Addressing Diversity and Moving toward Equity in Hospital Care

SUMMARY * Healthcare disparities are a major challenge for hospital and healthcare system leadership. Leaders must possess vision, visibility, and ability to drive organizational change toward an environment that fosters diversity and cultural competence. As challenging economic conditions force management to make difficult budgetary decisions, the integration of equity into the organization's core mission and strategic process is essential for sustainability. Building organizational capacity requires systematic actions including workforce composition, training and development, and policy advocacy. This article offers perspectives on the current state of diversity in hospitals, exemplars from pediatric hospitals, and considerations for the future. Healthcare leaders are influential in shaping the future of the organization through strategic planning and resource allocation to those efforts that enhance services, programs, and processes that support a culture of diversity and equity. INTRODUCTION Organizations, leaders, and providers continuously work to deliver healthcare services that meet the needs of patients and the community. Much attention is given and many resources are dedicated to promotion, development, and maintenance of a culturally and linguistically competent workforce and healthcare delivery system. But effective diversity management also involves strategic planning, clinical services, patient care, administrative and infrastructure support, human resources management, and community relations (Institute for Diversity in Health Management 2008). The cultural competency of an organization or system encompasses its capacity to integrate principles and values of cultural competence into its policy, structures, attitudes, behaviors, and practices (Goode, Dunne, and Bronheim 2006). An individual consumer may identify with general subgroups (such as age, gender, sexual orientation, or gender orientation) and shared life experiences (such as disability status, education, faith affiliation, occupation, socioeconomic status, or homelessness). Multiple memberships in these subgroups contribute to a healthcare consumer's personal identity and sense of "culture." Understanding how these factors influence the way a person seeks and uses health services is important to providing culturally competent care. Healthcare strategies must adapt as the needs of the patient population continue to change. The U.S. Census Bureau (2000) projects that, by 2030, 60 percent of the population will self-identify as white, non-Hispanic, and 40 percent will self-identify as members of other racial and ethnic groups. Messages from the Institute of Medicine, the Agency for Healthcare Research and Quality, The Joint Commission, and other organizations working in this area of healthcare are clear: Healthcare disparities exist, they affect the quality of care for diverse patient populations, and there are promising strategies and models for improving quality of care and reducing disparities in treatment and outcomes (Institute for Diversity in Health Management 2008). Initiatives to reduce racial and ethnic disparities can be conceptualized as a three-legged stool where the legs are public policy, clinical practice, and organizational behavior. Public policy contributes to these initiatives by ensuring a legal and regulatory environment designed to eliminate disparities in access and health status. In clinical practice, cultural competence among physicians can ensure patient satisfaction and loyalty and improve treatment outcomes. Organizational behavior plays a role in reducing disparities by ensuring that leadership, staff, and the culture of a health services organization represents and values the community it serves (Dreachslin, Weech-Maldonado, and Dansky 2004). Leadership and governance represent other opportunities to inform initiatives. This article offers a discussion of and perspectives on the current state of diversity and equity, provides examples of initiatives underway at Childrens Hospital Los Angeles and other pediatric facilities, and suggests considerations in moving forward. …