The Future of Diversity on Healthcare in America

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Mark-Toatley2By Mark Toatley, CRA

August 2013—George Miller, a dynamic, interactive, and informative speaker,  opened this session at the Annual Meeting by putting on a baseball cap backwards and dark sunglasses to share with us an encounter he experienced during his first days in one of his CEO roles. To measure the culture at his new hospital, he applied for a job donning this baseball cap and sunglasses (note that a picture of him as the new CEO was already on the wall; this connection between applicant and new CEO went unnoticed by all employees associated with this process). He was hurried through the application process, questioned and admonished about being in the building, and he witnessed his completed application (that contained his background as a George Bush appointee, prior CEO experiences, and stellar references) being discarded. He conveyed to session attendees that his demeanor throughout this experience was not unruly or uncooperative, and that security ultimately ushered him out of the building and onto the sidewalk that day. Persons in the various departments in this facility, who were identified with the treatment he received, were addressed soon after; representative of some of the initial steps of the new CEO’s efforts to assess and enhance the culture at his new facility. Diversity lesson number one delivered in an illustrative fashion.

After that memorable introduction, George turned the focus to global diversity, introducing perspective data such as, how on our planet of 7 billion people, 9 million people die each day, so for those who woke up this morning, there is much to acknowledge and be thankful for. He went on to point out that for those who have spare change in a dish at home, they are in the top 8% of the world’s population regarding their level of financial status. Discussion then moved on to how 700 million people on earth are currently living with the fear of battle, and for those who aren’t, this provides perspective associated with fear and safety. Also, despite the pervasiveness of computers today, only 1% of the world’s population own computers. Given this brief overview of global perspective and diversity, session attendees were encouraged to smile 100% of the time and hold our heads high.

The speaker next discussed how diversity in America is changing with regard to religion, race, national origin, age, gender, education, educational status, and mobility, and talked about two key divisions of cultural diversity and their approaches to healthcare. In the Western culture, there is a focus (with regard to disease states) on gaining dominion over nature, on activism, timeliness, planning ahead, strong messaging, and treating all people the same. In other cultures, there is a focus (with regard to disease states) on the sick accepting medical challenges with grace, striking a balance with nature and disease states, adopting a wait and see approach, invoking cautious deliberation, taking life as it comes, and to individualize through recognizing differences. These key divisions present cultural challenges, and resolving them includes developing cultural competency, quality, and addressing staffing issues and challenges.

The aging Baby Boomer population and the shift from acute care to chronic care currently has 50% of hospital revenue coming from the aged 50 and older group. Currently, 85% of Fortune 500 companies’ CEOs and 87% of hospital CEOs are Boomers. Given these aging trends and forecast, success in diversity, given the array of challenges and differences throughout the diversity categories, can be garnered from one key group: our patients.

A LEARN model (Listen, Explain, Acknowledge, Recommend, and Negotiate) was presented as a tool to engage our patients and acquire cultural competence. It is from listening and having the capacity to learn from patients that we can discern ways to improve and enhance service lines, departments, and organizations. Many patients perceive physicians as not speaking to them very often, which is something the LEARN model can help with.

Before closing, the speaker provided a leadership reminder that “running a department or facility is not a democracy,” and that “leadership is what leadership does.” Addressing diversity involves a commitment from leadership at the C-suite level (this helps capture physician buy-in); involvement and engagement in diversity workshops and training by all levels of healthcare workers; and finally, engaging a diverse range of patients and asking what they want and do not want as it pertains to service excellence.

Success in healthcare in America is directly linked to understanding diversity. The future of diversity in healthcare in America appears to hinge upon the capacity to develop along these lines. Leaders with the willingness to move in this direction show their ability to listen and put their patients (and thus their department/organization) at the center. Imparting a commitment representative of the needs of the community is gained from partnering with the community served, and not solely dictating to it without its input, even from those who wear baseball caps backwards and dark sunglasses.

Mark Toatley, CRA is the director of radiology at Wesley Long Hospital in Greensboro, NC. He can be reached at,

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