal medicine, 22(2), 360-361. Language Differences as a Barrier to Quality and Safety in Health
Care: The Joint Commission Perspective
Paul M. Schyve, MD
The Joint Commission, Oakbrook Terrace, IL, USA.
Effective communication with patients is critical to the
safety and quality of care. Barriers to this communication include differences in language, cultural differences, and low health literacy. Evidence-based
practices that reduce these barriers must be integrated
into, rather than just added to, health care work
KEY WORDS: language differences; cultural differences; low health
literacy; health care; information management; accreditation.
J Gen Intern Med 22(Suppl 2):360–1
© Society of General Internal Medicine 2007
hen a patient sees a clinician member of a treatment
team, the clinician uses the available knowledge base
(derived from her education and training, the literature,
experience, decision-support systems, and protocols) to decide
what data to collect about the patient and how to collect them.
The clinician and other members of the team collect these data
through conversations with the patient and the patient’s
family, observation of the patient, a physical and mental
examination, laboratory testing, and imaging. The treatment
team then synthesizes these patient-specific data with the
evidence-based information in the available knowledge base to
create new information: the patient’s diagnosis and prognosis
and, in the dialog with the patient, a treatment plan. Finally,
the team disseminates this newly created information to the
patient, the patient’s family, other members of the treatment
team, other professional caregivers, pharmacists, insurance
companies, and others. Dissemination occurs through oral
communication (e.g., in conversations with the patient,
patient’s family, and health care professionals), through
writing (e.g., in consent forms, instructions, educational
materials for patients, and in notes and instructions for other
professional caregivers and pharmacists), and through electronic transmission (e.g., in pharmacy orders, insurance claims, and
computerized, patient-accessible personal health records).
This collection of data, transformation of data into information, storage of data and information, and dissemination of
information are the key processes that comprise information
management. Today, in health care, much of this information
management is in the form of oral and written communications between team members, patients, and patients’ families.
The more the care is patient- and family-centered, the more
frequent the communication with the patient and the patient’s
family to understand the patient’s perspective and to involve
the patient in the treatment team itself.
Because much of medical care is really information management, this communication between treatment team members and the patient and patient’s family is a core component
of health care—it is more than an adjunct or facilitator of
health care. Collection of accurate and comprehensive patientspecific data that are the basis for proper diagnosis and
prognosis; involving the patient in treatment planning; eliciting
informed consent; providing explanations, instructions, and
education to the patient and the patient’s family; and counseling and consoling the patient and family requires effective
communication between the clinician, the patient, and the
patient’s family. Effective communication is communication
that is comprehended by both participants; it is usually
bidirectional between participants, and enables both participants to clarify the intended message. In the absence of
comprehension, effective communication does not occur; when
effective communication is absent, the provision of health care
ends—or proceeds only with errors, poor quality, and risks to
When patients with limited English proficiency are treated
by physicians and other health professionals who are proficient only in English, 3 factors converge to create a “triple
threat” to effective communication. First, the language differences themselves are a barrier to effective communication.
Unfortunately, this language barrier is often not immediately
evident. Instances in which patients identified themselves as
(reasonably) proficient in English, but were not, have been
reported, and a Joint Commission study found physicians and
hospital staff who believed themselves to be sufficiently
proficient in another language, but were not.1 Both the patient
and the clinician can underestimate the language barrier
Second, cultural differences—which are often associated
with language differences—are a barrier to effective communication. One’s culture affects one’s understanding of a word or
sentence and even one’s perception of the world. To learn a
language is not the same as understanding a culture—even
those who share a common native language may not share a
common culture. And not everyone born in the same place and
speaking the same language necessarily shares all the features
of a common culture. Therefore, there is a risk of either
underestimating the effect of cultural differences or of stereotyping individuals by their culture. Both will interfere with the
effectiveness of communication.
Third, low health literacy is a barrier to effective communication.2 Low health literacy in patients may be associated with
language and cultural barriers, but is also found in patients
who are proficient in English and who share the common U.S.
culture. This latter group may be especially at risk of having
their low health literacy go unrecognized. When language or
Schyve: Language Differences, a Barrier to Health Care Quality and Safety
cultural barriers are identified, it often leads the clinician to
explore whether the patient understands her oral or written
communication. But when the patient speaks the same
language and is of the same culture as the clinician, too often
the clinician assumes that the patient—in the absence of
questions—understands. Many clinicians have belatedly discovered that a patient is functionally illiterate: the patient cannot
read or write (general literacy), let alone understand the clinician’s medical jargon or complex instructions (health literacy).
In an increasingly multilingual, multicultural society, providing safe, high-quality health care requires overcoming these
3 barriers to effective communication with patients and their
families. When the Joint Commission first developed standards that required an organization to address the language
needs of patients, it was in the context (subsequently bolstered
by federal regulations) of the patient’s right to be fully informed
about his or her care. Later, the need to communicate
effectively was recognized as an element of the quality of
patient care. Today, effective communication—which takes
into account language, cultural differences, and health literacy—is seen as a prerequisite to safe health care. Communication problems are the most frequent root cause of serious
adverse events reported to the Joint Commission’s Sentinel
Event Database,3 and a Joint Commission study found that
when patients suffer adverse outcomes from medical errors,
the outcomes are more serious in limited English proficiency
patients than in English-speaking patients.4 Patient rights,
quality of care, and patient safety each in itself is sufficient to
justify a commitment to effective communication. Together
they make effective communication in health care obligatory—
it is a critical component of the health care itself.
Yet often those health care organizations that are struggling
to implement practices to reduce language, culture, and health
literacy barriers to communication do not know which practices are most effective.1 And even when effective practices are
known, their implementation in a reliable, sustainable, and
efficient manner is challenging. This JGIM Supplement begins
to provide some evidence-based solutions to this challenge.
But more is to be learned, and the solutions that have been
identified often must be adapted to individual organizations.
“Adaptation” does not adequately represent the challenge of
implementation. Too often, evidence-based practices are simply
bolted onto the existing system, thereby adding expense,
increasing complexity, and potentially compromising existing
work processes. Instead, an evidence-based practice should be
incorporated into a redesign of the work processes of the system
or subsystem of which it is to be a part. For example, it is more
effective to incorporate a language interpretation service (an
evidenced-based practice) into redesigned work processes in the
emergency department (a subsystem in a hospital), rather than
to simply graft it onto the department’s current system of
operations and expect it to integrate itself smoothly and
efficiently without interfering with other work processes.
A health care delivery organization, even a clinician’s office,
is a complex system. Among the characteristics of a complex
system are self-adaptation and nonlinear effects. That is, if the
inputs to a complex system are changed, such as the addition
of an interpreter service, the system itself will self-adapt—it
will change to accommodate the new input. However, the selfadaptation may not achieve the goals desired by either the
treatment team or the patient, but may instead lead to
outcomes that are neither expected nor desired by the
treatment team and the patient. The treatment team, patient,
and patient’s family need to anticipate and be alert to the
probability of these unintended consequences. And because
changes in complex systems have nonlinear effects, even the
smallest change in 1 part of the system can lead to a large change
elsewhere in the system. This can be an advantage when it is
used to leverage the effect of a small change; it can also be a
disadvantage if the large change is unexpected and adverse.
As a physician’s or other clinician’s office, clinic, hospital, or
other health care delivery setting focuses its attention on
improving the safety and quality of patient care, these
observations generate a set of principles:
Providing safe and high-quality patient care is dependent
upon effective communication between health care professionals, patients, and patients’ families.
Effective communication requires the recognition and
amelioration of 3 key barriers: language differences, cultural differences, and low health literacy.
There is a growing body of evidence-based practices that
address these 3 barriers (and of evidence that certain
practices are ineffective or unsafe).
For the implementation of these practices to be effective,
reliable, and sustainable, the practices should be incorporated into the redesign of the relevant work processes in
the health care delivery site (e.g., physician’s practice,
hospital), not just bolted onto the current system.
Changes in the site’s systems and processes are likely to
produce unintended consequences; a prospective identification of these potential consequences should be undertaken before implementation, and vigilance for these
consequences should follow implementation.
As the Joint Commission focuses the spotlight of its
standards and accreditation process on patient safety and
quality of care, these principles will guide its approach to
removing communication barriers related to language, cultural
differences, and low health literacy, as well as communication
barriers arising from physical factors such as hearing, speech,
and vision, and from health care interventions such as
intubation. But do not await Joint Commission actions—if
the goal of providing safe, high-quality care is to be achieved,
the obligation of health care professionals and organizations to
address linguistic, cultural, and health literacy barriers to
patient communication is immediate.
Corresponding Author: Paul M. Schyve, MD; The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181, USA
1. Wilson-Stronks A, Galvez E. Hospitals, Language, and Culture: A
Snapshot of the Nation. Oakbrook Terrace, IL: The Joint Commission;
2. The Joint Commission. ‘What Did the Doctor Say?:’ Improving Health
Literacy to Protect Patient Safety. Oakbrook Terrace, IL: The Joint
3. The Joint Commission. Root causes of sentinel events. Available at:
http://www.jointcommission.org/NR/rdonlyres/FA465646-5F5F-4543AC8F-E8AF6571E372/o/root_cause_se.jpg. Accessed August 27, 2007.
4. Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and
adverse events in U.S. hospitals: a pilot study. Int J Qual Health Care.
Overcoming language barrier in
healthcare settings using information and
To the Editor
We read with interest and congratulate Dr. Almutairi
for the recent publication of his article entitled “Culture
and language differences as a barrier to provision of
quality care by the health workforce in Saudi Arabia.1
Dr. Almutairi expressed his strategies to improve
educational and orientation programs regarding the
culture and language in Saudi Arabia to address the
language barrier issue in healthcare settings. In fact, we
are also confronted with a similar situation in Taiwan. As
Chinese is the main language of communication in the
Taiwanese healthcare system, foreign residents (2.3% of
the total population) often face communication-related
difficulties in explaining their health problems to
Taiwanese care providers’ sites.2,3 Thus, we wish to share
our Taiwanese experience where we found the use of
simple information and communication technologies
(ICT) tools, such as Skype, Google Hangouts, Google
translator, and mobile phone camera that was found to
be quite useful in settings explained by Dr. Almutairi.
We have observed several foreigners in Taiwan using
smartphone to type-in English text and translate into
Chinese for explaining their health-related problems, or
condition to care providers. For instance, recently, we
found a family who visited a clinic for the treatment
of their 6-year-old girl’s rash on her chest. The girl
was diagnosed with ‘herpes zoster’ by a dermatologist.
However, due to the language limitation (as the care
provider was Chinese speaking), the dermatologist
could not clearly explain to the girl’s parents about
the problem and its effects on others. The girl and her
parents planned to travel to Vietnam on the following
day after the problem was discovered. Being worried,
they took a picture of the affected skin area and sent
Saudi Med J 2016; Vol. 37 (3)
it to an English-speaking doctor in Australia for his
opinion. The girl’s parents and the doctor discussed
the girls’ condition through Skype. The doctor advised
them not to travel Vietnam for 2 weeks, as ‘herpes
zoster’ is contagious. The family canceled the Vietnam
trip to avoid potential problems that may arise.
As we can see, in the above situation, the use of simple
technologies, such as Skype and Smartphone camera
proved to be of immense use. These modern IT gadgets
can provide users with useful tools for the outreach of
the healthcare facility despite language and geographical
barriers. Therefore, we advocate to promote the use of
ICT tools among healthcare stakeholders, in addition
to educational and orientation programs regarding
language as suggested by Dr. Almutairi.
Goa Institute of Management
The Practice PLC
Reply from the Author
No reply was received from the Author.
1. Almutairi KM. Culture and language differences as a barrier
to provision of quality care by the health workforce in Saudi
Arabia. Saudi Med J 2015; 36: 425-431.
2. Lee FH, Wang HH, Yang YM, Tsai HM. Barriers faced by
Vietnamese immigrant women in Taiwan who do not regularly
undergo cervical screenings: a qualitative study. J Adv Nurs
2014; 70: 87-96.
3. Kumar A, Maskara S, Chiang IJ. Health care satisfaction among
foreign residents in Taiwan–an assessment and improvement.
Technol Health Care 2014; 22: 77-90.
Bridging the language divide in health
While the English language dominates much of the world’s public health information, several initiatives are underway to
provide such information in other widely spoken languages. Patrick Adams and Fiona Fleck report.
“A close relative had been diagnosed
with a rare disease. We searched for
information on it in Arabic and found
websites that were unstructured or were
essentially chat forums,” recalls Dr Majid Altuwaijri.
“But when we searched in English
we found a wealth of good quality information.”
As co-founder of the Saudi Association for Health Informatics, Altuwaijri
was well placed to help his relative, given
his expertise in information technology
and fluency in English.
However, globally only an estimated
600 to 700 million people have English
as a second language, like Altuwaijri,
in addition to some 335 million native
English speakers, with varying degrees
That leaves most of the world’s
population – some six billion people –
with little or no access to a large body
of public health information because it
is in English.
Language can be a barrier to accessing relevant and high quality health
information and delivering appropriate
health care – an unmet need that is
amplified on a global scale.
Cover of World Health Statistics 2015 – one of the
WHO publications that is published in all six official
United Nations languages.
“The trend towards monolingualism is far from decreasing, with the
hegemonic use of one language, English,
over the other five United Nations (UN)
languages,” the UN Joint Inspection
Unit concluded in a 2011 report on
implementation of multilingualism in
As part of the UN system, the World
Health Organization’s (WHO) six official
languages – Arabic (242 million native speakers), Chinese (1197 million),
English (335 million), French (76 million), Russian (16 million), and Spanish
(399 million) – are the first languages
of only 2.4 billion people, according
to Ethnologue: Languages of the World,
18th edition – less than half the world’s
In addition, German (78 million
native speakers) is an official language
in WHO’s European Region and Portuguese (203 million) in WHO’s African,
European and Americas Regions. For native speakers of other languages, such as
Hindi (260 million native speakers) and
Bengali (198 million), the unmet need
for health information may be great.
English has long been the lingua
franca of scientists – including those
working in public health – and while
more WHO publications and web pages
are produced in English than in any
other language, WHO publications appear in more than 70 languages.
All WHO’s official documents, such as
World Health Assembly reports and resolutions, are translated into the six official
languages, but this is not the case for the
rest of WHO’s publishing output, including
technical reports and clinical guidelines.
Moreover, WHO launched its six-language
multilingual website in 2005, but most of
its web content is still in English.
While Portuguese is the world’s
sixth most spoken language (after
Chinese, English, Hindi, Spanish and
Arabic), most Portuguese-speaking scientists seek to publish their work in English to gain wider circulation, according
to a study published in a report for the
European Molecular Biology Organization in 2007 by Rogerio Meneghini.
In public health, the linguistic
disconnect between those providing
health information and those who need
Bull World Health Organ 2015;93:365…
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