Many U.S. residents who speak little English may face language barriers when seeking health care. This article describes what is currently known about language barriers in health care and outlines a research agenda based on mismatches between the current state of knowledge of language barriers and what health care stakeholders need to know. Three broad areas needing more research are discussed: the ways in which language barriers affect health and health care, the efficacy of linguistic access service interventions, and the costs of language barriers and efforts to overcome them. In each of these areas, we outline specific research questions and recommendations.

Background Understanding how to mitigate language barriers is becoming increasingly important for health care providers around the world. Language barriers adversely affect patients in their access to health services; comprehension and adherence; quality of care; and patient and provider satisfaction. In 2003, the United States (US) government made a major change in national policy guidance that significantly affected limited English proficient patients’ ability to access language services. Objective The objectives of this paper are to describe the state of the language barriers literature inside and outside the US since 2003 and to compare the research that was conducted before and after a national policy change occurred in the US. We hypothesize that language barrier research would increase inside and outside the US but that the increase in research would be larger inside the US in response to this national policy change. Methods We reviewed the research literature on language barriers in health care and conducted a cross sectional analysis by tabulating frequencies for geographic location, language group, methodology, research focus and specialty and compared the literature before and after 2003. Results Our sample included 136 studies prior to 2003 and 426 studies from 2003–2010. In the 2003–2010 time period there was a new interest in studying the providers’ perspective instead of or in addition to the patients’ perspective. The methods remained similar between periods with greater than 60% of studies being descriptive and 12% being interventions. Conclusions There was an increase in research on language barriers inside and outside the US and we believe this was larger due to the change in the national policy. We suggest that researchers worldwide should move away from simply documenting the existence of language barriers and should begin to focus their research on documenting how language concordant care influences patient outcomes, providing evidence for interventions that mitigate language barriers, and evaluating the cost effectiveness of providing language concordant care to patients with language barriers. We think this is possible if funding agencies around the world begin to request proposals for these types of research studies. Together, we can begin document meaningful ways to provide high quality health care to patients with language barriers.

Royal Roads University (RRU) is a special purpose university in British Columbia, Canada. Since 1995, this university has focused primarily on multi-sectoral and interdisciplinary graduate education for working professionals. Most programs are offered in a blended online and face-to-face format, which enables adult learners to continue in their professions while they pursue their studies. While one might not expect a primarily distance education degree to be transformative, feedback from learners consistently points to the experience of transformative learning. This article explores the Master's of Arts in Leadership Studies (MA-L) program. It is proposed that there are at least three elements of the design of this program that contribute to experiences of transformation. First, the RRU Learning and Teaching Model creates a framework that can allow many learners to learn how to learn in a new way. Second, the MA-L program itself has its own competency framework that begins by priming learners to look inward before they seek to lead others. Third and finally, the first year two-week residency, completed after one month of online preparation, provides an embodied experience in what, for many, is a new way of being. This embodied experience creates an awareness of what is possible for human relationship and communication, not only in the context of their particular graduate learning cohort, but also with colleagues, family members, and friends. Taken together, these create an often unexpectedly, and somewhat paradoxically, transformative experience for mid-career professionals.

Structured Abstract:Purpose: This chapter explored theories related to inclusive leadership, and the application of inclusion and collaboration principles in a master's-level leadership program.Design/Approach: We reviewed the concept of inclusive leadership, its theoretical grounding in social construction, and the role of collaboration and dialogue in learning, creativity, and what has been called, "dialogic change" in creating an inclusive culture. The application of four principles -leadership as engagement, engaged scholarship, orientation to possibility, and learning as transformation -have been critical to the practices of the authors as leadership educators and in teaching leadership.Findings: Inclusive leadership practices can have a dramatic positive impact on employee engagement, organizational culture and, ultimately, on organizational effectiveness. Moreover, inclusive leaders can effectively navigate through a context of volatility, uncertainty, complexity, and ambiguity, through engaging those affected by these issues.Social Implications: Universities play a key role in making the world a better place by educating future leaders to work effectively and respectfully with others by fostering creative problem solving. When faculty and staff embrace inclusive leadership principles in their work together, they generate creativity, and improve their effectiveness. As leadership educators, we not only model inclusive leadership principles; we use them as a framework for our teaching.Originality/Value of paper: Our leadership journey from theory to practice is of interest to leadership educators, scholars, and practitioners seeking to better understand and apply the concept of inclusive leadership in their particular settings. While our setting is Canadian, we argue the theoretical discussion and principles have broader application.Keywords: Inclusion; post-heroic leadership; social construction; dialogic change; leadership education; generative metaphor. (Hamilton, Márquez, & Agger-Gupta, 2013 Classification: Conceptual paper [Maximum is 250 words in total (ours is 250 words). Please provide up to six keywords]

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