ANA Review: Institute of Medicine Report on Workforce Diversity

Alabama Nurse,  Mar-May 2004  

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The lack of racial and ethnic diversity among the health professions - despite efforts in recruitment and increased funding - and the societal need for an increasingly diverse and culturally competent healthcare workforce prompted the W.K. Kellogg Foundation to ask the Institute of Medicine (IOM) to study the issue. Specifically, Kellogg asked the Institute of Medicine to "assess the potential for institutional and policy-level strategies to increase under-represented minority participation in the health professions."

The result is a report, In the Nation's Compelling Interest: Ensuring Diversity in the Health Care Workforce, which has been developed by the IOM Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the U.S. Healthcare Workforce. The Committee, largely comprised of academics, includes two representatives of the nursing profession: Colleen Conway-Welch (Vice Chair), Dean and Professor, School of Nursing, Vanderbilt University, Nashville, TN, and Bette R. Kellner, Dean, School of Nursing & Health Studies, Georgetown University, Washington, DC (until 9/03).

Kellogg's request for the study was prompted by three realities:

* There is an increasing need for under-represented minority (URM) health professionals.

* Policy challenges threaten affirmative action.

* Little progress towards enhancing the number of URM students prepared to enter the health professions has been made.

Specifically, the W.K. Kellogg Foundation asked that the IOM:

* Assess and describe potential benefits of greater racial and ethnic diversity among health professionals;

* Assess institutional and policy-level strategies that may increase diversity within the health professions; and

* Identify mechanisms to garner broad support among health profession's leaders, community members, and other key stakeholders to implement identified strategies.

The issue of racial and ethnic diversity is considered particularly important for several reasons. Racial and ethnic minority health professionals are significantly more likely to serve, and thus improve access for, minority and medically under-served communities. Research in settings where provider and patient racial or ethnic backgrounds are matched also shows increased patient satisfaction. Nursing is particularly affected by the issue of workforce diversity since it is the largest health profession, provides the bulk of direct care services to consumers, and is woefully out of sync with population demographics. The ANA has identified the importance of cultural competence in meeting the needs of a diverse patient population in its Principles for Nurse Staffing (http://nursingworld.org/readroom/stffprnc.htm).

In developing Nursing's Agenda for the Future (NAF) (www.nursingworld.org/naf), the nursing community identified the need for a nursing workforce whose diversity reflects that of the patient population; for congruence between nursing education and societal needs; for improved recruitment and retention of a diverse workforce through increased funding, targeted recruitment strategies, and career mobility tracks; and for leadership that reflects and values diversity. For those familiar with NAF, the IOM report contains many similar recommendations, but also adds specific incentives - in a range of areas - to prompt needed changes.

The detailed report is available at: http://books.nap.edu/catalog/10885.html. A summary of the report's recommendations follows for your review. If you have any questions, please feel free to contact Katherine Kany at: 202/651-7131 or kkany@ana.org.

SUMMARY OF RECOMMENDATIONS:

IMPROVING ADMISSIONS POLICIES AND PRACTICES. Health Professions Education Institutions (HPEIs) should:

* Develop, disseminate and utilize a clear statement of mission that recognizes the value of diversity;

* Establish explicit policies regarding the value and importance of culturally competent care, and the role of institutional diversity in achieving this goal;

* Base admissions on a comprehensive review of each applicant, and balance the consideration of quantitative and qualitative data; and,

* Include voting representation from under-represented groups on admissions committees and provide special incentives to faculty for participation.

REDUCING FINANCIAL BARRIERS TO HEALTH PROFESSIONS TRAINING.

* HRSA's health professions training programs should be evaluated quarterly to ensure they maximize URM participation;

* Congress should increase funding for Public Health Service Act Titles VII and VIII programs shown to be effective in increasing diversity;

* Federal and state health agencies should increase support for diversity efforts, through programs such as loan forgiveness, tuition reimbursement, loan repayment, Medicaid GMH, and supportive affiliations with community-based providers; and,

* Public-private collaboration should be encouraged to support the common goal of developing a more diverse health care workforce.

ENCOURAGING DIVERSITY EFFORTS THROUGH ACCREDITATION. Accreditation bodies should: