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Small Steps Toward Fixing the Big Problem of Health Disparities

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By Marcia Faller, Ph.D., RN, chief clinical officer and senior vice president, AMN Healthcare
When someone broaches the topic of health disparities or we hear about it in the news, the sheer enormity of the healthcare issues facing certain minority or underserved populations in this country can truly be overwhelming. The problem is a big one. 

According to AHRQ’s latest disparities report, released in April, ethnic minorities, non-English speakers and low-income citizens still have less access to healthcare and lower quality of care than other Americans in many areas. In addition, half of the measures documenting disparities showed no improvement between 2002 and 2008.

But instead of wringing our hands or blaming the politicians for not doing more, perhaps it is time for a little introspection. Perhaps it is time to ask: What can an individual hospital do to bridge the gaps in care for the people in our realm of influence?

Another report released earlier in June from the Health Research and Educational Trust (HRET)--“Diversity and Disparities: A Benchmark Study of U.S. Hospitals,” commissioned by AHA’s Institute for Diversity in Health Management--may hold some clues. HRET surveyed the CEOs at more than 900 hospitals about what actions they are taking to reduce healthcare disparities and promote diversity in their leadership.

The results are highlighted in charts, graphs and short summaries that I recommend reading when you have the chance. But for now, here are a few key points and “to dos” that may help bring the large, overriding issue of health disparities down to a workable action plan in your facility or health system.
Six steps in the right direction:

1. Continue gathering patient demographic data. The HRET researchers found that the large majority of hospitals are currently doing a good job of this, collecting data on race (94%), ethnicity (87%), and primary language (90%). So keep up the good work.

2. “Mind the gap” in care, using REAL (race, ethnicity and language) data. According to the report, far fewer hospitals are actually using their data to benchmark gaps in care related to race (26%), ethnicity (25%) and language (28%). So, “Mind the gap!” as our British colleagues might say.  In other words, devote some resources to using the data you’re collecting to find out where your services are in relation to where you want be, and to determine what progress you make over time.

3. Train staff in cultural competency. Eight out of 10 hospital CEOs said they are instructing their new employees how to address the cultural and linguistic factors affecting their patients’ care, and 6 out of 10 require all employees to attend diversity training. Yet less than half (45%) provide training in all five cultural competency areas: languages spoken by patients, available language services, diverse health beliefs held by patient populations, religious beliefs affecting health care, and family/community interactions. How is your facility doing in these areas?

4. Consider the diversity of your staff a priority. In recent years, there have been a number of efforts to bring more minorities into the healthcare profession, in part to help relate to an increasingly diverse patient population. Yet, among the 924 hospitals surveyed, just 38% said that they have made recruitment and retention of minority and underrepresented groups in the workforce part of their strategic plan. An official commitment to this goal could help your organization make significant strides in bridging this ethnic/cultural gap.

5. Consider the diversity of your leadership, as well. Although minorities represent 29% of patients nationally, only half that many are represented on hospital boards (14%), in executive leadership positions (14%) and in first-and mid-level management positions (15%). What more can you do to recruit and promote leaders who represent your patient population?

6. Ask your patients and staff what they recommend. According to the survey, only 60% of hospitals are actually asking their patients how they are doing serving diverse populations and those with language needs, and how they can improve; less than half (47%) have a standardized system to collect feedback from staff on the same subject. If you want to know how you can lessen health disparities and improve your services, just ask! You’re sure to get an earful of good ideas.

Admittedly, providing equitable care for all of the patients we serve is a complicated issue, but each healthcare provider can start to make a difference with a few small steps.

If you have specific ideas or examples of how you are bridging the health disparity gap at the facility level, please share by posting a comment.

American Hospital Association and Institute for Diversity in Health Management. Diversity and Disparities: A Benchmark Study of U.S. Hospitals. Chicago: June 2012. Accessed at

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