Change Management Proposal for Royal London Hospital: NHS

This report proposes a departmental change management project focused on implementing multilingual tablet translators at Royal London Hospital, a NHS hospital in the UK, to address communication barriers faced by non-English speaking patients. The report begins with an introduction outlining the need for change and the benefits of using multilingual tablet translators to overcome language barriers and improve patient care, particularly in emergency situations. It then provides background information on the challenges associated with individual interpreters, including availability issues, privacy concerns, and potential biases. The project aims to replace individual interpreters with electronic devices that can translate languages, ensuring the privacy and accessibility of translation services. The report details the nature of the change management project, justifying the selection of multilingual tablet translators. It also describes the implementation process, including change management models, leadership strategies, and evaluation methods. Furthermore, it discusses how the proposal will enhance the quality of service, roll out the change, and communicate the benefits to stakeholders. The report concludes by emphasizing the importance of adapting healthcare services to meet the needs of diverse patient populations, with the goal of enhancing the efficiency of the public relations department by improving the quality of services.

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CHANGE MANAGEMENT IN AN ORGANIZATION
Student Name
Institution Affiliation
Facilitator
Date

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Table of Contents
1.0 Introduction................................................................................................................................3
1.1Overview.................................................................................................................................3
1.2 Justification on Choosing Multilingual Tablet Translators....................................................4
1.3 Nature of Change Management Project.................................................................................5
2.0 Background................................................................................................................................7
2.1 Background Information on the Adopting Multilingual Tablet Translators..........................7
2.2 Impacts of the Proposed Change (Multilingual Tablet Translators) on Members.................9
3.0 Implementing the Change........................................................................................................10
3.1 Background to Change Models............................................................................................10
3.2 Leadership............................................................................................................................11
3.3 Quality Improvement Model................................................................................................12
3.4 Impacts of Multilingual Tablet Translators Change on Other People.................................13
3.5 Multilingual Tablet Translators Change Evaluation............................................................13
3.6 How the Proposal will Enhance Quality of Service Users...................................................14
3.7 Rolling Out and Communicating the Change......................................................................14
4.0 Conclusion...............................................................................................................................15
5.0 References................................................................................................................................15

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1.0 Introduction
In any sector of the economy, changes are inevitable. Healthcare systems too have
witnessed changes in the way operations are undertaken aimed at improving the quality of
services. For instance, it’s through changes in the healthcare systems that the traditional way of
reusing syringes was abandoned and the approach of single-use adopted because it was risky.
Also, the operation of most healthcare systems has shifted from the initial 12hrs to 24/7 after it
was realized that emergency cases could not be predicted and that led to high death rates. A keen
observation on these and other changes which have taken place in healthcare sector globally, the
important role of healthcare changes comes out clearly. So, as far as any change impacts the
sector positively, it should be encouraged. This paper proposes a change to bridge the gap
between patients who don’t understand or speak the English language in Royal London Hospital
in UK. These patients face difficulties, especially when under emergency conditions and a
translator can’t be easily accessed. Considering the fact that some electronic devices have the
capability of translating one language to another, the paper proposes the adoption of Multilingual
tablet translators for patients who don’t speak English in Royal London Hospital, a NHS
Hospital in UK.
1.1Overview
Patients with limited English proficiency as well as those who totally do not know
English usually go through a lot of suffering in Royal London Hospital, a NHS hospital in the
UK because the main language used by healthcare practitioners is English. Individual
interpreters have been used to facilitate translation from patients to healthcare providers and vice
versa (Institute of Health Improvement). However, weaknesses associated with individual
interpreters have inconvenienced the effectiveness of healthcare services in most cases. Among

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the weaknesses of individual interpreters is the lack of quick response in times of emergencies
and privacy issues. In regard to timed response, patients usually who require emergency response
usually suffer a lot to the extent of death when they reach the hospital and an interpreter cannot
be easily accessed to facilitate the interpretation. On the other hand, some health matters are
confidential and patients may shy to talk about them openly in front of another person. This
denies such kind of patients a chance to receive necessary treatment.
Clearly, the two weaknesses of individual interpreters presented above have
compromised the effectiveness of healthcare systems in the UK before. In this paper, I have
chosen the implementation of multilingual tablet translators to replace individual translators in
the Royal London Hospital, a NHS hospital in the UK. With multilingual tablet translators which
are electronic devices, the gadget will be placed in front of a patient to translate as the patient
explains his or health issues to doctors or nurses (Kotter, 1996). Similarly, any instructions to the
patient will also be passed through the device so that it can translate English into the patient’s
local dialect. The device will have taken care of the main weaknesses of individual translators.
This is in consideration of the fact that multilingual translators are electronic devices which only
require power to operate and hence their availability at all times is guaranteed. Also, patients will
not shy away expressing themselves in front of the gadget.
1.2 Justification on Choosing Multilingual Tablet Translators
As discussed in the overview section above, there have been some challenges in the
previous system of translation which has been using individual translators. The main challenges
faced by hospitals out of their reliance on individual interpreters are based on availability, quick
response, and privacy. With multilingual tablet translator in place, these challenges will be

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avoided. This is in consideration of the fact that multilingual tablet translators are electronic
devices which require power and maybe internet access to facilitate the service. Their availability
is hence guaranteed. The privacy issues will also be taken care of by the fact that patients will be
interacting with the device directly hence taking care of the privacy factor. Unlike in the case of
individual interpreters where patients under critical conditions would arrive in the hospital and
suffer a lot waiting for an interpreter to arrive and help translate the explanation to clinical
officers, patients will no longer have to wait because multilingual tablet translators will be
readily available at all times.
1.3 Nature of Change Management Project
In its basic definition, change management is a structured approach which is aimed at
moving any kind of organization from its current state to a more desirable state in the future. A
typical change management project consists of five processes which are assessment, preparation,
planning, implementation, and sustainability (Lewin, 1951). The assessment phase entails
drafting the requirements needed to convert outputs into benefits. The preparation phase involves
creating a vision and gathering support. Moving forward, the planning phase entails
brainstorming on how to effect the changes while the implementation step involves the
coordination of different activities to transform a business or a program from the status quo to a
new working system. The sustainability phase involves maintaining the changes to ensure that
the objectives of the project or the program are achieved.
There are four different types of change management. The first type is the organizational
change management. This is a change that is managed at an organizational level with its main
focus on culture. It’s the practice of managing enterprise changes like mergers and acquisitions,

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restructuring and culture transitions. Its main focus lies on the side of the people. In most cases,
this is an executive management program which is controlled by the department of human
resources. The second type of change management is the program change management which
manages changes at the program level (NHS England). This type of change management controls
changes to an ongoing project portfolio to ensure that the goals of the program are met. This
change is managed by program managers assisted with change control boards. The goal is to
balance the needs for changes with the objectives of the program
Moving forward, the third type of change management is project change management.
This is a controlled change integration which is done in every phase of a project. These changes
are mainly evaluated in consideration of quality, risks and cost benefits. The last type of change
management is the departmental change management. It is a type of change which is
implemented at the department level to match the departmental budget and requirements and the
constraints.
Based on the four types of change management projects, my project is expected to be a
departmental change management project in nature. This is in consideration of the fact that it will
be taking place at the department level. Issues to do with patient challenges in the hospital are
under customer relations which fall under the department of public relations (NHS
Improvement). As the definition of departmental change management suggests, this change will
be affected to take care of the constraints of the department. The challenges faced by non-
English patients when they receive poor services as a result of communication barriers are a
challenge to the efficiency of the public relations department which portrays a picture of failure

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in the department. Adopting multilingual tablet translators to replace the initial system which
relied on individual interpreters will rekindle the department image.
2.0 Background
2.1 Background Information on the Adopting Multilingual Tablet Translators
According to Heaney and Moreham (2002), interpretation is very important in
metropolitan healthcare systems. Through interpretation, the language barrier is overcome in
healthcare systems. In addition to that, they also facilitate a multi-dimensional communication
that is sensitive to multicultural experiences hence the need to ensure translation is done in the
most effective way. According to another article written by an American Family Physician,
drawing data from the census bureau of 2014, it indicated that more than 25 million people who
attended American national hospitals speak English than very well. Also, the article indicated
that more than 60million people used other languages to express themselves. This was evidence
that interpreters were critical in healthcare systems.
Interpretation in healthcare settings helps in mitigating risks. This is in consideration of
the fact that having interpreters in some cases is a matter of life and death. For example, if
clinicians are not in a position to effectively engage their patients, misdiagnosis, and malpractice
treatments are likely to occur. But with an interpreter around, he or she communicates medical
terminologies effectively to mitigate the risks of language barriers.
Additionally, Heaney and Moreham (2002) put more emphasis on the importance of
having a translation system which is effective. The word effective translation in their research

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has been used to denote a translation system which is easily accessible in times of emergencies, a
system that is not biased in any way and finally a system that encourages participation of patients
without fear. However, according to Viruell-Fuentes, Miranda, and Abdulrahim (2012) in their
scrutiny on the effectiveness of individual interpreters, some of the standards of an effective
translation system proposed by Heaney and Moreham (2002) are not met by this system. For
instance, the research shows that individual translation systems are not readily available. This
has been based on the fact that the system relies on people who have personal needs and other
body requirements which may not allow them to be readily available in times of emergency.
Also, the research indicated that individual interpreters may be biased on a racial basis which
compromises the effectiveness of their translations. Lastly, the paper indicated that individual
translation system scared patients with sensitive health issues which could compromise the
effectiveness of the healthcare services as well.
According to the data protection act of 2018 in the UK which aimed at controlling how
personal information should be used by organizations (Carey, 2018), everyone using personal
data was entitled to adhere to strict rules called principles of data protection. According to those
principles, personal data was supposed to be used fairly, lawfully and privacy of that data
maintained as well. Stronger legal protection for more sensitive information was also drafted on
the basis of race, religious beliefs, health matters, and ethnic backgrounds (NHS Institute for
Innovation and Improvement, 2005). Failure to adhere to those principles would lead to strict
measures being taken against the people in charge. Controlling patient information privacy has
been hard under individual translation system because information is fed on interpreters who
can’t be regulated like information systems. Patients’ sensitive information has hence been
shared regularly compromising their privacy.

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Replacing the traditional translation system of interpretation with a multilingual tablet
translator as proposed in this paper will, therefore, take care of the challenges profound in the
individual translation system. For instance, the privacy of a patient’s sensitive information will
be maintained since the information will be stored electronically where passwords and
encryption measures are possible. Also, the challenge of availability as outlined by Heaney and
Moreham (2002) in their research will have been addressed. Finally, patients will be free to
express all their health issues openly unlike in the previous system where sensitive information
was hard to let out. Viruell-Fuentes, Miranda, and Abdulrahim (2012) approve the use of
electronic device translators on the basis of the fact that they meet all the standards for an
effective translation system.
2.2 Impacts of the Proposed Change (Multilingual Tablet Translators) on Members
Just like any other change in an organization, the proposed change (replacement of
Individual Translation System Multilingual Tablet Translators) in this case will affect
organization members differently. For instance, this change will enable no-English patients to
enjoy their rights of proper treatment like all the other patients. This is because the chances of
language barrier will be minimal unlike in the individual interpretation system which
compromised the effectiveness of healthcare services through various ways like biased
interpretations, unavailability and delayed response to emergencies.
The proposed change will have severe impacts on the already existing individual
interpreters in the system. This is because the change is more of a threat to their source of
livelihood. From this perspective, this change is likely to face opposition as workers in the sector
will stand out to defend their jobs (Rogers, 2003). On a clinician point of view, mixed reactions

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are expected because of the usability factor. Some will oppose the change on the basis of
unfamiliarity with its usability while others who know how it is used will embrace the change in
consideration to its expected benefits. Considering the fact that the change may result in
disruptions in the co-production, alternatives to help the workers expected to be negatively
affected will be sought first before implementation of the change. For example, some of the
translators may be deployed in other departments and others placed to be in charge of the new
translation system.
3.0 Implementing the Change
3.1 Background to Change Models
In today’s fast-moving environments, any business organization whose pace of change is
slow is prone to sorely disappointment. This is because the world is changing: right from the
population, customer trends, technology, and economy. Businesses organizations which will not
embrace change are likely to fail because they will not be in a position to compete with other
businesses (Institute for Health Improvement). This indicates the importance of change in an
organization because without change organizations lose their competitive edge by failing to meet
the changing demands of customers. Change in an organization must be done in a controlled
manner to avoid splash back impacts. This calls for change management. Change management is
the structured approach in transitioning people or organizations from the current state to a
desirable state in the future. Mainly change management is applied when downsizing, expanding
or introducing new technology. Through change management, an organization manages to help
its employees to commit, understand, embrace and accept changes. In the change management
process, model approaches are used in order to simplify the approaches to be involved in the

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management process. Some of the common models in change management include Lewin’s
change model, ADKAR model, Kotter’s 8-step change model, Kubler-Ross change curve.
To implement the Multilingual Tablet Translators as a replacement to the traditional
individual interpreters, I will follow Kurt Lewin’s change model. According to this model, the
change process entails the creation of a perception that a certain change is needed, expounding
on the proposed change and then finally solidifying the change to become a norm in an
organization. The change, in this case, will follow the three steps suggested by Kurt Lewin.
The first step will be the unfreezing step. As a change that will entail losing jobs for some
organization workers like the interpreters and send others to training on how to use and maintain
the multilingual tablets, it is likely to face a lot of opposition (Bowers, 2011, p.32). In order to
counter the arguments put forward as the reasons behind the resistance, this step will involve the
creation of awareness on how the traditional system of individual interpreters has been
inconveniencing the efficiency of health systems in different ways. In the process, the operation
of the old system, its weaknesses and the ways through which it has failed the health systems, in
general, will be carefully examined in order to prove to the employees that the change is
necessary.
The second step will involve commissioning the necessary measures to achieve the
change. This step is commonly known as the changing step. Since people will have understood
the need for the change and started to embrace the change, measures such as purchasing the
gadgets, installation of support applications and integrating the gadgets into the organization
systems. Preparing the clinical officers on the usage of these gadgets will also be involved in this
step (Prochaska and DiClemente, 2005). After all, is done, the change will proceed to the final

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step “Refreezing step”. In the refreezing step, the main activities will be to reinforce, stabilize
and solidify the new state after the adoption of the change
3.2 Leadership
In order to achieve positive results in the implementation of any change, the approach
taken on cheering the implementation of a project plays a very important role. In the
implementation of my proposed change, I will follow a servant leadership approach. This is in
consideration of the fact that it is a new system being introduced in the healthcare system and
different workers will have different challenges when it comes to its usage. For that matter,
before considering any evaluation of the new system, I will strive to ensure all the needs and
challenges faced by other organization members are addressed.
To ensure that the leadership approach is successful, I will base it on the three leadership
models; managerial Grid, Four framework approaches, and situational leadership. Guided by the
managerial grid, the needs and concerns of other organization members will be used to predict
the outcome of the implemented change (NHS Change Model). This will make it possible to
learn on the weaknesses of the change and rectify. Moving forward, the Four Framework
Approach will be used to define the leadership behavior necessary to make the change
successful. Under this model, the structural framework will be used in response to problems
which may arise in the course of the implementation. In addition to the two models, the
situational leadership model will also be applied in the implementation process to ensure that the
change has been adopted in an expected way. This step will include supervision and supporting
the different implementation plans to ensure efficiency.

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3.3 Quality Improvement Model
After completing the implementation process, the change will need a continuous
evaluation to maintain its functionality. This will be achieved through Quality Improvement. QI
is a formal and systematic approach used to analyze the performance of a project in order to
improve where necessary (Kotter, 1996). Through this approach, the efficiency and performance
of the implemented change will be improved over time. Among the three QI models; Plan-Do-
Study-Act (PDSA), Six Sigma and Lean, this project will use the PDSA model. This is because
it’s a new project and will require continuous testing which is supposed to be on a small scale
testing.
3.4 Impacts of Multilingual Tablet Translators Change on Other People
Replacing the traditional translation system of interpretation with a multilingual tablet
translator as proposed in this paper will, therefore, take care of the challenges profound in the
individual translation system. For instance, the privacy of a patient’s sensitive information will
be maintained since the information will be stored electronically where passwords and
encryption measures are possible. Also, the challenge of availability as outlined by Heaney and
Moreham (2002) in their research will have been addressed. Finally, patients will be free to
express all their health issues openly unlike in the previous system where sensitive information
was hard to let out. Viruell-Fuentes, Miranda, and Abdulrahim (2012) approve the use of
electronic device translators on the basis of the fact that they meet all the standards for an
effective translation system.
3.5 Multilingual Tablet Translators Change Evaluation

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To evaluate this change, four steps will be followed. The first step will entail reviewing
the impacts of the change in the healthcare system in order to know whether it's progressing in an
expected manner. The second step will involve gathering the evidence for evaluation. This will
help in ascertaining whether the changes are positive or negative. Step three will involve the
analysis of the collected evidence to determine their validity. Finally, the findings obtained in the
evaluation process will be shared with friends in order to get their criticism.
3.6 How the Proposal will Enhance Quality of Service Users
This paper proposes the replacement of the traditional system of interpretation with an
implementation of multilingual tablet translators. With multilingual tablet translators which are
electronic devices, the gadget will be placed in front of a patient to translate as the patient
explains his or health issues to doctors or nurses. Similarly, any instructions to the patient will
also be passed through the device so that it can translate English into the patient’s local dialect.
The traditional system had some weaknesses which have been addressed in this system. Patients,
who are the service users under this new system of interpretation, will no longer suffer due to
delayed response of individual interpreters.
3.7 Rolling Out and Communicating the Change
To roll out and communicate the proposed change, the following five steps will be put
into use. First, change plans will be finalized before the change implementation is started.
Secondly, processes to be followed in the implementation phase will be clearly outlined and
defined. Thirdly, a strong communication channel will be established between different
departments which will be affected by the change. Fourthly, feedback will be collected from time

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to time in the course of implementation and finally, good performance goals will be established,
explained and maintained throughout the implementation process.
4.0 Conclusion
In summary, this paper has scrutinized the change process management in the healthcare
system. The proposed change has been the replacement of the traditional system of translation
which used people as interpreters with a digital system which will use multilingual tablets to
facilitate the translation process. Moving forward, different approaches to achieving change in an
organization have been considered and explained in details to understand the processes of change
management in an organization.

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5.0 References
Bowers B (2011) Managing change by empowering staff. Nursing Times;107:32-33
Braveman, P. A., Kumanyika, S., Fielding, J., LaVeist, T., Borrell, L. N., Manderscheid, R., &
Troutman, A. (2011). Health disparities and health equity: the issue is justice. American journal
of public health, 101(S1), S149-S155.
Change tools Fish Bone diagrammed 5 whys Plan-Do-Study-Act
Heaney, C., & Moreham, S. (2002). Use of interpreter services in a metropolitan healthcare
system. Australian Health Review, 25(3), 38-45.
Institute for Health Improvement (Improvement Model)
http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx
Institute of Health Improvement (no date) 5 Whys: Finding the Root Cause. Available from
http://www.ihi.org/resources/Pages/Tools/5-Whys-Finding-the-Root-Cause.aspx {accessed 10
October 2018)
Kotter (1996) http://www.kotterinternational.com/our-principles/changesteps/changesteps
Kotter J (1996) Leading Change. Harvard Business Review. Boston
Lewin (1951) http://www.change-management-coach.com/kurt_lewin.html
Lewin K (1951) Field Theory in Social Science, Harper and Row, New York
NHS Change Model https://www.england.nhs.uk/sustainableimprovement/change-model/

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NHS England (no date) The Change Model Guide. Available from
https://www.england.nhs.uk/wpcontent/uploads/2018/04/change-model-guide-v5.pdf {accessed
10 Oct 2018}
NHS Improvement (no date) Online library of Quality, Service Improvement and Redesign tool.
Cause and effect (fishbone) available from; https://improvement.nhs.uk/documents/2093/cause-
effect-fishbone.pdf [accessed 10 October 2018]
NHS Institute for Innovation and Improvement (2005) Improvement Leaders’ Guide. Managing
the human dimensions of change. Personal and organisational development.
Prochaska and DiClemente (2005)
http://currentnursing.com/nursing_theory/transtheoretical_model.html
Rogers E (2003) Diffusion of Innovations. Fifth edition. Free Press
Viruell-Fuentes, E. A., Miranda, P. Y., & Abdulrahim, S. (2012). More than culture: structural
racism, intersectionality theory, and immigrant health. Social science & medicine, 75(12), 2099-
2106.

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