Hospitals are working harder to monitor and increase diversity, from the C-suite to the board table. But there's still a long way to go toward completely eradicating disparities in care.
That's the key takeaway from a recent survey of hospitals, commissioned by the American Hospital Association-affiliated Institute for Diversity in Health Management. One bright spot? A majority of hospitals surveyed have a plan in place to improve the representation of minorities on the board and in leadership positions, says Fred Hobby, president and CEO of IFD. And almost 9 percent of chief executives are minorities, he says, up from less than 2 percent in 1995.
"It's slow progress, but it is progress," Hobby told me by phone earlier this week. "What we're looking for is leadership teams and boards that reflect the community they serve."
The AHA's Health Research & Educational Trust surveyed 924 hospitals by mail, looking to see how they were addressing disparities in care, and the results were unveiled today at IFD's annual meeting in Nashville, Tenn. The vast majority of hospitals are collecting patient data related to diversity, including race (94 percent), ethnicity (87 percent) and primary language (90 percent). But only 18 percent actually used that data to benchmark gaps in care, surveyors found.
Hobby listed myriad reasons why hospitals might be failing to meaningfully use the data, such as some fearing potential liability issues after publicly acknowledging disparities in care, concerns about the public relations backlash and a lack of knowledge in developing clinical programs that would reduce or eliminate inequalities. Plus, some don't have a "diversity champion" on their staff to help lead the effort, he says.
Hospitals also seem to be making progress in educating staff on diversity, with some 81 percent teaching new hires how to address "the unique cultural and linguistic factors affecting the care of diverse patients," and 61 percent requiring employees to attend diversity training, according to the survey.
The IFD says that about 29 percent of patients in the nation are minorities, and that number is expected to swell with the implementation of the Affordable Care Act. Yet, minorities only represent 14 percent of hospital board membership, 14 percent of executive leadership positions, and 15 percent of first- and mid-level positions, the survey found. As a sign of progress, though, nearly half of hospitals surveyed had a plan to recruit and retain a diverse workforce matching their patient population, and 42 percent said they implemented a program to find diverse employees in the organization worthy of promotion.
Hobby says it's critical that hospital boards and leadership teams mirror the community they serve in order to provide "culturally competent care." He gave the example of most women receiving ice chips to help with dehydration after they give birth, whereas Asian women prefer a hot beverage. If a hospital was seeing a high rate of dehydration in post-birth Asian women, he says, a board member or leader with a similar background could help catch that issue much earlier on.
Only 20 percent of hospitals analyzed clinical quality indicators by race and ethnicity to identify patterns, while 14 percent looked at hospital readmissions, and 8 percent analyzed medical errors. "Disparities contribute significantly to the unnecessary costs of care," Hobby says. Regardless of the negatives found by the survey, he thinks it's encouraging that hospitals are discussing the topic.
"Diversity and disparities are beginning to appear on the radar screens of our nation's hospitals," he says. "Just a few years ago, this work was not a priority, and now it is emerging as a priority topic. We're encouraged. The evolutionary process is still moving forward versus getting worse."