ALL OF USEmbracing Diversity in HealthcareBy Susan Birk.docx

ALL OF US
Embracing Diversity in Healthcare
By Susan Birk
I
n approaching the complex, sometimes contro-
versial and profoundly important subject of
diversity, ACHE Chairman Gayle L. Capozzalo,
FACHE, believes it comes down to respect.
"I believe that the bedrock principle upon which our
endeavors to provide compassionate and culturally
competent care is based is respect," Capozzalo, execu-
tive vice president. Strategy and System Development,
Yale New Haven (Conn.) Health System, said during
the 2012 American Hospital Association Annual
Meeting May 6—9. "We embrace diversity because it is
fundamentally about respect, and we believe it is both
an ethical and business imperative that can improve
our organization's quality, safety and services."

Implicit in her words is what some leaders might call les-
son No. 1 about this issue: Diversity is not merely a jaded
nod in the direction of affirmative action (although
affirmative action is an important element of diversity
programs). Nor is it a "social program" to be delegated to
Human Resources. Rather, it requires a desire by senior
leadership to welcome many perspectives and differences
and to inculcate respect and appreciation for those per-
spectives as a basic organizational value.
More Than Policies
Patricia Harris, global chief diversity officer of
McDonald's Corp., sums it up in the title of her
book: None of Us Is as Good as All of Us: How
McDonald's Prospers by Embracing Inclusion and
Diversity (Wiley, 2009).
"You need to embed in your organization's culture
the recognition that diversity and equal treatment
are not simply policies to be policed," says Susan M.

Nordstrom Lopez, FACHE, president of Advocate
Illinois Masonic Medical Center, Chicago.
"It has to come from inside," she says. "And like
all organizational values, it has to come from the
top, and it has to be observed consistently
throughout the organization." That inclusivity
applies to race, generation, gender, ethnicity, reli-
gious affiliation, culture and sexual orientation.
And it holds true whether attending to the cultural
needs of patients, building a workforce or develop-
ing a leadership team that mirrors the community
it serves.
Signs of Progress
The healthcare sector's progress in this regard has
been "somewhere between fair and significant,"
says Frederick D. Hobby, president and CEO of
the Institute for Diversity in Health Management,
Chicago. According to Hobby, evidence of prog-
ress can be seen in the national call to action to
eliminate healthcare disparities launched last year
by the American Association of Medical Colleges,
ACHE, American Hospital Association, Catholic
Health Association of the United States and
National Association of Public Hospitals and
Health Systems.
The Equity of Care initiative aims to: (1) increase
the collection and use of race, ethnicity and lan-
guage (REAL) preference data by hospitals and
health systems, (2) increase cultural competency

training for clinicians and support staff, and (3)
increase diversity in governance and management.
But the Institute for Diversity in Health
Management's latest "Diversity and Disparities: A
Benchmarking Study of U.S. Hospitals," released in
June, found that only 15 percent of hospital board
positions, 14 percent of executive leadership positions
and 9 percent of CEO positions are held by people of
ALL OF US Embracing Diversity in Healthcare
color despite the fact that these
minorities represent an average of 29
percent of the patient population. In
some metropolitan areas, that per-
centage is much higher.
"Obviously, there's a lot of room for
improvement," Hobby says. Still, he
adds, "we're excited to see some of
the largest healthcare associations
Another sign of progress is the
Healthcare Equality Index (HEI) of
the H u m a n Rights Campaign

(HRC) Eoundation, Washington,
D.C., a nonprofit organization
working to achieve equality and fair-
ness for lesbian, gay, bisexual and
transgender (LGBT) Americans.
HEI surveys hospitals and health
facilities annually regarding their
I "When we promote diversity, we're not promoting it for I
the sake of some numerical goal; we're promoting it |
because individuals from diverse communities are going
to have more insight into the beliefs and preferences of
those communities. It results in better care."
—Frederick D. Hobby
Institute for Diversity in Health Management I
in the country join hands around
this issue."
"There has been more of a focus on
inclusion within the cultural space,
which I think is a great advance-

ment," says Stephanie Drake, execu-
tive director of the American Society
for Healthcare Human Resources
Administration (ASHHRA),
Chicago. ASHHRA's annual mem-
bership surveys reveal growing inter-
est in the recruitment and retention
of diverse employees and in cross-
generational workforce issues, she
reports (see sidebar page 36). "Still,
we need to do a lot of work to ensure
that our employee population is con-
sistent with our patient population."
policies and practices and recognizes
top-performing providers. The sur-
vey has drawn increased national
attention to the rights of LGBT
patients and their families.

"While considerable work remains to be
done, it is clear that a sea change in the
healthcare landscape [for LGBT
Americans] is now under way," states Joe
Solmonese, HRC president, in the HEI
2010 report.
As key developments, Solmonese cites
the new Joint Commission standards
prohibiting discrimination and
President Barack Obama's directive giv-
ing patients the right to designate their
visitors and have their choices respected
about who will make healthcare deci-
sions for them.
Good for People, Good
for Business
Diversity initiatives are gaining
momentum in part because healthcare
executives are beginning to understand

that diversity is a business issue as well
as a human one, says Hobby. "When
we promote diversity, we're not promot-
ing it for the sake of some numerical
goal; we're promoting it because indi-
viduals from diverse communities are
going to have more insight into the
beliefs and preferences of those com-
munities. It results in better care."
Hospitals and health systems with
effective diversity programs and inclu-
sive hiring and promoting practices
that have taken bold steps to eliminate
disparities will find themselves more
favorably positioned in the market-
place. Hobby says.
"We're encouraging hospitals to
address these challenges now and to

start to build loyalty with minority
patients and communities before they
reach majority status," he says.
"Potentially, 30 million more citizens
will have health insurance after 2014.
A disproportionate number of them
will be minorities. We have not always
done a great job of creating a welcom-
ing environment for the uninsured.
Hospitals need to be able to manage
the diversity of this increasing insured
population and be prepared to com-
pete for their business."
3 2 Healthcare Executive
JULY/AUG 2012
ALL OF US
''''''^'*"'™*'™'°'™'*^'"
North Shore-Long Island
Jewish Health Center

North Shore-Long Island Jewish
Health Center (NSLIJ), New Hyde
Park, N.Y., has long known that build-
ing loyalty with minority patients and
creating a culturally competent work-
force are "the right things to do and
the right business things to do," says
Joseph Cabrai, senior vice president
and chief human resources officer.
The 15-hospital system employs a staff
of 43,000 and serves a population that
speaks 135 languages.
"When you are as large and diverse as
we are, having a workforce that repre-
sents your patients becomes a business
imperative," Cabrai says. "We can
build a hospital, but if we don't get the
community to embrace it, they're not

necessarily going to come to us."
Despite impressive accomplish-
ments—a 51 percent minority work-
force, a team of hospital CEOs that is
75 percent female, and a cardiologist
serving as chief diversity and Wellness
officer—the system deals with some
hefty challenges.
Chief among these is finding caregivers
who are fluent in the languages spoken.
For example, though NSLIJ treats a
large Latino population, it doesn't have
enough nurses who speak Spanish,
Cabrai says.
To tackle the shortage, the system has
developed workforce readiness programs
in high schools, colleges and even some
junior high schools in underserved areas

to encourage students to enter health-
care. These programs yield dual benefits
of creating job opportunities and build-
ing a culturally astute workforce. "If we
don't take care of the pipeline issue we
won't be able to provide effective health-
care," he says.
The system has also created a "high
potential" program to groom future
senior leaders from minority groups.
Cabrai says. And at Hofstra North
Shore-LIJ Medical School at Hofstra
University, Hempstead, N.Y, the
organization's new teaching institu-
tion, cultural competency training
was integrated into the curriculum
from the start.
Minority representation on the sys-

tem's hospital boards needs
improvement. Cabrai acknowl-
edges. "But we're not afraid to have
healthy conversations about it, and
we have a recruitment plan," partic-
ularly in the Asian and Latino com-
munities, he says.
"Diversity is not about quotas; it's
about how we can serve our patients
with a workforce that feels engaged,
respected and valued," says Cabrai.
"It's not an isolated area; it's woven
through everything we do."
Georgia Center for
Oncology Research and
Education
Diversity is also threaded through the
organizational fabric of the Georgia
Center for Oncology Research and
Education (Ceorgia CORE), Atlanta,

a nonprofit organization that joins
specialists in designing and conduct-
ing clinical trials statewide. Founded
in 2003, the organization counts
increasing access to leading-edge
clinical trials among minority and
rural populations as one of its chief
accomplishments.
That accomplishment grew naturally
from Ceorgia CORE's mission,
which includes reducing disparities
in cancer treatment, notes Nancy M.
Paris, FACHE, president. "We have
"We have doctors and nurses from many types of
institutions and specialties who want to serve a
hroad spectrum of the community. Diversity is part
and parcel of the way that they work, and
consequently, it's the way our network functions.
That's what you get when you have strategic

alignment from the top."
—Nancy M. Paris, FACHE
Georgia Center for Oncology Research and Education
I
I
JULY/AUG 2012
Embracing Diversity in Healthcare
doctors and nurses from many types
of institutions and specialties who
want to serve a broad spectrum of
the community," she says. "Diversity
is part and parcel of the way that
they work, and consequently, it's the
way our network functions. That's
what you get when you have strate-
gic alignment from the top. We're
not deliberately trying to develop
tactics at the point of care or hiring
to fulfill a quota. Diversity flows
from our commitment to improving
cancer care for everyone."
Georgia CORE's creation of an eth-
nically and racially diverse board of
trustees, however, was intentional,
Paris says; so was the inclusion of
many different types of specialists

on the board. "The perspectives of
many are critically important in
cancer treatment."
"We model that multiplicity of per-
spectives in the way we run our orga-
nization," Paris says. That involves
reaching out to patients in a diverse
geographic range of cultural and
socioeconomic pockets in both rural
and urban areas. Paris believes
healthcare has a way to go, particu-
larly with the inclusion of women at
senior levels. The low numbet of
women leaders "is alarming when
you consider the importance of
reflecting healthcare consumers
within leadership," she says.
The common but misguided ten-
dency for people to want to connect
primarily with others like themselves
does not translate into effective orga-
nizational management, Paris con-
tends. That tunnel vision doesn't
generate the diversity of perspectives
that enables an organization to
respond to its workforce and patients,
she says. "It's hard for me to see that
an organization can look only one
way [with regard to its executive
ranks] and say with complete honesty
that patients who are different are
receiving equal care."

Advocate Illinois
Masonic Medical Center
At Advocate Illinois Masonic Medical
Center, Chicago, where equality is a key
organizational value, "diversity is a natu-
ral for us," says Susan M. Nordstrom
Lopez, FACHE, president. The commu-
nity speaks 40 languages and has one of
the richest mixes of residents in the coun-
try in terms of race, ethnicity, age, income
and sexual orientation. According to the
Healthcate Equality Index 2010, Illinois
Masonic is one of the eight top-perform-
ing hospitals in the United States.
"In a sense, all we've done is open our
doors so that what's inside the hospital
reflects what's outside," Lopez says.
"Discrimination of any kind can be an
impediment to productivity, job satisfac-

tion and excellence. A culture that
embraces diversity benefits your com-
munity and your institution. It's good
business. It opens up new markets."
According to Lopez, developing and
sustaining that inclusivity requires
some formal structures. "You have to
have systems in place, articulate your
commitment strongly and hold peo-
ple accountable, and you can never
declare victory," she says.
At Advocate Illinois Masonic, those
structures include annual system goals
regarding the hiring and promotion of
diverse candidates; a targeted tectuit-
ment strategy to ensure a diverse mix
of candidates for executive and mana-
gerial positions; intetnships and fel-

lowships for diverse new professionals
through the University of Illinois at
Chicago's health administration pro-
gram; cultural training for all new
associates; clinical training on special
topics, such as HIV and the aging of
and caring for LGBT elders; and initia-
tives to reach special populations,
including Latinos, Polish-speaking resi-
dents, and the deaf and hard of hearing.
Lopez believes it is her job to lead by
example. She regularly rounds with
other members of the senior leadership
team and encourages employees to con-
tact her directly with diversity-related
concerns via a "Dear Susan" internal
email address. "If someone is ever wor-
ried that we're not being inclusive, I

hope that they would bring that for-
ward," she says. "I don't think anything
is more effective than modeling the
behavior that you want to encourage."
Cardon Children's
Medical Center
At Cardon Children's Medical
Center, Mesa, Ariz., cultural
Healthcare Executive 3 5
JULY/AUG 2012
competency and respect for
diversity are natural outgrowths of
the organization's focus on family-
centered, person-centered care, says
CEO Rhonda M. Anderson, RN,
DNSc, FACHE. Cultural
sensitivity is inherent in the
collaborative approach to care
planning that is a part ofthe

organization's mission to "make a
difference in people's lives through
excellent patient care," she says.
The medical center is part ofthe 583-
bed Banner Desert Medical Center,
also in Mesa, and one of the 23 hospi-
tals and health facilities in seven states
that make up Banner Health,
Phoenix, one ofthe largest nonprofit
health systems in the country.
"What worries me when we talk spe-
cifically about diversity is that we
begin to stereotype, and then we have
as much of a problem or more when
we try to individualize care,"
Anderson says. "You can't make
Closing the Generational Gap
In terms of diversity, perhaps no other issue cuts as broad a

swath across the work of a healthcare organization as gen-
eration. The "natural disconnect" between healthcare
workers and patients of widely disparate ages presents spe-
cial challenges for providers that will become increasingly
evident as the baby boomer generation ages, says Robert
W. Wendover, CSP, director of The Center for
Generational Studies, Litdeton, Colo.
The recession also kept more older workers in the industry
out of financial necessity, producing workforces that can
span many generations, each with its own set of motiva-
tors and career outlooks, notes Stephanie Drake, executive
director ofthe American Society for Healthcare Human
Resource Administration, Chicago.
Adding to the challenge is the reality that "there are just
not a lot of opportunities to sit people down and talk
about this issue," Wendover says. "The attitude is 'let's do
it but let's do it in 15 minutes because we all have to get
back to work."'

To deal with these time constraints, Wendover recom-
mends educating staff in short snippets using video clips
and Twitter. "One ofthe stories I hear regularly is ofthe
22-year-old with no life experience and no way to connect
in a hospital full of 60-, 70- and 80-somethings," he says.
A smartphone video offering five or six conversation start-
ers with older patients can be uploaded to YouTube or the
hospital's intranet, with a tweet reminding staff to watch
it. "It has to be accessible," Wendover notes. "If it takes less
than two minutes and they get used to it, that's a better
way to program the process. Otherwise people just don't
get around to it."
Wendover advocates informal mentoring opportunities as
well. "One ofthe downsides of a formal mentoring pro-
gram is that there are a lot of mismatches, and then people
abandon the process. It's not something that can be
assigned. It takes trust and exposure," he says.
"Younger people in the workplace are dependent on older

people to learn a lot of what they do, so you've got to foster
that cross-generational relationship because otherwise
you'll end up with two camps, " Wendover says. And it's
up to leadership to make generational issues part ofthe
conversation. If an older and a younger worker have
formed a partnership, publicize it, he recommends. "This
invites others to do the same thing."
assumptions. Every patient and fam-
ily member is diverse. It doesn't mat-
ter what color they are or what
culture they are from. The real core is
individualizing care for every person
who comes into our facility."
At Cardon, that focus manifests
most clearly in the hospital's cove-
nant for all staff to view care
"through the eyes of a child." "It's
about understanding what that
child is thinking and bringing to
their hospital experience,"
Anderson says. "Their culture is a
part ofthat. We have a lot of
Asian, black and Latino patients.
Our goal is to understand their
perspective. Before we say 'this

will happen,' we want to know
what they want to have happen."
According to Anderson, that cove-
nant dovetails with the essence of the
clinical measures that are at the heart
of healthcare reform. Those clinical
measures include the development of
a care plan that actively involves the
person using the services in their own
care. "That's the switch we're all try-
ing to make in healthcare," she says.
"Does the care plan have the person
using your services at the center? Is it
merely your plan for them, or do they
help create it and endorse it?"
At Cardon, those care plans are
created in multidisciplinary care
conferences also involving
physicians, nurses, family
members, translators, spiritual care
associates and social workers.
These conferences infuse awareness
of and sensitivity to cultural and
social needs into clinicians' daily
work because they're "not just
about science, and they're not
about making associates do
something; they're about what they
do in their jobs every day."
Anderson sees her role as "ensuring
that our associates understand that
we need to meet our patients and

their families where they are in their
understanding, acceptance and cul-
tural beliefs about their illness, and
then help them based on what they
want. That has to be a core, heartfelt
center of what the organization
means to the community."
Susan Birk is a freelance writer based
in Wheaton, III.

Related Resources
American College of Healthcare Executives
A C H E ' S "Statement on Diversity." Visit the Diversity
section of ache.org and see pages 98—99 in this issue.
ACHE Policy Statements "Increasing and Sustaining
Racial/Ethnic Diversity in Healthcare Management,"
"Considering the Value of Older, Experienced
Healthcare Executives" and "Strengthening Healthcare
Employment Opportunities for Persons With
Disabilities." Visit the Policy Statements section of
ache.org.
"Fueling the Pipeline: Diversity in Health Professions
as a Key Strategy." Webinar/Audio CD.
Visit ache.org/Education.
"Diversity in Healthcare—Leading Toward Culturally
Competent Care." Frontiers of Health Services Management,
spring 2010. Visit ache.org/HAP.

American Society for Healthcare Human Resources
Administration
Visit ashhra.org.
Equity of Care
Eliminating Health Care Disparities: Implementing the
National Call to Action Using Lessons Learned, February
2012. Visit equityofcare.org.
Institute for Diversity in Health Management
Visit diversityconnection.org.
The Center for Generational Studies
Visit generationaldiversity.com.
JULY/AUG 2012
Copyright of Healthcare Executive is the property of American
College of Healthcare Executives and its
content may not be copied or emailed to multiple sites or posted
to a listserv without the copyright holder's
express written permission. However, users may print,
download, or email articles for individual use.
Cultural Integration and Workforce Diversity Scenario
Diversity in the workplace focuses on similarities and
differences all employees bring to the

organization. Diversity such as education, cultural, gender,
geographical location, and ethnic
background should be encouraged and valued. Employees
should consider how work policies,
communication, and practices have a different impact on their
colleagues.
You are just promoted to a health administration management
position. Your organization
currently manages a home health unit where you are responsible
for seven RNs, three dieticians,
two billing and coding staff members, one physical therapist,
one social worker, one accountant,
and one health administrator overseeing the administrative
duties of the organization.
The community is culturally diverse consisting of Hispanic,
Arab Americans, and American
Indian populations. Additionally, your staff is diverse
consisting of one male RN, several RNs
near retirement age, two newly graduated dieticians, and a few
staff members representing
several cultures. You find the staff does not seem to work well
together and there appears to be
several groups who do not include others at the lunch table. You
have a vision to develop the

team to promote unity, increase motivation, and share the same
vision for a successful
collaborative effort. You think how you will gather information
so you can further develop your
plan of action to turn the unit from one where there appears to
be miscommunication and
misinformation to a well-functioning team unit.

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