Diversity in Healthcare: A Synopsis

Diversity in Healthcare: A Synopsis of Current Trends Diversity in Healthcare Minorities and Health Care Diversity and Women Ecosystems Approach to Diversity Managing Diversity: Best Practices Progress in Reform Diversity in Healthcare Human Resource Management is a diverse and wide encompassing field that embraces a number of topics, not the least of which is diversity management. As the world becomes increasingly multi-dimensional and diverse, the issue and importance of diversity initiatives has permeated almost every industry, including the health care industry.

Diversity within the health care industry is a growing problem, and one that administrators and HR representatives are working to identify and address. The following synopsis examines the current state of diversity within the health care industry and suggests approaches to alleviating diversity issues within the industry at large and within the communities the healthcare industry serves. Minorities and Health Care In a brief institute report published by the State Legislature in 2002, the Institute of Medicine's committee chairman Dr.

Alan Nelson reports that minorities are still more likely to receive a lower quality health care than white Americans and even less likely to receive routine medical procedures, whether or not they have insurance. According to the study, differences in the quality of health care provided minorities may result in increased mortality rates among minorities.

The article points out that despite efforts to incorporate diverse practices and equality within the field of healthcare, many minorities are still subjected to unequal treatment and racial disparities with regard to the quality of health care they receive. The study also reveals that racial and ethnic minorities are much less likely to get treatment for serious conditions including HIV and cancer. According to the Institute patient and provider attitudes combined are to blame for the inequality that exists.

The study suggests that "system-level factors" exist that contribute to racial and ethnic inequality in the healthcare industry, and that among these are language barriers, geographic barriers, cost containment pressures such as those imposed by managed care and even attitudes and beliefs. According to Dr.

Nelson patients have difficulty establishing a relationship that is trusting with regard to healthcare, in part because they have a difficult time relating to and communicating with physicians, and in part because providers are often hurried and pressed for time, thus don't spend an adequate amount of time assessing patient's needs and illnesses. Even more so, the committee chairman suggests that clinical "uncertainty" often leads pressured and hurried providers to "fall back on stereotypes" with regard to minority health care issues.

The biggest challenge for the future of the healthcare industry according to this report is addressing the inequality. The Institute of Medicine has suggested an education and awareness campaign that will help increase the public's acknowledgment and awareness of the inequalities and disparities that do exist with regard to health care.

In addition the Institute has recommended that publicly funded health plans work toward increasing the diversity of health care providers because racial and ethnic minority providers "are more likely to serve in minority and underserved communities." Among the educational recommendations presented include increased awareness regarding the manner in which stereotypes may influence a physician's behavior. In inner cities physicians also have to work toward providing more quality care for patients living in less well off areas.

Diversity and Women Expanding on the first article surveyed, the article "Health Care Needs of Medically Underserved Women of Color: The Role of the Bureau of Primary Health Care" discusses the significant health care problems that exist for underserved populations, particularly women.

The authors suggest that when access is severely limited as is the case in many minority groups and poverty stricken areas, people have a tendency to obtain health care services that are less quality oriented, if they seek out any health care at all, resulting in poor health outcomes. Underserved populations according to the article generally reflect a tradition of not seeking medical care which is reflected in the higher mortality rates and increased rates of chronic and acute diseases among this population including cancer, heart disease and strokes.

The intent of the authors is to describe the potential benefit of the Bureau of Primary Health Care and other public services in combating diversity-based health inequality particularly in medically underserved populations and among women of color. The Bureau of Primary Health Care according to the article was developed as a diversity agent to help increase access to "comprehensive primary and preventive health care" as well as improve the health status among underserved populations.

The program targets families and individuals that traditionally do not have access to adequate primary health care. Among the barriers to health care identified by the researchers for underserved populations include insufficient health insurance, old age, poor health outcomes, insufficient supplies of physicians and cultural, attitudinal and linguistic barriers. The study take the approach that diversity is an essential component of the health care industry but that practitioners and medical facilities have yet to become fully diverse and embrace the entire population as a whole.

The risk of limited access to medical care is increased substantially according to the authors not simply by being minority but also by being a woman. For diverse programs to succeed in reaching underserved populations the article suggests that the healthcare industry work on examining the healthcare delivery system with regard to geographical location, culture, language and financial aspects.

In general primary physicians willing to work in areas defined as underserved are hard to find, thus another emphasis of the industry should be establishing a core of physicians reading, willing and able to work in these areas.

The article also discusses 12 health status variables that have been designed to measure "The extent and distribution of vulnerability in state and county populations" which has determined that more than 43 million Americans still lack access to quality medical care, to a primary physician and more, and that most of these individuals are poor, young, female and uninsured (Barrett, et. al, 1998).

The study suggests that diversity effort be targeted not only on medically underserved populations but also be gender specific, in order to address the health care deficit that exists for poor young females in many regions of the nation.

Ecosystems Approach to Diversity In the article "The Inclusive Workplace: An Ecosystems Approach to Diversity Management" the author argues that health care organizations and organizations in general throughout the nation need to expand their concept and understanding of diversity to include the larger system that constitute the organizational environment, not simply the organization itself. Barak introduces the concept of an inclusive workplace where an organization doesn't simply accept and utilize diversity within its own workforce, but also is active in diversity programs that target the community.

For the healthcare industry or an organization to be diverse, one may therefore conclude according to Barak's comments that it must not simply adopt diverse practices, but also must actively engage in activities that help it reach diverse communities, as well as participate in state and federal programs that are designed specifically to help the working poor. The article suggests solutions for the diversity issues presented in the first two articles.

Barak takes an "ecosystems" perspective of diversity, suggesting that the industry would benefit from collaboration across cultural and national boundaries. The focus of a diverse program would be promotion of patient-physician mutual interests. Diversity problems according to the author are more caused by a healthcare organizations lack of ability to "integrate and use a heterogeneous workforce at all levels of the organization." This is evidenced by the lack of minority physicians available to serve underserved communities as mentioned in the previous article.

The argument presented in the article is that for organizations to be truly diverse they first need to focus on internal processes and expand their notion of diversity so that it includes not just a single healthcare organization but the healthcare environment in general. This will include considering the larger community and the people in the community that might be impacted and benefited from more diverse practices and inclusive practices.

Barak introduces the concept of an inclusive workforce, which is a workforce that accepts and uses diversity within itself but also is active within the community and participates in programs designed to include the working poor. An inclusive and diverse workforce within the healthcare industry thus would also collaborate across cultural and national boundaries in order to focus on common interests.

The healthcare industry that is truly diverse could be defined as one that utilizes "inter-group differences" within the workforce to its advantage, is one that cooperates and contributes to the community at large, one that helps modify and address the needs of underserved populations and one that collaborates with other health care organizations and communities across "national and cultural boundaries." Barak goes one step further to suggest that the social work field can help implement diverse work programs within the health care industry by helping foster better relationships among medical care providers and the community at large.

Barak concludes by suggesting that the issue and concept of diversity take on a "special urgency" in human service healthcare organizations among the organization as a whole and staff, and that the organization review its quality of service and commitment to the community in order to truly impact the lives of diverse populations.

Managing Diversity: Best Practices HR Management often works off of the ideals of 'best practices.' This concept is discussed in the next article, "Managing the Diversity Revolution: Best Practices for the 21st Century Business." Aronson takes a more general approach to diversity but one that can be applied directly to the healthcare industry nonetheless. Aronson points out many of the trends previously identified with regard to diversity problems in the nation's business climate as a whole.

In particular the author points out that diversity issues may stem from a number of causes including cultural differences and systematic discrimination, which may be widespread in a number of industries including the healthcare industry. Among the populations more likely to be discriminated against according to the author include women and older Americans, as well as those living under lower socio-economic status, as confirmed by the previous articles examined.

The author suggests that corporate attempts to improve diversity programs should include outreach programs that focus specifically on these underserved populations if diversity programs are to be fully successful and meaningful within any industry. Aronson proposes a broad approach to diversity initiatives, one that is inclusive of the many different facets of diversity including: race, ethnicity, gender, age, religion, disability and sexual orientation (Aronson, 2002:46).

It is along these lines the author claims that a person is most likely to be discriminated against and treated unfairly, and it is along these lines that most stereotypes have been developed by healthcare officials, providers and other agents. Among the critical elements of a successfully implemented diversity awareness program according to the author is a commitment from top management to promote the ideals of diversity.

Management has to be held accountable for the results of a workable diversity program; otherwise according to the author, diversity programs become more optional than necessary, and generally result in an "unfocused effort" producing only "spotty results." Further the article suggests that diversity programs need be supported at all levels and administered with regular and consistent assessments of successes in order to be truly impacting.

Communication according to the author is also a critical aspect of a successful diversity program and ensures that an organization remains responsive to the needs of not only diverse employees but also diverse community members. A good diversity program as proposed by Aronson is one that "embodies values that are consistently upheld and regularly reaffirmed" (Aronson, 2002:46).

A program is only as good as it is on paper if it is not followed through on and if the day-to-day practices that are adopted by an organization do not produce real world results. Thus it will be important for health care providers and organizations to not only implement programs that are diverse in nature but for them to also monitor their progress and reaffirm their commitment to diversity on a consistent basis.

Diversity efforts can be focused in many different categories and in many system wide practices in order to assure the best possible outcomes. The best practices among diverse organizations are those that promote opportunities for everyone. Within the health care industry this would include not only the employees of health care organizations but also the community and patients that are recipients of the care being provided.

Progress in Reform In the article "Reflecting on Progress, Health and Racism: 1900 to 2000" Keigher suggests that though the health care industry is on the service dedicated to health promotion, risk reduction and disease prevention, it generally only does so for certain populations, particularly those that are more affluent. The lack of a diverse and well rounded approach according to the author is the result of the "raw forces of capitalism" that govern the method in which the U.S. health care system is run.

The author acknowledges the large body of evidence that exists suggesting that disparities in health care treatment and services generally result from the inaccessibility of health care as well as the ineffectiveness of the health care system "in dealing with the complex patterns of ill health among ethnic minority groups" (Keigher, 1999: 243). The author suggests that the government need get involved in order the aid health care reform and promote more diverse practices among all populations, particularly those that are poor and underserved.

Further the author acknowledges that within the modern health care system there are "enormous disparities" that exist among individuals of varying socioeconomic status, race and ethnicity and that the proportion of quality care is not progressing or improving for ethnic minority groups in particular. The author points out many of the same inequalities noted by the previous authors, including a higher incidence of AIDS, cancer related deaths, adolescent teen pregnancies and poor neonatal outcomes more common in minority populations than in affluent ones.

In many cases the author acknowledges that access to adequate primary care has declined for the most part because fewer and fewer individuals are able to obtain adequate health insurance coverage. The author quotes a U.S. Public Health Service reporting system which tracks the nation's annual progress in health goals including reducing the health disparities that exist among subpopulations and achieving access to preventive services for everyone.

The author notes that there is still room for substantial improvement and that the weakest areas of performance still reside in the realm of diversity efforts. Disparity within the healthcare industry can be attributed to the current U.S. federal structure which according to the author is designed to help the "rich get rich" and to protect capital rather than to ensure that diversity programs that serve the underserved are meaningfully and successfully carried out.

Racism and inequality according to this article are still deeply ingrained in social policy and that policy is evident within the health care industry and within health policy implementation programs. The author closes by urging communities and physicians as well as officials to work together to develop more feasible solutions to the health care crisis and diversity issues that still dominate the health care industry.

The author suggests that the modern health care industry is no better off than it was in the early 1900s, when diversity was virtually non-existent, as the same discrepancies in care.