Discussions of diversity often fail to hold our attention. We have more urgent issues on our plate, we just don’t see the business case, or diversity simply isn’t a priority. Healthcare benefits from a culture of diversity at all levels: throughout the organizational hierarchy, to the bedside, to the communities we serve. However, the benefits are only realized when an organization’s executive management takes the reins in creating and sustaining a culture of diversity.
Creating, embracing, and sustaining a culture of diversity is essential to success in healthcare. Studies show that in the United States, the majority population is quickly becoming the minority. The Institute of Medicine (2004, 23), for example, reports that “the United States is rapidly transforming into one of the most racially and ethnically diverse nations in the world. Groups commonly referred to as minorities—including Asian Americans, Pacific Islanders, African Americans, Hispanics, American Indians, and Alaska Natives—are the fastest-growing segments of the population and are emerging as the nation’s majority.” The report goes on to explain that, according to 2003 data from the U.S. Bureau of the Census, “ in California, Hawaii, New Mexico, and the District of Columbia, groups traditionally termed ‘minority’ constitute a majority of the population.”
In a study of 697 hospital and health system CEOs and human resource and minority executives, Witt-Kieffer (2007, 2) found that “survey respondents generally concur about the business case for diversity leadership. Both groups—82 percent of the majority and 81 percent of minorities—agree or strongly agree with the statement, ‘Internal diversity programs support the organization’s overall mission/vision.’” Yet minorities remain significantly underrepresented among our top leadership ranks. The business case has not yet been made.
As we discuss diversity in this issue of Frontiers, lead author Richard Cordova points out that it isn’t just about broad categories of minorities and majorities. He reminds us that “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.”
Equally compelling is lead author Tony Armada’s reminder that “people of color receive lower-quality healthcare than whites do, even after adjusting for insurance status, income, age, and the severity of their conditions. Given the fact that over 80 percent of new private health insurance enrollees are people of color, the implications of disparities research suggests that the healthcare industry’s fastest growing customers are receiving the worst care.”
Each commentary astutely delves deeper into the varied dimensions of diversity, expanding our opportunities to progress and to address many of the issues that plague us in healthcare. Mark Eustis, Gordon Alexander, and Sue Plaster describe the diversity program Fairview Health Services in Minneapolis has followed for the past decade. Their commentary charts the evolution of the program and shares its results. Denise Brooks-Williams and Diane Howard contend that any diversity initiative must begin with a thorough understanding of the community’s makeup. An organization must examine the demographic data to determine whether the cultural groups it serves can be further broken down into subgroups with distinct needs. Finally, Steven Grant draws attention to some potential roadblocks an organization may meet with in a diversity initiative.