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For other articles and previous issues click here. April 26, 2004 Business
Sense & Social Justice According to the U.S. Census Bureau’s most recent statistics, the Hispanic population has grown faster than the population as a whole (to nearly 39 million) and the Asian population has experienced the highest rate of growth (to 11.6 million).1 The rate at which some minority groups are growing is so dramatic that later this century, Caucasians are expected to be a minority. The change in the ethnic and racial mix of the population has a natural consequence on the diversity of the people seeking healthcare services as well. However, the same cannot be said for healthcare providers. The percentage of minorities in healthcare professions is far below their percentage in the entire population. According to the American Medical Association, only 3.4% of physicians are Hispanic compared with 13.5% of the whole population; 2.5% of physicians are African American, but 12.7% of the population is African American. The percentage of minorities in other healthcare professions—including nursing and radiologic technology—is similar. Business Considerations “People who seek care like to see people they can relate to,” says Charles Washington, BS, RT(T), administrative director of radiation oncology at the University of Texas M.D. Anderson Cancer Center in Houston. “The most important thing, of course, is that the provider is well-trained and competent to provide care, but diversity is also important to make sure that folks receive care from those they can relate to racially, ethnically, and socioeconomically.” For people seeking healthcare services, the attitudes and perceptions toward their provider and the health system in general can affect their willingness to seek care. Numerous studies have been conducted on the provider-patient relationship and race. Several studies have found that patients who receive care from providers of the same race report greater satisfaction with their care compared with patients who receive care from providers of a different race. Further, several studies have found that racial and ethnic minorities are more likely to seek care from nonwhite providers than white providers. Patient Comfort “It’s important from a healthcare system standpoint for institutions to be closer in diversity to the patient population they serve,” says Sal Martino, EdD, executive vice president of the American Society of Radiologic Technologists (ASRT). “In the past, radiologic technologists [RTs] were mostly female and white, and although that has changed in the last 10 to 15 years, the profession is still more than 70% female.” Increasing diversity in the workforce not only helps patient satisfaction but also may contribute to issues with their access to care. Several studies have documented that healthcare workers from racial and ethnic minority groups are much more likely than white healthcare providers to serve in minority and medically underserved communities. Minority healthcare providers are also more likely to serve in areas where there are larger minority populations. Better Care Increasing diversity in the workforce can benefit the organization as a whole. “Studies have shown that people from diverse backgrounds bring new ideas and different ways of solving problems,” Gallagher says. “Diversity of employees helps ensure that organizations stay competitive.” Diversity can also help the individual employees and improve their work environment. “If you surround yourself with people with other experiences and backgrounds, then you can be enriched by all of them,” says Washington. People of diverse backgrounds in health professional schools and programs can improve the education and training of the entire class. According to a survey of medical school students from two schools, conducted by the Harvard Graduate School of Education and published in Academic Medicine, the students reported that having peers from diverse backgrounds greatly enhanced their educational experience.3 “Diversity in the student environment makes for a more robust student exchange in the classroom,” says Conway-Welch. “The level of intellectual inquiry in the classroom increases when you have a more diverse student body,” says Martino. “This translates to patient care because the more exposure people have to a number of cultures as a student, the more informed they are about diversity in the workforce.” In addition, increasing diversity in the workforce brings with it other benefits, such as the ability to recruit and retain qualified healthcare workers. “People want to go into a profession with more people who are similar to them,” Gallagher says. “This [diversity] then makes the workplace better, creates more equity among employees, and improves the quality of patient care.” Many healthcare professions are experiencing workforce shortages, as has been evidenced in radiology in recent years. The ability to recruit minority candidates can help decrease the shortage and also help retain workers. Retaining Staff “Retainment of minority employees is a big problem,” says Gallagher. “In many organizations, the top leadership is still all white and employees think that they won’t get promoted because of that. It’s important to create an environment that is friendly toward diversity in different ways—through incentives, promotion policies, benefits, and all policies and procedures in general.” In addition, in the future, changes in federal and state government policy may provide financial incentives or tax breaks to healthcare and educational institutions that actively work toward increasing the number of minorities in their workforce. To make the healthcare workforce better reflect the larger population, it is necessary to increase the diversity among students studying to be health professionals. In February 2004, the Institute of Medicine published a report that examined diversity’s benefits and discussed institutional- and policy-level strategies to enhance it. The report recommended several tactics, such as changing admission policies and practices for health professional schools. The report suggested that emphasizing leadership, service, and community work rather than grades and standardized tests scores will increase the diversity of the students in educational institutions. It also discussed reducing the financial barriers to minority students in health professions education. As tuition and associated educational costs continue to rise faster than overall inflation, the financial barriers in entering the health professions field for individuals without adequate financial resources also increases. The report recommended several strategies for providing financial assistance for minority students.4 Many organizations and corporations have increased the number of scholarships to minority students. The ASRT, for example, offers several scholarships to minority students studying to be RTs. Scholarships do more than assist with the financial burden of school, says Martino. “When people see that minority scholarships are offered, the students get the message that our profession is friendly and welcomes racial and ethnic minority students and that we are making an effort to include them. The ASRT is one of the few healthcare specialty organizations that offers minority scholarships. In the future, we hope to increase our funding for the scholarships so we can offer even more.” Increasing diversity among students in the health professions can happen many ways. According to Conway-Welch, Vanderbilt University is partnered with Fisk University, a historically black university, to offer a baccalaureate nursing degree to Fisk students. After taking five semesters of courses at Fisk, students complete their clinical nursing training at Vanderbilt and obtain their bachelor’s degree in nursing from Fisk. “This program benefits both schools,” says Conway-Welch. “Fisk did not previously have a nursing program… With this program, Fisk students have an opportunity to obtain a degree and Vanderbilt students gain from having a more diverse student body.” Establishing mentoring programs helps retain students and employees. According to Martino, in the next two years, the ASRT plans to implement a mentoring program for students. “A mentor can be a good mentor no matter what their ethnicity or race; but if a minority student has a mentor of the same race or ethnicity, the student sees the mentor as themselves, with the same background, dealing with the same experiences or adversity as they are.” M.D. Anderson Cancer Center’s Office of Institutional Diversity is also taking active steps toward making the workplace friendlier for minority students by establishing an informal mentoring system. Diversity Education “Increasing workforce diversity as a sole intervention does not solve the problem,” says Tawara D. Goode, MA, director of the National Center for Cultural Competence (NCCC), a component of the Georgetown University Center for Child and Human Development in Washington, D.C. “Just because a provider is a person of color does not mean that he or she is culturally competent in providing care. Providers need values, attitudes, knowledge, and skill sets to work effectively with a diverse patient population. Many providers have not received this in their academic training, nor are they supported in their healthcare settings to acquire such knowledge and skills.” Countless incidences have been reported of providers misunderstanding the way their minority patients express pain, view illness and disease, comply with treatment, and communicate. “When I was working as a nurse in Hawaii in the labor and delivery ward, a Japanese woman who was pregnant was having contractions and was admitted. Her makeup and hair were perfectly done and her face was composed and calm,” says Conway-Welch. “Because I was an experienced nurse, I could tell that something was wrong and sent her to the delivery room right away, where she delivered her baby less than five minutes later. A less experienced provider who did not know that some Japanese women express their pain differently may have seen her condition and sent her to a room to wait, thinking that there were several hours before she was going to deliver.” Cultural Competency “The radiation oncology department has been working with our Office of Institutional Diversity to heighten the awareness and understanding of diversity,” says Washington, who is also presenting a talk on diversity at the ASRT annual meeting in June. “People talk about diversity all the time, but you have seldom heard about the practical things people are doing to increase diversity.” Many organizations, schools, and institutions have incorporated diversity education into their curriculums and training. The ASRT revised its curriculum so all students learn about and better understand their peers and patients from different backgrounds. “Vanderbilt nursing students learn about diversity throughout their education, not just in one course,” says Conway-Welch. This past May, the NCCC also unveiled a cultural competence assessment tool for health practitioners. The tool is designed to improve the delivery of services to people in underserved communities and promote cultural competence as an essential approach for practitioners in the elimination of health disparities among racial and ethnic groups. As population demographics shift, the healthcare workforce will slowly move toward becoming more diverse naturally. Efforts to more quickly increase workforce diversity—recognizing social and business benefits—require considerable work from government agencies, educational institutions, and healthcare organizations to revise policies and practices to make healthcare better reflect the larger population. Individuals play a role in changing the climate for diversity by becoming more aware of the need for cultural understanding and sensitivity. — Sonia Elabd is a freelance writer based in Philadelphia. References |
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