Diversity in Healthcare

Why increased diversity and supporting culturally and linguistically appropriate services (CLAS) leads to safer, healthier, and stronger communities…and how we can help.

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Vivian Hazzard Nursing Professional
Vivian Hazzard

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Vivian Hazzard is a registered nurse, certified in public health, with over 30 years of experience. Her clinical experience includes medical surgical, pediatrics, oncology, hospice, home and community health, ambulatory, and healthcare quality.

The cost of healthcare often dominates the news. From privatization to Medicare for all to the price of insulin, there’s plenty of disagreement and controversy to go around. But when it comes to care itself, one belief seems universal no matter where you fall in the great policy debate: you want a doctor you can trust. “If your patient feels they’re just another number, you won’t establish the trust you need to create a connection,” said Dr. James Doty, clinical professor of Neurosurgery at Stanford University. But do strong doctor/patient connections impact health outcomes?

13%

of U.S. population who are African-American

4%

of U.S. medical doctors who are African-American

17%

of U.S. population who are Hispanic or Latino

0.4%

of U.S. medical doctors who are Hispanic or Latino

In the Bay Area, researchers from Stanford University and the University of California at Berkeley conducted an experiment. They recruited 1,300 African-American men from Oakland and offered them $25 to complete a general health survey, and then offered them a free health screening and an additional $50. The rub? Some would receive care from black doctors, and some from non-black doctors. The results? Those who saw black doctors were 56% more likely to get a flu shot, 47% more likely to agree to diabetes screening, and 72% more likely to accept a cholesterol screening.

This doesn’t mean the non-black doctors provided inadequate or inferior care. When rated, the black and non-black doctors actually received equal scores for quality of care. But it does mean the patients felt more comfortable and/or more secure with a physician they could connect with. And in this case, the connection was race.

In healthcare, trust matters. Representation matters. More diversity in healthcare means safer, healthier, and stronger communities across the entire United States. So how can we help?

How We Can Help: Promote CLAS

Developed by the U.S. Department of Health & Human Services (HHS), the National Culturally and Linguistically Appropriate Services (CLAS) standards advance equitable healthcare services regardless of race, religion, gender, class, or nationality. CLAS encourage medical and health facilities to establish respectful and effective environments that take into account the unique needs of individual cultures and backgrounds. Examples may include hiring medical staff who speak preferred languages, offering culturally accepted foods, and that ensuring patients can observe their traditions while seeking care. If you work in a hospital or another patient-focused healthcare facility, here are three key areas you can promote CLAS.

Leadership

Leadership

CLAS promote an approach from the top down, ensuring leaders of medical and health facilities receive the training and resources needed to implement appropriate standards. Leaders are expected to promote equity through staff training, policy creation, introduction of practices, and allocation of resources. When hiring new staff, leaders should look for those who can provide a diverse workforce in areas of culture and language and work to promote these individuals to roles allowing the most effectiveness. For existing staff, leaders should develop training and continuing education programs that expound on care practices promoting equity, cultural sensitivity, and meeting patients where they are to best care for them.

Communication & Language

Communication & Language

CLAS standards on communication and language continually underscore the importance of providing appropriate language services to patients with limited English language proficiency. Examples of meeting this standard include providing translators and/or hiring staff with fluency in various languages. Patients and their families should be told about the existence of language services as soon as possible to make it easier for them to receive a prognosis and plan of treatment. In addition to offering verbal language services, hospitals and care facilities should also post signs in common non-English languages or offer multimedia services in a variety of languages. All staff providing language services should be trained and tested in their communication abilities to ensure maximum efficiency.

Engagement & Growth

Engagement & Growth

After implementing CLAS standards, facilities must continue to monitor and improve services. Leaders and staff alike can set goals and create accountability procedures to ensure they meet benchmarks along the way. Leaders can also bring in internal or external consultants to conduct regular assessments that test for the effectiveness of newly implemented policies and suggest ways of improvement, if needed. As part of this process, facilities should collect demographic data on all patients to ensure everyone – regardless of race, gender, age, religion, or nationality – receives the same level of care. Leaders can also reach out to various community groups for input and ask for ways of improving cultural and linguistic services.

As a healthcare professional

As a healthcare professional

Many healthcare professionals recognize the need to create diverse, welcoming, and safe spaces for patients but lack the time needed to research ways of accomplishing this goal. While anti-discrimination policies should form the backbone of any medical facility strategic plan, hospitals and care centers can go further in making all feel welcome. By cultivating an understanding of the languages and cultures represented by both patients and coworkers, healthcare professionals can show care and interest. They can also look for places where cross-cultural communication frequently gets lost in translation and develop processes for responding when this happens. Key examples of cultural competence in action include:

Room assignments

In addition to creating safe and private spaces for all individuals in your care, some patients may need additional support to meet religious and/or cultural observances. Some Muslims, for instance, may want to face Mecca five times daily for prayer. Seriously ill patients may not be able to get out of bed, making it necessary for nurses to turn their beds eastward or find a room that naturally faces east. They must also wash their hands before and after prayers, making it important to provide easy access to running water.

Modesty gowns

Hospital menu

Accessible hours

As a healthcare student

As a healthcare student

Data from the American Association of Medical Colleges found that African American and Hispanic/Latinx students made up six percent and five percent, respectively, of 2015 medical school graduates. The reality remains that persons of color or those who identify as members of a minority group lack support to pursue these paths. If you’re a minority healthcare student, make your voice heard and share your experiences. Talk about the surprisingly positive experiences you’ve had, but also discuss how negative experiences have shaped your thoughts on medical care. Look for ways to continue expanding your understanding of transcultural nursing by taking electives or participating in specializations that highlight the importance of understanding and embracing diversity.

How We Can Help: Support Equal Opportunity

Despite ongoing efforts to encourage and legislate equal opportunity for all, racism, religious discrimination, and cultural barriers still exist in all industries. The medical field is not immune to discrimination, but there are steps that both students and healthcare professionals can take to champion equal opportunity and fight for increased diversity.

As a healthcare professional

As a healthcare professional

Diversity recruitment programs: Many hospitals and healthcare facilities now maintain diversity recruitment programs that help identify exceptional talent from underrepresented populations. More and more of these programs are popping up at hospitals across the country, so take time to seek them out when applying for jobs.

Examples include:

As a healthcare student

As a healthcare student

Use pipeline programs: Under Titles VII and VII of the Public Health Service Act, the Health Resources and Services Administration supports pipeline programs to ensure diverse workforces within the medical arena. These programs work to develop more opportunities for minority students and those from other underrepresented groups to take their place in medical schools and health education degrees. Pipeline programs focus on developing supportive measures to both prepare learners for the rigors of higher education and provide support mechanisms such as mentorship while enrolled. More and more of these programs are popping up in response to continued public funding and policies aimed at creating better representation within medicine. Examples of pipeline programs include:

  • Duke University School of Medicine. The Office of Diversity & Inclusion at Duke provides the Visiting Clinical Scholars Program for minority and socioeconomically disadvantaged students. This program allows fourth year med students to take part in clerkships at their school or residency program of choice to get a better sense of the path they wish to follow.
  • Penn State College of Medicine. Penn State provides several pipeline programs, including the Minority Association of Pre-Medical Students, the Health Careers Exploration Program, Males in Medicine, and Short-Term Educational Programs for Underrepresented Persons.
  • Cooper Medical School of Rowan University. CMSRU provides pipeline programs for elementary and high school students as well as undergraduates seeking summer enrichment programs.

Build leadership skills: Minority students often lack the same levels of access to leadership development programs as their peers, but that doesn’t mean they can’t find ways of building these skills. In addition to applying for any student clubs and organizations in high school and college, consider reaching out to local nonprofits and community organizations for volunteer positions. While you may not start in a leadership role, sustained commitment over time will help build organizational trust and lead to more opportunities for taking on responsibilities and leadership positions

How We Can Help: Support Inclusive Schools

When taking a balcony view of the medical landscape, it’s important to remember that schools serve as the primary training ground for students hoping to work as medical professionals. For students from underrepresented populations to succeed in fulfilling their goals, they need the support and championing of their colleges and universities. Supporting inclusive schools that go above and beyond to create diverse classes is one of the most important steps you can take. Some signs of an inclusive school include:

  • Inclusive admissions
    In addition to providing appropriate demographic options for minority students to accurately answer how they identify, inclusive schools also ask questions that provide a greater understanding of the path a student took to get to that school. Questions surrounding cultural barriers, experiences with prejudice, and unique family obligations can all provide a better understanding.
  • Minority faculty
    When students look at a list of professors in the medical school, they need to see themselves reflected. A department comprised heavily of white professors does not signal an inclusive and diverse learning environment and may steer some students to other institutions.
  • Learning flexibility
    Students from many religious and cultural traditions – or those from socioeconomically disadvantaged backgrounds – often find it difficult to attend classes at standard times. Some may be responsible for taking care of their families, while others may need to work full-time. Schools must look for ways to provide maximum learning flexibility by offering classes at non-standard times and implementing online degrees
  • Financial assistance for minority students
    Aside from providing general scholarships, schools that are serious about creating a diverse class can offer scholarships specifically to minority learners. Examples of what to look for include the University of Louisville School of Medicine’s National Medical Fellowship and Ohio University’s physician diversity program awards.

20 Great Diversity Resources

Still looking for more information about increasing diversity in healthcare? Check out the curated list of resources below.

4 Ways to Promote Diversity in the Medical Office. VeryWellHealth offers actionable tips for healthcare professionals and administrators looking to create more welcoming atmospheres for patients of diverse backgrounds.

Achieving Inclusivity: The University of California at San Francisco provides a framework that other universities can follow when restructuring their approach to student admissions.

Addressing Health and Health-Care Disparities: The Public Health Reports academic journal shares information on the role of a diverse workforce and the social determinants of health.

A Diversity and Inclusion Framework for Medical Education: Academic Medicine provides this peer-reviewed tool for medical schools looking tor detailed information on next steps to take in their diversity programs.

American Muslim Health Professionals: This professional member organization advocates for Muslim individuals working in healthcare, provides professional development, offers mental health resources, and maintains a regularly updated job board.

Diversity and Inclusion in the Academic Medicine Workforce: This academic article, featured in MedEdPORTAL, takes a look at the importance of encouraging medical students and residents to consider academic careers.

Diversity in Medicine has Measurable Benefits. Johns Hopkins Medicine takes a look at some of the quantitative data available on bringing more diverse voices and experiences into the health arena.

Diversity in Med School: Why It’s Important and What Minority Applicants Need to Know: StudentDoctor takes a look at this important topic and offers actionable advice for minority learners.

DiversityRX: This nonprofit works to improve quality and access to healthcare services for minority communities and provides many resources along the way.

Interventions to Improve Cultural Competence in Healthcare: This academic journal article provides a systematic review of improvement methods and outcomes.

Measuring Diversity and Inclusion in Academic Medicine: This HHS study takes a look at the results of a Diversity Engagement Survey and what it shows about the state of inclusion in medical school.

National Coalition of Ethnic Minority Nurse Associations: This professional group brings together Asian American, Pacific Islander, American Indian, Hispanic, Black, and Philippine Nurses working in America and advocates on their behalf.

National Hispanic Medical Association: The NHMA provides resources, annual conferences, access to events, scholarships, advocacy, and job boards for Hispanic medical professionals.

National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care: The U.S. Department of Health and Human Services’ Office of Minority Health offers this comprehensive guide on CLAS guidelines.

Promoting Inclusion in Academic Medicine: JAMA Network provides an analysis of a patient survey on the importance of healthcare providers who reflect their life experiences.

Resume Tips for Minority Nurses: After completing a degree in nursing, minority graduates can use this guide to create a winning resume that grabs the attention of recruiters.

The Case for Diversity in the Health Care Workforce: This Health Affairs article takes a look at the myriad benefits provided by including individuals from diverse backgrounds in the medical arena.

The Importance of Cultural Competency and Diversity in Medicine: Kaplan provides a comprehensive review of why diversity in medicine remains of central importance and what still needs to be done to achieve more equity.

Tours for Diversity in Medicine. This nonprofit tours various schools and cities across the country to encourage and champion minority students who want to work in medical roles.

World Professional Association for Transgender Health: WPATH provides a standards of care guide for medical professionals seeking information on how to provide appropriate and adequate care to transgender patients.