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Workforce Diversity in Healthcare

Shea-Lewis, Anne MBA, RNC

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Anne Shea-Lewis, MBA, RNC, Administrative Nursing Supervisor, The New York Hospital and Medical Center of Queens, Flushing, NY (

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“Workforce diversity” refers to the mix of people from varied backgrounds in the labor pool. There are several federal regulations and state labor laws that affect workplace diversity. Title VII of the Civil Rights Act of 1964 prohibits employer discrimination on the basis of race, color, religion, sex, or national origin. 1 The Civil Rights Act was followed by Executive Order 11246. This order stipulates that any employer of more than 50 people, with federal contracts greater than $50,000, is defined as a federal contractor. All federal contractors are required to abide by an equal employment policy; perform an employee analysis to determine if minorities are under-represented; and, if so, develop and implement an Affirmative Action plan to eliminate said under representation. 2

Most health service organizations (HSOs) receive reimbursement from both the federal and state governments in the form of Medicare and Medicaid funds, respectively. Thus, most HSOs are federal contractors and must determine representation of minorities through some form of diversity audit.

Pollar 3 outlines 5 steps that human resource managers can take to promote diversity as a key human resource principle within an organization. First, create a diversity task force made up of individuals of various cultural and ethnic backgrounds from different levels within the organization. Second, the human resource manager must conduct a cultural audit to determine where the organization stands regarding overall cultural climate. Third, in conjunction with the task force, the human resource manager needs to develop a strategic plan to improve diversity. Fourth, human resource managers must see to the training needs of the organization with regard to the diversity initiative. Finally, as with any policy change, the outcome of the training must be measured to determine effectiveness. Pollar 3 concludes that the organization that successfully incorporates a diversity initiative will be able to meet the needs of its diverse markets and customers.

Workforce diversity in a health services organization is of extreme importance. Diversity provides a more comprehensive range of knowledge and abilities. Diversity allows for better decision making based on different life experiences and perspectives. A diverse workforce can better provide health services to diverse populations.

In the healthcare arena, a lack of diversity can have serious consequences. During the last decade, there were 12 million immigrants to this country. 4 Most of these people speak English as a second language. When they require healthcare, they are entitled to the same care, respect, and dignity afforded other patients. Indeed, many hospitals include the importance of recognizing cultural diversity within mission statements honoring respect for people of different cultures and pledging to provide impartial care. Cultural barriers can pose a significant dilemma for patient and healthcare worker alike. A patient who describes himself as White may be a Muslim from Bosnia or an Irish Catholic. As Hilton 5 tells us the differences between the 2 differ significantly where religion, mental health, physical health, and language are concerned.

The question of language barriers, in particular, must be addressed. While the federal government, through the Americans With Disabilities Act, mandated that all HSOs be equipped to provide care to the deaf, the same amenity was not provided for those who speak a language other than English. However, the Joint Commission on Accreditation of Health Organizations as well as the American Hospital Association’s patient’s bill of rights require HSOs to meet the communication needs of their patient population. Reticence to comply with these mandates opens the HSO to the possibility of litigation if a patient’s language barrier contributes to a negative outcome. 6 Further, Joint Commission on Accreditation of Health Organizations standards mandate patient education as one of the critical functions in adequate patient care. Nursing staff must document the impact any possible cultural, religious, and emotional barriers have on patient education. 4

HSOs can meet the Joint Commission on Accreditation of Health Organizations and American Hospital Association’s specifications through the use of family members as interpreters or through the use of interpreting services provided by telecommunication companies. It is, however, cost effective to consider hiring hospital staff from the surrounding community. This provides the HSO with staff that is capable of interpreting when necessary while also providing culturally sensitive care. It is this willingness and ability to furnish culturally sensitive care that improves patient outcomes, provides optimum customer service and attracts customers.

According to census data presented by Davidhizer, Havens, and Bechtel, 7 in 1990, 75% of the people in the United States were Whites of European descent. Projections are that by 2020, only 53% of the population in this country will fit that description. To the extent that these projections are accurate, workplace diversity is inevitable. Regardless of inevitability, workplace diversity makes sense. Openness to diversity gives an institution the ability to recruit excellent talent from the entire labor pool. Human resource managers and nurse executives should strive to recruit and retain a workforce as diverse as the population served.

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1. Nobile RJ. HR’s top ten legal issues. HR Focus. 1997; 74 (4): 19–21.

2. Jackson SE, Schuler RS. Managing Human Resources: A Partnership Perspective. 7 th ed. Cincinnati, OH: South-Western College Publishing; 2000.

3. Pollar O. A diverse workforce requires balanced leadership. Workforce. 1998; 77 (12): S4–S6.

4. Shumaker RP. Multicultural needs bring on new opportunities. AORN Journal. 1998; 68 (5): 744–746.

5. Hilton C. Collecting ethnic group data for inpatients: is it useful? Br Med J. 1996; 313 (7062): 923–925.

6. Sloan A. When language is an obstacle. RN. 1995; 58 (6): 55–58.

7. Davidhizer R, Havens R, Bechtel GA. Assessing culturally diverse pediatric clients. Ped Nurs. 1999; 25 (4): 371–379.

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© 2002 Lippincott Williams & Wilkins, Inc.