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.

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.

Development and validation of an organizational readiness to change instrument focused on cultural competency.

OBJECTIVE: To validate a brief survey developed to be used in hospitals nationwide to assess organizational readiness to change to increase cultural competency. DATA SOURCES/STUDY SETTING: Analysis of primary data collected as part of a 125-item Organizational Assessment Survey conducted in the ten US hospitals participating in the Robert Wood Johnson Foundation Expecting Success program in 2005-2006. STUDY DESIGN: The study utilized a cross-sectional survey. DATA COLLECTION: Surveys were distributed to participants in the ten hospitals based on job title and role within the organization (including clinicians, clinical administrators, other clinical professionals, and those in relevant nonclinical roles; respondents = 513; response rate = 31%). Missing data were deleted listwise. We computed internal consistency reliability via Cronbach's alpha and interrater agreement using the rwg(j) index, and conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to examine validity of the survey. We subsequently conducted ANOVAs to examine whether the instrument adequately distinguished between hospitals. PRINCIPAL FINDINGS: Across 408 complete responses, a scree plot generated by the EFA and a follow-up CFA indicated a 2-factor solution (RMSEA = 0.06; CFI = 0.96; GFI = 0.96; RMSR = 0.08). We identified these primary factors as two scales, a 12-item Readiness to Address Quality scale (α = 0.85; rwg(j)  = 0.93) and an 11-item Readiness to Address Disparities scale (α = 0.65; rwg(j)  = 0.89). ANOVAs suggested that these scales distinguished between hospitals (RTAQ: F[9, 428] = 3.70, P < .001; RTAD: F[9, 435] = 3.02, P = .002). CONCLUSIONS: This survey can help identify an organization's readiness to change to increase cultural competency.

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.

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.

What motivates medical students to learn about traditional medicine? A qualitative study of cultural safety in Colombia.

OBJECTIVES: This study explored motivation dynamics of medical students engaging with traditional medicine in Colombia. METHODS: We conducted a qualitative descriptive study as part of a larger participatory research effort to develop a medical education curriculum on cultural safety. Four final-year medical students participated in a five-month program to strengthen knowledge of traditional medicinal plants with schoolchildren in Cota, a municipality outside Bogota with a high proportion of traditional medicine users. Students and schoolteachers co-designed the program aimed to promote the involvement of school children with traditional medicine in their community. The medical students shared written narratives describing what facilitated their work and discussed experiences in a group session. Inductive thematic analysis of the narratives and discussion derived categories of motivation to learn about traditional medicine. RESULTS: Five key learning dynamics emerged from the analysis: (1) learning from/with communities as opposed to training them; (2) ownership of medical education as a result of co-designing the exercise; (3) rigorous academic contents of the program; (4) lack of cultural safety training in university; and (5) previous contacts with traditional knowledge. CONCLUSIONS: We identified potential principles for engaged cultural safety training for medical students. We will use these in our larger training program. Our results may be relevant to other researchers and medical educators wanting to improve the interaction of medical health professionals in multicultural settings with people and communities who use traditional medicine. We expect these professionals will be better prepared to recognize and address intercultural challenges in their clinical practice.

Clinical Relevance and Psychometric Properties of the Swedish Version of the Cultural Competence Assessment Instrument.

Based on the increasing diversity of Swedish society, health professionals, like occupational therapists, find it challenging to provide culturally competent services to international clients. Consequently, cultural competence among professionals needs to be measured and improved using psychometrically tested instruments. This study examines the clinical relevance, construct validity, and reliability of the Swedish version of the Cultural Competence Assessment Instrument among Swedish occupational therapists. Material and Methods. A randomised sample of 312 Swedish occupational therapists answered a survey based on the Swedish version of the Cultural Competence Assessment Instrument with supplementary questions on the clinical relevance of the instrument. Descriptive statistics were used to examine the clinical relevance of the Swedish version of the Cultural Competence Assessment Instrument. Factor analyses, both exploratory and confirmatory, were run to examine the factor structure. Cronbach's alpha was performed to assess the internal consistency of the instrument. Results. The participants reported that the 24 items had high clinical relevance. The validation yielded a three-factor model: openness and awareness, workplace support, and interaction skills. All three of these factors showed high loadings. Conclusions. The study results indicated positive clinical relevance and psychometric properties for the Swedish version of the Cultural Competence Assessment Instrument and strong support to be utilised in Sweden. The implications of this study are important given the rapid growth in migration over the last few decades. A self-rating instrument measuring cultural competence could support occupational therapists' professional knowledge and development when they interact with international clients. As the tool was originally developed in English in the United States, the feedback from the Swedish version could potentially be useful for the instrument in modified form and for use by occupational therapists in English-speaking countries.

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.

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.

Moving From Knowledge to Action: Improving Safety and Quality of Care for Patients With Limited English Proficiency.

Objective. This study assessed safety culture and staff communication with patients with limited English proficiency (LEP) to identify system-level approaches to increasing interpreter use and reducing health care disparities. Methods. An electronic survey and 7 focus groups were conducted with health care professionals in pediatrics and obstetrics/gynecology. Survey data were examined with univariate descriptive analysis. Focus group transcripts were coded through an iterative consensus process. Results. Survey participants (n = 68) reported less confidence in their ability to communicate effectively (74%) and form therapeutic relationships (56%) with LEP patients versus English-proficient patients. Focus groups identified knowledge as a facilitator of interpreter use. Workflow constraints, supply-demand mismatch, variable interpretation quality, and gaps in communication with interpretation services management were barriers. Conclusion. Knowledge gaps may not be a primary cause of interpreter underuse. Strategies to address workflow barriers and engage with interpretation services are critical to move from knowledge to action to improve LEP patient care.

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.

[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.

Metodología de diálogos interculturales / Methodology of intercultural dialogues

Contiene un marco legal sobre la salud de los pueblos indígenas. El objetivo del documento es el de "Propiciar un espacio de encuentro y consenso entre las percepciones y expectativas de terapeutas tradicionales y prestadores de salud institucional, basado en la generación de la auto-identidad y el respeto a las diferencias." Señala además que, "La atención primaria en salud requiere de establecimientos adecuados y personal sensibilizado para prestar sus servicios con pertinencia cultural, la cual, es un enfoque de intervención que busca que la atención sanitaria sea conceptualizada, organizada e implementada tomando como referentes los valores de la cosmovisión de los pueblos indígenas." Enfatizando ser una estrategia institucional, agrega que: "El Departamento de Promoción y Educación en Salud de la DGSIAS propone esta metodología para la realización de diálogos interculturales que tiene como objetivo principal generar un proceso estratégico para la adecuación de los servicios de salud y la sensibilización del personal hacia una atención con pertinencia cultural." Hace referencia al documento: "Normas con pertinencia cultural: hacia la interculturalidad", que también puede encontrarse en eBlueInfo En el marco conceptual, aborda términos relacionados, y específicamente enumera los nombres (en lengua) y sus "especialidades" en la medicina tradicional. "Esta metodología fue construida con acompañamiento de la Unidad de Atención en Salud para Pueblos Indígenas e Interculturalidad (UASPIIG) y validada en campo entre los años 2014 y 2015 como ejercicio de diálogos entre comadronas y proveedores de servicios de salud del MSPAS, en la plataforma de intervención del Proyecto Mesoamérica 2015." Incluye además, talleres de concientización intercultural, tanto para "terapeutas tradicionales", como para el personal médico.

Improving Behavioral Health Equity through Cultural Competence Training of Health Care Providers.

Racial/ethnic disparities have long persisted in the United States despite concerted health system efforts to improve access and quality of care among African Americans and Latinos. Cultural competence in the health care setting has been recognized as an important feature of high-quality health care delivery for decades and will continue to be paramount as the society in which we live becomes increasingly culturally diverse. Unfortunately, there is limited empirical evidence of patient health benefits of a culturally competent health care workforce in integrated care, its feasibility of implementation, and sustainability strategies. This article reviews the status of cultural competence education in health care, the merits of continued commitment to training health care providers in integrated care settings, and policy and practice strategies to ensure emerging health care professionals and those already in the field are prepared to meet the health care needs of racially and ethnically diverse populations.

Mental health services in the Northwest Territories: a scoping review.

The impacts of colonization have had significant impacts on the mental health and community wellness Indigenous peoples in the Northwest Territories (NWT). It is important that all communities in the NWT have access to key services in a culturally relevant way in achieving mental and community wellness. A scoping review was conducted to identify mental health services available in the NWT. To guide the understanding of the landscape of mental health services in the NWT, the information on health services gathered was organized using the First Nations Mental Wellness Continuum (FNMWC) Model's Continuum of Essential Services. Documents accessed included grey literature, consisting of government documents, practice guidelines, education materials, community wellness reports, internet searches and expert consult interviews to collect data on mental health and wellness services in the NWT. 68 mental health services were included in this review, from 23 different sources. Results were summarized and described the Continuum of Essential Services from the FNMWC Model. This guided approach was found to be useful for mapping mental health services for communities in the NWT. The findings highlight and catagorize existing mental health services and gaps in relation to a First Nation's perspective using the FNMWC Model. Specific areas examined included the Continuum of Essential Services, Key Partners, Culture as a Foundation, and Indigenous Social Determinants of Health. Findings can guide communities and health authorities in planning, implementing and coordinating a full range of optimized mental health services in the NWT.

Service gaps related to culturally appropriate mental health care for African immigrants.

The population of overseas-born Australians continues to grow including the recent increase of immigrants and refugees from African countries. Due to this increase, healthcare services need to assess if current available services are culturally appropriate for African immigrant inpatients. This qualitative study, with a quality improvement focus, examined current services to identify key service gaps and consider recommendation to improve care of African immigrant mental health inpatients in the hospital from the point of view of staff working within the organisation. What was revealed is that services currently offered to African mental health inpatients were culturally inappropriate. Emerging themes included inadequate interpreter services, lack of cultural awareness staff training, lack of organisation link with other services, unmet spiritual needs, use of staff/families as interpreters, culturally inappropriate information, and lack of or inadequate culturally appropriate policies and framework. Changes to current practices are recommended to provide culturally appropriate mental health care to African inpatients.

Exploring why and how encounters with the Norwegian health-care system can be considered culturally unsafe by North Sami-speaking patients and relatives: A qualitative study based on 11 interviews.

BACKGROUND: Citizens of Norway have free and equal access to healthcare. Nurses are expected to be culturally sensitive and have cultural knowledge in encounters with patients. Culturally safe care is considered both a process and an outcome, evaluated by whether the patients feel safe, empowered and cared for, or not. All patients request equal access to quality care in Norway, also Sami patients. OBJECTIVES: The aim of the study is to identify whether Sami patients and relatives feel culturally safe in encounters with healthcare, and if not, what are the main concerns. METHODS: This qualitative study used semi-structured interviews in the North Sami language, with 11 North Sami participants.The transcribed data were analysed through a lens of cultural safety by content analysis. FINDINGS: Data analysis explicated themes including: use of Sami language, Sami identity and cultural practices, connections to positive health outcomes to enhance cultural safe care and well-being for North-Sami people encountering the Norwegian health-care system. CONCLUSION: Culturally safe practices at the institutional, group and individual levels are essential to the well-being of Sami people. An engagement in culturally safe practices will facilitate (or) fulfil political and jurisdictional promises made to the Sami people, consequently improving positive impact of healthcare.