Consider the following scenario: A senior Irish woman was hospitalized and scheduled to have surgery. Several days before the surgery, the woman told her family that she was experiencing extreme pain, but she didn’t say anything about this to her physician. The doctor, who was unaware that Irish culture typically minimizes expressions of pain, failed to recognize the woman’s worsening state. When the senior requested that the surgery take place sooner, the physician viewed it as unnecessary — and so she ignored the request. By the time the scheduled surgery took place, the patient was in a substantially worsened state. As a result, she died during the operation.
This is from a case study provided by cultural diversity expert Dr. Geri-Ann Galanti, and it is but one of many stories of inequity in the healthcare system. Stories like this highlight the necessity of cultural diversity in healthcare. Healthcare professionals, from leadership to entry-level positions, have a responsibility to ensure each patient has access to the care they need. Without a diverse and culturally competent workforce, however, this goal cannot be achieved.
Why is cultural diversity important in healthcare, and how can we achieve it? This article will discuss these issues and shine a light on the path toward a more equitable healthcare system.
Statistics indicate that there are substantial racial gaps when it comes to minority representation in healthcare — particularly when it comes to African American and Hispanic healthcare professionals. These groups respectively account for 13.4% and 18.3% of the U.S. population, but they are underrepresented in most healthcare fields.
Take a look through the occupations below to see the extent of these disparities, based on data from the U.S. Department of Health and Human Services Health Resources and Services Administration:
|Healthcare Occupation||% of African American Professionals||% of Hispanic Professionals|
|Dietitians and Nutritionists||15%||8.5%|
|Emergency Medical Technicians||6.3%||10.3%|
These are but a few examples of the many gaps in representation in healthcare, but they are not reflective of all occupations in the field, nor of all disparities. American Indians, Pacific Islanders, and other minorities are also underrepresented in many roles. Conversely, Asians are overrepresented in many categories. Further, women outnumber men in over 80% of all healthcare occupations.
Of particular note is the fact that many entry-level healthcare positions have greater minority representation. For example, African Americans represent 32% of all Nursing, Psychiatric and Home Health Aides, while Hispanics represent 26.1% of all Medical Assistants. This is partially due to the fact that there are many options for accessing free certified nursing assistant programs, making this an accessible way to get involved in the field. Such representation has a profound impact on patient outcomes — a fact that we’ll explore further below.
A lack of cultural diversity in healthcare can lead to many problems, including stereotyping and unequal patient treatment — particularly in cases where cultural differences in healthcare expectations lead to poor patient outcomes. Indeed, negative results are arguably inevitable when there is an underrepresentation of cultural and ethnic diversity in leadership and throughout training.
Stereotyping is the act of making (often incorrect) assumptions about groups of people based on their perceived shared characteristics. Discrimination occurs when those beliefs affect the way individuals treat those groups of people.
Such practices have no place in healthcare, where a false assumption can have alarming effects on patient outcomes. The case study from the introduction of this article makes it clear that cultural competency is a must. As a result of a lack of it the physician did not act in the best interest of the patient, which led to fatal consequences. Such errors can have a profoundly negative impact on the efficacy of treatment plans and medical procedures, not to mention cause needless suffering.
Such anecdotal accounts alone paint a disturbing picture, but the magnitude of this problem is backed up by studies as well. For example, in a study on breast cancer treatment, it was shown that, without intervention to help breast cancer patients understand their medical options fully, black women had an 80% five-year survival rate. In contrast, white women had a 91% survival rate. With intervention, however, this gap disappeared entirely. This is but one of many examples of disparate patient outcomes down racial lines.
Different cultures may have different expectations for how healthcare procedures should be carried out, how treatment plans should be enacted, and how healthcare information should be conveyed. Here are a few examples:
As you can see, a lack of understanding of the ethnic-, age-, or gender-related cultural differences among patients can lead to compromised healthcare.
The key to preventing the risks outlined above is to improve minority representation in healthcare and emphasize cultural competency on both an organizational and individual level. In “Cultural Competence and Ethnic Diversity in Healthcare,” the authors state: “Measures to improve cultural competence and ethnic diversity will help alleviate healthcare disparities and improve health care outcomes in (minority) patient populations.”
Hirers and executive staff can take a few different approaches to achieve these goals.
The benefits of diverse representation can be seen in entry-level occupations. Employees such as certified nursing assistants — an occupation in which, as noted above, nearly a third of the workforce is African American — typically have the most “face time” with patients. CNAs must adhere to a strict code of ethics and have strong communication skills, which makes these employees an effective intermediary for patients of diverse backgrounds, helping them understand medical processes and their options.
However, in order for healthcare institutions to truly embrace diversity, they must do so in every level of their organizational structure. They must employ diverse individuals in leadership positions, as well as prioritize hiring diverse staff throughout their workforce. These employees must be given support and a forum to communicate their thoughts and suggestions if they are to be truly engaged and committed to organizational objectives.
In addition to hiring a diverse staff, healthcare employers must implement effective cultural competency training programs. While these aren’t a substitute for diverse hiring, they can augment a workforce’s ability to adapt to meet the unique needs of each patient.
The specifics of a cultural competency training program may differ from role to role. For example, understanding cultural and spiritual needs is a key skill that prospective nursing assistants must have, as evidenced by its focus on the NNAAP exam. As such, a program designed for these employees should emphasize that skill. This may involve learning specific cultural expectations based on the employer’s region.
Healthcare employers can also improve the care of marginalized populations by advocating for improved hiring and patient care practices. This means prioritizing diversity in mission statements, hiring practices, and workplace processes. It also means engaging with local communities to highlight the needs of minorities.
Professionals can also arm patients to become advocates for themselves, enabling them to better seek out the care they need. Patients and providers can locate nearby self-advocacy groups online. These are great resources that can help patients acquire the information, tools, and financial help they need to achieve optimal health outcomes.
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