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Diversity / CD&I

Article by Patricia A. Oceanic, MC, CDM

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

Our nation's landscape seems to be increasingly fraught with labored discussion around diversity, inclusion and the progress we have and have not made. Now, more than ever, the importance of understanding the concerns and issues connected to various communities who make up our society cannot be understated. Regardless of political position, it is exciting to know that we are faced with significant opportunities to discuss the spaces in which we are more or less inclusive in our practices.

The Affordable Care Act (ACA) has been upheld as constitutional by the Supreme Court. Explicit in the ACA is the language of providing equitable, quality healthcare for all communities defined in the "Triple Aim:"

  1. Improve the patient experience of care (both quality and satisfaction)
  2. Improve the health of populations
  3. Reduce the per capita cost of healthcare

How can healthcare accomplish the Triple Aim and reduce injustice as identified by Dr. King? Part of the answer lies in having a culturally competent and diverse workforce. Workforce diversity does not automatically translate to a culturally competent workforce.

What can an organization do?

Develop an organizational culture that is culturally competent. This goes well beyond understanding that an interpreter is needed if a patient/family speaks a language other than English. It also goes beyond learning as much as you can about health care preferences at the group level. Not every Jehovah’s Witness patient will refuse a blood transfusion and not every Muslim family will observe the Ramadan fast in the same way. Real cultural humility comes from the understanding that each patient and family is made up of multiple group identities, all of which come into play in health care interactions. Negotiation often is the first line of recourse when providers are busy. Here are some questions to ask before engaging in negotiation:

  1. What is your prior experience with the health care system? (Identify issues in the past at the group or individual level.)
  2. What is your preferred style of communication? How are health care decisions made in your family? Is there someone who needs to be here who is not present?
  3. Would you prefer to have our conversation in another language? How do you learn best? (Assess literacy and provide printed material that is written at no higher than the fifth grade level. Also remember that health care literacy is something that not all patients have, even if they are otherwise well educated.)
  4. How do you think you got this illness? Do you have concerns about any potential side effects of the prescribed medication/procedure?
  5. What is going on in your life beyond what brings you here today? (Probe regarding stressors – financial and otherwise – and /or supports.)

The "Teach Back" method is a highly effective way to make sure that what you have attempted to communicate has been received and processed accurately. Say, "We've covered a lot of information today. Can you tell me in your own words what you need to do once you’ve left here?" Before the person leaves, you know if your instructions were clear or if you need to explain again. Re-explain if necessary and repeat Teach Back.

Respect, curiosity and empathy create a trusting environment in any setting – health care or otherwise.

If the topics of Culture, Diversity & Inclusion interest you, please consider writing an article to be included in Network News, CD&I section. Contact Beth Allen at for more information.

Patricia A. Oceanic, MS, CDM


Pat serves as Director of Nemours/Alfred I. duPont Hospital for Children's Office of Health Equity and Inclusion. In her role, she has oversight for the Office's cultural competence training and workforce diversity and inclusion. She attended the Disparities Leadership Program at Massachusetts General Hospital/Harvard Medical School, where the Office received the award for Best Project of the Year. Other awards include the Delaware Healthy Mothers and Infants Consortium’s Health Equity Champion Award, leadership status in the Human Rights Campaign's Healthcare Equity Index, and the U.S. Health and Human Services’ Office of Minority Health's Mid-Atlantic Region's Health Equity Hero Award.

Among her credentials, Pat holds a Master of Science degree in organization development from American University in Washington, D.C., and a certificate in diversity management from the American Hospital Association and Georgetown University.

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