Diversity and Disparities - IFDHE · Fenwick, AHA senior executive director of personal membership groups, at [email protected] or (312) 422-2820. Additional information on the survey

Diversity and

DisparitiesA Benchmark Study of U.S. Hospitals in 2013

Diversity and Disparities

Contents

■ About the Survey ............................................................................................................1

■ Summary Findings ..........................................................................................................2

■ Collection and Use of Data .............................................................................................6

■ Cultural Competency Training ......................................................................................11

■ Leadership and Governance ........................................................................................13

■ Appendix .......................................................................................................................27

■ National Call to Action ..................................................................................................41

1 Diversity and Disparities

About the Survey

■ In 2013, the Institute for Diversity in Health Management, an affiliate of the American Hospital Association (AHA), commissioned the Health Research & Educational Trust (HRET) of the AHA to conduct a national survey of hospitals to determine the actions that hospitals are taking to reduce health care disparities and promote diversity in leadership and governance.

■ Data for this project were collected through a national survey of hospitals mailed to the CEOs of all 5,922 U.S. registered hospitals at the time of the survey.

■ The response rate was 19% (1,109 hospitals), with the sample generally representative of all hospitals.

■ All data are self-reported.

© 2014 Health Research & Educational Trust. All rights reserved.

For more information on the survey, contact Matt Fenwick, AHA senior executive director of personal membership groups, at [email protected] or (312) 422-2820. Additional information on the survey and resources on this issue can be found at:www.hret.orgwww.diversityconnection.orgwww.equityofcare.org


Summary Findings

■ Hospitals and health systems possess a great opportunity to affect health care disparities using three core areas:

• Increasing the collection and use of race, ethnicity and language preference (REAL) data

• Increasing cultural competency training

• Increasing diversity in leadership and governance

■ The survey results highlight that, while more work needs to be done, some progress is being made in key areas that can promote equitable care, such as collecting demographic data, providing cultural competency training, and increasing diversity in leadership and governance.

■ The survey results offer a snapshot of some common strategies used to improve the quality of care that hospitals provide to all patients, regardless of race or ethnicity.

■ This overview provides data to help the health care field focus attention on areas that will have the most impact and establish a benchmark to gauge hospitals’ progress in the coming years.


Summary Findings on Collection and Use of Data

The collection and use of patient demographic data is an important building block to identify areas of strength and opportunities for improvement in providing the highest quality of care for all patients.

■ Overall, hospitals are actively collecting patient demographic data, including race (97%); ethnicity (94%); and primary language (95%).

■ 22% of hospitals have utilized data to identify disparities in treatment and/or outcomes between racial or ethnic groups to analyze (one or more of the following): clinical quality indicators, readmissions or CMS core measures. This is an increase from 20% in 2011.


Summary Findings on Cultural Competency Training

Cultural competency training ensures that caregivers have a deeper understanding of patients they care for, ensuring individualized care based upon their needs.

■ 86% of hospitals educate all clinical staff during orientation about how to address the unique cultural and linguistic factors affecting the care of diverse patients and communities. This is an increase from 81% in 2011.

■ 64.5% of hospitals require all employees to attend diversity training. This is an increase from 60.5% in 2011.


Summary Findings on Leadership

A leadership and governance team that reflects the community served encourages decision making that is conducive to best care practices.

■ The survey found that minorities represent 31% of patients nationally, up from 29% in 2011.

■ Minorities comprise:

• 14% of hospital board members, unchanged from 2011; • 12% of executive leadership positions, unchanged from 12% in 2011; • 17% of first- and mid-level management positions, up from 15% in 2011.


Collection and Use of Data

■ Overall, hospitals appear to be actively collecting patient demographic data, including:

• Race (97%)• Ethnicity (94%)• Gender (99%)• Primary language (95%)• Religion (88%)• Disability status (71%)• Sexual orientation (19.5%)• Veteran status (51%)

■ Data used to benchmark gaps in care for:• Race (29.5%)• Ethnicity (29%)• Gender (32%)• Primary language (28%)• Religion (15%)• Disability status (19%)• Sexual orientation (7%)• Veteran status (13%)



Patient Data Collected at First Encounter

Collection and Use of REAL Data

8

Patient Data Collected at First Encounter

94%

87% 90% 88%

70%

19%

51%

97% 94% 95%

99%

88%

71%

19%

51%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Race Ethnicity Primary language

Gender Religion Disability status

Sexual orientation

Veteran status

2011

2013


Collection and Use of DataData Used to Benchmark Gaps in Care

10

26% 25%

28%

15%

17%

6%

10%

30% 29% 28%

32%

15%

19%

7%

13%

0%

5%

10%

15%

20%

25%

30%

35%


Gender Religion Disability status

Sexual orientation

Veteran status

2011

2013

More hospitals are using patient demographic data to benchmark gaps in care in 2013 than in 2011, but more work needs to be done.



Collection and Use of Patient Demographic Data – 2013

Collection and Use of REAL Data (cont. 1)

11

Collection and Use of Patient Demographic Data -- 2013 97%

94% 99%

95% 88%

71%

19%

51%

30% 29% 28% 32%

15% 19%

7% 13%

37% 33%

40% 33%

17% 15%

7% 12%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Gender Religion Disability status Sexual orientation

Veteran status

Data collected at first patient encounter

Data used to benchmark gaps in care

Data used to analyze demographics of patient satisfaction surveys



Utilizing data to identify disparities in treatment and/or outcomes between racial or ethnic groups

Collection and Use of REAL Data (cont. 2)

13

Utilizing data to identify disparities in treatment and/or outcomes between racial or ethnic groups

20%

8%

14% 15%

21%

8%

14% 13%

0%

5%

10%

15%

20%

25%

Clinical Quality Indicators Medical Errors Hospital Readmissions CMS Core Measures

2011

2013


Cultural Content Areas Included in Hospital Orientation – 2013

Cultural Competency Training (cont. 1)

16

Cultural Content Areas Included in Hospital Orientation -- 2013

86%

70% 67% 67%

65%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Available Language Services

Family/Community Interactions

Religious Beliefs Affecting Health Care

Languages Spoken by Patients

Diverse Health Beliefs Held by Patient

Population

Cultural Competency Training


Cultural Competency Training

Cultural Content Areas Included in Hospital Orientation

Cultural Competency Training (cont. 1)

17

Cultural Content Areas Included in Hospital Orientation 89%

74%

67% 69%

63%

86%

70% 67% 67% 65%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Available Language Services

Family/Community Interactions

Religious Beliefs Affecting Health Care

Languages Spoken by Patients

Diverse Health Beliefs Held by Patient

Population

2011

2013


Minority Representation – 2013

Leadership and Governance

19

Minority Representation

29%

14%

12%

15%

31%

14%

12%

17%

0%

5%

10%

15%

20%

25%

30%

35%

Patients Board Members Executive Leadership First/Mid-Level Officials and Managers

2011

2013



Minority Representation in Hospital Leadership and Governance


20

Leadership and Governance (cont. 1)

69%

13% 10%

2% 2% 2% 1%

86%

6% 3% 3% 2% 1% 0%

86%

6% 3% 2% 2% 1% 0% 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

White Black/African American

Hispanic or Latino

Two or more races

Asian American Indian/Alaska Native

Native Hawaiian/Other Pacific

Islander

Minority Representation in Hospital Leadership and Governance

Patients

Board

C-Suite


Minority Representation in Executive Leadership Positions – 2013

Leadership and GovernanceLeadership and Governance (cont. 3)

23

Minority Representation in Executive Leadership Positions -- 2013

9%

13%

6%

17%

11%

58%

16%

0%

10%

20%

30%

40%

50%

60%

70%

Chief Executive Officer (n=987)

Chief Operating Officer (n=649)

Chief Financial Officer (n=947)

Chief Medical Officer (n=693)

Chief Nursing Officer (n=851)

Chief Diversity Officer (n=296)

Chief HR Officer (n=904)


Minority Representation in Executive Leadership Positions

Leadership and GovernanceLeadership and Governance (cont. 3)

24

Minority Representation in Executive Leadership Positions

9%

14%

7%

16%

10%

60%

14%

9%

13%

6%

17%

11%

58%

16%

0%

10%

20%

30%

40%

50%

60%

70%

Chief Executive Officer

Chief Operating Officer

Chief Financial Officer

Chief Medical Officer

Chief Nursing Officer

Chief Diversity Officer

Chief HR Officer

2011

2013


Appendix A: Data Utilization

Hospitals’ Utilization of Data to Address Health Care Disparities – 2013


25

59%

36%

30%

27%

0% 10% 20% 30% 40% 50% 60% 70%

Hospital has analyzed the supply and demand for language services (n=1035)

Hospital has a mechanism for measuring the quality of cultural and linguistic services (n=1029)

Hospital has analyzed the percentage of clinical staff trained in culturally and linguistically appropriate care (n=1034)

Hospital has analyzed variations in clinical management of preventable and chronic diseases (n=1033)

Hospitals’ Utilization of Data to Address Health Care Disparities --2013



Hospitals’ Utilization of Data to Address Health Care Disparities


26

60%

32%

30%

26%

59%

36%

30%

27%

0% 10% 20% 30% 40% 50% 60% 70%

Hospital has analyzed the supply and demand for language services

Hospital has a mechanism for measuring the quality of cultural and linguistic services

Hospital has analyzed the percentage of clinical staff trained in culturally and linguistically appropriate care

Hospital has analyzed variations in clinical management of preventable and chronic diseases

2013

2011

Hospitals’ Utilization of Data to Address Health Care Disparities


Inclusion of Goals within Hospitals’ Strategic Plans

Appendix B: Strategic GoalsAppendix B: Strategic Goals

28

Inclusion of Goals within Hospitals' Strategic Plans -- 2013

52%

50%

44%

39%

32%

32%

22%

19%

0% 10% 20% 30% 40% 50% 60%

Collection of race, ethnicity, and language preference data for community/patient population assessments

Improving quality of care for culturally and linguistically diverse patient population

Collection of race, ethnicity, and language preference data for the hospital’s workforce assessments

Hospital recruitment and retention of minority and underrepresented groups in the workforce

Guidelines for incorporating cultural and linguistic competence into operations

The use of reports for measuring progress on diversity-related goals

The use of reports for measuring progress on diversity management

The use of reports for measuring progress toward addressing disparities

Inclusion of Goals within Hospitals' Strategic Plans


Inclusion of Goals within Hospitals’ Strategic Plans

Appendix B: Strategic GoalsAppendix B: Strategic Goals

29

Inclusion of Goals within Hospitals' Strategic Plans

51%

57%

44%

38%

32%

30%

25%

22%

52%

50%

44%

39%

32%

32%

22%

19%

0% 10% 20% 30% 40% 50% 60% 70%

Collection of race, ethnicity, and language preference data for community/patient population assessments

Improving quality of care for culturally and linguistically diverse patient population

Collection of race, ethnicity, and language preference data for the hospital’s workforce assessments

Hospital recruitment and retention of minority and underrepresented groups in the workforce

Guidelines for incorporating cultural and linguistic competence into operations

The use of reports for measuring progress on diversity-related goals

The use of reports for measuring progress on diversity management

The use of reports for measuring progress toward addressing disparities

2013

2011


Percent of Hospitals Having Established a Goal to Reduce Disparities According to Patient Characteristics – 2013

Appendix C: Strategic Goals

29

35% 35%

31%

35%

26%

30%

25% 23%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Race (n=1022) Ethnicity (n=1022)

Gender (n=997) Disability status (n=1018)

Veteran status (n=1023)

Primary language (n=1023)

Religion (n=n=1024)

Sexual Orientation

(n=999)

Percent of Hospitals Having Established a Goal to Reduce Disparities According to Patient Characteristics -- 2013

Appendix C: Strategic Goals


Percent of Hospitals Having Established a Goal to Reduce Disparities According to Patient Characteristics

Appendix C: Strategic GoalsAppendix C: Strategic Goals

30

Percent of Hospitals Having Established a Goal to Reduce Disparities According to Patient Characteristics

33% 33%

28%

23%

32%

26% 24% 24%

35% 35%

31%

35%

26%

30%

25%

23%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Race Ethnicity Gender Disability status

Veteran status Primary language

Religion Sexual Orientation

2011

2013


Hospitals’ Efforts to Reduce Racial/Ethnic Health Care Disparities – 2013

Appendix D: Reducing DisparitiesAppendix D: Reducing Disparities

31

50%

50%

62%

64%

66%

87%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Hospital has a standardized system to collect feedback from staff for improving services for diverse patient

populations (n=965)

Hospital has performance improvement projects aimed at improving the quality of care provided to diverse patient

populations (n=1109)

Hospital conducts patient interviews or surveys to obtain patient satisfaction data for improving services for diverse

populations ((n=1109)

Hospital has a standardized system to collect feedback from patients for improving services for diverse patient

populations (n=968)

Hospital has a standardized system to collect feedback from patients with language needs (n=940)

Hospital has a standardized mechanism to translate hospital related documents into languages that are most

prevalent among visitors and patients (n=998)

Hospitals' Efforts to Reduce Racial/Ethnic Health Care Disparities -- 2013


Appendix D: Reducing Disparities

Hospitals’ Efforts to Reduce Racial/Ethnic Health Care Disparities

Appendix D: Reducing Disparities

32

Hospitals' Efforts to Reduce Racial/Ethnic Health Care Disparities

59%

47%

61%

80%

62%

54%

64%

50%

66%

87%

62%

50%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Hospital has a standardized system to collect feedback from patients for improving services for diverse patient populations

Hospital has a standardized system to collect feedback from

staff for improving services for diverse patient populations

Hospital has a standardized system to collect feedback from patients with language

needs

Hospital has a standardized

mechanism to translate hospital related documents into

languages that are most prevalent among visitors

and patients

Hospital conducts patient interviews or

surveys to obtain patient satisfaction data for

improving services for diverse populations

Hospital has performance

improvement projects aimed at improving the quality of care provided

to diverse patient populations

2011

2013


Appendix E: Reducing Disparities

Disease-Specific Interventions Planned or Implemented by Hospitals to Reduce Racial/Ethnic Disparities – 2013


33

24%

20% 18% 18% 18% 18%

16% 14% 14%

0%

5%

10%

15%

20%

25%

30%

Hypertension (n=1053)

Chronic obstructive pulmonary

disease (n=1071)

Stroke (n=1062)

Other (n=1099)

Cancer (n=1076)

Congestive heart failure

(n=992)

Acute myocardial infarction (n=988)

Pneumonia (n=1074)

Diabetes (n=983)

Disease-Specific Interventions Planned or Implemented by Hospitals to Reduce Racial/Ethnic Disparities -- 2013



Disease-Specific Interventions Planned or Implemented by Hospitals to Reduce Racial/Ethnic Disparities


34

Disease-Specific Interventions Planned or Implemented by Hospitals to Reduce Racial/Ethnic Disparities

27%

21% 21%

29%

22% 22% 20% 19%

18%

24%

20% 18% 18% 18% 18%

16% 14% 14%

0%

5%

10%

15%

20%

25%

30%

35%

Diabetes Hypertension Stroke Other Cancer Congestive heart failure

Acute myocardial infarction

Pneumonia Chronic obstructive pulmonary

disease

2011

2013


Appendix F: Reducing Disparities

Hospitals’ Collaboration with External Organizations to Reduce Disparities – 2013


35

13.4%

22.7%

25.7%

28.9%

30.7%

33.6%

37.1%

39.4%

41.5%

47.7%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

Regional hospital/health care associations (n=1048)

Corporate partners/collaborators (n=1035)

Faith-based organizations (n=1045)

National hospital/health care associations (n=1045)

Schools/universities (n=1049)

Homeless shelters (n=1038)

Relevant government agencies and organizations (n=1048)

Other community organizations (n=732)

State hospital/health care associations (n=1049)

Community agencies/advocacy organizations (n=1050)

Hospitals' Collaboration with External Organizations to Reduce Disparities -- 2013



Organizations with which hospitals have collaborated with to reduce disparities over the last 3 years?


36

55%

36%

47%

39%

25%

47%

25%

40%

31%

29%

48%

37%

13%

42%

23%

39%

26%

34%

29%

31%

0% 10% 20% 30% 40% 50% 60%

Community agencies/advocacy organizations

State hospital/health care associations

Other community organizations

Relevant government agencies and organizations

Homeless shelters

Schools/ universities

National hospital/health care associations

Faith-based organizations

Corporate partners/collaborators

Regional hospital/health care associations

2013

2011

Organizations with which hospitals have collaborated with to reduce disparities over the last 3 years?


Appendix G: Reducing Disparities

Does Your Organization Have a Community-based Diversity Advisory Council or Committee? – 2013


37

19%

71%

10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Yes (n=187) No (n=682) Not Sure (n=92)

Does Your Organization Have a Community-based Diversity Advisory Council or Committee? -- 2013



Does Your Organization Have a Community-based Diversity Advisory Council or Committee?


38

20%

72%

8%

19%

71%

10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Yes No Not Sure

2011

2013


Appendix H: Cultural Competency

Has Your Hospital Conducted an Assessment of the Racial and Ethnic Demographics of Your Community in the Past Three Years – 2013


39

63%

21%

15%

0%

10%

20%

30%

40%

50%

60%

70%

Yes (n=567) No (n=192) Not Sure (n=137)

Has Your Hospital Conducted an Assessment of the Racial and Ethnic Demographics of Your Community in the Past Three Years -- 2013



Has Your Hospital Conducted an Assessment of the Racial and Ethnic Demographics of Your Community in the Past Three Years


40

61%

30%

9%

63%

21%

15%

0%

10%

20%

30%

40%

50%

60%

70%

Yes No Not Sure

2011

2013.0


Appendix I: Cultural Competency

Types of Interpreters Used by Hospitals – 2013


41

86%

38%

65%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Agency or third-party interpreters (n=957) Formal interpreters, such as individuals on staff for whom interpretation is a primary

job function (n=423)

Informal interpreters, such as multilingual staff, for whom interpretation is not a

primary job function (n=717)

Types of Interpreters Used by Hospitals -- 2013



Types of Interpreters Used by Hospitals


42

41%

93%

75%

38%

86%

65%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Formal interpreters, such as individuals on staff for whom interpretation is a

primary job function

Agency or third-party interpreters Informal interpreters, such as multilingual staff, for whom

interpretation is not a primary job function

2011

2013

Types of Interpreters Used by Hospitals


Appendix J: Cultural Competency

Hospitals’ Verification of Interpreter Quality – 2013


43

52%

50%

49%

50%

50%

51%

51%

52%

52%

53%

All interpreters are formally trained in clinical translation (n=571)

All interpreters are tested to ensure competency (n=551)

Hospitals’ Verification of Interpreter Quality -- 2013



Hospitals’ Verification of Interpreter Quality


44

Hospitals’ Verification of Interpreter Quality

41%

93%

38%

86%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All interpreters are formally trained in clinical translation All interpreters are tested to ensure competency

2011

2013


Appendix K: Leadership

Hospitals’ Leadership Goals – 2013


46

Hospitals' Leadership Goals -- 2013

13%

18%

27%

37%

37%

50%

0% 10% 20% 30% 40% 50% 60%

Hospital ties a portion of executive compensation to diversity goals (n=959)

Hospital governing board members are required to demonstrate that they have completed diversity training (n=1109)

Hospital has a plan to specifically increase the number of ethnically, culturally, and racially diverse executives serving on

the senior leadership team (n=904)

Hospital incorporates diversity management into the organization’s budgetary planning and implementation process

(n=987)

Hospital governing board has set goals for creating diversity within its membership that reflects the diversity of the hospital’s

patient population (n=896)

Funding resources allocated for hospital cultural diversity/competency initiatives are sustainable (n=880)



Hospitals’ Leadership Goals


47

10%

15%

23%

30%

33%

45%

13%

18%

27%

37%

37%

50%

0% 10% 20% 30% 40% 50% 60%

Hospital ties a portion of executive compensation to diversity goals

Hospital governing board members are required to demonstrate that they have completed diversity training

Hospital has a plan to specifically increase the number of ethnically, culturally, and racially diverse executives serving

on the senior leadership team

Hospital incorporates diversity management into the organization’s budgetary planning and implementation

process

Hospital governing board has set goals for creating diversity within its membership that reflects the diversity of the

hospital’s patient population

Funding resources allocated for hospital cultural diversity/competency initiatives are sustainable

2013

2011

Hospitals' Leadership Goals


Appendix L: Diversity Management

Percentage of Hospitals Participating in Diversity Improvement Plans – 2013


47

Hospitals' Leadership Goals -- 2013

22%

48%

58%

65%

78%

86%

93%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Hospital hiring managers have a diversity goal in their performance expectations (n=975)

Hospital has a documented plan to recruit and retain a diverse workforce that reflects the organization’s patient population

(n=889)

Hospital has implemented a program that identifies diverse, talented employees within the organization for promotion (n=789)

Hospital requires all employees to attend diversity training (n=215)

Hospital collaborates with other health care organizations on improving professional and allied health care workforce training and educational (n=665)programs in the communities served.

Hospital educates all clinical staff during orientation about how to address the unique cultural and linguistic factors affecting the

care of diverse (n=516)patients and communities.

Hospital has a nondiscrimination policy that includes the ethnic, racial, lesbian, gay, bisexual, transgender, and transsexual

communities (n=413)



Percentage of Hospitals Participating in Diversity Improvement Plans


48

16%

48%

42%

61%

75%

81%

89%

22%

48%

58%

65%

78%

86%

93%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Hospital hiring managers have a diversity goal in their performance expectations.

Hospital has a documented plan to recruit and retain a diverse workforce that reflects the organization’s patient

population.

Hospital has implemented a program that identifies diverse, talented employees within the organization for

promotion.

Hospital requires all employees to attend diversity training.

Hospital collaborates with other health care organizations on improving professional and allied

health care workforce training and educational programs in the communities served.

Hospital educates all clinical staff during orientation about how to address the unique cultural and linguistic

factors affecting the care of diverse patients and communities.

Hospital has a nondiscrimination policy that includes the ethnic, racial, lesbian, gay, bisexual, transgender, and

transsexual communities.

2013

2011

Hospitals' Leadership Goals


National Call to Action to Eliminate Health Care Disparities

Launched in 2011, the National Call to Action is a national initiative to end health care disparities and promote diversity. The group is committed to three core areas that have the potential to most effectively impact the field.

■ Increase collection and use of race, ethnicity and language preference data

■ Increase cultural competency training

■ Increase diversity in leadership and governance


Call to Action Partners

www.equityofcare.org


Equity of Care Platform

Offers free resources for the health care field:

■ Best practices

■ Monthly newsletter

■ Case studies

■ Guides

■ Webinars and educational opportunities

■ Current research

www.equityofcare.org

Documents

Diversity and Disparities - IFDHE · Fenwick, AHA senior executive director of personal membership groups, at [email protected] or (312) 422-2820. Additional information on the survey