Diversity Important in Health Care?

¶ … Diversity Important in Health Care? COMING TO TERMS WITH MULTICULTURALISM Is Diversity Important in Healthcare Organizations? One out of four persons living in the U.S. has a different racial or ethnic origin. There are 75 million of them today and increasing every year. The American workforce and its health needs are consequently turning more and more culturally diverse in character. Two of the goals of the Healthy People 2010 equate health and well-being within a cultural context and challenge healthcare professionals to promote culturally responsive care.

Healthcare disparities continue to exist among culturally diverse groups but the direction appears irreversible to enforce this new value. Introduction Recent statistics reveal that 30% of the American population has culturally diverse origins and the trend has been increasing. Two of the goals of the Healthy People of 2010 support the well-being and health of ethnic and racial minorities. The Institute of Medicine also endorsed this new value for health professions and organizations. The Sullivan Commission likewise made the endorsements to educational institutions.

Disparities in the healthcare system have reportedly remained but these trends clearly indicate the importance of cultural diversity in healthcare organizations. Methodology and Literature Review Methodology This study uses the descriptive-normative research method in recording, describing, interpreting, analyzing and comparing data from recent and authoritative sources. Literature Review Business Wire (2009). Healthcare Disparities at the Community Level. Business Wire: CBS Interactive, Inc.

Retrieved on June 17, 2009 from http://findarticles.com/p/articles/mi_mOEIN/is_20090506/is_n31633838/?tag=content;col1 Senior Vice President David Costello of Consumer Segmentation and Engagement, in his new white paper, writes on how to serve higher-cost members, especially underserved communities and still reduce overall costs.

His new white paper is entitled "Doing Well by Doing Right: Fairer Healthcare can lead to Lower Costs." He writes that the members' experience of their world and healthcare within this world is central to the mission of Health Dialog, the publisher of the white paper. Health Dialog says that through customized messaging in the community level can effectively identify, target and connect with members who experience healthcare disparities.

Costello elaborates that dealing with these members within the communities will not only improve the quality of care but also reduce overall costs. Health Dialog is a subsidiary of Bupa, a global provider of healthcare services, such as health coaching for medical decisions, chronic conditions, and wellness, population analytic solutions and consulting. Individuals can participate in their healthcare decisions, form more effective relationships with their physicians and live well-rounded lives through Health Dialog. AHRQ (2007). The National Healthcare Disparities Report, 2006. Agency for Healthcare Quality and Research.

Retrieved on June 18, 2009 from http://www.ahrq.gov/qual/nhdr06/nhdr06.html The bottom line in this Report is that disparities still pervade the American healthcare system in the racial, ethnic and socioeconomic realms. These disparities permeate all the system's aspects -- quality, access, levels, types, clinical conditions and care settings.

Impact on quality affects quality effectiveness, patient safety, timeliness and patient centeredness, among others; on access, facilitators and barriers to care and healthcare use; on levels and types, preventive care, treatment of acute conditions and management of chronic disease; clinical conditions include cancer, diabetes, end-stage renal disease, heart disease, HIV, mental health, substance abuse, and respiratory disease; and on care settings, primary, home health care, hospice, emergency departments, hospitals and nursing homes.

The most affected subpopulations are women, children, elderly, rural residents, the handicapped, those with special needs, ethnic minorities and the poor. Blacks, Asians, American Indians and Alaska Natives, and Hispanics receive poorer quality care than Whites. The poor also receive lower quality care than the high-income individuals. Blacks, Asians and Hispanics experienced discrimination in securing preventive services, treatment of acute illness, management of chronic disease and disability, timeliness and patient centeredness.

This Report provides new information on obesity, asthma management, hospice care, patient safety, patient centeredness in hospital care, workforce diversity, Hispanic subpopulation, language assistance and un-insurance. However, it admits that gaps still exist. Many healthcare educational and service providers now address multicultural diversity. They are made up of organizations and individuals who subscribe to their clients' cultural values, beliefs and practices. They are thus equipped to provide culturally acceptable care. They can systematically evaluate each client and provide individualized care, promote health and prevent disease.

It thus becomes imperative that these organizations become culturally knowledgeable and competent in order to serve these clients. Jeffreys, M.R. (2005). Clinical Health Specialists as Cultural Brokers, Change Agents and Partners in Meeting the Needs of Culturally Diverse Populations. Journal of Multicultural Nursing & Health: Riley Publications, Inc.

Retrieved on June 17, 2009 from http://findarticles.com/p/articles/mi_qa3919/is_200507/ai_n14825639/?tag=content;col1 Jeffreys delves into the ever-rising trend in cultural diversity in the United States partly because of the increasing number of immigrants, refugees, and individuals with multiple racial origins in the workforce. Recent statistics show that one out of four persons living in U.S. belongs to a racial or ethnic minority group or more than 75 million people in all. Furthermore, more than one million immigrants enter the U.S.

every year, indicating that the U.S. is becoming more and more culturally diverse. This population trend makes culture a compelling element in healthcare and in the workforce. Furthermore, two goals of the Healthy People 2010 require cultural considerations in healthcare. One states that "quality of life" and "health and well-being" can be achieved only within the cultural context. The other seeks to eliminate health disparities in the diverse population. This position challenges healthcare professionals to promote culturally responsive care.

The clinical nurse specialist, in particular, is called to function as a positive change agent and a visionary leader in the three spheres of influence. These are patient/client, nursing personnel, and organization/network. The clinical nurse specialist or CNS is uniquely positioned to provide care to a continuously enlarging multicultural workplace and diversifying and global 21st century society. In order to fulfill the function, she must acquire cultural competency and update her knowledge of innovative strategies.

Acquiring this competency is a complex, multidimensional, continuous and dynamic process for which many conceptual models are available. In her performance within the three spheres of influence, she functions directly as a cultural broker, change agent, collaborative partner and visionary leader while meeting the healthcare needs of her culturally diverse clients or patients. In the first sphere of influence, that is, with her patient, the CNS systematically assesses the dynamic patterns and cultural dimensions of the patient's particular culture, subculture or society.

These dimensions include religious, kinship, political, economic, educational, technologic, and cultural aspects. She inter-relates these aspects to influence the patient's behavior within the given environmental context. She considers and examines the patient's cultural similarities and differences with other cultures. In the second sphere of influence, she fills the gap in culturally competent care and in workplace harmony. Her actions in this sphere include consultation and collaboration with a trans-cultural nurse generalist to help other health practitioners develop greater awareness, sensitiveness and cultural competence in handling diverse patient populations.

Their cooperation can result in a series of personnel workshops on general trans-cultural principles and concepts and the process of cultural competence. And in her third sphere of influence, the CNS may effect a positive change in her collaborative effort with trans-cultural nurse leaders. She can plan, implement and evaluate program impact according to outcomes and satisfaction in the workplace. She becomes a change agent by identifying necessary changes in organizational policy on ethnic or racial group categories and policy alternatives.

She may also initiate a scrutiny of assessment tools for culturally insensitive or adverse effects. She and a trans-cultural nurse may help provide cultural congruent care to the organization. Purnell, L. (2005). Purnell Model for Cultural Competence. The Journal of Multicultural Nursing & Health: Riley Publications, Inc. Retrieved on June 17, 2009 from http://findarticles.com/mi_qa3919/is_200507/ai_n14825638/?tag=content;col1 The Purnell Model of Cultural Competence can serve as guide for achieving cultural competence in many primary, secondary and tertiary settings.

It can help an organization systematically appraise each client and individualize care. It uses the 12 domains of culture, needed to assess the cultural attributes of a person, family or group. These are overview, locality and topography of the subject; communication; family roles and organization; workforce issues; bio-cultural ecology; high-risk behaviors; nutrition; pregnancy and childbearing practices; death rituals; spirituality; and healthcare practices. Response to pain and the sick role may be added. The Model also presents and discusses the primary and secondary characteristics of culture.

The primary characteristics are nationality, race, color, gender, age and religious affiliation. These cannot be easily changed. The secondary characteristics include educational status, socioeconomic status, occupation, military experience, political beliefs, place of residence, enclave identity, marital status, parental status, physical characteristics, sexual orientation, gender issues, reason for migrating and length of time of stay away from native country. Alabama Nurse (2004). ANA Review: Institute of Medicine Report on Workforce Diversity, 2004. Alabama State Nurses' Association: ProQuest Information and Learning Company.

Retrieved on June 17, 2009 from http://findarticles.com/p/articles/mi_qa4090/is_200403/ai_n9465495/?tag=content;col1 Impelled by the perceived societal need for an increasingly diverse and culturally competent healthcare workforce, W.K. Kellogg Foundation asked the Institute of Medicine to review the issue. The Foundation called specific attention to the prospect of institutional and policy-level strategies to increase the participation of under-represented minorities in the health professions. In response, the Institute Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the U.S.

Healthcare Workforce came out with a report, entitled "In the Nation's Compelling Interest: Ensuring Diversity in the Health Care Workforce." The Committee consisted mostly of academicians, two of whom represented the nursing profession. In its report, the Committee recognized the importance of increasing racial diversity among health professionals in order to improve access to care, greater patient choice and satisfaction and better educational experiences for practitioners, among other benefits. It also recognized the lack of strategies in reducing institutional and policy-level barriers among health profession educational institutions or HPEIs.

In response to the lack, the Committee recommended that health professions education make a clear stand and mission on the value of diversity; the federal Health Resources and Services Administration increase enrollments and funding of under-represented minorities; the creation of a critical mass of under-represented minorities in the health professions and the explicit recognition of the value and importance of diversity among health professionals; comprehensive strategies to improve institutional climate for diversity in the health professional education institutions; and institutional objectives to support the goal to increase healthcare workforce diversity.

Summers, J. And Nowicki, M. (2004). Diversity: How Does it Help? Financial Management: Healthcare Financial Management Association. Retrieved on June 17, 2009 from http://findarticles.com/p/articles/mi_m3257/is_2_58/ai_n6079912/tag?=content;col1 Summers and Nowicki believe that diverse experiences and backgrounds broaden perspectives on life and the world but do not necessarily insure performance. People from diverse cultures will not necessarily input improved thinking just because they have varying life experiences and alternative life perspectives. Their job experiences, training and education are the measure of their contribution.

They should be given cases to demonstrate their creative and innovative contributions. If they exhibit positive marketing benefits, their diverse experiences can be counted worthwhile. This provides ground to encourage diversity among the minority groups, other races and women. But the authors argue that gender, race and ethnicity alone do not guarantee greater creativity, innovation or helpful viewpoints. Instead, they believe that managers should carefully define the meaning of diversity and the goals they want to achieve from it.

They believe that clear thinking and clear organizational goals should prevail over all other considerations. Advocates of diversity say it broadens ideas and perspectives, improves marketing and organizational outcomes and solves past injustices from discrimination. Healthcare professional associations should evaluate these justifications. Walsh, S. (2004). Formulation of a Plan of Care for Culturally Diverse Patients. International Journal of Nursing Terminologies and Classification: Nursecom, Inc.

Retrieved on June 17, 2009 from http://findarticles.com/p/articles/mi_qa4065/is_200401/ai_n9387460/?tag=content;col1 This plan of care was inputted into the nursing diagnosis-based documentation computer system for easy reference. It is a positive and proactive response to the health needs of a diverse population. At the same time, it avoids negative stereotypes resulting from cultural barriers to understanding or acceptance. The first nursing diagnosis in the care plan is impaired communication.

Interventions consist of interpreter services, alternative communication methods, health information resources in native languages, and recognition of the importance of specific personal values. The second is ineffective health maintenance, which includes cultural practices not conducive to wellness. Interventions include alignment of religious or cultural practices with the patient's health needs, support and logic for a change of behavior and information on the patient's culture. The third diagnosis is knowledge deficit.

This can result from a lack of familiarity with information resources, communication barriers, and cultural or religious practices incongruent with wellness. Interventions center on teaching strategies suited to the patients' learning needs and culture. The last diagnosis if compromised family coping, which relates to the lack of relevant ethnic and religious resources, non-traditional family units, lack of privacy, specific religious or cultural beliefs, severity of disease and disparity of roles. Interventions include integration of illness beliefs and family cultural patterns, and encouragement and sensitivity to family values.

The plan offers unique and positive opportunities in caring for patients or working with those with diverse cultures. Sullivan Commission (2004). U.S. Health Care Professionals Separate and Unequal. Black Issues in Higher Education: Cox, Matthews & Associates. Retrieved on June 17, 2009 from http://findarticles.com/p/articles/mi_mODOXK/is_17_21/ai_n6347988/?tag=content;col1 This 16-member commission's mission is to provide excellent and high-quality health care for all.

This mission is guided by, and expressed in, three overlying principles: an increase in the health professions, new and non-traditional directions to these professions, and commitments to this change in the highest levels of an organization. Colleges, universities, health systems and relevant organizations must review their practices in pursuit of the first principle. Under the second principle, health profession schools must keep tab of the major improvements in the K-12 education system. And under the third principle, institutional leaders must support change to make it happen.

The Commission listed 37 specific actions to fulfill this mission. Key among these were the shift of financing from student loans to scholarships in health professions education; reduced dependency on standardized testing in admitting enrollees in the schools of medicine, nursing and dentistry; enhancing two-year college courses in preparation for health professions; and substantial increase in federal funding for diversity programs within the National Health Services Corps, and Titles VII and VIII of the Public Service Act. Mateo, M. And Smith, S.P. (2001). Workforce Diversity a Reality.

Journal of Multicultural Nursing & Health: Riley Publications, Inc. Retrieved on June 17, 2009 from http://findarticles.com/p/articles/mi_qa3919/is_1_54/ai_59177141/?tag=content;col1 The authors note from Bureau of Census records that almost 30% of the current American population belongs to ethnic or racial minority groups -- 12% African-American, 11.9% Hispanic, 4.1% Asian and Pacific and 1% other classifications. As a result, both patients and health care workers increasingly belong to culturally diverse groups. This phenomenon demands increased awareness and training within organizations to contend with it.

When the organization decides to value and promote diversity within its ranks, it can choose approaches to take to increase diversity.

It can determine the level of diversity to pursue, especially at higher management levels; evaluate its healthcare consumer and community racial and ethnic composition; identify the barriers to diversity initiatives, that must be changed; get minorities to participate in activities, which can bring them up the career ladder; from them choose qualified candidates for senior management positions who can mentor new employees from minority groups; and consult with an organizational development specialist on ways to facilitate diversity management.

A study of 14 focus groups on health care delivery system redesign, which addresses difficulties in communication and conflict resolution, listed major considerations for the redesign. These are the evaluation of communication effectiveness by racially diverse members from their own perspectives and as alternate realities; an awareness of reinforcing factors, which deepen the conflict and dissatisfaction; and of leadership as a powerful factor in influencing perceived communication effectiveness of health care delivery. The organization's health services strategic plan will consist of an assessment phase, an exploration phase, and a transformation phase.

In the first phase, patient satisfaction is routinely evaluated and compared with that of other racial and ethnic groups in the organization. Executive management and support staff attend diversity training under the second phase. And in the third phase, the organization applies the learning on the job offers by race and ethnicity. Vast human and financial resources have been utilized by organizations in undertaking diversity initiatives in every stage and approach.

But all the investment does not compare with requirement of continued monitoring and evaluating outcomes, which will show positive or profitable cost-ratio. To insure the worthwhile-ness of the entire endeavor, evaluation methods must be designed and used and participated in by the organization staff at different levels. Jessamy, H.T. (2000). Making Diversity a Reality. Healthcare Financial Management: Healthcare Financial Management Association.

Retrieved on June 17, 2009 from http://findarticles.com/p/articles/mi_m3257/is_1_54/ai_59177141/?tag=content;col1 A recently-conducted study, entitled Diversity in Healthcare Leadership, sought out behaviors and attitudes among healthcare executives, which could be obstructing efforts to identify and hire qualified minority employees for finance positions. The study documented the thinking and comments of these executives. They believe that a diverse management team is essential to organizational goals and objectives, yet half of them said that no minority candidates were hired for senior management positions.

The majority of these executives at 81% said that minority candidates for the positions were hard to find, although minority respondents disagreed. The management executives believed that women were better able to reach higher ranks than minority candidates. Hence, women were appointed or hired for senior management roles and minorities were not.

While almost half of all minority respondents believed that a healthcare organization's personnel staff could improve the minorities' chances of getting promoted within the organization, only 21% of the majority respondents saw the role of recruitment and retention of minorities as important. And while 69% of minority respondents considered the lack of access to minority candidates the greatest barrier to recruitment, only 35% of majority respondents agreed and saw organizational resistance as a barrier. Findings and Discussion One out of every 4 persons living in the U.S.

today belongs to a minority ethnic or racial group (Jeffreys, 2005). This translates into 30% of the population (Mateo & Smith, 2001) or 75 million people. Add to.