Diversity In Health Care
Posted by Mitch Mitchell on Sep 26, 2012
Years ago I did a presentation to a health care group on the subject of diversity. It went pretty well except for maybe a 3 minute period where there was a breakdown in belief that highlighted exactly what I was talking about. It wasn't pretty but it was able to be handled fairly quickly so I could move on, as it occurred 10 minutes into the presentation.
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What I'm showing below is a breakdown of the types of questions and issues faced by both the people who register patients when they come into the hospital and the people themselves. It's interesting because these issues aren't all due to the people themselves. These are things that have to be tracked, both for the hospital's benefit and the government's benefit as far as information gathering goes.
THE TYPES OF PEOPLE WHO COME THROUGH REGISTRATION
1. BREAKDOWNS BY RACE
Believe it or not, some hospitals tell their people not to ask this question but to try to guess what someone's race is. I find this shocking and yet I understand why some are afraid of the issue.
2. BREAKDOWNS BY FINANCIAL STATUS
This is a major issue because it sets up an initial perception of the type of patient that's in the facility, and the patient's perception of the type of facility they're in based on what the person registering them looks like and how they're dressed.
3. BREAKDOWNS BY INSURANCE
This makes hospitals run. Getting the insurance information correct up front makes the billing process go smoother, but knowing the insurance type helps hospitals budget easier and negotiate contracts with those insurance companies they can negotiate with better. That and you figure you know how soon your money will be coming in, or not.
4. BREAKDOWNS BY LANGUAGE
This is a bigger deal than most would think. By law, a hospital has to have the ability to communicate with any patient that comes in, no matter what language they're speaking. That part is handled easily enough. Yet, there are many hospitals with high minority presence in the community where English isn't their first language that won't even think about recruiting someone in the community who speaks that language. I used to rail against this one all the time without success, but finally, after 4 years, the hospital did hire someone who spoke Spanish and someone who knew sign language.
5. BREAKDOWNS BY PHYSICAL STATUS
How bad does the patient look when presenting themselves to the hospital? Are they disabled? What about how the person taking information; what do they look like? Is that person disabled, or hairy, or smelly, or dirty, or attractive, or...
6. BREAKDOWNS BY AGE
Major issue, especially when it's a person on Medicare, which requires more forms to be signed and more questions to be asked, as well as a host of other issues.
7. BREAKDOWNS BY FAMILIARITY
If you're in a small community you know a lot of the people who come into the hospital. It's this very reason that many patients don't want to go to local hospitals, because they fear that too many other people will know their personal business, HIPAA or not. Also, knowing someone immediately alters your perception of them as a patient, whether favorable or not.
8. BREAKDOWNS BY RELIGION
I always hated this question and it turns out not to be mandatory. However, you ask it because you never know if someone will turn for the worse and request a religious leader to visit them. And, as we all know, some people are against certain religions and thus might not treat some patients with the same professionalism as everyone else.
9. BREAKDOWNS BY DEGREE OF ILLNESS/INJURY
I can't remember if I ever told the story of working in the emergency room and having two people present themselves as possibly having bugs crawling all over their bodies. That provoked strong negative feelings from all of us, even moreso than someone showing up with flu-like symptoms. The truth is that even medical professionals will show different attitudes towards patients depending on presenting symptoms, even though they shouldn't. Health care workers get trained in presenting a professional face, but it doesn't mean all their actions on the back end will mirror that.
10. BREAKDOWNS BY PERCEPTIONS OF ATTITUDE
Finally being addressed, the hidden and yet not so hidden problem. How does either party react when any of the first 9 points are reviewed internally? Do they matter in the long run or are any of them something that person can't push aside and continue doing their job professionally? And if they can't get it done, who does it hurt more, the patient or the hospital?
Some things to think about, especially for those hospitals who believe they have no diversity issues. Yeah, right.
Unfortunately you are right again, Mitch and I think this is global problem. Many people dying everyday worldwide. When my wife had to give a birth, the procedure was not possible until I pay in full. Few days before that, a tourist have diet in another hospital, just because it is foreigner and he didn’t carry credit card in his pocket. I don’t want to give more examples, because I am getting mad about the whole system.
Don’t get mad Carl; just stay aware and, when you have the opportunity, try to change things when engaged.
I guess most people have surrender to the system and this is the main problem, this way nothing major will change.
This is a societal problem, though in health care it can have fatal consequences. Several years ago, I was a carpenter and I had been looking for jobs as a crew lead. I received a call from a guy who owned property and was flipping houses. We talked for several minutes and all went well. He asked me to come in for an interview and I agreed, then he said something about how I seemed like the right guy for the job, that was clearly an articulate Anglo, who could lead a crew. I couldn’t believe it! This was in Santa Fe, New Mexico, where much of the population is Hispanic and the state constitution is officially bi-lingual. I still shake my head in disbelief when I think about that incident!
Mike, that’s both a funny story and a sad one. Many people have preconceived notions of the people they’re going to run into without having a true basis for that belief. However, we also all have to acknowledge those things that make discussions on diversity important to have. I just went the health care route because it was easiest for me, but it happens in all industries. At least you got that job; good for you.