Academic journal article Frontiers of Health Services Management

Our Experience: Strong Foundations Accelerate Change in Diversity and Cultural Competence

Academic journal article Frontiers of Health Services Management

Our Experience: Strong Foundations Accelerate Change in Diversity and Cultural Competence

Article excerpt

AT FAI RVI EW HEALTH SERVICES, a 22,000-employee integrated health system in Minneapolis-St. Paul, Minnesota, our system-wide diversity and cultural competence initiative is marking its first decade of effort. We hired a director of diversity and established a central office of diversity for the system in early 2000. Our metro-area hospitals have been asking our patients their race/ethnicity, primary language preference for healthcare, and spiritual affiliation since 2004. Our Fairview Diversity Council took shape in early 2000 and since then has been joined by a coordinated set of six hospital- and site-based diversity teams - an advocacy and support network united by a common vision and strategic goals.

Our diversity vision, developed by the Fairview Diversity Council in early 2000, remains evergreen: "Our communities will choose Fairview first as employer, healthcare provider, and partner, and we will inspire employee pride, because we understand, respect, and leverage our differences to improve the lives of those we touch." This commentary represents for us a marker and a challenge to address those areas where we know we can make further and faster progress.


In our diversity and cultural competence work as an integrated health system, the following six key levers have formed the basis for our diversity change initiative and given every employee a way to take part, if they choose to do so:

1) Offers of direction, presence, involvement, and action from leaders at all levels

2) Systematic data collection and knowledge of that data

3) Community involvement in our diversity work

4) Establishment of the Office of Diversity as a central catalyst and consulting function to support action and foster learning

5) Empowerment of diversity advocates for their consultation, involvement, and support

6) Expectations for performance and competency for employees at all levels

Following their benchmark study on hospitals, language and culture, The loint Commission issued in 2008 a follow-up report titled One Size Does Not Fit All (Wilson-Stronks et al. 2008). This study summarized a framework for cultural competence work in hospitals and identified the following key elements:

1) Building a foundation

2) Acknowledging the needs of specific populations

3) Collecting and using data to improve services

4) Establishing internal and external collaborations

The levers that have been foundational for us over the past decade reflect to some degree The Joint Commission's findings in their study of 60 hospitals. But because we framed our work as a change initiative, additional elements - a central facilitating function, the vital role of advocates, and the expectation of action by every employee - naturally also became part of our foundation. Using The Joint Commission's framework as a basis for comparison in 2008 was a benefit to us. Principal investigator Amy Wilson-Stronks (2009) of The Joint Commission says, "The One Size Doesn't Fit All framework was developed based on an analysis of promising practices identified from the Hospitals, Language, and Culture study. The framework is meant to help hospitals develop and employ practices to meet the diverse needs of the patients they serve. We have been so gratified to see both smaller hospitals and large hospital systems like the Fairview system, one of the judgment sample organizations from our original study, understand the framework and use it to evaluate their own efforts."


We heartily applaud the theme "Time to Get Real!" espoused by Tony Armada and Marilyn French Hubbard. For many of our hospital and healthcare systems, the attention to specific healthcare disparities is a major focus of the diversity work, and often the challenge is to determine which disparity to address first, and how.

As have many other health systems, we evaluated our existing data on equity of care, dividing our considerations into four categories of equity: access, treatment, service, and outcomes. …

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