importance of diversity in healthcare essay

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The Importance of Diversity in Health Care: Medical Professionals Weigh In

To provide the best possible care for all patients and help minimize racial disparities, medical professionals need to acknowledge and recognize differences among varying populations. Diversity among physicians—pertaining to socioeconomic status, race, gender identity, and so on—is key. Many physicians already recognize that a commitment to diversity is critical, yet there is still progress to be made.

To learn more about diversity in health care from the inside out, take a look at what some physicians have to say on the topic.

Exploring diversity in medicine so far

By looking at the statistics in the chart below, the medical field is still primarily white males with a smaller contingent of of females and other ethnic groups. It’s pretty clear that the medical field has a long way to go.

“Diversity in Medicine: Facts and Figures 2019” from the Association of American Medical Colleges (AAMC) touches on gender distribution among doctors , revealing that nearly two-thirds of physicians are male. However, that figure may even out over time. AAMC data comparing applicants and enrolled medical students by sex shows that females now outnumber males in US medical schools.

The same report also includes a breakdown of active physicians by race and ethnicity , which shows that more than half of practicing physicians are white, 17 percent are Asian, 6 percent are Hispanic, and 5 percent are Black. This is something that comes as no surprise to Dr. Antonio Webb, an orthopedic spine surgeon, who notes that one AAMC report found there were fewer Black male medical students in 2014 than there were in 1978. He says that when he was a child, he didn’t know any doctors who looked like him.

“My parents weren’t physicians, and I didn’t really have any mentors,” he recalls. “I kind of carved my own path—there was no YouTube back then.”

Additionally, the majority of medical students come from affluent, higher socioeconomic status backgrounds. According to An Updated Look at the Economic Diversity of U.S. Medical Students from the AAMC, more than 75 percent of medical students are from families who are in the top two quintiles for household income as identified by US census data.

While research on sexual and gender orientation as well as religious affiliation among physicians is limited, diversity in these realms is also important for developing good bedside manner and providing quality care.

How diversity in health care benefits patients

A lack of diversity in the workforce limits the capabilities of medicine, containing it within a single ethnic lens and a particular set of values. The medical workforce should instead reflect the variety of patients for which they provide care.

“It is important for physicians to be diverse in large part because our patients are diverse,” explains Dr. Lisa Doggett, a family physician. “If we can understand our patients’ belief systems and values, we will be able to provide better care for them.”

For instance, patients’ religious beliefs can similarly affect the quality of care they receive. A recent paper on cultural competence in medicine reveals the many ways in which an individual’s beliefs can affect them as a patient. Additionally, the medical research community acknowledges that health disparities among LGTBQ individuals are a significant issue. Just consider this reflection from one transgender patient.

“The more diverse the people are who provide medical care, the better they can respectfully and knowledgeably assist their patients.”

“As a transgender person, it’s very difficult to access health care with competent providers knowledgeable about transgender health care,” explains Jordan Rubenstein of Ellevest . “The more diverse the people are who provide medical care, the better they can respectfully and knowledgeably assist their patients.”

When a patient cannot find providers that resemble them, their beliefs, their culture, or other facets of their life, they run the risk of not being understood or being able to receive the appropriate treatment. One clear example of this is the extreme divide in health outcomes for expecting mothers based on race. The Centers for Disease Control and Prevention (CDC) reveals Black and native women are two to three times more likely to die of pregnancy complications than white women.

A more diverse physician workforce also makes needed care more accessible to patients who might otherwise be overlooked—research on primary care physician distribution shows that practitioners who are from minority racial and ethnic groups are much more likely to work in underserved communities than their white counterparts.

How diversity in health care benefits providers

Physicians themselves could enjoy a better quality of life as a result of a more diverse health care workforce. Doctors who are part of an underrepresented group are often able to build incredibly strong relationships with the minority individuals they serve.

“I find that I can better relate to my patients,” Dr. Webb says.

Dr. Jaydeep Tripathy, a UK-based primary care physician at DoctorSpring , notes there are other benefits to working with people from a variety of backgrounds as well. “Diversity in the workplace, in my opinion, fosters a greater sense of identity and culture, making me feel better and more rewarded at work,” he says.

This diversity can go a long way toward improving morale and reminding physicians why they became doctors in the first place. It also encourages physicians to expand their horizons.

“We run the risk of becoming shortsighted or boxed in to a particular way of thinking when everyone is the same,” Dr. Doggett explains. “We lose a certain richness and opportunity to learn from one another. We, as individual clinicians, are certainly affected when there is a lack of diversity, but our patients are impacted even more.”

Diversity in health care starts at the beginning

To truly work toward a more diverse, more equitable health care system, it’s critical to reach potential physicians as early as possible. “There should be more of a focus on exposing kids to careers in medicine,” Dr. Webb says, who is actively involved in this effort through his video interview series . “Hospitals and schools can create more pipeline programs,” he adds.

Additionally, diversity efforts must continue into medical school , which can be achieved through a more holistic admissions process. When classes are more diverse, all students benefit from broadened perspectives. Diverse classrooms help students improve active thinking, intellectual engagement, social skills, empathy, and racial understanding—all critical components to a physician’s education. Research even shows that cross-cultural interactions during medical school help students feel better prepared to serve diverse populations later on.

“Doctors are required to be competent not only in medicine but also in communication and caring for people with different disease burdens, socio-cultural realities, expectations, values, and beliefs,” explains  Dr. Satesh Bidaisee , a professor of public health and preventive medicine and assistant dean for the School of Graduate Studies at St. George’s University. “Doctors of today need a global competence to understand the diverse populations they serve.” He feels it’s the responsibility of medical schools to provide this competence for students, who in turn will provide nuanced care for patients of all walks of life.

Diversity in health care matters

Diversity in health care helps ensure all backgrounds, beliefs, ethnicities, and perspectives are adequately represented in the medical field. It’s about providing the best possible care for all patients.

If you’re interested in a career in medicine and want to gain an edge with a global perspective, then learn more by reading our article, “ 6 Little-Known Perks of Attending an International Medical School .”

*This article was originally published in December 2018. It has since been updated to reflect information relevant to 2021.

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Why Diversity, Equity, and Inclusion Matter for Patient Safety

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Meghan B. Lane-Fall; Why Diversity, Equity, and Inclusion Matter for Patient Safety. ASA Monitor 2021; 85:42 doi: https://doi.org/10.1097/01.ASM.0000798588.38346.fc

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The recent focus on diversity, equity, and inclusion (DEI) has highlighted many of the ways that individuals and organizations in health care are fallible; for example, by making decisions informed by social group membership instead of factors more germane to such decisions. We make patient care safer in part by introducing routinization and standardization and by engineering systems that are resilient in the face of human fallibility. It may seem, then, that the steps we take to ensure safety would obviate DEI concerns. In reality, we encounter DEI issues in much of the safety work that we do as members of the anesthesia and perioperative care team. Confronting and learning from these issues can make us better clinicians and team members.

As a leader in DEI, I find it helpful to ground conversations in this space with operational definitions of terms often used imprecisely. Diversity is a characteristic of groups (i.e., a single person cannot be “diverse”) that indicates a range of lived experience ( Acad Med 2015;90:1675-83 ). I think of characteristics that shape peoples' perspectives on the world, work, problem solving, and relationships to other people. In the U.S., conversations about diversity often center on race, ethnicity, and gender identity, but many additional aspects of experience are relevant to safe patient care, including age, languages spoken, physical mobility, body size, handedness, and visual acuity, to name just a few. Equity is about fairness and includes both opportunity and addressing barriers (Organizational Behavior, Theory, and Design in Health Care. 3rd edition, 2021). This might manifest as avoiding dissimilar treatment for similar behaviors, such as women and men being treated differently for speaking directly or raising their voice. I think of inclusion as a sense of belonging, which requires an organizational culture that welcomes differing perspectives. Inclusion does not mean that consensus needs to be achieved in all decisions, but an inclusive culture is one with strong psychological safety and the ability to take “interpersonal risks” like speaking one's mind without a fear of ridicule, retribution, or censure ( Annual Review of Organizational Psychology and Organizational Behavior 2014;1:23-43 ). Importantly, the organizational benefits of diversity depend critically on inclusion (Organizational Behavior, Theory, and Design in Health Care. 3rd edition, 2021).

“In reality, we encounter DEI issues in much of the safety work that we do as members of the anesthesia and perioperative care team. Confronting and learning from these issues can make us better clinicians and team members.”

What does this have to do with safety? Let's think about our clinical environment as work systems, as engineers do. In one human factors model, we think about the work system as having five basic components: the care team, tools and technologies, the physical environment, organizational conditions , and the tasks we perform ( Appl Ergon 2020;84:103033 ). I submit that DEI is relevant to all five of these components. Many recent articles have focused on the value of diverse and inclusive care teams. Here I focus on the perhaps less obvious intersections between DEI and the remaining four parts of the work system. A unifying theme across these work system elements is that diversity, equity, and inclusion are necessary to build and maintain systems that are responsive to different team members under a broad range of clinical conditions.

In considering tools and technologies , the concepts of usability and bias are relevant to DEI. Human factors engineers are trained to consider the needs of diverse groups in designing products like machines or software to be usable. Buttons, for example, should be operable by people regardless of dexterity, and user interfaces should be visible by people of different heights. Teams with diversity in these and other characteristics are poised to identify and ameliorate potential safety threats that can be encountered during clinical care. Diverse teams may also help identify or focus attention on bias in technologies, such as pulse oximetry and artificial intelligence ( APSF Newsletter 2021;36 ; BMJ 2020;368:m363 ).

Similar to tools and technologies, the physical environment in health care must be designed to accommodate a diverse workforce. Characteristics such as height, girth, reach, strength, dexterity, mobility, and sensory acuity all influence the way that we interact with our environment and may influence our ability to perform as expected in routine and emergent clinical scenarios (Handbook of Human Factors and Ergonomics in Health Care and Patient Safety. 2nd edition, 2011).

Organizational conditions and tasks are where I think equity and inclusion are most relevant. Our safety measures are developed and executed by people working in complex sociotechnical systems. For these systems to operate at peak performance, team members need to be confident that they will be treated equitably and that their perspectives will be considered in the design, evaluation, and optimization of the systems in which they work. In short, they need to perceive psychological safety. In their review of published research in health care and industry, Edmondson and Lei found that psychological safety was positively associated with organizational learning and organizational performance and that it may mitigate factors like conflict that can undermine performance ( Annual Review of Organizational Psychology and Organizational Behavior 2014;1:23-43 ). Psychological safety is promoted by inviting input, listening to team members, and celebrating failures ( asamonitor.pub/3zSykTj ). It is undermined by explicit or implicit actions that exclude or alienate team members. Microaggressions (also called “subtle acts of exclusion”) experienced by marginalized groups could therefore compromise psychological safety and team functioning ( asamonitor.pub/2YArTH0 ).

As seen in other aspects of health care, like biomedical research and medical education, attention to DEI can broaden our perspectives and allow us to meet the challenges posed by shifting patient populations, innovations in care, and organizational constraints. In highlighting DEI issues relevant to our work system in anesthesia, I believe that applying this lens to safety can help us design better, more resilient, and safer teams and health care systems.

Meghan B. Lane-Fall, MD, MSHP, FCCM. Vice President and Member, Board of Directors, Anesthesia Patient Safety Foundation, and David E. Longnecker Associate Professor and Vice Chair of Inclusion, Diversity, and Equity, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

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Home — Essay Samples — Social Issues — Diversity — Culture And Diversity In Healthcare

Culture and Diversity in Healthcare

• Categories: Cultural Competence Diversity

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Published: Mar 19, 2024

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Table of contents

The influence of culture, promoting cultural competence, the importance of diversity, challenges and initiatives.

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Valuing Diversity and Inclusion in Health Care to Equip the Workforce: Survey Study and Pathway Analysis

Jiban khuntia.

1 Health Administration Research Consortium, Business School, University of Colorado, Denver, CO, United States

2 Business Department, University of Wisconsin Parkside, Kenosha, WI, United States

Wayne Cascio

Rulon stacey.

The COVID-19 pandemic, with all its virus variants, remains a serious situation. Health systems across the United States are trying their best to respond. On average, the health care workforce is relatively homogenous, even though it cares for a highly diverse array of patients. This perennial problem in the US health care workforce has only been accentuated during the COVID-19 pandemic. Medical workers should reflect on the variety of patients they care for and strive to understand their mindsets within the larger contexts of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities. Along with talent and skills, diversity and inclusion (D&I) are essential for maintaining a workforce that can treat the myriad needs and populations that health systems serve. Developing hiring strategies that will help achieve greater workforce diversity remains a challenge for health system leaders.

The primary aims of this study were to: (1) explore the characteristics of US health systems and their associations with D&I practices and benefits, (2) examine the associations between D&I practices and three pathways to equip workforces, and (3) examine the associations between the three pathways to better equip workforces and business and service benefits. The three pathways are: (1) improving D&I among existing employees (IMPROVE), (2) using multiple channels to find and recruit the workforce (RECRUIT), and (3) collaborating with universities to find new talent and establish plans to train students (COLLABORATE).

During February to March 2021, 625 health systems in the United States were surveyed with the help of a consultant, 135 (21.6%) of whom responded. We assessed workforce talent- and diversity-relevant factors. We collected secondary data from the Agency for Healthcare Research and Quality Compendium of the US Health Systems, leading to a matched data set of 124 health systems for analysis. We first explored differences in diversity practices and benefits across the health systems. We then examined the relationships among diversity practices, pathways, and benefits.

Health system characteristics such as size, location, ownership, teaching, and revenue have varying associations with diversity practices and outcomes. D&I and talent strategies exhibited different associations with the three workforce pathways. Regarding the mediating effects, the IMPROVE pathway seems to be more effective than the RECRUIT and COLLABORATE pathways, enabling the diversity strategy to prompt business or service benefits. Moreover, these pathway effects go hand-in-hand with a talent strategy, indicating that both talent and diversity strategies need to be aligned to achieve the best results for a health system.

Conclusions

Diversity and talent plans can be aligned to realize multiple desired benefits for health systems. However, a one-size-fits-all approach is not a viable strategy for improving D&I. Health systems need to follow a multipronged approach based on their characteristics. To get D&I right, proactive plans and genuine efforts are essential.

Introduction

Health systems have been overwhelmed with COVID-19 patients [ 1 ]. Perennial shortages in the health care workforce have been exacerbated during the pandemic [ 2 ]. Stress, trauma, and burnout have tested the limits of health systems’ existing workforces [ 3 ], and health systems lack workforces to treat the diversity of COVID-19 patients [ 4 , 5 ].

In general, the workforce in medicine is relatively homogenous, despite serving diverse populations. The health care system faces significant challenges matching patients’ beliefs, attitudes, expectations, and care customization to an appropriately diverse workforce. In 2020, the US health care workforce reportedly comprised more than 50% white, approximately 20% Asian, 7% Black, and less than 1% Hispanic and Native American workers [ 6 ]. Two-thirds of physicians and surgeons are Christian, 14% are Jewish, and fewer than 15% represent other religions [ 7 ]. In addition, two-thirds are men, although this is changing as more women are admitted to medical schools [ 8 ]. In addition, dropouts among medical students in the first 2 years are high due to socioeconomic factors [ 9 ]. Assessment of sexual and gender diversity is also problematic, as disclosures risk discrimination claims [ 10 ], although schools attract unrepresented LGBTQ applicants [ 11 ]. In general, a lack of diversity in the health care workforce poses challenges for caring for diverse populations of patients, leading to variable and often detrimental access and quality issues [ 12 ]. Although the value of diversity has been well-established, unless health system leaders adopt explicit strategies to improve diversity and inclusion (D&I), they will not accomplish this goal. Moreover, it is not clear how health systems can best equip their workforces along with best practices to achieve a diverse workforce.

This study sought to assess efforts to improve D&I, as reported by chief executive officers (CEOs) of health systems across the United States. We argue that in addition to the talent and skills required for effective health care delivery, D&I needs to be part of the strategic agenda. Without this consideration, catering to the diverse needs of various populations will continue to present a challenge. This study thus explored the characteristics of US health systems and the perceived benefits of D&I. To achieve a diverse workforce in health care, health systems need to leverage different pathways. We examined factors that may shape those pathways to help balance talent and diversity. We also explored the associations between workforce pathways and both business and service benefits. Our approach will provide decision-makers with helpful practice and policy inputs [ 12 , 13 ].

Health Care Workforce Diversity

Health disparities are not homogeneous. Segments of populations are affected differently by different diseases. Accordingly, approaches and treatments may vary across these segments and thus require customized care [ 13 ]. Therefore, it stands to reason that a lack of diversity in the health care system can negatively affect patients. For instance, an Indian patient with traditional ethnic or religious values or a transgender patient may have needs unique to their circumstances and worldview. A diverse workforce in health systems should respectfully and knowledgeably approach and assist all patients with an appreciation of their values and needs [ 12 ]. Professionals from different cultures and backgrounds bring unique perspectives to share with colleagues and patients alike as they strive to better understand and respond to patients’ needs.

Alarmingly, when patients do not find providers, approaches, or treatments that echo or align with their beliefs, culture, or life circumstances, they are more prone to delay or avoid care. This problem is inherent in the current health care system. Patients from different cultures may perceive diseases and treatments differently. Greater diversity among health care workers will help reduce the barriers patients face when seeking care and contribute to better access and quality of care.

Prior research suggests that health care workforce diversity can improve creativity and decision-making while catering to multiple perspectives and contexts [ 14 , 15 ]. Specific to the COVID-19 context, research suggests that diversity-oriented leadership could improve employees’ knowledge-sharing, promote professional collaborations, and help reach marginalized and hard-to-reach communities [ 16 , 17 ]. For example, immigrant and refugee professionals represent essential resources that can provide linguistic and cultural services for their communities during and after the COVID-19 pandemic [ 18 ]. Greater diversity broadens traditional boundaries to improve care and patient satisfaction, and could prove helpful in managing stressful environments [ 4 , 5 ].

Employee engagement is also higher in organizations with diverse workforces [ 19 ]. As the populations served by doctors are becoming increasingly diverse, doctors need to adopt a more global mindset. Ensuring a diverse student body in medical schools will help future doctors broaden their perspectives and improve their understanding of D&I. Doctors from such schools will be better equipped to provide care in diverse environments [ 6 ].

Prior Work on the Value and Benefits of D&I

Valuing D&I in the workforce goes beyond the basic requirements of skills and capabilities. Prior research suggests seven categories of diverse attitudes and perceptions: (1) diversity sensitivity, (2) integrity with a difference, (3) interaction variations, (4) valuing differences, (5) team inclusion, (6) managing conflict over differences, and (7) embedding inclusion [ 20 ]. Diversity focuses on the makeup of a population or its demographics, while inclusion encompasses involvement, engagement, and integration into organizational processes [ 21 ]. It is vital to create a supportive environment that is diverse, respectful, and inclusive [ 20 ]. Such an environment eases the expression of dissenting opinions, is open to new problem-solving approaches, encourages innovative thinking, and more effectively avoids the dangers of groupthink, thereby opening doors for innovation and creativity-based organizational culture and business performance [ 22 ]. Diverse customers are often more loyal to diverse workforces and businesses [ 11 ]. Thus, through diversity, companies create organizational capabilities beyond their collective talents and skills, and can be more responsive to a comprehensive system of values and customers in a competitive marketplace [ 23 ]. To illustrate, a diverse and inclusive organization can potentially tap into the disposable income of African Americans in the United States, which reached US $1.2 trillion in 2018 [ 24 ], and the buying power of Asian Americans, which topped US $1 trillion in 2018 [ 25 ].

Although diversity has attracted substantial research attention, significant barriers and difficulties often accompany its implementation [ 26 ]. A workable approach begins with embedding inclusiveness in all aspects of an organization’s culture, starting with recruiting different races, genders, sexual orientations, national origins, and religions. It also requires a conscious shift toward a culture in which policies and procedures provide opportunities for all employees to excel [ 27 ].

Diversity goes beyond the traditional “black and white” [ 28 ]. In addition to addressing observable attributes of inclusiveness such as race, invisible attributes such as religion, values, and beliefs are also important features of organizational culture to promote inclusiveness actively [ 29 ]. For instance, gender differences in the professional workforce have decreased considerably. Women now represent 47% of the US workforce and 52% of all managerial and professional positions [ 30 ]. Technology-driven, gender-fair hiring processes in many organizations have contributed to this trend [ 31 ]. In addition to hiring more women to improve diversity, there is an increasing trend of better representation among racial and ethnic minorities, immigrants, and people with disabilities in the US labor market. A 2018 study by Accenture found that the US economy could grow up to US $25 billion if more people with disabilities were to join the labor force [ 32 ]. US regulations also require federal contractors to hire more workers with disabilities to avoid penalties [ 33 ]. There is a myth that hiring people with disabilities will cost more, which is a concern among organizations with low revenue levels. However, research has shown that more than 30% of the accommodations for workers with disabilities do not require additional expenditures, even after purchasing assistive technologies [ 34 , 35 ]. Nevertheless, valuing D&I must move beyond the surface or visible attributes to encompass different cultural and situational values and behaviors [ 36 ]. Ultimately, such efforts must become embedded within the organizations to be successful.

Firms outside of health care (eg, Apple, Google, IBM) recognize the benefits of diversity [ 37 ]. Research has shown that a discriminatory work environment can hinder an organization’s ability to build and equip the workforce it needs, leading to decreased productivity and performance. Conversely, proactively valuing D&I can attract the best talent and create an environment of belongingness and respect [ 36 ].

Health care workforce diversity needs to improve to successfully treat a greater variety of patients, from increasing care reach to improved satisfaction for racial and ethnic minority patients. Accessibility to underserved patients through a diverse workforce will bring health care closer to African American, Hispanic, and Native American communities [ 38 ]. Patients treated by physicians of their own racial or ethnic background are more likely to report receiving higher-quality care [ 39 ]. Improving access, care, quality, and reach all have significant implications for the long-term success of the health care sector in the United States.

Pathways to Equip the Workforce: Improve, Recruit, and Collaborate

What is the starting point toward greater workforce diversity? Undoubtedly, schools and universities are the formative platforms to inculcate D&I in young minds through examples, demonstrations, and practices [ 6 ]. Diverse classrooms broaden perspectives, promote active thinking, foster intellectual engagement, develop social skills, teach empathy, and improve racial understanding, all of which are essential for embracing diversity [ 40 ]. At the same time, organizations need to put more significant pressure on the education system to drive diversity. We consider three pathways to achieve this.

First, existing employees must acquire the necessary skill sets and diversity training. Programs such as “returnships,” in which experienced professionals take career breaks for training through professional and executive development programs, can help to promote and equip a more diverse workforce [ 41 ].

Second, technologies have made the recruitment process more efficient. Platforms such as LinkedIn and other social media avenues have become instrumental in finding talent. While health systems rely on traditional recruitment processes, using emerging channels to discover new talent could prove helpful.

Third, reaching out to and collaborating with universities can effectively expand the talent pool to recruit. This may start at the beginning of an education cycle, continue through projects and internships, and result in hiring from the collection of students engaged with the organization through these avenues.

For large health systems with diverse customers, a diverse base of employees is required. The revenue status of a health system can change its recognition of the direct link between diversity and performance. Major teaching health systems, as knowledge-based organizations, may have more proactive organizational cultures and reputations for openness, which will help them attract talent regardless of nationality or ethnic background. Macro factors such as increased mobility due to climate change and changing economic situations portend more women, more people of color, and more immigrant workers in the United States over the next 25 years [ 42 ]. To broaden recruitment to reflect the composition of society and the spread of business operations, organizations will need more women and people from different ethnic origins. In this context, understanding what health systems are doing to diversify their workforces remains an open question. In addition, due to social distancing policies implemented during the COVID-19 pandemic, digital transformations such as virtual teams and telehealth pose new challenges for collaboration. Diverse backgrounds among virtual collaborators, if managed well, can promote better learning to achieve more efficient outcomes [ 43 ]. Recognizing this potential will enhance remote working both during and after the COVID-19 pandemic.

The question remains as to which one or more of the three pathways mentioned above—improve, recruit, and collaborate—can effectively meet the challenges of D&I requirements. Identifying and assessing effective pathways will help instill appropriate plans in health systems. For example, explicitly valuing D&I will motivate organizations to develop long-term career plans to retain talent [ 44 ]. Organizations can better equip existing employees by developing internal training and education programs [ 20 ]. The critical element is an individual’s openness to change, which can be improved through training [ 45 ]. At the same time, it is also essential to recruit new employees, as having a diversity of work experience is a helpful way to refresh organizational culture. Finally, external collaboration with strategic partners benefits allying partners’ resources, including human resources [ 46 ]. This study further explores these three pathways to equip the workforce better—improving, recruiting, and collaborating—and their relative associations with business and service-oriented benefits.

The pathway model has been used in previous studies on diversity [ 47 ]. A common framework is diversity practices–pathways–performance [ 48 ]. Following this framework, we considered business and service benefits as the performance component. We examined the associations with three pathways: improving, recruiting, and collaborating. The two types of diversity practices are D&I strategy and talent strategy.

Data Collection

The effort to study the talent strategy in health systems is part of a broad project undertaken by the Health Administration Research Consortium at the Business School of the University of Colorado Denver. The idea of monitoring health systems emerged from observations and conversations with several chief executives of health systems during the COVID-19 pandemic. This research is part of the Health Systems’ Climate Study of 2021 conducted by the Health Administration Research Consortium [ 49 ]. The Climate Study aims to understand the current state of health systems in the United States following the COVID-19 pandemic. The objective was to collect and disseminate the insights of health systems’ CEOs to help inform policymakers, practitioners, and academic stakeholders as they collaborate to create ongoing strategies to help the industry respond to this pandemic and prepare for the next crisis.

A questionnaire was developed in December 2020 to collect data from health systems. We drew the survey items from prior literature, and questions were reworded to fit the health systems context. We sought input from knowledgeable researchers, consultants, and executives with the requisite expertise to design and evaluate the questions. The survey was pilot-tested, revised, and finalized in January 2021 with five top executives who are part of the Health Administration Program Advisory Board.

A contact list of CEOs was compiled from 624 health systems across the United States using multiple sources, contacts, professional connections, websites, and annual reports. The survey instrument was administered using a professional online survey platform, and was mapped to emails to the platform to create unique, trackable links for each health system. Email and phone solicitations were made in multiple rounds between January 25 and March 2, 2021. In addition, the authors called several CEOs and asked them to complete the survey instrument either online or in paper format. The researchers also requested CEOs who had participated in the survey to share the link with other CEO colleagues. A total of 148 responses were received, with a 24% response rate; however, 13 incomplete responses could not be used, leaving 135 usable responses. We address potential nonresponse bias in a later section.

The 135 health systems represented in this survey varied from 1 to 18 hospitals and from 176 to 75,000 employees. The annual revenue of the health systems in 2020 ranged from US $0.7 million to US $14 billion. The health systems represented US $300 billion in revenue and 1.1 million employees across the United States.

We then matched the survey data set with secondary data collected from the Agency for Healthcare Research and Quality compendium to construct a complete picture of the health systems. Our final sample included data from 124 health systems across the United States. We analyzed this combined data set, which yielded several important insights.

Variables and Measures

Table 1 describes the variables used in this study. The two constructs of health systems’ workforce strategy focus are D&I STRATEGY and TALENT STRATEGY. The two constructs of health systems’ benefits are BUSINESS BENEFIT and SERVICE BENEFIT. These variables were each measured using 7-point Likert scales. We also tested the internal-consistency reliability of these multi-item variables using Cronbach α. The four α values were close to or greater than the recommended acceptable threshold of .70 for exploratory research [ 50 ].

Description of variables, including survey questions and coding scheme.

a Responses reflect a 7-point Likert scale from 1=strongly disagree to 7=strongly agree.

b D&I: diversity and inclusion.

c AHRQ: Agency for Healthcare Research and Quality.

The three variables used to measure the pathways to equip the workforce by health systems were IMPROVE (ie, improve current talent), RECRUIT (ie, recruit new talent), and COLLABORATE (ie, collaborate with universities). This study’s other independent and control variables represented several categories: size, region, teaching status, revenue, and several other system characteristics. We coded these variables (see Table 1 ) to reflect the attributes of a health system.

The size variable measures the number of beds in a given health system (SIZE_B-SMALL, SIZE_B-MEDIUM, SIZE_B-LARGE). The region variable reflects the location of a health system (REGION-NE, REGION-MW, REGION-SOUTH, REGION-WEST). The teaching status variable assesses how a health system operates in association with a teaching program (TEACHING-NON, TEACHING-MINOR, TEACHING-MAJOR). The revenue variable measures the annual revenue of a health system (REVENUE-LOW, REVENUE-MEDIUM, REVENUE-HIGH). Finally, we included variables to capture the high discharge levels of the health systems (HIGH-DSH-HOSP), uncompensated care burden (HIGH-BURDEN-SYS and HIGH-BURDEN-HOSP), ownership status (OWNERSHIP), number of physicians (PHYSICIANS), and number of hospitals (HOSPITALS). Table 1 presents complete information about the variables in our study.

Sample Statistics

The descriptive statistics and pairwise correlations among the key variables used in this study are shown in Table 2 and Table 3 , respectively. As shown in Table 2 , health systems, on average, value a talent strategy for improving employees’ skills and capabilities more than a D&I strategy. The most popular pathway to equip a workforce is through collaboration with universities, followed by recruitment, and then by improving the current workforce.

Summary statistics of the variables (N=124).

a See Table 1 for variable descriptions.

Pairwise correlations among key variables (N=124).

b Values in italics indicate a significant correlation at P <.10.

In addition, to ensure there was no nonresponse bias, we compared the characteristics of responding and nonresponding health systems. As shown in Table 4 , the t test results for all comparisons indicated no significant difference between respondents and nonrespondents.

Characteristics of responding and nonresponding health systems.

a The numbers of physicians and hospitals are presented in this table in different categories for easy comparison across respondents and nonrespondents.

Statistical Analysis

We used ordered logit regressions to estimate (1) the relationship between specific hospital characteristics and workforce-strategy focus as well as diversity benefits, (2) the relationship between workforce-strategy focus and pathways to equip the workforce, and (3) the mediating effects of workforce choices on the relationship between workforce strategy focus and diversity-driven business and service outcomes. We used ordered logit regressions because the dependent variables are ordinal. This approach does not assume equal intervals between levels of the dependent variable. The ordered logit model is as follows:

where Y i * is the propensity of respondents to indicate higher levels of the dependent variables, X i is a set of explanatory variables, β a vector of parameters, and e i are disturbances (errors).

We do not observe Y i *; instead, we observe the ordinal dependent variable Y i . Depending on the values of thresholds or cut-off points τ m –1 and τ m , the probability distribution of Y i is as follows:

Ethical Considerations

An ethics review was not applicable for this study. The data used was received through a leading professional consulting firm that anonymizes and provides secondary firm-level data for research and analysis to draw insights.

Estimation Outcomes

The first two columns in Table 5 display the results from the ordered logit-model estimations that describe the relationship between contingent factors and health systems’ workforce strategy focus. The remaining two columns in Table 5 present the results on health systems’ diversity-enabled benefits.

Differences across health systems a .

a The results of the cut points are omitted for brevity.

b See Table 1 for variable descriptions.

c D&I: diversity and inclusion.

d Pseudo R 2 =0.0247 (n=124 observations).

e Pseudo R 2 =0.0298 (n=124 observations).

f Pseudo R 2 =0.0282 (n=124 observations).

g Pseudo R 2 =0.0401 (n=123 observations).

First, the results indicate that compared to small-sized health systems, medium-sized health systems are less likely to value diversity and inclusiveness in their D&I strategies ( P <.001). Conversely, large-sized health systems are more likely to value D&I strategies than small-sized health systems ( P =.002). There are some differences between health systems located in the Northeast and West, insofar as those in the West tend to focus more on diversity and inclusiveness ( P =.001).

Second, when the health system includes at least one high-discharge-patient-percentage hospital, it tends to value D&I more ( P <.001). The results also showed that high-revenue health systems seem to value D&I less than low-revenue health systems. In addition, health systems with a system-wide high uncompensated care burden tend to value D&I less.

These results differ from the estimation results of the contingent factors on valuing a talent-acquisition strategy ( Table 5 ). In terms of a workforce strategy focus, there seem to be no differences in health systems concerning size, ownership status, discharge, uncompensated care burden, and the number of physicians and hospitals. Region and revenue level yielded the most significant differences. The results indicate that health systems in the Northeast emphasize employees’ skills and capabilities more than those located in the South and West. In addition, compared to low-revenue health systems, medium- and high-revenue health systems tend to place less emphasize on a talent-acquisition strategy ( P <.001).

The last columns in Table 5 show the associations between health system characteristics and business and service benefits (while valuing D&I). The results of size and revenue were consistent for both types of benefits. For both business benefits ( P <.001) and service benefits ( P <.01), small-sized health systems tend to gain compared with medium- and large-sized health systems. Further, high-revenue health systems are more likely to gain both types of benefits than low-revenue systems ( P <.001).

We also found some differences between these two benefits across health systems. For the business, investor-owned health systems, health systems with medium revenue (vs low revenue), health systems with at least one high-discharge-patient-​percentage hospital, and health systems with a system-wide uncompensated care burden tend to gain more benefits, whereas health systems with more hospitals are more likely to gain fewer business development benefits due to a diversity strategy. For service-oriented benefits, some differences were found according to region. Compared with health systems located in the Northeast, those in the South and in the West seem to gain fewer service-improvement benefits ( Table 5 ).

Table 6 shows the different relationships between the three workforce pathways and the D&I and talent strategies. The results indicate a significant and negative relationship between D&I STRATEGY and COLLABORATE, but a significant and positive relationship between TALENT STRATEGY and RECRUIT. The relationship between TALENT STRATEGY and COLLABORATE was significant and positive. The relationships between the two strategies and the IMPROVE pathway as well as the relationship between D&I STRATEGY and the RECRUIT pathway were not significant.

Workforce strategy focus and workforce pathways a .

a The results of the cut points are omitted for parsimony.

c Pseudo R 2 =0.0336 (n=124 observations).

d Pseudo R 2 =0.0940 (n=124 observations).

e Pseudo R 2 =0.0856 (n=124 observations).

f D&I: diversity and inclusion.

Table 7 displays the mediating effects of the three workforce pathways (ie, IMPROVE, RECRUIT, and COLLABORATE) on the direct relationship between D&I and talent strategies and the business benefit. Analysis of the mediating models using Sobel Goodman tests, which determine whether a variable carries (or mediates) the effect of an independent variable to the dependent variable (the outcome of interest), showed that overall, IMPROVE has a higher mediating effect (44%) than COLLABORATE (4%) and RECRUIT (7%) between a D&I strategy and business benefit. Similarly, IMPROVE has a higher mediating effect (13%) than COLLABORATE (5%) and RECRUIT (1%) between a talent strategy and business benefit.

Associations of workforce pathways and business benefits a .

c Pseudo R 2 =0.1209 (n=124 observations).

d Pseudo R 2 =0.1539 (n=124 observations).

e Pseudo R 2 =0.1391 (n=124 observations).

f Pseudo R 2 =0.1334 (n=124 observations).

g Pseudo R 2 =0.1638 (n=124 observations).

h D&I: diversity and inclusion.

i Not included in model.

Table 8 shows the mediating effects of the three workforce pathways (ie, IMPROVE, RECRUIT, and COLLABORATE) on the direct relationship between D&I and talent strategies on service benefit. Analysis of the mediating models using Sobel Goodman tests showed that overall, IMPROVE has a higher mediating effect (27%) than COLLABORATE (2%) and RECRUIT (0.05%) between a D&I strategy and service benefit. Similarly, IMPROVE has a higher mediating effect (26%) than COLLABORATE (0.06%) and RECRUIT (0.02%) between a talent strategy and service benefit.

Associations of workforce pathways and service benefits.a

c Pseudo R 2 =0.123 (n=123 observations).

d Pseudo R 2 =0.153 (n=123 observations).

e Pseudo R 2 =0.178 (n=123 observations).

f Pseudo R 2 =0.135 (n=123 observations).

g Pseudo R 2 =0.194 (n=123 observations).

Implications of Findings

Getting diversity right in the health care workforce remains a challenge, regardless of the widespread realization that D&I is critically important in this sector. Health systems lag in proactive plans, results-driven strategies, and subsequent implementations. Without these, the concept of D&I will be but a fad without any tangible results for decades to come.

This study explored the differences in D&I strategies across different health system characteristics. The findings suggest that health systems with fewer beds, those located in the western United States, with low revenues, with at least one high-discharge hospital, and a relatively low system-wide uncompensated care burden tend to value D&I more and are more likely to have a D&I strategy in place. Plausibly, these systems are driven by a focused strategy, locational alignments, and a manageable suite of complexities to instill D&I plans. Some of these differ from a talent-acquisition approach, indicating that health systems treat these two diversity practices differently. Regarding the diversity benefits, it seems that small health systems with comparatively high revenue have been able to gain both business- and service-related benefits; however, in other aspects of the health systems, the benefits vary across categories.

The most important contribution of this study has been to compare and contrast the three workforce pathways and their associations with benefits. The findings suggest that health systems that value only a D&I strategy may not rely on collaboration with universities to equip their workforces. However, health systems that value a talent strategy will look externally to recruit new workers and seek collaboration with universities.

While examining the pathways through mediation analyses, we established that the IMPROVE pathway is more effective than the RECRUIT and COLLABORATE pathways in enabling the diversity strategy to prompt business or service benefits. Moreover, these pathway effects go hand-in-hand with a talent strategy, indicating that both talent and diversity strategies need to be aligned to achieve the best results for a health system.

Limitations and Directions for Further Research

This study has some limitations that future studies may be able to address. For example, we did not focus on the effects of internal issues (eg, management, coordination) on diversity. Furthermore, the opportunities and barriers to diversity strategies should be studied in detail. Relating diversity to well-known aspects of health care delivery, such as cost, quality, and patient-experience outcomes, is also essential. We also need to note that the 22% response rate is not very high, although it represents the US health systems’ population. Increasing response rates and covering all health systems in a study will require significant resources, and we may perform such a study in the future.

The challenges and uncertainties that COVID-19 presented to health systems in the United States have been unprecedented. The pandemic has propelled many issues to the forefront, including diversity. It is time for health systems to address the diversity issue, which has been a point of conversation for more than two or three decades. However, little progress has been made to date, and few proactive strategies are in place, leading to a nondiverse workforce in US health care.

This study demonstrates that D&I efforts have numerous positive business and service outcomes. Regarding the methods to address the talent shortage, it seems that health systems that value D&I are less likely to seek external collaborations. This may be because external collaboration is not an effective way to promote D&I inside the health systems. A notable point is the importance of professional and executive training programs, and further education for instilling a D&I mindset, strategy, and pathways in a health system. This improvement pathway is beneficial for outcomes; however, diversity and talent-acquisition efforts must be aligned with recruitment to yield multiple benefits for health systems. Following these findings, our recommendations will help health systems establish a more diverse health care workforce and improve outcomes for a diverse population.

Acknowledgments

Our sincere thanks to the active and candid participation of the executives from 135 health systems. The authors thank Naser Shekarian, PhD candidate in the Computer Science and Information Systems Business PhD program at the University of Colorado Denver, for help in compiling chief executive officers’ addresses and for data collection in the climate study. The authors thank the Business School at the University of Colorado Denver for support for this project and, specifically, the Health Administrations and the Computer Science and Information Systems Business PhD Programs for the time and effort of the authors involved with this study.

Abbreviations

Conflicts of Interest: None declared.

The Importance of Diversity and Inclusion in the Healthcare Workforce

Affiliation.

• 1 Obesity Medicine Physician Scientist, Massachusetts General Hospital and Harvard Medical School, Division of Neuroendocrine and Pediatric Endocrinology, Affiliated Faculty, Mongan Institute of Health Policy Associate, Disparities Solutions Center, United States. Electronic address: [email protected].
• PMID: 32336480
• PMCID: PMC7387183
• DOI: 10.1016/j.jnma.2020.03.014

Background: Diversity and inclusion are terms that have been used widely in a variety of contexts, but these concepts have only been intertwined into the discussion in healthcare in the recent past. It is important to have a healthcare workforce which represents the tapestry of our communities as it relates to race/ethnicity, gender, sexual orientation, immigration status, physical disability status, and socioeconomic level to render the best possible care to our diverse patient populations.

Methods: We explore efforts by the Liaison Committee on Medical Education (LCME), the Institute of Medicine (IOM), and other medical organizations to improve diversity and inclusion in medicine.

Conclusion: Finally, we report on best practices, frameworks, and strategies which have been utilized to improve diversity and inclusion in healthcare.

Keywords: Diversity; Healthcare; Inclusion; Workforce.

Copyright © 2020 National Medical Association. Published by Elsevier Inc. All rights reserved.

• Cultural Diversity*
• Delivery of Health Care / organization & administration
• Health Personnel*
• Health Workforce*
• Societies, Medical
• United States

Grants and funding

• L30 DK118710/DK/NIDDK NIH HHS/United States
• P30 DK040561/DK/NIDDK NIH HHS/United States

Increasing Cultural Awareness in Healthcare Essay (Critical Writing)

Introduction, importance of education, on-field training, promotion of personal exposure, resources and action items.

Despite the recent tendency of offsetting globalization due to the pandemic, the international movement of people still exists, and the cultural diversity will remain. The recipients of healthcare include representatives of numerous ethnicities, social affiliations, and other groups. Equal indiscriminate treatment of all patients can lead to conflicts between practitioners and clients, which may result in negative care outcomes. Promoting cultural awareness is essential in creating a medical environment that respects diverse identities.

People carry their personal beliefs and experiences into all spheres of life, including work. One of the ways to develop a culturally sensitive environment is to select health professionals who have received training in intercultural communication. The more culturally competent the medical staff is, the fewer conflicts would arise out of misunderstanding on the basis of gender, race, age, sexuality, or culture. The administration of a healthcare organization can adjust its hiring policy accordingly.

Another venue for cultural promotion in healthcare is to actively propagate the inclusion of cultural training in education. Hospitals, clinics, and other healthcare organizations can influence medical educational establishments to correct the curricula to cover cultural sensitivity. For instance, introducing corresponding subjects with mandatory completion or having cross-cultural practice may increase future health professionals’ understanding of sensitive areas. Subsequently, it will lead to an overall friendlier medical environment when the students graduate and start working.

The deficit of cultural competence in healthcare will not be resolved by proper education alone. Current practitioners are going to stay in the field of patient care, even though a large number of them do not satisfy the requirements posed by modern diversity. A logical solution to the issue would be improving the skills of the active workforce. According to Henderson et al. (2018), “instead of focusing on training, cultural competency in community healthcare implies that one must attempt to develop a higher level of moral reasoning in community practitioners” (p. 611). By combining the immediate patient care experience with the knowledge relating to diversity issues, it is possible to make the healthcare setting more culturally sensitive.

Educating the already working practitioners may even provide better results than accentuating changes in the curriculum. For instance, Govere and Govere (2016) write that “a systematic review of 34 studies by Beach et al. (2005) found that training improved knowledge in 17 of 19 studies and skills and attitudes in 21 of 25 studies” (p. 408). As a result, implementing educational courses for the staff during their workdays can foster cultural sensitivity in healthcare.

Another way of enhancing personnel’s communicative skills is by influencing their experiences outside of the work. Anyone who is exposed to foreign or unfamiliar groups, whether they are social, ethnic, sexual, or cultural, is more tolerant and welcoming of people of different backgrounds. Therefore, the administration of an organization can encourage their subordinates to establish cross-cultural connections on their own, for example, by offering vacations in foreign countries.

There is also research that proves that the inclusion of communication with people with different social orientations elevates cultural sensitivity at work. A study by Gözüm et al. (2020) delved into the causes of low cultural competence in hospitals. Their findings asserted that “health professionals’ frequently establishing contact with friends or neighbors from different cultures in their private lives was one of the major factors positively affecting cultural competency levels” (p. 15). Subsequently, promoting personal exposure is a viable way of making healthcare organizations appreciate differences.

Changes in group behavior are accomplished via properly motivating its members. A healthcare organization possesses resources, which can compel the staff to adopt a less rigid view of other identities. Santana et al. (2018) argue for the adoption of a person-centered-care, which acknowledges patients’ gender, sexuality, race, and culture. The researchers point that an organization can “provide adequate incentives in payment programs; celebrate small wins and victories to ensure resources for staff to practice PCC” (p. 432). Ultimately, the employee policy decides the staff’s attitude to patients.

As for the actual steps an organization can take to strengthen cultural sensitivity, there are three major initiatives. According to Hollinger-Smith, entities can involve their members in “assessing their perceptions of cultural problems and conflicts, and plan how they should be fixed” (p. 8). She also argues for the adoption of policies respecting cultural differences, for instance, by adjusting when and how meals are served according to respective traditions. Finally, an organization can provide the working personnel with information on cultural subtleties, which may complicate communication.

Altogether, it is evident that in order to make the healthcare setting more appreciative of differences, it is necessary to work with the working staff. Promoting cultural education will make medical graduates more competent. Administrations can set up courses for the medical staff, which would raise their awareness. Encouraging personal first-hand experience of communicating with various identities will help in culturally sensitive patient care. Overall, healthcare organizations should create conditions motivating health professionals to increase their cultural competence.

Govere, L., & Govere, E. M. (2016). How effective is cultural competence training of healthcare providers on improving patient satisfaction of minority groups? A systematic review of literature. Worldviews on Evidence‐Based Nursing , 13 (6), 402-410.

Gözüm, S., Tuzcu, A., & Yurt, S. (2020). Developing a cultural competency scale for primary health care professionals. Studies in Psychology . 1-22. Web.

Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: A concept analysis. Health & Social Care in the Community , 26 (4), 590-603. Web.

Hollinger-Smith, L. (n.d.). Diversity & cultural competency in health care settings. Mather. Web.

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person‐centred care: A conceptual framework. Health Expectations , 21 (2), 429-440. Web.

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2023, January 23). Increasing Cultural Awareness in Healthcare. https://ivypanda.com/essays/increasing-cultural-awareness-in-healthcare/

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1. IvyPanda . "Increasing Cultural Awareness in Healthcare." January 23, 2023. https://ivypanda.com/essays/increasing-cultural-awareness-in-healthcare/.

Bibliography

IvyPanda . "Increasing Cultural Awareness in Healthcare." January 23, 2023. https://ivypanda.com/essays/increasing-cultural-awareness-in-healthcare/.

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• Leadership Skills and Planning
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Seasonal community dynamics and toxicity potential of cyanobacteria in Lough Arrow, an oligo-mesotrophic lake in the north-west of Ireland

• Garland, Darren
• Koehler, Henry
• McGirr, Stephen
• Parkes, Rachel
• E Lucy, Frances
• Touzet, Nicolas

Favourable water quality is paramount to ensuring the protection of natural habitats and the resources they provide. Phytoplankton are an important assessor of the health of aquatic ecosystems, particularly in lakes. As such, the characterisation of phytoplankton communities over time enables a detailed assessment of a water body's ecological condition. This study examined the characteristics of cyanobacteria in Lough Arrow, a lake in Ireland's northwest, over the course of a year to ascertain their community dynamics as well as potential for cyanotoxin production. DGGE analysis of 16 S rRNA gene amplicons for spherical cyanobacteria revealed seasonal shifts in Lough Arrow, with greater diversity in the summer and autumn. Non-metric multidimensional scaling showed that seasonal changes in the cyanobacterial community were largely driven by changes in environmental factors such as temperature and conductivity. The presence of the toxigenic species Microcystis sp. was confirmed from DGGE profiles. Analysis for the potential production of microcystin toxins in the lake was undertaken via qPCR analysis of the mcyE gene. No significant difference between the summer and autumn seasons was observed. Microcystin concentrations, estimated via the application of an ELISA assay, showed very low concentrations in the lake (max conc. 0.027 µg/l), which were not significantly different between the summer and autumn. The species richness and abundance of cyanobacteria in Lough Arrow was seasonal; responding dynamically to changes in environmental factors. The presence of Microcystis sp. and potential for microcystin production detected in the summer and autumn seasons indicating that the establishment of a tailored monitoring plan could be of benefit for better ascertaining and managing water quality parameters and potential risks to human and animal health.

• Cyanobacteria;
• Cyanotoxins;
• ELISA microcystins;