Workforce diversity: Challenges and strategies

Journal of Multicultural Nursing & Health, Summer 2001 by Mateo, Magdalena A, Smith, Suzanne P

Striving to recruit and effectively manage an increasingly diverse workforce, healthcare organizations soon realize that an enormous and ongoing amount of time energy, and resources are needed to sustain its goals. In this article, the numerous issues an organization encounters when working toward its goals of diversity (integrating diversity management throughout the organization, identifying staff roles for meeting goals, and determining ways to measure outcomes) are discussed. The opportunities and strategies for dealing with diversity management challenges are presented.

KEY WORDS: Cultural diversity; Diversity leadership; Diversity management; Health care organizations; Multiculturalism; Outcomes; Workforce diversity.

The U.S. population is growing increasingly diverse. According to the Bureau of Census, almost 30% of the U.S. population are from ethnic or racial minority groups, 12.8% are African American, 11.9% are Hispanics, 4.1% are Asian and Pacific, and 1% represent other groups. Patients and health care workers likewise are increasingly reflecting the ethnicity and diversity of the country. The mandate has never been stronger to strengthen organizations' cultural awareness and training.

Integrating Diversity Management throughout the Organization

Diversity in healthcare, seen at all organizational levels, includes people from differing cultures, races, religions, gender, physical ability, backgrounds, and values (Ivancevich & Gilbert, 2000). Once an organizational decision is made to value and promote diversity among staff, the challenge lies in trying to manage this diversity through "systematic and planned commitment...to recruit, train, reward, and promote a heterogeneous mix of employees." (Ivancevich & Gilbert, 2000, p. 75)

Many approaches have been used in healthcare to manage diversity. The most common are training sessions, subordinates' feedback, performance appraisals, and reward systems (Wallace, Ermer, & Motshabi, 1996). Whatever strategies are used, common goals are fostering staff commitment to diversity, recruiting and empowering staff champions, identifying the value added to the system by group differences, and empowering staff through skill development (Mateo, 1999). Specific strategies that have proven successful are increasing staff governance, setting clear expectations, increasing communication, and increasing staff coaching and education (Seago, 1996).

Recruiting and Retaining Diverse Leaders

Since leaders have such a strong influence on any organizational endeavor, including, a first step in diversity management is recruiting and retaining a culturally diverse leadership team. Having a diverse management team that showcases the positive side of people being different is a reminder to all staff that the organization's diversity goals are in the forefront. However, a diverse executive team is not the norm.

Moore and Japsen (1997) reported that only 1% of presidents and chief executive officers were minorities from among the 5 million hospital workers in the US in 1996. The majority of those assuming high level positions are not in the public sector. Moore and Japsen suggested the following reasons for finding so few minorities in executive positions. First, there may not be strong incentives for minority candidates to pursue a health administration career -- administrative residencies are long and top-level jobs are few. Second, young minorities often are unaware of career choices that are available in health care. Third, since many minorities lack insurance, they have not traditionally been seen as important customers needing representation as employees, particularly at the managerial level.

Even with years of effort from state and professional organizations, as well as individual institutions, to promote workforce diversity, most can not readily produce outcome statistics such as the number of minorities who are in chief executive or other top-level positions. As healthcare leaders realize that they must be sensitive to their customers, many of whom are minority people with considerable income and purchasing power, they will see that it makes economic sense to increase diversity in top level management positions.

In an ethnographic study of nursing care provided to ethnically diverse patients, it was not nurses at an individual level but rather institutional forces that conspired to perpetuate the inequities felt by ethic minorities; the authors concluded that more diversity in management was necessary if the needs of ethnically diverse employees and patients were to be met. (Garnish, 1999). In another study, a healthcare executive search firm reported that of the 370 executives placements in their firm in 1996, 6% were minorities: 3.3% were African American; 1% Hispanic; 0.6% Asian; and approximately 1% Other (Jessamy, 1997).

Preparing an organization to increase the number of minority staff requires a comprehensive process that is part of a total quality improvement process (Jessamy, 1997). Suggested strategies that should be made known internally and externally are to provide active mentorship to help minorities move up the career ladder and hire outside minority executives using a deliberate and thoughtful selection process.