Janice L. Dreachslin

Integrative Literature Review: Diversity Management Interventions and Organizational Performance:A Synthesis of Current Literature

Despite the growing body of literature focused on diversity management and its implications for career experiences and perceptions, team dynamics, customer service, and other dimensions of organizational performance, a significant gap remains. To address the gap, this article reviews the managing diversity literature published between January 2000 and December 2005 to identify the subset of the literature that examines the effectiveness of specific diversity interventions implemented in organizations. Only 38 such studies were identified. We conclude that the current evidence base provides limited guidance to human resource professionals as they design and implement diversity interventions. Each study identified in the review is categorized by research methodology and by type of intervention: diversity training and education; mentoring; and other organizational development interventions. Characteristics of effective interventions are identified. Gaps in the literature and areas for future research are described.

Workforce diversity: implications for the effectiveness of health care delivery teams.

This paper examines the implications of racial diversity for the self-perceived communication effectiveness of nursing care teams. An RN leads the nursing care team (NCT) and delivers care in collaboration with two or more nonlicensed caregivers. Overlap is intentionally designed into the roles of NCT members and the range of duties the team performs is generally expanded to include functions previously performed by personnel from centralized departments. NCTs are highly reliant on mutual respect and effective communication among team members. Team conflict and miscommunication can be exacerbated by the strong correlation between role on the nursing care team (NCT) and race. Verbatim transcripts of fourteen focus groups from two study hospitals were used to develop a grounded theory of the role that race plays in the self-perceived communication effectiveness of nursing care teams. Two themes that emerged from the focus group discussions constitute the overarching framework within which racially diverse team members evaluate team communication effectiveness: different perspectives and alternative realities. Three additional themes, social isolation, selective perception and stereotypes, that serve as reinforcing factors were also identified, i.e., these factors deepen the conflict and dissatisfaction with team communication that occurs as a natural consequence of the overarching framework of different perspectives and alternative realities. Leadership emerged as a powerful mitigating factor in the model of how race influences the self-perceived communication effectiveness of nursing care teams. Leaders who can transcend racial identity as evidenced by the ability to validate alternative realities and appreciate different perspectives appear to moderate the potential negative effects of racial diversity on team communication processes and strengthen the positive aspects of diversity.

Racial/ethnic diversity management and cultural competency: the case of Pennsylvania hospitals.

EXECUTIVE SUMMARY Major demographic trends are changing the face of Americas labor pool, and healthcare managers increasingly face a scarcer and more diverse workforce. As a result, healthcare organizations (HCOs) must develop policies and practices aimed at recruiting, retaining, and managing a diverse workforce and must meet the demands of a more diverse patient population by providing culturally appropriate care and improving access to care for racial/ethnic minorities. Ultimately, the goal of managing diversity is to enhance workforce and customer satisfaction, to improve communication among members of the workforce, and to further improve organizational performance. Research on diversity management practices in HCOs is scarce, providing few guidelines for practitioners. This study attempted to close that gap. Results show that hospitals in Pennsylvania have been relatively inactive with employing diversity management practices, and equal employment requirements are the main driver of diversity management policy. The number and scope of diversity management practices used were not influenced by organizational or market characteristics. The results suggest that hospitals need to adopt diversity management practices for their workforces and need to pay particular attention to marketing and service planning activities that meet the needs of a diverse patient population.

Communication patterns and group composition: implications for patient-centered care team effectiveness.

To assess how diversity affects team communication and to identify strategies to improve communication and patient care, focus groups of care production team members were held in two case study hospitals that have implemented the patient-centered care model. Results indicate that care production team members generally support patient-centered care as a model that can work effectively in practice, even in an urban environment in which diversity concerns can affect team cohesiveness and communication. Successful implementation of the model, however, requires that hospitals consistently employ management strategies and reward structures that reinforce the value of teamwork and emphasize training and staff development. Key steps that healthcare executives can undertake to improve the performance of care production teams are detailed in this article and center around the following themes: team involvement in process improvement; a heightened emphasis on training (i.e., team and diversity training for all team members, task focused training for nonlicensed care givers; and leadership training for RNs); and the implementation of team-based reward and incentive structures.

Organizational strategy and diversity management: diversity-sensitive orientation as a moderating influence.

Empirical studies on diversity suggest that health care organizations have been slow to embrace diversity management. We propose that sensitivity to diversity, at the corporate level, moderates strategic decision making, which influences human resource management practices such as diversity initiatives. This study of 203 hospitals explored the relationships among organizational strategy, organizational sensitivity to diversity, and diversity management practices.

Cultural competency assessment tool for hospitals: Evaluating hospitals' adherence to the culturally and linguistically appropriate services standards

BACKGROUND The U.S. national standards for culturally and linguistically appropriate services (CLAS) in health care provide guidelines on policies and practices aimed at developing culturally competent systems of care. The Cultural Competency Assessment Tool for Hospitals (CCATH) was developed as an organizational tool to assess adherence to the CLAS standards. PURPOSES First, we describe the development of the CCATH and estimate the reliability and validity of the CCATH measures. Second, we discuss the managerial implications of the CCATH as an organizational tool to assess cultural competency. METHODOLOGY/APPROACH We pilot tested an initial draft of the CCATH, revised it based on a focus group and cognitive interviews, and then administered it in a field test with a sample of California hospitals. The reliability and validity of the CCATH were evaluated using factor analysis, analysis of variance, and Cronbachs alphas. FINDINGS Exploratory and confirmatory factor analyses identified 12 CCATH composites: leadership and strategic planning, data collection on inpatient population, data collection on service area, performance management systems and quality improvement, human resources practices, diversity training, community representation, availability of interpreter services, interpreter services policies, quality of interpreter services, translation of written materials, and clinical cultural competency practices. All the CCATH scales had internal consistency reliability of .65 or above, and the reliability was .70 or above for 9 of the 12 scales. Analysis of variance results showed that not-for-profit hospitals have higher CCATH scores than for-profit hospitals in five CCATH scales and higher CCATH scores than government hospitals in two CCATH scales. PRACTICE IMPLICATIONS The CCATH showed adequate psychometric properties. Managers and policy makers can use the CCATH as a tool to evaluate hospital performance in cultural competency and identify and target improvements in hospital policies and practices that undergird the provision of CLAS.

The role of leadership in creating a diversity-sensitive organization.

The opportunity for personal growth that a focus on DSO development offers leaders is compelling, as it provides and requires new experiences and new ideas. Seasoned healthcare executives and their organizations are offered the opportunity for renewal-to see things in a new light and experience the organization, the service area, and each other differently. Researchers at the Gallup Organization, based on studies of more than 50,000 leaders in diverse industries, have identified the following seven demands of leadership: visioning, maximizing values, challenging experiences, mentoring, building a constituency, making sense of experience, and knowing ones self (Conchie 2004). To meet these demands with courage and conviction in the context of diversity is, perhaps, the ultimate healthcare leadership challenge in the foreseeable future.

Diversity leadership and organizational transformation: performance indicators for health services organizations.

Health services organizations can follow a five-part process to reposition themselves through diversity leadership. The first part of the process, discovery, refers to the emerging awareness of racial and ethnic diversity as a significant strategic issue; the second part, assessment, refers to systematic review of the organizations racial and ethnic diversity climate; the third part, exploration, denotes systematic training initiatives to improve the health services organizations ability to effectively manage diversity; the fourth part, transformation, refers to fundamental changes in organizational practices that result in a culture in which racial and ethnic diversity is valued; and the final part, revitalization, refers to renewal and expansion of racial and ethnic diversity initiatives to reward change agents and to include additional identity groups among the health services organizations diversity initiatives. This article presents a series of behaviorally based performance indicators for each of the five parts of the diversity leadership process. Healthcare executives are encouraged to assess their organizations strategic positioning against best demonstrated practices, as represented by the performance indicators. A method for analyzing organizational performance against the diversity leadership indicators is outlined as are suggestions for future research.

Focus groups as a quality improvement technique: a case example from health administration education

States that growing numbers of experienced adult professionals are pursuing higher education on a part‐time basis and are enrolling selectively in university and workplace‐based undergraduate, graduate, and continuing professional education programs. As competition for this growing population of lifelong learners increases, the assessment of student satisfaction requires more attention. This article discusses the advantages of focus groups – a structured group interview technique – over other techniques for assessing the satisfaction of adult learners, presents key aspects of focus group methodology, and provides a case illustration of focus group methodology applied to quality improvement in a professional master’s level management program that serves adult professionals who are employed full‐time in the health professions.

Three Case-Type Classifications: Suitability for Use in Reimbursing Hospitals

This study compared three case-type classifications—the cross-classification of the Commission on Professional and Hospital Activities, Diagnosis-Related Groups (DRGs) and Staging—with respect to per cent of variance in total patient charges accounted for. The purpose was to assess the relative usefulness of the classifications for application in hospital reimbursement schemes. The sample consisted of 50 hospitals. A nested analysis of variance was performed with case type nested within hospital. Per cent of variance accounted for was calculated for each of three data sets: the full data set, a truncated version of that set and a logarithmically transformed version. Results support the contention that none of the currently available classifications accounts for enough variance to permit straightforward use of case-type standard costs in a reimbursement mechanism. New developments in case-type classification may result in a classification that is more suitable for this use.