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The Importance of Diversity and Inclusion in the Healthcare Workforce

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

In order to explain diversity and inclusion in healthcare and beyond, the popular colloquialism has been dispersed on social media outlets originally coined by diversity advocate, Verna Myers, “ Diversity is being invited to the party; Inclusion is being asked to dance.” While many believe this to be a gross oversimplification of these issues, it does provide context regarding how we can began to understand and address these issues in healthcare. Throughout all facets of healthcare, race/ethnicity, gender, sexual orientation, immigration status, physical disability status, socioeconomic level plays a role in representation, acceptance, and progress both within and outside of the healthcare setting. We will evaluate the current status of diversity and inclusion in healthcare and note strategies to achieve success in this domain.

The Liaison Committee on Medical Education (LCME) is the US Department of Education body which accredits programs leading to the M.D. degree in the U.S. and Canada, and it is jointly sponsored by the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA). 1 In 2009, they developed 2 diversity accreditation standards which mandated that allopathic medical schools engage in systematic efforts to attract and retain students from diverse backgrounds and develop programs to broaden diversity amongst qualified applicants. 2 In a recent publication to evaluate the impact of these LCME diversity standards, Boatwright and colleagues conducted an observational study to examine the change in US medical school matriculant sex, race, and ethnicity after their implementation. 3 After implementation of the LCME diversity accreditation standards (2012–2017), there was an increase in female, black, and Hispanic matriculants in medical schools in the US. In 2017, 50.4% of matriculants identified as female, 7.3% as black, 8.9% as Hispanic, 24.6% as Asian, and 58.9% as white. 3 While there is some progress, the current number of medical school matriculants does not mirror the population of black and Hispanic persons in the US which is 14.1% 4 and 17% 5 , respectively.

Within medical specialties, problems with diversity training emerge. Let’s explore nuances regarding diversity in physician trainees from underrepresented minorities in medicine and the patients that they serve in several key specialties and subspecialties: internal medicine, pediatrics, and critical care. Cardinal and colleagues evaluated training of internal medicine residents with regard to the care of patients with limited English proficiency. They found that an effective training curriculum is necessary, but such a curriculum is not uniformly present. 6 In an evaluation on standards in pediatrics, Mendoza and colleagues distributed an 8-question survey to 131 US pediatric chairs to assess plans for diversity, targeted groups, departmental diversity, diversity measures, perceived success in diversity, and presence and type of cultural competency training. Approximately 50% of the chairs responded and approximately 75% reported having a plan for diversity, which targeted racial, ethnic, gender, lesbian, gay, bisexual, and transgender, disabled, and social class groups. Despite these assertions, racial and ethnic diversity was limited among trainees, faculty, and leaders; there was limited information about promotion success for minority groups; and information was even more sparse for lesbian, gay, bisexual, and transgender trainees and faculty. 7 Along similar lines, Lane-Fall and colleagues determined that the current critical care workforce in medicine has a low number of women and racial and ethnic minorities which has persisted for many years. They conclude that further research is needed to elucidate the reasons underlying persistent underrepresentation of racial and ethnic minorities in critical care fellowship programs. 8

There is often malalignment with the perceptions and experiences of persons from racial and ethnic minority groups in academic medicine compared to majority groups with regard to their health system and its performance surrounding cultural competency. Aysola and colleagues surveyed ~3500 healthcare professionals to ascertain demographic characteristics, length of employment, position, and place of work and their reported perceptions of institutional culture. They found that minorities and women were less likely to rank their organization as culturally competent, and they concluded that organizational efforts to achieve cultural competency would benefit from measuring this factor to target their efforts. 9

Just as medicine has sought to evaluate diversity, nursing has tackled the issue also. The Institute of Medicine released its landmark report, The Future of Nursing: Leading Change, Advancing Health , which called for more racial, ethnic, and gender diversity among nurses in order to improve quality of care and reduce health disparities. 10 In 2015, Villaruel and colleagues evaluated the impact of the 2010 report and determined that there is progress, but there are also challenges that remain. 11 There has been an increase in racial and ethnic groups in nursing to 20%, but this is still short of the 37% of the US population that are considered to be racial and ethnic minorities. Unfortunately, there continues to be barriers to diversity in nursing education.

So, what are systematic strategies that have been developed to address diversity and inclusion in academic medicine? What is the dialogue surrounding creating change in diversity and inclusion in medicine? Smith noted that we must build institutional capacity for diversity and inclusion in academic medicine to achieve sustained change by including a “deeper engagement of mission, one that considers diversity as core to excellence” which aligns to key institutional elements and identifies diverse talent for leadership at all levels. 12 Since diversity and inclusion are such large tasks to evaluate comprehensively, there have been different strategies proposed to address disparities in different groups. Gillespie and colleagues developed 10 best practices to achieve gender parity in global health organizations which include the following: (1) make diversity and inclusion (D&I) an essential element of global strategy, (2) tailor global D&I to fit local needs, (3) embed D&I throughout organizations, (4) multiply D&I impact via external partnerships, (5) maximize the role of employee resource groups, (6) maximize the role of diversity councils, (7) leverage D&I for innovation, (8) leverage D&I for business development, (9) engage CEO, and (10) make sharing of D&I best practices a meta best practice. 13 As we evaluate the lesbian, gay, bisexual, and transgender community in medicine, Eckstrand and colleagues developed a framework with elements and processes for successful lesbian, gay, bisexual, and transgender organizational change. Their key elements for success are: organizational champions, organizational priority, depth of mission, commitment to continuous learning, commitment to diversity and inclusion, and organizational resources, and their key processes for success are: change management, information exchange, action research, relationship building, values in action, and leveraging resources. 14 Regardless of which framework or strategy is utilized to improve diversity and inclusion in healthcare, Gill and colleagues note: “there is a growing understanding of the relationship between the providers’ work environments, patient outcomes, and organizational performance”. 15

Much of healthcare has jumped on the “diversity and inclusion bandwagon”, but is the change actually making a difference in the experience of health care workers and the increasingly diverse patient population to whom we render care? Many would argue that much needs to be done. It is not enough for organizations to just add a person to oversee diversity efforts- the organization as a whole must value diversity and inclusion as central to their mission and consistently assess these diverse groups of their perception of progress. Perhaps, Dr. Martin Luther King, Jr. said it best when he stated: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” We have much to do to truly ensure that diversity and inclusion in healthcare is the norm and not the exception.

Here are some tangible strategies to ensure diversity and inclusion in your organization: 1) Ensure that diversity and inclusion is ingrained within the culture by making it integral to the mission and outputs within the organization, 2) Integrate stakeholders from all levels of the organization and ensure that all groups are included in discussions to enact and maintain diversity and inclusion efforts, 3) Share successes and failures with similar organizations as it is this discourse that will allow the organization to reflect on strengths and weaknesses in previous diversity and inclusion strategies, and 4) Start young- engage with local communities and schools to ensure that persons from underrepresented groups get early exposure to fields in medicine. While these are only a few steps, any step forward is a step in the right direction to improve diversity and inclusion in medicine.

Grant Support:

This perspective was supported by grants NIDDK P30 DK040561 , and L30 DK118710 from the National Institutes of Health.

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The author has no conflicts of interest. There was no research conducted on either human participants or animals. As such, this work is exempt from ethical consideration. Additionally, no informed consent was necessary as there was no participation of human subjects.

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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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How to Improve Cultural Competence in Health Care

Social determinants of health, such as working and living conditions and quality healthcare access, aren’t the same for everyone. Health inequities pose a serious challenge to the healthcare community, but healthcare providers have a powerful tool at their disposal: cultural competence. Cultural competence in health care addresses the disparities that people of racially and culturally diverse backgrounds often experience. It can ensure all patients get the care they need to live healthier lives.

What Is Cultural Competence in Health Care?

Cultural competence in health care means delivering effective, quality care to patients who have diverse beliefs, attitudes, values, and behaviors. This practice requires systems that can personalize health care according to cultural and linguistic differences. It also requires understanding the potential impact that cultural differences can have on healthcare delivery.

For example, race, socioeconomics, health literacy, and other factors can influence:

• How patients perceive symptoms and health conditions
• When and how patients seek care
• Patients’ expectations of care
• Patients’ preferences regarding procedures or treatments
• Patients’ willingness to follow doctor recommendations or treatment plans
• Who patients believe should participate in making healthcare decisions

While cultural competence in health care initially referred to meeting the needs of people from distinctive ethnic and racial groups, it now also refers to meeting the needs of people with disabilities, those from diverse socioeconomic backgrounds, and members of the LGBTQ community.

The Need for Cultural Competence in Health Care

Differences between healthcare providers and patients can affect communication. This can, in turn, impact both clinicians’ and patients’ decisions with regard to treatment. For example, a clinician may misinterpret a patient’s silence as a lack of interest in receiving care. As a result, the clinician may not order a diagnostic test, when in fact the patient’s response reflected their notion of respectful behavior.

When healthcare providers fail to recognize the differences between them and their patients, they may inadvertently deliver lower-quality care. Cultivating skills that improve cross-cultural communication can play an important role in delivering equitable care.

Additionally, building teams with healthcare professionals who reflect the diversity of the patient populations served can also improve cross-cultural communication. Diverse teams have a wider cultural knowledge base that they can share with one another. This makes them likely to respond with empathy to the unique cultural needs of patients.

Language accessibility is also key. Language barriers keep patients from accurately describing their symptoms and providers from explaining diagnoses. Language barriers can also create unsafe and inappropriate situations in other ways.

For instance, clinicians may rely on children to serve as interpreters, putting young people in the position of telling a parent they have cancer. As another example, clinicians may rely on abusive spouses to interpret for their battered partners. Both situations pose significant problems.

Combining Cultural Competence with Cultural Humility

Healthcare providers strive to develop a multicultural orientation to deliver culturally sensitive care and improve communication. However, even when healthcare professionals have a meaningful understanding of a culture, they still can’t predict the behaviors and attitudes of their patients simply based on their cultural backgrounds. That’s because people are unique, and their behavior and beliefs might not always reflect those of their cultures.

Given this, healthcare professionals must focus on building cultural competence and cultural humility. Cultural humility recognizes the limits of people’s knowledge of others. It also acknowledges that even people who have cultivated their cultural awareness can still have unintentional, unconscious biases about cultures other than their own.

Cultural humility involves an ongoing process of self-evaluation. Through exploration of and reflecting on their own beliefs and behaviors, healthcare professionals can improve their awareness of implicit biases and foster an approach to patients characterized by openness and curiosity about each new patient.

Goals of Cultural Competence in Health Care

Cultural competence aims to break down barriers that get in the way of patients’ receiving the care they need. It also strives to ensure improved understanding between patients and their providers.

The growing diversity in the U.S. population demands that the healthcare community expand its ability to address patient needs. Cultural competence offers a pathway and a framework to reach the goal of better health for all patients.

Culturally and linguistically appropriate services, or CLAS, respond to individual preferences and needs of each patient. They also help improve health outcomes and decrease health disparities.

According to the U.S. Department of Health and Human Services Office of Minority Health, the principal standard of CLAS involves delivering equitable care that is:

• Understandable

Importance of Cultural Competence in Health Care

Cultural competence significantly benefits healthcare organizations and patients alike. It results in more patient participation and engagement, fostering respect and improved understanding, which can lead to:

• Increased patient safety
• Reduced inefficiencies
• Reduced care disparities
• Decreased costs

Improved Patient Outcomes

Cultural competence improves communication, which keeps patients safer. Clear communication allows healthcare providers to collect accurate medical information. It also encourages active dialogues in which patients and providers can ask questions, correct misunderstandings, and build trust.

Studies have shown that the absence of culturally competent care can lead to preventable mistakes and adverse events.

For example, a recent study in Hospital Pediatrics that examined patient safety in hospitals across the U.S. suggests that patients lacking English language proficiency experience more adverse safety events during hospitalization than fluent English language speakers. The events they experience tend to be more severe as well.

Examples of Improved Patient Outcomes

On the flip side, the use of culturally competent strategies can lead to marked improvements in health outcomes. A  Plos One  study reviewing culturally competent strategies found numerous examples of interventions that made noteworthy differences.

For example, after a medical center introduced a bilingual Russian internist to help resolve language barriers, Russian-speaking patients with diabetes experienced significant reductions in their blood pressure and cholesterol.

In another example, an in-patient psychiatric unit that incorporated Spanish language proverbs into therapy sessions found increased participation, improved motivation, and greater willingness to explore emotional topics among Spanish-speaking patients.

Improved Patient Experiences

Healthcare environments that show an awareness of and respect for differences create more satisfying experiences for patients. When providers adjust treatments to meet patient needs and preferences, patients notice, and their overall experience improves.

The  Plos One  review found that Black men rated providers’ behaviors and attitudes significantly higher after the clinic gave its providers cultural competence training.

Another recent study published in the  Journal of Sport Rehabilitation  found cultural competence positively affects how patients experience health care. In addition to raising patient satisfaction, it increases the likelihood that patients will follow medical advice. The more culturally competent patients find their providers to be, the better their experiences. The study also indicated that patients treated by providers who could speak their language felt more satisfied as well.

If a healthcare provider uses medical jargon unfamiliar to a patient or makes assumptions about a patient because they use public health insurance, the patient may likely feel frustrated. Conversely, if clinicians show nonjudgmental openness in response to differences, actively listen, and make efforts to verify patients have understood them, their patients are more likely to feel satisfied with their care.

Examples of Cultural Competence in Health Care

The following examples of cultural competence in health care illustrate ways that healthcare organizations address cultural differences when providing care even when obstacles and differences in perspectives exist. Consider the following situations:

Navigating a Challenging Birth

A pregnant farm laborer from Mexico arrives at an emergency room in medical distress. Doctors discover the patient’s placenta has separated from the uterine wall, making an urgent C-section necessary. The patient responds “yes” to all questions, though it appears they have little understanding.

After the C-section, doctors admit the newborn to the NICU because the baby is premature and has respiratory distress syndrome. The patient, their husband, and their mother, all indigenous, speak only a smattering of Spanish and no English. Spanish-speaking staff members try to get a clear history about the mother and explain the baby’s condition to the family, but communication is a challenge.

As the baby’s condition becomes tenuous, the family wants to bring in a traditional healer to cleanse the baby of its illness.

Culturally Competent Responses

In this case, delivering culturally competent care requires securing an interpreter who speaks the patient’s native language. Only then can the healthcare providers take a thorough medical history of the patient, learn about potential exposure to pesticides through their work, and give the patient the opportunity to fully understand the medical conditions of both the mother and the baby.

Additionally, with an interpreter in place, healthcare providers can explain their medical perspective and engage the patient and their family in a conversation to understand their cultural perspectives and preferences in receiving care. Such a conversation gives the family a chance to express its desire to bring a traditional healer, as well as any other desires or concerns.

Once the medical team has better information and back-and-forth communication, it can recommend culturally appropriate care and negotiate a plan of action that everyone agrees on.

Adapting to a New Patient Population

A local hospital experiences an influx of ultra-orthodox Jewish patients as a newly established Hasidic community nearby grows. The hospital staff has little knowledge of the customs or traditions of this growing segment of the facility’s patient population.

However, the staff has already encountered:

• Situations of patients refusing to eat
• Complaints that visitors who couldn’t use elevators on Jewish holidays lacked access to stairwells
• Confusing exchanges when members of the orthodox community refused to shake hands with healthcare providers of the opposite sex

The hospital invites representatives from the Hasidic community to meet with administrators and staff members to openly discuss traditions and customs potentially relevant to their health care. The hospital also asks the community representatives to explain their community’s specific needs.

In this way, the hospital gets ideas and suggestions about established solutions the community already has for dealing with customs, such as not using electricity on Shabbat. The hospital also learns of other customs, such as no physical contact between members of different genders.

Based on the conversations, the hospital proposes policies and procedures that can better serve the needs of the Hasidic patient population. It then discusses those policies and procedures with the community representatives to ensure the proposals are appropriate.

Respecting a Patient’s Choices

A severely ill 80-year-old patient learns that one of their heart valves has stopped working. To survive, they need surgery to replace the valve. The patient has a history of excessive bleeding. This will require doctors to perform blood transfusions during the surgery.

The patient is a devout Jehovah’s Witness. According to their religious beliefs and interpretations, the Bible does not allow any type of blood transfusion, so the patient refuses the surgery.

The patient’s medical team engages the patient, their family, and trusted members within the patient’s religious community in discussions about the nature of the surgery and the risk that the patient might not survive without it. After the patient gets all the information and seems to understand all the risks, the medical team respects their choice to forgo the operation.

To meet the needs of all patients, organizations must learn how to improve cultural competence in health care. They can begin by implementing strategies that develop and improve cultural competence among healthcare teams.

Promote Awareness and Education to Improve Cultural Competence in Health Care

Promoting awareness and education plays a key role in improving cultural competence in health care. To develop cultural competence, healthcare professionals need to identify their beliefs and build an awareness of their culture. This gives them a basis to improve their cross-cultural awareness.

Cross-cultural awareness makes healthcare providers more open to unfamiliar attitudes, practices, or behaviors. It also improves collaboration with patients and helps them respond with flexibility. Benefits of cross-cultural awareness include:

• Improved rapport
• Tailored treatment plans
• Improved patient attendance and compliance

How can healthcare organizations best promote the cross-cultural awareness and other skills needed for culturally competent health care?

Cultural Competence Training

Cultural competence training teaches healthcare providers intercultural communication skills and helps trainees respond to cultural differences with greater agility.

Additionally, cultural competence training can help organizations uncover organizational policies or practices that act as barriers to different communities. Then, they can adjust them to ensure they meet the needs of diverse patients.

Accessibility Leads to Improved Cultural Competence in Health Care

Cultural competence in health care demands accessibility. Accessibility means ensuring that language, culture, race, and other such factors don’t become barriers to patients’ receiving quality care. How can healthcare organizations make health care more accessible?

Build Knowledge About the Local Community

Healthcare organizations should learn about the populations they serve. Collecting and analyzing demographic data and sending targeted surveys to specific communities builds important knowledge about local communities, which puts them in a much better position to meet patient needs and ensure accessibility.

In this way, a hospital may learn it needs interpreters in Korean or Farsi, or it may discover a large segment of the population requires Halal dietary options for hospital stays.

Surveys and community engagement can uncover other key information that enables healthcare organizations to become more accessible. For instance, community engagement may clarify the need for staff members familiar with Nepalese culture or the need to bolster a diabetes outreach program.

Recruit and Retain Diverse Team Members

Recruiting and retaining team members who accurately reflect the populations they serve gives healthcare organizations a clear advantage in their efforts to deliver culturally competent health care.

When patients encounter team members who look like them, speak their language, and share their culture, they tend to feel more welcome. Healthcare providers who share cultural similarities with their patients often have a greater capacity to communicate with them, understand their perspectives, and anticipate their needs.

Diverse team members can also share their insights with their colleagues, deepening everyone’s capacity to deliver culturally competent care.

Barriers to Cultural Competence in Health Care

Promoting cultural competence can present challenges. Some of the barriers to cultural competence in health care include:

Adequate Knowledge of an Organization’s Cultural Competence

To successfully address cultural competence, healthcare organizations need to first gauge their current performance. This involves answering questions such as:

• Where does the organization fall short in providing language accessibility?
• Where do care disparities exist within the system?

Without knowing where disparities exist, leadership can’t properly channel its energy and resources.

As such, healthcare organizations that value cultural competence must collect data about their patients’ races, language preferences, sexual orientations, ethnicities, etc., as well as track disparities. Patient surveys can also offer insight into an organization’s level of cultural competence.

With the right information, healthcare organizations can target areas to improve.

As an example, data might reveal an organization serves a larger number of patients from the LGBTQ community than previously realized. This gives leadership the opportunity to make sure it has enough healthcare providers with specialized knowledge in LGBTQ health care.

Putting Cultural Competence Into Action

To put cultural competence into action, healthcare organizations must create an institutional framework that:

• Demonstrates culturally competent practices
• Cultivates cross-cultural awareness and communication
• Maintains a diverse workforce

Cultural competence demands an ongoing commitment and multipronged approach. Healthcare organizations must build an infrastructure that supports activities and protocols that ensure culturally competent practices.

Additionally, organizations must weather pushback from staff members who may perceive cultural competence as limited to racial and ethnic diversity and already consider themselves culturally competent. In such cases, healthcare organizations can implement educational programs that broaden definitions of cultural competence.

Limited Resources to Support Cultural Competence

Realizing cultural competence in health care takes resources. Organizations must invest time, money, and leadership into developing the infrastructure required to make cultural competence more than just a value.

This means budgeting for, among other things:

• Linguistically diverse materials
• Interpreters
• Cultural competence training
• Diverse staff recruitment programs

Though prioritizing cultural competence comes with a price tag, it ultimately offers an essential return on investment.

Promote Cultural Competence in Health Care

Healthcare administrators have an instrumental role to play in promoting cultural competence in health care. Their expert knowledge in organizational behavior, financial management, and information systems and analysis empowers them to build the infrastructures needed to support culturally competent systems.

Explore how Tulane University’s  Online Master of Health Administration  equips graduates with the skills needed to develop culturally competent systems capable of meeting the needs of diverse communities.

Agency for Healthcare Research and Quality, “Cultural Competence and Patient Safety”

American Hospital Association, “Becoming a Culturally Competent HealthCare Organization”

County Health Rankings, “Cultural Competence Training for Health Care Professionals”

Every Nurse, “Seven Steps to Become a More Culturally Sensitive Nurse”

Focus, “Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients”

Harvard Public Health Review, “The Importance of Effective Communication in Healthcare Practice”

Hospital Pediatrics, “Racial, Ethnic, and Socioeconomic Disparities in Patient Safety Events for Hospitalized Children”

Journal of Sport Rehabilitation, “Does Having a Culturally Competent Health Care Provider Affect the Patients’ Experience or Satisfaction? A Critically Appraised Topic”

Med City News, “The Need for Cultural Competence in Healthcare”

Minority Nurse, “5 Ways to Improve Cultural Competence in Nursing Care”

Plos One, “Culturally Competent Healthcare –A Scoping Review of Strategies Implemented in Healthcare Organizations and a Model of Culturally Competent Healthcare Provision”

Quality Interactions, “Cultural Awareness in Healthcare: A Checklist”

The Society for Diversity, “Benefits of Having Cultural Diversity in a Healthcare Organization”

U.S. Department of Health and Human Services, The National CLAS Standards

U.S. Department of Health and Human Services, National Culturally and Linguistically Appropriate Services Standards

U.S. Department of Health and Human Services, What Is CLAS?

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Cultural Diversity Issues in Healthcare Essay

Chong family moved from China (Sichuan province) to the US (New York, NY) in 2017. The family consists of parents, two children aged nine and 15, and a grandmother. The reason for such relocation is career opportunities offered to the father. In particular, a large corporation is working for provided promotion in the US for the position of a chief manager that requires managing people and introducing Chinese technologies as a joint production of common products. The key problem is associated with the fact that none of these family members is familiar with the US context, traditions, values, and other issues that should be taken into account while living in another country. Also, they encounter difficulties and misunderstandings in receiving adequate health care services. At the same time, the Chong family prefers to preserve their Chinese culture.

To address the identified issue, it seems essential to apply social cognitive theory (SCT) theory elaborated by Bandura, who considered that human behavior might be explained in terms of environmental factors, personality traits, and the very process of behavior interaction (“Social and behavioral theories,” n.d.). Since the given family encounters cultural and adaptation difficulties, SCT seems to promote greater cooperation with a counselor as well as enhanced understanding. In particular, the environment in the above theory influences the personality to the same extent that a person affects the environment, creating mutual formation. Such continuous interaction leads to a certain balance between freedom and determinism in SCT (“Social and behavioral theories,” n.d.). Human behavior, according to the social cognitive theory, is, for the most part, absorbed by mastering patterns of behavior.

Among the suggested goals, it is possible to pinpoint achieving a greater understanding of the US context, existing treatment options, and potential challenges, identifying the required health services and discussing their application, as well as determining the anticipated treatment outcomes. As reckoned by Spector (2017), cultural diversity should be taken into account in a variety of forms, through which groups and societies find the expression that can be transmitted between them. Cultural targeting should be utilized in this case to align collectivism and individualism, thus making closer different values and symbols. The goals should be approved both by the family members and a counselor. Being based on SCT and cultural diversity assumptions, the identified goals seem to address this family’s problem.

Speaking of the intervention, shared decision making (SDM) may be applied to this family to increase their awareness of diversity and more concise perception of the local context (Alden, Friend, Schapira, & Stiggelbout, 2014). In other words, treatment planning should be based on SDM and will presumably involve the following aspects: initial group consultation with a care provider, individual meetings with every family member, and the final planning consultation to reveal and align key needs and expectations of the family. Alden et al. (2014) state that it is of great importance to understand the extent to which cultural values affect the family decisions and use them as a decision aid content. Along with cultural targeting, tailoring techniques may be beneficial for the given family to analyze cultural mindsets and develop long-term cooperation between caregivers and family members. In general, it seems essential to built proper relationships and communication between the mentioned parties since both the context and personal traits should be thoroughly collected and interpreted to achieve the stated goals.

Alden, D. L., Friend, J., Schapira, M., & Stiggelbout, A. (2014). Cultural targeting and tailoring of shared decision making technology: A theoretical framework for improving the effectiveness of patient decision aids in culturally diverse groups. Social Science & Medicine , 105 , 1-8.

Social and behavioral theories . (n.d.). Web.

Spector, R. E. (2017). Cultural diversity in health and illness (9th ed.). New York, NY: Pearson Education.

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Diversity in Healthcare

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Patient outcomes in healthcare is a topic that is coming to the forefront in a world that is increasingly becoming more diverse, as there is an increase in migration across the world, whether it be by choice or by necessity. This means that healthcare professionals throughout different healthcare domains must ...

Keywords : Diversity, graduate education, cultural/linguistic, healthcare

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Home — Essay Samples — Social Issues — Diversity — Diversity in Nursing: A Critical Analysis

Diversity in Nursing: a Critical Analysis

• Categories: Diversity

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Words: 879 |

Published: Sep 12, 2023

Words: 879 | Pages: 2 | 5 min read

Table of contents

Recruitment: fostering a diverse nursing workforce, cultural competence: navigating a diverse patient population, patient care: the impact of diversity on health outcomes.

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Culture And Diversity In Healthcare

Show More Healthcare is a universal need. People around the world need healthcare to make sure they stay in perfect health. To stay perfectly healthy people needs access to doctors, nurses, and other health professionals including health information management to evaluate and document their healthcare diagnosis and care. However, health professional has experience some issues when it comes to take care of people’s health. One of the main issues that many health care providers face is the wide variety of diversity of their patient ’s culture and beliefs. There are many cultures and beliefs around the world. Because of the variety of culture and beliefs, many health professional face barriers that interfere with the care of their patient’s health. The most …show more content… There are many languages around the world. Unfortunately, most people only speak and understands only one language, which is usually depends on where they live. Unfortunately, there are circumstances in people’s lives that cause people to move to another city, state, or country. When people move, they might move into a place that speaks a different language that they do not know. With no knowledge or ability to speak the new language, the person that moved will fall into disadvantage if they become sick and need to search for healthcare. When they come to seek treatment, the sick person will struggle to try to communicate with the doctors and nurses about their condition. Since the patient speaks a different language the doctors and nurses might be unable to correctly diagnose or treat the patient. The language barrier can lead to mistakes in diagnosing and treating the patient and can increase cost of their medical bills. This issue of language barriers can affect the amount and quality of health care received (Ihara, “Cultural Competence in Health Care: Is It Important for People with Chronic …show more content… Healthcare professionals can come from different culture backgrounds. However, to have a successful working hospital or clinic all healthcare professionals have to work together as a single unit. Working together can become an issue when different cultures clash. The culture clash can leave people feeling that they are being discriminated against racial or ethnic identity, gender, socioeconomic status, weight or age in health care settings (Newcomb, “Stereotypes in Health Care Can Make Patients Feel Worse, Study Finds.”). If these issues of prejudice are not solved, the hospital or clinic will provide poor service to patients that need their help. The poor service would cause patients to avoid the hospital or clinic, which in turn, can cost the hospital or clinic of potential payments because nobody wants to pay for poor

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Healthcare Chapter 2 Paper

Chapter 2 is about organizational culture, cultural competency, and diversity in healthcare. Organizational culture is the set of values, beliefs, attitudes, and rules that outline and influence employee behavior. The culture reflects how employees and customers experience the organization and its brand. The benefits of having a strong and identifiable organizational culture are innovation, learning, and growth for the employees and the organization. The organization will have a happy, productive team that enjoys working together. The company will improve communication between its employees, management, and customers. Employees will be driven and highly motivated to achieve their goals. There will be an improved performance from the employees …show more content…

a.k.a. a.k.a. a.k.a. Cultural competence also includes linguistic competence. Linguistic competence is the use of language through the expression and interpretation of concepts, thoughts, feelings, facts, and opinions to perform oral and written discussions (Linguistic Competence, n.d.). When linguistic competency is used in healthcare, it gives a physician the ability to provide patients who do not speak English or who have limited ability to speak English, with direct communication in the patient's primary language (Cultural & Linguistic Competency, n.d.). The changing demographics of the United States have already impacted its cultural competence. Demographics refers to age, race, ethnicity, gender, marital status, income, education, religion, employment, and socioeconomic status. These changes were caused by immigration. People moved to the United States from all over the world, so that has changed the way people recognize and understand other beliefs, traditions, and customs. Diversity varies in race, ethnicity, gender, disability, social class, socioeconomic status, sexual orientation, gender identity, primary spoken language, and geographic …show more content…

They feel that the providers are more respectful, trustworthy, and empathic to their needs. Patients are also more likely to receive the preventive care they need and agree to the recommended care (Zephyrin et al.). Diversity management is when an organization includes employees from different backgrounds in their organizational structure through their policies and procedures because of the growing diversity of the workforce worldwide. Advancements in technology allow companies to hire and manage employees from around the world and in different time zones (Corporate Finance Institute, 2022). Diversity management promotes good management practices, and it also prevents discrimination, and promotes inclusiveness. Some benefits of diversity management are diversity makes it easier to recruit top talent and customers respond to diversity (Team, 2019). People who are looking to work at an organization are more likely to choose one that has a diverse workforce. It is best to have employees from different backgrounds with different perspectives. This helps boost creativity, problem-solving, solutions, and business

More about Healthcare Chapter 2 Paper