Diversity planning as a new strategy in the reformed health care environment – High Performance Health Care
Health Policy, Leadership

Diversity planning as a new strategy in the reformed health care environment

39170034In a recent paper, Charles Moseley and colleagues studied 478 hospitals in the United States to examine the prevalence of diversity planning in hospitals.  They defined diversity planning as having three elements:

  • Does the hospital or health system have a plan to develop, execute or evaluate a diversity strategy or plan?
  • Does the hospital collect data on race/ethnicity and primary language of its patients?
  • Does the hospital provide translation services?

They also examined a number of factors that they felt could predict the level of diversity planning, including:

  • Community demand (e.g. was the hospital located in a highly diverse community)
  • Financial resource availability
  • Managed care penetration
  • Ownership type
  • External orientation toward its physicians and the community

The investigators found that those factors which were the strongest predictors of diversity planning were financial resource availability, managed care penetration and external orientation.  Community demand was not a strong predictor. 

Although correlations are sometimes difficult to interpret, here is one explanation. Hospitals that are located in highly diverse communities may feel no need to be engaged in diversity planning as they “live it every day.”  Although this strategy may have been sufficient in the past, it is dangerous for the future.

In 1999, 28 percent of U.S. residents were members of racial or ethnic minority groups and the U.S. Census predicts this will rise to 40 percent by 2030.  In addition, by 2014, 96 percent of U.S. residents will have health insurance due to the Affordable Care Act (ACA).  Because these facts are well known, hospitals with a strong external orientation and money see diversity planning an important strategy to improve chances for success in the future.

The ACA also contains two sections that support diversity planning. Section 5307 provides increased funding for training health professionals in cultural competency, prevention, and public health.  Therefore, graduating providers will have improved cultural competency skills. 

Another unique feature of the ACA is the “primary care extension program” (Section 5405) which is modeled on the very successful agricultural extension programs of the USDA.  The agents in this program “will facilitate and provide assistance to primary care practices by implementing quality improvement or system redesign, incorporating the principles of the patient-centered medical home to provide high-quality, effective, efficient, and safe primary care and to provide guidance to patients in culturally and linguistically appropriate ways, and linking practices to diverse health system resources.”  This new resource will help existing primary care practices to improve their cultural competence.

Hospitals that are improving their diversity planning are clearly seeing an opportunity to both improve the health of their communities and increase market share.  The ACA will provide even more support to integrate diversity planning into the mainstream of hospital and health system strategy.

The University of St. Thomas’ Multicultural Forum is dedicated to exploring issues such as these.  This year it has a special focus on methods to integrate diversity and inclusion (D&I) into every level of an organization to underscore that all employees are responsible for an inclusive workplace.

The Multicultural Forum’s full program is here. Consider attending and building diversity planning into your long term strategy.



Moseley, C. B., J. J. Shen, and G. O. Ginn. 2011. “Characteristics of Acute Care Hospitals with Diversity Plans and Translation Services.” Journal of Healthcare Management 56(1): 45.

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