Representation matters: The vital role of DEI in healthcare

Within the United States reside diverse and culturally rich communities, each containing a unique makeup of values, beliefs, and traditions. As a registered nurse, I took a pledge to honor the autonomy and personal values of the patients I am entrusted with caring for. I do possess the self-awareness, however, to understand that I am not privy to every unique characteristic of each culture that I encounter in the exam room. Each patient brings with them their own background and story, which shape their view of the world—and, therefore, their healthcare goals and needs. Being cognizant of this, I understand the need for the presence of those who possess a diverse array of insights and cultures within a healthcare unit.

Why representation matters in healthcare teams

Imagine traveling to another country and becoming ill. You go to the hospital, lie on the gurney, and in enters a team of individuals who do not speak your language well, nor are you fluent in theirs. That would add an intimidating and scary layer to an already stressful situation. How can you trust what they are telling you to do? What if you misunderstand them? What if they are not able to understand you?

This is how it can feel for patients who find themselves being cared for by a healthcare team that does not relate to them culturally. It creates an environment ripe for miscommunication and can significantly decrease the quality of care delivered. As nurses, a cornerstone of our practice is the implementation of holistic, whole-person care. This means that we understand the importance of considering the entirety of our patient’s identity as we’re caring for them.

The only way to truly ensure that patients are provided the opportunity to be cared for by a healthcare workforce that understands them and their needs is to cultivate a healthcare workforce that is as diverse as the patient population it serves. That is what diversity, equity, and inclusion (DEI) means. It is not hiring someone simply because they are a minority or because they speak Spanish to meet some quota for the sake of optics or public perception. It is the hiring and retention of qualified individuals who are best equipped to provide the unique care that diverse patient populations require. Unfortunately, the United States as a whole falls short in this area, and a recent analysis of North Carolina’s health workforce reflects this, as well.

Historical distrust and racial disparities in healthcare

Studies consistently demonstrate that patients are more likely to follow the instructions of their healthcare team if the team is culturally and ethnically similar to them. For the Black community, this can be largely attributed to wariness of the healthcare system due to years of racist tactics which have caused harm still rippling through our communities today, with one of the most famous examples of systemic racism being the Tuskegee Syphilis Study. Another reason people are more likely to follow their healthcare team’s direction resides in the simple fact that people feel more comfortable around those they can relate to.

The fact that glaring health disparities exist in certain racial groups is a testament to the fact that race matters in the healthcare world. Black women and their infants are approximately three times as likely to perish due to pregnancy-related complications, yet only a minuscule fraction of midwives are Black. More Black and Hispanic mothers report feeling mistreated and unheard during their pregnancy experiences than White mothers do, which can, in part, be attributed to bias. Both unconscious and conscious biases are not only harmful emotionally, but they can also be deadly. Bias exists within all of us, but one of the ways we can keep it in check and create safeguards for patients is by cultivating a diverse makeup of healthcare professionals who can better understand the perspectives of a particular patient group.

Policy challenges and the need for diversity in healthcare

Yes, there are online modules that healthcare staff are often required to complete that address cultural competence. These modules can help ensure that staff are exposed to the concept of cultural competence, but they do not make the staff member completing the module culturally competent. These helpful adjuncts cannot replace the inexorable fact that to achieve diversity, equity, and inclusion. We must continue intentional and effective efforts to diversify our healthcare workforce. One of the most critical measures to be taken is enacting policy change to improve diversity in the healthcare field. Such measures have been implemented for years and have succeeded in moving the needle on the issue. However, today, these initiatives are under fierce attack, and misinformation is rampant.

With the current presidential administration’s attack on diversity efforts, our healthcare system’s ability to make progress in promoting the importance of a diverse workforce is dramatically hindered. The gravity of this massive leap backward cannot be overstated. Those who have suffered the most from a lack of diversity and equity in our healthcare systems—minorities—will continue to receive healthcare that wasn’t designed with them in mind and will, therefore, suffer. Without diversity and equity, health disparity gaps will only widen as ill-equipped teams struggle to provide the care that unique patient populations require. A diverse healthcare workforce is stronger, better equipped to deliver competent care, and provides an essential element of a healing environment: safety. As a healthcare worker with a decade of service under my belt, I cannot stress enough that diversity, equity and inclusion are concepts integral to and inseparable from providing quality care.

Resources:

• Importance of Diversity in Health Care
• Estimation and Comparison of Current and Future Racial/Ethnic Representation in the US Health Care Workforce
• The Case for Diversity in the Health Professions Remains Powerful
• The Importance of Diversity and Inclusion in the Healthcare Workforce
• How does the racial and ethnic diversity of NC health professionals compare to the racial and ethnic diversity of the state population?
• About the USPHS Syphilis Study
• How Unconscious Bias in Health Care Puts Pregnant Black Women at Higher Risk