Date of Submission


Document Type



Doctor of Education




bilingual(ism), language competency, patient centered care, neuropsychology, culture


In a bilingual health care institution, how can specialized practitioners improve students’ administration of standardized assessments in neuropsychology to French-speaking patients in the absence of language competencies, in alignment with the cultures of both patient-centered care and efficiency? This OIP was developed for a Canadian bilingual health care institution, operating in alignment with political and legal language service and patient care obligations. However, increasing demand for services and professional language competency coupled with reduced funding has led to efficiency-focused departmental practices. Challenges in balancing a culture of efficacy and efficiency with the culture of patient-centered care and bilingualism have led to a culture gap. In this organization, specialized practitioners train students in a non-standardized manner to assess French-speaking patients, and graduate students without language competency tools or support must use clinical judgment to navigate the assessment process. This culture gap impacts the patient’s experience and overall assessment results, as well as the student and specialized practitioners value congruence with the organization.

To implement change in this organization as an informal leader and teacher, I use both linear and cyclical change models that align with Symbolic Interactionism. To lead change, I use adaptive and distributed leadership styles, within an ethics of care framework. Both the implementation and leadership approaches focus on double-loop organizational learning, and participatory, stakeholder-driven change. The chosen solution targets the modification of three current organizational practices: student placement, student on-boarding, and patient assessment.

The solution is incremental and iterative, promoting stakeholder empowerment and sustainable change, towards an organizational culture that is congruent with organizational and stakeholder values. All elements of the implementation plan, including ethical considerations, are subject to periodic study and revision. The communication strategy is tailored to each stakeholder group, and includes a questioning and appreciative approach, supporting informal leadership and development of a shared vision.