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Addressing equity of care remains an imperative for hospitals and health systems. According to the 2010 U.S. census, about 36 percent of the population belongs to a racial or ethnic minority. By 2050, the Census Bureau projects that 54 percent of the population will comprise minorities.

A 2013 report by the American Hospital Association's Institute for Diversity in Health Management and the Health Research & Educational Trust shows that while progress is being made to address health care disparities, more work needs to be done. The elimination of health disparities requires a three-pronged approach: the collection of race, ethnicity and language preference data; increased cultural competency training; and increased diversity in governance and leadership.

"It's critical to have an understanding of the minority patient experience," says Joseph Betancourt, M.D., director of Massachusetts General Hospital's Disparities Solution Center. "We fortified how we collect patient demographic, so we could take a deeper dive into how we care for our minority patients." Equally important, Betancourt says, is ensuring that the organization's board and executive leadership reflect the ethnic and racial makeup of the community. His organization's leadership has diversity metrics as part of their performance measures, and human resources places emphasis on the recruitment and retention of minorities.

One of the challenges to addressing racial disparities is limited resources, notes John Corlett, vice president of government relations and community affairs for MetroHealth Cleveland. But, he adds, "if it's the right thing to do, we can figure out a way to do it."

Improving equity of care is a business imperative, as well as a moral imperative, says Virginia Tong, vice president of cultural competence and partnership innovation at Lutheran Medical Center, New York City, "Patients have a choice," she says. "If you make your programs accessible, they will use your services. There is a business incentive to this as well."

This gatefold examines hospitals' equity of care initiatives and looks at how hospitals are successfully addressing the challenges of providing care to diverse populations.

The Benefits of Cultural Competency

Social Benefits

Increases mutual respect and understanding between patient and organization.

Increases trust.

Promotes inclusion of all community members.

Increases community participation and involvement in health issues.

Assists patients and families in their care.

Promotes patient and family responsibilities for health.

Health Benefits

Improves patient data collection.

Increases preventive care by patients.

Reduces care disparities in the patient population.

Increases cost savings from a reduction in medical errors, number of treatments and legal costs.

Reduces the number of missed medical visits.

Business benefits

Incorporates different perspectives, ideas and strategies into the decision-making process.

Decreases barriers that slow progress.

Moves toward meeting legal and regulatory guidelines.

Improves efficiency-of-care services.

Source: “Becoming a Culturally Competent Health Care Organization,” Institute for Diversity in Health Management and the Health Research & Educational Trust, 2013

Three Key Steps Toward Cultural Competency

Community Survey

The hospital or health care system analyzes demographic data to determine the composition of the local community and the hospital’s patient population. With this analysis, the hospital or care system can conduct microtargeting surveys to determine the needs for specific communities.

Community Engagement

The hospital or health care system communicates survey findings to community members and determines priorities. This information serves as the basis for staff education.

Staff education

Working with community feedback and survey data, the hospital or care system educates staff on the importance of cultural competence and the particular cultural needs of patients with whom staff interact each day.

Source: “Becoming a Culturally Competent Health Care Organization,” Institute for Diversity in Health Management and the Health Research & Educational Trust, 2013

Case Studies

Lutheran Medical Center | New York City

Lutheran Medical Center, a 404-bed teaching hospital, is committed to providing culturally competent, equitable care to a growing population of minorities. The organization’s service area, once home to a predominantly Norwegian community, now comprises a mix of minorities of Chinese, Arab, Dominican and Mexican descent, among others. “The immigrant community continuously changes,” says Virginia Tong, vice president of cultural competence and partnership innovation. Community liaisons and cultural advisory committees provide outreach to the community’s Chinese, Arabic and Orthodox Jewish communities to help them navigate the health care system. Nine community health centers further the organization’s community outreach. Between 60 and 70 percent of hospital staff are bilingual. A dedicated Chinese inpatient unit offers multilingual medical staff 24 hours a day and food prepared by a Chinese cook. 

Massachusetts General Hospital | Boston

Massachusetts General Hospital took an aggressive approach to addressing racial and ethnic disparities following the Institute of Medicine’s 2002 report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.” In 2003, the organization formed the MGH Committee on Racial and Ethnic Disparities in Health Care to: improve the minority patient experience and access to care; develop ways to better identify and eliminate racial and ethnic disparities; and raise awareness and education among staff. The organization formed the Disparities Solution Center in 2005 to address disparities and serve as a local, regional and national resource for hospitals and other health care organizations. “We’ve made drastic changes,” says Joseph Betancourt, M.D., director of the center. “We are committed to providing high-quality health care to all who come through our doors.” Critical to the organization’s initiative is the collection and distribution of patient demographic data. A disparities dashboard is shared with clinical leaders and the governance board, and is also posted on the organization’s intranet and website. “The hospital holds itself responsible for results,” Betancourt says.