A physician who spent their formative years in another culture. A nurse originally from a rural, impoverished background. A payroll specialist with a disability not visible to the trained eye.
All of these people are valuable members of today’s healthcare workforce. Yet they might not be hired or treated equitably on the job.
With America’s increasingly diverse patient population, how can you ensure that your workplace promotes equity in hiring, retention, and other areas of your practice? These days, creating an equitable workplace is key to a successful practice—and to improving patient outcomes.
First, we have to define equity in the context of a healthcare workplace. It’s not defined simply, and it means more than fair treatment for members of protected classes. According to Jenae Ball, an employment-law attorney at Randall Danskin in Spokane, Washington, “When we’re looking at things through an equity lens, we may look at it through income, race, gender, national origin, or other areas. There are a whole host of things that may impede or help people in getting where they are in their life.”
Generally, the law tends to be behind the cultural and technological curve in matters of equity, so issues commonly discussed today impact the workplace even if they haven’t been legally adjudicated. For example, you might have a woman in your practice who’s a primary caregiver, and assume she wouldn’t want to travel because she has young children at home. As a result, she misses out on career-accelerating opportunities. According to Ball, “That’s an example of caregiver discrimination on the basis of gender.”
EQUITY ISSUES IN THE HIRING PROCESS
Of course, employers are looking for the best candidate to fill every job opening. But when looking at hiring through an equity lens, they may overlook life experiences. Perhaps you’re interviewing a candidate who didn’t attend a highstatus university—but it’s because they’re a first-generation immigrant who had to pay their own way through school. Is that an indication you wouldn’t be getting a top performer if you hired them? Of course not. But it might impact that person’s chances of getting the job.
“We can see that a person is Black or Latino. We can see that somebody is female,” Ball says. “But if you’re a primary caregiver, if you have dyslexia or a vision or hearing impairment that needs a reasonable accommodation—those can be harder for an employer to determine. It’s really hard during the interview process. Employers don’t want to know that information, because if they do find out, and they don’t end up hiring that person, the applicant may allege that they weren’t hired because of their membership in that protected class.”
She adds that certain mental disabilities can also be difficult to ascertain. “There’s a lot of fear and misunderstanding around people who suffer from mood disorders, bipolar, or other conditions. And therefore there’s a tendency for employers, once they learn this sort of information, to not want to have to deal with those employees, and to try and get rid of them. To do so, however, could invite a discrimination claim. Additionally, an employer may be required to accommodate an employee with a mental or emotional disability.
That employer must have notice, actual or constructive, that an employee has a disability for which they may need an accommodation. Unless the employer is on notice, the duty to accommodate that disability is not triggered.”
OVERCOMING CULTURAL DIFFERENCES IN THE WORKPLACE
Equity issues aren’t limited to support staff or lower-level employees. Increasingly, healthcare practices and hospitals are hiring physicians with H-1B visas, who often come from a different culture. This brings tremendous advantages for patient care, but also may present cultural conflicts that need to be addressed.
As an example, Ball points to HIPAA and patient privacy. “In some cultures, disclosing a mother’s terminal diagnosis only to her son, and not to the mother at all, is an appropriate course of action,” she says. “Doctors come here, and they've been operating within their cultural framework for decades. Then they're having to completely rethink how they engage their patient population, the notion of informed consent, and how everything is supposed to flow through their patient.”
Ball also notes the cultural differences that affect how staff members are treated. “When you have physicians coming from societies that are very maledominated, often they didn’t experience a lot of women in higher education or within the medical field,” she says.
“They’re not used to dealing with female physicians who are their equals, and they’re also used to really ruling the roost with mid-level employees and other support staff. So those physicians can get into trouble over that as well.”
EQUITY PROMOTES BETTER PATIENT OUTCOMES
Physician practices and healthcare systems should be working toward equity in their hiring, staffing, and management policies, and that takes time and effort on everyone’s part—but the benefits are significant. Think of the patient experience. A patient could wait months to see a physician. With so much riding on the time they have with that physician, a proper care plan is only part of the equation. Was the patient treated with dignity, kindness, respect, and warmth? Do they feel like the doctor really listened to them? Did the patient identify with the healthcare provider?
It’s also worth noting that many patients are comforted by interacting with healthcare professionals who have had similar life experiences to theirs—so the more different backgrounds represented on staff, the better.
Practices with equitable workforces can see better outcomes, along with a higher level of satisfaction when patients evaluate the practice. As Ball says, “It’s wonderful for a patient when they come in to see a physician, and they’re from the same culture. They can speak freely, and that doctor understands where they’re coming from. Imagine how comforting that is to that patient. There’s so much beauty in that. And I just think it’s really unfortunate that there isn't more focus on it.”
Building Equity and Protecting Against Liability
What steps can employers take to build an equitable practice and protect themselves against liability?
- Create an environment with “intercultural competence.”
This includes making your work environment attractive to people from diverse backgrounds, so everyone can think, act, and communicate appropriately. Depending on the size of your practice or hospital, this can be a challenge. But it’s always an advantage when your staff work alongside other members of their cultural community and don’t feel singled out.
In addition, intercultural competence is critical when dealing with patients. For example, consider a basic component of care: discharge instructions and documents. Having a staff that is diverse, has language skills, or is savvy about finding medical translation is important when you serve a multicultural population.
- For open positions, place job listings in a way that targets the cultures you want to reach. Are there geographic areas, websites, publications, or other media in which people of color or from other cultures are more likely to see your listing? If your job listings aren’t generating the desired response, it’s time to think differently and creatively about reaching prospective employees.
- Review your current policies and procedures. Ball suggests starting with unlawful discrimination, sexual harassment, and retaliation policies—all of which may manifest themselves in subtle ways, sometimes in combination. “It’s a multi-layered analysis that you need to go through,” says Ball. “I often see clients trip up in that, and that’s where they get sued sometimes.”
- Ensure that your policies and procedures are clearly communicated. This may include translating them into other languages for support staff whose primary language isn’t English.
- Document everything. “The lack of documentation is the kiss of death in a case,” Ball notes. “Juries and judges don’t care when you say, ‘Oh, we had this conversation, this is what I intended.’ Rightly or wrongly, the burden is on the employer, the practice, and the provider to have that information. And if you don’t, they almost invariably default to what the plaintiff says. So in the employment realm, when you’re having those disciplinary meetings or issues and an employee says, ‘I feel I’m being discriminated against,’ you have to be papering the hell out of that file. You just have to.”