Optimizing the success of diversity and inclusion committees.

Recent years' events have resulted in increased attention to concepts related to diversity and inclusion. In the healthcare setting, diversity and inclusion committees provide a venue for the development and implementation of initiatives aimed at improving outcomes for underrepresented groups. The creation of diversity and inclusion committees must occur in an intentional manner to optimize results. In this Editorial, we outline best practices to ensure the development of successful diversity and inclusion committees.

Ensuring equity, diversity, and inclusion in the Society for Vascular Surgery: A report of the Society for Vascular Surgery Task Force on Equity, Diversity, and Inclusion.

Diversity, equity, and inclusion represent interconnected goals meant to ensure that all individuals, regardless of their innate identity characteristics, feel welcomed and valued among their peers. Equity is achieved when all individuals have equal access to leadership and career advancement opportunities as well as fair compensation for their work. It is well-known that the unique backgrounds and perspectives contributed by a diverse workforce strengthen and improve medical organizations overall. The Society for Vascular Surgery (SVS) is committed to supporting the highest quality leadership, patient care, surgical education, and societal recommendations through promoting diversity, equity, and inclusion within the SVS. The overarching goal of this document is to provide specific context and guidance for enhancing diversity, equity, and inclusion within the SVS as well as setting the tone for conduct and processes beyond the SVS, within other national and regional vascular surgery organizations and practice settings.

Update on workforce diversity in vascular surgery.

OBJECTIVE: Creating a diverse workforce is paramount to the success of the surgical field. A diverse workforce allows us to meet the health needs of an increasingly diverse population and to bring new ideas to spur technical innovation. The purpose of this study was to assess trends in workforce diversity within vascular surgery (VS) and general surgery (GS) as compared with orthopedic surgery (OS)-a specialty that instituted a formal diversity initiative over a decade ago. METHODS: Data on the trainee pool for VS (fellowships and integrated residencies), GS, and OS were obtained from the U.S. Graduate Medical Education reports for 1999 through 2017. Medical student demographic data were obtained from the Association of American Medical Colleges U.S. medical school enrollment reports. The representation of surgical trainee populations (female, Hispanic, and black) was normalized by their representation in medical school. We also performed the χ2 test to compare proportions of residents over dichotomized time periods (1999-2005 and 2013-2017) as well as a more sensitive trend of proportions test. RESULTS: The proportion of female trainees increased significantly between the time periods for the three surgical disciplines examined (P < .001). Hispanic trainees also represented an increasing proportion of all three disciplines (P ≤ .001). The proportion of black trainees did not significantly change in any discipline between the two periods. Relative to their proportion in medical school, Hispanic trainees were well represented in all surgical specialties studied (normalized ratio [NR], 0.95-1.52: 0.95 OS, 1.00 GS, 1.53 VS fellowship, and 1.23 VS residency). Compared with their representation in medical school, women were under-represented as surgical trainees (NR: 0.32 OS, 0.82 GS, 0.56 VS fellowship, and 0.78 VS residency) as were black trainees (NR: 0.63 OS, 0.90 GS, 0.99 VS fellowship, and 0.81 VS residency). CONCLUSIONS: Although there were significant increases in the number of women and Hispanic trainees in these three surgical disciplines, only Hispanic trainees enter the surgical field at a rate higher than their proportion in medical school. The lack of an increase in black trainees across all specialties was particularly discouraging. Women and black trainees were under-represented in all specialties as compared with their representation in medical school. The data presented suggest potential problems with recruitment at multiple levels of the pipeline. Particular attention should be paid to increasing the pool of minority medical school graduates who are both interested in and competitive for surgical specialties.

A Study Looking at a Lower Cost Option for Cultural Competence Education.

To meet the growing demands in the US healthcare system caused by multiculturalism and the expansion of health inequities, due diligence must be given to testing the efficacy of tools used in teaching nurses to provide culturally competent care. This project assessed the utility of a free US government-developed training module. The team found an improved trend in nurse-patient communication scores and improved willingness to ask for help with cultural issues for the intervention unit. The use of no-cost, publicly available resources may be a cost-effective option for training materials.

Inclusion, Diversity, Access, and Equity (IDA&E) Roadmap: Infectious Diseases Society of America's Commitment to the Future.

This article identifies the major elements of the strategic road map for the Infectious Diseases Society of America's (IDSA) Inclusion, Diversity, Access, and Equity (IDA&E) initiative and discusses the long-term goals and the proposed steps needed to achieve these goals.

The experiences of the process of planning, starting and organizing a culturally specific nursing home for Finnish-speaking older persons: a qualitative study.

BACKGROUND: Globally there are growing multicultural and multilingual societies. As a result of extensive international migration, the number of elderly migrants has increased and will further increase in the future. This makes it necessary for elderly healthcare services to meet elderly migrants' healthcare needs concerning language and cultural barriers. To our knowledge, previous research in the area of culturally specific nursing homes for migrant seniors is still limited. Thus, the study aimed to investigate the experiences of planning, starting and organizing a culturally specific nursing home for Finnish-speaking older persons. METHODS: An explorative qualitative study using both semi-structured individual interviews and focus group interviews as data collection. Thirteen informants were purposively recruited, two from Finnish-speaking association, seven healthcare professionals and two family members. Data were analysed by qualitative content analysis. RESULTS: Three categories, each with sub-categories, emerged from the data: 1) Motivation to develop this particular culture-specific nursing home; 2) Organizational issues and 3) Aspirations for the future. The study found that information from policy makers, the localization and activities of the nursing home, having healthcare staff who speak the minority language, organizing the nursing home as a mixture of older members of both the majority and the minority communities, all affected the planning, starting and organization of a culturally specific nursing home. CONCLUSION: This study found that information, localization, activities and language adapted to elderly migrants affected the planning, starting and organization of a culturally specific nursing home for Finnish-speaking older persons. These findings should support the healthcare organization in planning, managing and organizing sustainable nursing home care for older people belonging to a minority in order to attain the aim of person-centered and equal healthcare.

The association between organizational cultural competence and teamwork climate in a network of primary care practices.

BACKGROUND: A health system's commitment to delivering culturally competent care is essential in creating a culture of respect for patients, clinicians, and administrative staff. As the diversity of the health care workforce grows, gaining an understanding of the perspectives among different health care personnel and the value that they place on organizational cultural competence is a first step in developing more effective team environments. PURPOSE: The aim of the study was to determine whether an association exists between perceptions of organizational cultural competence and teamwork climate among employees in a health system. METHODOLOGY/APPROACH: One thousand eighty employees in a primary care network consisting of 49 ambulatory practices were surveyed on their perceptions of senior management's efforts in organizational cultural competence and teamwork climate in their own work setting using 5-point Likert scales. Linear regression models were used to evaluate the association between organizational cultural competence and teamwork climate. RESULTS: The overall organizational response rate for the survey was 84%. Higher perception of organizational cultural competence was associated with better teamwork climate (coef. = 0.4, p <0.001) after adjusting for gender, age, years in specialty, race, and position type. The association was stronger in magnitude for support staff compared to administrators and clinicians and stronger for younger compared to older age groups. CONCLUSIONS: Higher employee perceptions of organizational cultural competence are associated with better self-reported teamwork climate, and this relationship is magnified for support staff and younger employees. PRACTICE IMPLICATIONS: Senior leaders of health systems should consider investment in cultural competence as a contributor toward team effectiveness. Specifically, organizations may help support cultural competence by committing resources to the following: developing a comprehensive plan that addresses patients' cultural needs, recruiting and retaining a diverse staff and leadership, collaborating with the community, recognizing and rewarding care that meets patients' cultural needs, and providing adequate diversity training.

Australian military and veteran's mental health care part 1: an introduction to cultural essentials for clinicians.

OBJECTIVE: This article aims to define the cultural specificity of Australian military and veterans, and introduce some of the essential clinician knowledge, skills and attitudes required for effective cultural competence in the management of mental health (MH) conditions in this population. CONCLUSION: Military culture has the defining characteristics of the military as an organisation with a formal structure, as a cultural group governed by norms and shared values, and as a social group that provides people with identities. Key requirements for cultural competence introduced here are basic knowledge of the military structure, norms and identity; clinical skills including basic assessment and awareness of the commonly occurring MH disorders; and an exploration of attitudes of both the clinician and the military or veteran patient. Further research is needed, particularly in terms of assessing clinician's cultural competence.

[Development of a Culturally Sensitive Version of the Mini-International Neuropsychiatric Interview (MINI) in Standard Arabic]. / Entwicklung einer Kultursensiblen Version des Mini-International Neuropsychiatric Interview (MINI) in hocharabischer Sprache.

OBJECTIVE: In light of the current humanitarian crises in the Arabic world, a version of the Mini International Neuropsychiatric Interview (MINI) in standard Arabic, enabling a fast and efficient diagnosis of psychiatric disorders, is urgently needed. The aim of the present pilot study was to provide a culturally sensitive translation and adaptation of the MINI to standard Arabic and to undertake first steps towards its validation in a sample of Arab refugees. METHODS: Various experts in the field of psychiatry and psychotherapy, familiar with both Western and Arab cultures, were involved in the multi-level adaption process. N = 20 Arabic speaking refugee patients could be recruited for the pilot study at the Clearingstelle, established by the Charité, Univeritätsmedizin Berlin. The MINI diagnoses were compared to diagnoses by experts who were blinded to the MINI diagnoses, and screening instruments for depression (Patient Health Questionnaire 9, PHQ-9) and posttraumatic stress disorder (PTSD) (Harvard Trauma Questionnaire, HTQ) were used. RESULTS: Details concerning the particularities of the cultural adaptation process are comprehensively summarized and presented. Kappa values did not show any satisfactory concordance between the MINI and expert diagnoses. However, significantly strong concordance was found between the MINI and the PHQ-9 (κ = .69) and the HTQ (κ = .68). CONCLUSION: These results provide first indications for the validity of the standard Arabic version of the MINI and can be used as a basis for further, more comprehensive validation studies. Moreover, this study depicts a model process for the cultural adaptation of psychometric instruments.

Current status of the intercultural opening at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria.

Objectives: Intercultural opening of the health care system is supposed to optimize health services for migrants. It is part of the National Integration Plan and promoted by medical societies in Germany. This study examines its state of implementation at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria. Methods: A written survey was conducted using a modified version of the questionnaire for the implementation of intercultural opening in the mental health care system IKÖ-P (Penka et al. 2012a). Results: Altogether 18 institutions responded. Migrants were underrepresented among patients and employees excluding physicians. Specialized psychotherapeutic interventions for migrants were rarely available, but frequently used when offered. Conclusions: Intercultural opening was poorly implemented in a structural level. Due to the low response-rate of 21.7 % the survey is not representative. Participation of institutions interested in intercultural opening could have led to biased results. To provide adequate psychosomatic medical care for migrants, intercultural opening should be further developed.

Survey Development: Caregivers Help Define a Tool to Measure Cultures of Care.

OBJECTIVE: The aim of this study was to develop an instrument that measures all healthcare staff's perceptions of a culture of caring. BACKGROUND: Healthcare organizations have increased their focus on cultures of caring within their staff to improve staff satisfaction and patient satisfaction. Nurses and physicians traditionally have been the focus in understanding caring cultures excluding non-direct care staff who do impact organizational culture. METHODS: An exploratory and partial confirmatory factor analysis was completed on 2 instruments that measure the perception of a caring culture in both direct care and non-direct care staff. RESULTS: Results demonstrate that both the direct and non-direct care instruments are valid and reliable measures for assessing a caring culture. CONCLUSIONS: The new 14-item clinical and new 10-item nonclinical staff caring assessment instruments will provide healthcare and nursing leaders with the ability to assess their culture through a direct and non-direct care perspective.

Home to health care to hospital: Evaluation of a cancer care team based in Australian Aboriginal primary care.

OBJECTIVE: To evaluate the acceptability of a cancer care team based at an Australian Aboriginal medical service in supporting patients' cancer journeys and to assess improvements in access to cancer care. DESIGN: The cancer care team consisted of an Australian Aboriginal health worker, counsellor and enrolled nurse employed for 2 days a week, supported by a general practitioner. The cancer care team supported patients from prediagnosis while investigations were being undertaken, at diagnosis and through treatment, such as surgery, chemotherapy and radiotherapy, and follow-up, including to palliative care and grief support where these were required. They coordinated preventive programs, such as cervical smear and mammogram recall registers, and coordinated health promotion activities to promote prevention and early detection of other cancers, such as bowel cancer, skin cancer, liver cancer and prostate cancer. The program was evaluated qualitatively using semistructured interviews with current clients of the cancer care team and stakeholders, using grounded theory to analyse emerging themes. SETTING: An Australian Aboriginal community-controlled health service in New South Wales. PARTICIPANTS: The cancer care team provided care for 79 clients. MAIN OUTCOME MEASURES: Acceptability and accessibility of cancer care services. RESULTS: The evaluation involved recruitment of eight Australian Aboriginal clients of the cancer care team and eight stakeholders. The main themes to emerge included improved accessibility of cancer care services, including availability of home visits, transport and accompaniment to tertiary settings. The service was viewed as being culturally safe. CONCLUSION: A primary care-based cancer care team in an Australian Aboriginal medical service provided a culturally safe and accessible service for clients.

Modelling change and cultural safety: A case study in northern British Columbia health system transformation.

The relationship that Indigenous Peoples have to the Canadian healthcare system makes the system's weaknesses and complexities obvious. The long-standing lack of consideration to the historical and contemporary realities of Indigenous Peoples has resulted in miscommunication, misunderstanding, mistrust and racism. Health leaders, including health authorities, across the province are thus challenged to ensure that culturally safe environments are available and culturally safe practices are being used. This article begins with an overview of contemporary social political contexts in which Indigenous individual and collective realities are situated. Following is a conceptual discussion focused on health system change and the experiences of Indigenous Peoples. Change at structural, systemic and individual levels is the focus of the change model presented in this article. Throughout this exploration, examples of concrete actions currently underway in a health authority are offered. The article concludes with visions for future change.

Enabling cultural safety in Indigenous primary healthcare.

The Aboriginal Health Access Centre (AHAC) and Aboriginal Community Health Centre Model of Wholistic Health and Wellbeing is critical to addressing inequities and barriers that limit access to comprehensive primary healthcare for Indigenous people. Even with this model in place, there are multiple points of intersection with mainstream healthcare service providers across health sectors. Further, there is considerable cultural diversity among Indigenous healthcare staff and professional groups. These factors place Indigenous people at risk of culturally unsafe experiences causing harm. Given this, it is essential that leaders focus on cultural safety education to address both intercultural frictions within the Indigenous centres and systemic and structural racism widespread within the broader healthcare system. This article explores how one AHAC has undertaken to examine these complex challenges, while offering some direction on leadership within the sector.

Cultural Competency Matters: Calling for a Deeper Understanding of Healthcare Disparities Among Nurse Leaders.

Healthcare disparities for racial and ethnic minority patients are a serious issue in the United States. Although socioeconomic factors are a key contributor to these disparities, there are many other influences, related to the patient, system, and provider. A key strategy to address provider-related factors is to assess the cultural competence of caregivers. Utilizing a survey and interviews of AONE members, this study explored the influences affecting the ability of nurse leaders to lead their teams in providing culturally competent care. The study found that nurse leaders need a deeper understanding of the presence of healthcare disparities for racial and ethnic minority patients, more formalized training, and increased opportunities to reflect on their own abilities and potential for bias. Cultural competence must be a strategic priority, providing resources for training, and by holding leaders accountable to improve the level of cultural competence of their teams.

Hospital cultural competency as a systematic organizational intervention: Key findings from the national center for healthcare leadership diversity demonstration project.

BACKGROUND: Cultural competency or the ongoing capacity of health care systems to provide for high-quality care to diverse patient populations (National Quality Forum, 2008) has been proposed as an organizational strategy to address disparities in quality of care, patient experience, and workforce representation. But far too many health care organizations still do not treat cultural competency as a business imperative and driver of strategy. PURPOSES: The aim of the study was to examine the impact of a systematic, multifaceted, and organizational level cultural competency initiative on hospital performance metrics at the organizational and individual levels. METHODOLOGY/APPROACH: This demonstration project employs a pre-post control group design. Two hospital systems participated in the study. Within each system, two hospitals were selected to serve as the intervention and control hospitals. Executive leadership (C-suite) and all staff at one general medical/surgical nursing unit at the intervention hospitals experienced a systematic, planned cultural competency intervention. Assessments and interventions focused on three organizational level competencies of cultural competency (diversity leadership, strategic human resource management, and patient cultural competency) and three individual level competencies (diversity attitudes, implicit bias, and racial/ethnic identity status). In addition, we evaluated the impact of the intervention on diversity climate and workforce diversity. FINDINGS: Overall performance improvement was greater in each of the two intervention hospitals than in the control hospital within the same health care system. Both intervention hospitals experienced improvements in the organizational level competencies of diversity leadership and strategic human resource management. Similarly, improvements were observed in the individual level competencies for diversity attitudes and implicit bias for Blacks among the intervention hospitals. Furthermore, intervention hospitals outperformed their respective control hospitals with respect to diversity climate. PRACTICE IMPLICATIONS: A focused and systematic approach to organizational change when coupled with interventions that encourage individual growth and development may be an effective approach to building culturally competent health care organizations.

Enhancing Cultural Sensitivity in a Community Health Care Setting for LGBTQ Patients.

Lesbian, gay, bisexual, transgender, or queer (LGBTQ)-identified individuals, particularly transgender individuals, experience significant health inequities such as increased risk for chronic health conditions and mental health concerns. Discrimination by health care professionals is a major deterrent for LGBTQ individuals to seek health care. The purpose of the article is to offer practice recommendations using targeted community actions to enhance LGBTQ cultural sensitivity in community health care settings. Strategic planning, assessment for readiness to change, environmental strengths, weaknesses, opportunities, and threats analysis, and use of community resources are recommended as part of a basic model for change in a community setting. Outcomes are measured using a cultural competency tool.

A modified Continuous Quality Improvement approach to improve culturally and socially inclusive care within rural health services.

BACKGROUND: The sickest Australians are often those belonging to non-privileged groups, including Indigenous Australians, gay, lesbian, bisexual, transsexual, intersex and queer people, people from culturally and linguistically diverse backgrounds, socioeconomically disadvantaged groups, and people with disabilities and low English literacy. These consumers are not always engaged by, or included within, mainstream health services, particularly in rural Australia where health services are limited in number and tend to be generalist in nature. OBJECTIVE: The aim of this study was to present a new approach for improving the sociocultural inclusivity of mainstream, generalist, rural, health care organisations. DESIGN: This approach combines a modified Continuous Quality Improvement framework with Participatory Action Research principles and Foucault's concepts of power, discourse and resistance to develop a change process that deconstructs the power relations that currently exclude marginalised rural health consumers from mainstream health services. It sets up processes for continuous learning and consumer responsiveness. RESULTS: The approach proposed could provide a Continuous Quality Improvement process for creating more inclusive mainstream health institutions and fostering better engagement with many marginalised groups in rural communities to improve their access to health care. CONCLUSION: The approach to improving cultural inclusion in mainstream rural health services presented in this article builds on existing initiatives. This approach focuses on engaging on-the-ground staff in the need for change and preparing the service for genuine community consultation and responsive change. It is currently being trialled and evaluated.

The Chemical Sciences and Equality, Diversity, and Inclusion.

There has been mounting concern over the absence of gender equality in the sciences in recent years. This has been accompanied by a broadening of the perspective, in order to address issues of equality, diversity and inclusion, relating to a wide range of circumstances in which individuals suffer discrimination. While some progress has been made in some countries, nationally or at the level of institutions, much more needs to be done. The chemical sciences can play a leading role in addressing biases, through 1) becoming a model of good systemic practice in policies, processes, and actions; 2) developing practical skills through training in cultural competence; and 3) promoting a stronger evidence base to uncover both the extent of problems and the degree to which approaches to improve equality, diversity, and inclusion are working.

Cultural safety and engagement: Keys to improving access to care.

The challenges of providing equitable and timely access to high-quality care are numerous, and the proposed solutions are well documented. However, frequently absent from discussions dealing with access to care is how access is being defined and by whom. This article demonstrates the importance of engaging individuals and communities when defining access and developing improvement strategies, and the experience of an Indigenous regional health and social services authority.