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 Conduct a case study analysis.


Diversity in the Health Care Workforce

Nancy K. Sayre and Sally O. Casey

A human resource manager works at a small hospital in a rural community of 30,000 mostly Spanish-speaking people in southern New Mexico. The hospital has a job opportunity for a business manager for a new outpatient clinic that is about to open. The human resource manager is considering three different candidates for the position:

1.    An individual who grew up in the community and just completed an undergraduate degree in Health Administration from an in-state college about 500 miles away. She completed an internship but has no other practical experience.

2.    A bilingual man in his 50s who has spent his entire career working at the local bank in finance, helping to get loans for regional farms or other businesses. He wishes to switch to a more personally fulfilling opportunity.

3.    A nurse who works at a large hospital in the state capital, about 200 miles away, who would like to transition from direct patient care to management. She is well-liked and has had excellent performance reviews. She grew up on tribally owned lands for the Navajo and needs to return to care for her elderly parents.

The CEO of the hospital catches the HR manager in the hospital cafeteria and he mentions that he has just returned from a national conference and learned a lot about diversity in hiring. He passes on these thoughts. Achieving diversity in health care management requires commitment among all professionals including entry-level staff, middle managers, and senior executives. Five solutions for diversity success include being sensitive to cultural differences in the workplace, establishing strategic goals that emphasize cultural diversity, seeking regular input from employees about diversity initiatives, promoting minorities from within, and mentoring them as well (Witt/Kiefer, 2011). The American College of Healthcare Executives (ACHE, 2010) calls for “awareness of diversity issues, hiring practices that attract diverse staff, development and mentoring in educational programs and organizations, and organization wide diversity training,” which are all key practices on which HR needs to focus. “Our country’s increasingly diverse communities result in a more diverse patient population” (ACHE, 2010) and require a more diverse health care workforce. The Institute for Diversity in Health Management is a resource for strategies, programs, and leadership initiatives with the ultimate goal of having the health care workforce in the United States reflect the makeup of the communities served.

Given the current U.S. demographic trend of moving toward a minority nation and the need for all health care organizations to adhere to the National Standards for Culturally and Linguistically Appropriate Services in Health Care, achieving greater diversity in the health care workforce will continue to be an important challenge (Office of Minority Health, 2001). Within health professions, the representation of Hispanics, Native Americans, and African Americans is lower than their representation in the general population. The American Hospital Association data indicated that the majority (94%) of hospital CEOs were white; whereas only 65% of the population was white in census data from 2010 (ACHE, 2010). Increasing racial and ethnic diversity has been associated with improved patient care and satisfaction, improved clinical outcomes, and stronger financial performance (Witt/Kiefer, 2011). Studies have suggested that by increasing diversity, the field of health care management can improve work-place culture, enhance community relations, and have an overall positive impact on the health of the community (ACHE, 2010).

Discussion Questions

1.    What required and preferred qualifications should be included in the job description or job posting to ensure competitive and appropriate candidates apply for the business manager position?

2.    Give examples of three to five questions that could be asked during the interview to determine the candidate’s cultural proficiency.

3.    Should cultural proficiency and community awareness be rated more highly and thus given greater importance than other qualifications in the hiring process?

4.    How important should background and/or experience in health care be rated?

5.    What management, training, and leadership practices support a new manager and ensure clinic programs, practices, and services are responsive to the needs of the community?

6.    Health care organizations must engage the communities they serve in order to improve cultural proficiencies and reduce health disparities. Describe three to five community engagement strategies the newly hired outpatient clinic could implement.

7.    What strategies can health care organizations use to evaluate the effectiveness of their community engagement strategies?

8.    What strategies can health care organizations use to evaluate the effectiveness of their diversity and cultural proficiency strategies?


American College of Healthcare Executives (ACHE). (2010). Increasing and sustaining racial/ethnic diversity in healthcare management. Chicago, IL: ACHE. Retrieved from http://www.ache.org/policy/minority.cfm

Institute for Diversity in Health Management. http://www.diversityconnection.org/

Office of Minority Health. (2001). National standards for culturally and linguistically appropriate services in health care: Final report. Washington, DC: U.S. Department of Health and Human Services.

Sayre, N., & Chavez, R. (2012). Addressing health disparities: Cultural proficiency. In S. B. Buchbinder & N. H. Shanks (Eds.), Introduction to health care management (2nd ed., pp. 313–332). Burlington, MA: Jones & Bartlett.

Witt/Kiefer. (2011). Building the business case: Healthcare diversity leadership: A National survey report. Retrieved from http://www.diversityconnection.org/diversityconnection/membership/Resource%20Center%20Docs/Healthcare%20Diversity%20Leadership-%20a%20National%20Survey%20Report.pdf

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