A Language Policy for Japanese Hospitals in Tokyo with

No Foreign Language Speaking Doctors and Staff

Introduction
Language planning and policy (LPP) is usually perceived as a matter that is done on a
national level, or an activity that is supposed to be undertaken by the government with
the end goal of influencing and/or changing the way of speaking and learning practices
within a country. However, over the past years, the concept had evolved and it is now
acknowledged that LPP can occur at three levels: (a) the macro, (b) the meso and (c)
the micro (Baldauf, 2006). In addition to this, recently in the field of research, there has
been a shift from macro-level language planning and policy to micro-level because of
the belief that it is easier to address linguistic problems and issues through a bottom-up
approach instead of top-down. Contrary to macro-level LPP, LPP in the micro-level
takes place within schools, families, communities, organizations, and other institutions
(Shen & Guo, 2019).
LPP is a means of addressing and resolving language problems. In hospitals, such
policies can be put in place in order to avoid language barriers which is a challenge in
achieving satisfaction among patients and medical practitioners, in ensuring the safety
of the patients, and in providing better and higher quality of healthcare and various
medical services. Language barriers make it difficult for people who do not speak the
same native language to communicate and understand each other well. In a place
where the health and lives of the people is the priority, such as hospitals, language
barriers can be a major problem as it can affect the quality of healthcare which the
hospitals and its people can provide. In their research, Floyd & Sakellariou (2017) found
that foreign patients who do not speak or do not have any knowledge about the local
language are disadvantaged when it comes to accessing and availing of healthcare
services. In addition to this, several studies have found that foreign patients who are
burdened by language barriers tend to have poor health outcomes unlike that of those
who know and speak the local language (Divi et al., 2007; Squires, 2017; Al Shamsi et
al., 2020). If the doctors, nurses, receptionists and other medical professionals do not
speak the same language as their patients, then the communication process between
them might fail and thus healthcare services will not be delivered effectively. Hence, one
might ask: Who needs to adjust to whom? Should the patient learn the language of the
doctor and medical professionals in order for him/her to experience higher quality of
healthcare? Or is it possible that the hospital itself set some policies which will meet the
needs of various patients?
This essay talks about the need for a hospital language policy in Japanese hospitals
located in Tokyo, Japan where foreign patients from various countries usually visit. This
essay believes that it should be the hospital’s mandate to ensure that it caters to the
needs of all its patients, regardless of nationality, language, race, religion, or any other
category of differences. Hospitals are dutybound to serve their patients and to deliver
 high quality healthcare and medical services to them. If challenges, such as language
barrier, is not addressed, then the hospital fails to comply to their duty as such.
Situation in Japan re: foreign language learning
Japan is among the countries which is known to be very relaxed to learning foreign
languages, including English, as a second language. People merely learn basic English
grammar and vocabulary without realizing that they need to learn better English (Morita,
2017). As a result, they later found it difficult to work at the workplace using English.
Because of globalization and internalization, Japan started to create policies aimed at
English language learning and further improving skills and knowledge in relation thereto,
in order for Japan to connect and interact with other nations. At present, Japan believes
that studying English is important in order to keep the country’s status and
competitiveness in the international sphere (Shimizu, 2010).
Japanese people are known to have anti-immigration sentiments primarily because of
fear that allowing immigrants to enter the country might lead to the loss and non-
preservation of Japanese values, tradition and culture (Davison & Peng, 2021). Moreover,
they have a so-called exclusionary attitude, where they adhere to ethnic nationalism
(Morita, 2015). Simply put, the only persons who should be granted Japanese
citizenship should be those that are ethnically Japanese; or foreigners in Japan should
do things the Japanese way. Nevertheless, because of the decreasing number of
population in Japan, its aging society, labor shortage and its need for skilled foreign
workers, its immigration policies have allowed more foreign people to enter the country.
Many people from other countries migrate to Japan with the intention to reside therein
as a permanent resident. To picture this, below is a table which shows the percentage
of foreign population in Japan from 2014 to 2019. It clearly shows that a large number of
people from various countries such as China, Korea, Philippines, Brazil, Vietnam and
US come to Japan and live there permanently.

Table 1. Foreign population by the countries of origin 2014–2019: Japan. (Davison & Peng, 2021)

Tokyo is reported to have the largest foreign population at present, followed by Aichi,
Osaka and Kanagawa. (Nippon, 2019). It is worth noting that the abovementioned
countries do not speak the same language as Japan. This is one practical reason why
there is a need to learn various foreign languages, or to at least learn English as a
foreign language. Moreover, learning English was proved to mitigate discrimination
against foreigners because it paves the way for better communication between
Japanese and foreigners. According to the Education First English Proficiency Index
2021 report where 112 countries are ranked by English skills, among Asian countries,
Japan only placed 13th with Singapore and Philippines taking the 1st and 2nd places
respectively; and among all 112 countries, Japan ranked 78 th which is undeniably a low
proficiency ranking (Education First, 2021). In addition to this, the report showed a
slight decrease in the performance of Ja-pan from last year’s results. A copy of the
Asian rankings is reproduced below for easy reference.

Table 2. Education First English Proficiency Index 2021: Asian (Education First, 2021)

According to Morita (2017), this low English proficiency might be because of the English
learning method used is schools, particularly the so-called grammar-translation methos
where they translate English texts into Japanese, word-by-word. There is an evident
lack of communication-based approaches/methods in teaching English.
Language barrier in Japanese hospitals
Hospitals are among the places where differences in the language spoken or used can
cause problems and misunderstandings. Although Japanese healthcare system has
been gaining admiration and praises from other nations because it is made easily
accessible to Japanese people, many foreign residents, on the contrary, experience
difficulty in accessing health care, and there is obvious health disparity between
Japanese and foreign patients (Yasukawa et al., 2019). It was reported that foreign
residents have a higher mortality rate than Japanese citizens in terms of serious
diseases such as renal failure and diabetes (Kobori et al., 2017; Morita, 2017).
Morita (2017) argues that there is a higher death rate among foreign residents because
there is a lack of language support in favor of foreign residents. In one study, it was
found that foreign nationals in Japan are less likely to seek medical help from or contact
appropriate services for various mental illnesses by reason of lack/absence of medical
interpreters (Takubo et al., 2020). Further, it is argued that the unavailability of medical
interpreters in hospitals compromises and negatively influences the quality of healthcare
for patients who do not speak not have knowledge regarding the language of the host
country. Foreign patients find it difficult to communicate in and understand Japanese,
and at the same time, the medical practitioners and hospital staff also find hard to
communicate and comprehend when interacting with non-Japanese speakers. This is
why foreigners are often hesitant to go to Japanese hospitals or clinics. They do not feel
that they will be provided the necessary and quality healthcare services that they need.
In addition to this, even of interpreters are available, the lack of necessary and proper
language knowledge, skills and training result to serious errors, mistakes and
consequences especially affecting the health of the foreign patients (Flores, 2005). The
same claim is supported by Al Shamsi et al., (2020) when they found in their study that
language barriers in healthcare often leads to miscommunication between the
healthcare provider and the patient. Consequently, they concluded that there is a need
to provide and implement online translation tools in order to somehow improve the level
of satisfaction among key actors and to improve the quality of healthcare.
At this point, it is also important to emphasize the important role that nurses and
receptionists play in hospitals and clinics. They are the ones who initially interact with
the patients, which is why their communication and language skills is key to making all
patients, both foreigners and Japanese nationals, feel safe, at ease and confident in
seeking the help of healthcare providers.
In order to address the challenges posed by language barrier, this essay proposes the
following language policies: (a) basic language courses/s for hospital staff (especially
for doctors, nurses and receptionists, and other persons who often directly interact with
patients) to ensure that they are proficient in certain language/s; (b) medical information
in multiple languages to be distributed, posted or published within hospitals and on web
pages; and (c) providing expert interpreters, when needed/requested.
Hospital Language Policies
A. Basic language course/s for hospital staff
According to Al Shamsi et al. (2020), communication between healthcare providers and
patients is the key to effective healthcare. As mentioned earlier, there is a need to
highlight the role of receptionists and nurses as they are the ones who initially face and
talk with the patients. It is important that nurses understand the language of every
patient who come to them to seek medical assistance so that the latter will be
encouraged to express his/her needs and be open to sharing all pertinent information
regarding his/her health status with the end of ensuring that treatment to the particular
illness and eventual recovery will be properly adjusted (Pytel et al., 2009).
Also, even doctors and physicians encounter problems because of language barriers.
Ideally, they should be provided with sufficient information regarding the health
condition of their patient/s. However, research show that patients tend to hide or omit
some relevant details because of language barriers. Patients are usually not familiar
with medical terms, which is mainly the reason why doctors must be able and know how
to explain to their patients in simple terms such medical and scientific matters. Yet, this
cannot be done if they speak in different languages.
This is why there is a need to provide basic language courses to hospital employees,
mainly those who interact directly and more frequently with the patients. They must be
fully equipped with the basics so that effective communication can take place with the
end goal of ensuring that health care is effectively provided to all patients.
B. Medical information in multiple languages (within hospitals and online)
Information dissemination is very important especially in times of pandemic. It is a fact
that foreign residents experience difficulty in finding medical or health care information
written in their primary language (Miller et al., 2021). Hospitals can utilize the internet
and take advantage of it in reaching as many patients as possible so that access to
health care services and information can be easier.
Foreign patients must have access to sufficient information regarding healthcare so that
they will be able to make informed decisions in relation to their health conditions, such
as whether they should consult and seek the help of a physician, or whether they should
undergo a certain medical procedure. Otherwise, they will always fear going to hospitals
and seeking medical assistance.
C. Providing expert interpreters, when the circumstances demand such
This may sound very simple and irrelevant, but this essay believes that the choice of
language of the patient should be followed. This is why there is a need for hospitals to
provide various language courses to its staff. Some should learn a particular language;
while the other should learn a different one. This is to ensure that no matter what
language a patient speaks, the hospital already has someone who can assist and
communicate effectively with the patient using the patient’s preferred language.
The quality of consultations between doctors and patients is largely dependent on the
fluency and language proficiency of the interpreters. The needs and preference of the
patient should be prioritized in order for them to feel at ease whenever they seek the
assistance and help of hospitals. Evidence from various research suggests that
providing access to trained professional interpreters can result to patient satisfaction,
better health care and outcomes and few errors (Flores, 2005).
According to Drew (2014), patients can be assisted by ad hoc interpreters, such as their
family members or friends, however, this is not advisable because such interpreters are
likely to commit errors in interpreting and translating. If the patient feels the need for an
interpreter, then one should be provided for him/her. However, it must be emphasized
that the interpreter must be an expert. This is to ensure that zero to very least number of
errors in the interpretations can be made so that the diagnosis will be accurate and the
treatment and recovery can be properly adjusted accordingly. Therefore, what is
needed in hospitals are expert medical interpreters.
Conclusion
Due to the increasing number of immigrants and foreign residents in Japan, there is a
need for some Japanese hospitals, especially those located in cities where such foreign
residents usually reside, to meet the linguistic and cultural needs of foreign patients by
putting in place some language policies. Learning a new language is one thing, but what
is needed is the proficiency and fluency to speak and communicate using a particular
language. Again, communication is the key to effective health care provision.
However, policies are merely policies and will not be of significance if not implemented
properly. The best way to conclude this essay is to provide for a final policy which will
ensure that all above-mentioned policies will be effectively implemented and applied in
actual practice—the provision of customer service training for hospital staff
incorporating all the said policies. In addition to this, regular evaluations should be put in
place.

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