Standard 2: Staff Diversity (guideline)

“Health care organizations should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.”

Value of diversity to organization mission and activities
A healthcare organization that
cultivates a bilingual, bicultural staff will be more sensitive to the diversity of cultural issues that may arise from the members of the community that it serves. Moreover, staff members who are proficient in the languages of that community can significantly reduce potential communications issues with patients. From an organizational perspective, having staff members from population groups similar to those being served makes for better understanding of the needs of those groups, as well as helps patients feel more comfortable and welcome in the facility.

Beyond the potential benefits of staff serving members of their own communities, staff diversity is key to developing and maintaining a culturally and linguistically competent organization—a significantly more challenging goal. This larger goal requires that an organization consistently strive for diversity at every staff level, with each individual accepting the attitude and practice of diversity. This acceptance should be incorporated from the ground up—in the organization’s mission statement and its strategic planning. A culturally diverse staff can make vital contributions to addressing community members’ needs in the organization’s services and outreach efforts.

Importance of Diversity Among All Staff
Although diversity among staff members who have direct patient contact—eg, clinical care, administration, outreach—is vital, it is not enough. Diversity must also be incorporated at the leadership level of senior managers, chief executives, and boards of directors. Diversity at the leadership levels can enhance strategic planning and policy and decision making so that they are inclusive of the cultural and linguistic needs of all of the organization’s patient populations. Diversity at all staff levels not only symbolizes an organization’s cultural and linguistic competence, but it also serves to motivate the organization to continuously provide the most relevant and effective services for its patients.

Besides cultivating diversity throughout an organization’s vertical structure, Standard 2 also requires horizontal application across its contractual and subcontractual relationships. This would include, for example, the affiliated providers of services such as mental healthcare or emergency services that many healthcare organizations employ.

Strategies to Build Staff Capacity
Cultural diversity among clinical staff represents a key challenge, with graduates of schools of medicine, public health, nursing, and other health professions continuing to be fewer than the needs of the communities of which they are members. Culturally and linguistically diverse health professionals holding degrees from institutions outside the United States may encounter difficulties in becoming licensed to practice in this country. Along with this, other industries are increasingly interested in hiring bilingual, bicultural persons, placing them in competition with healthcare organizations’ efforts to diversify their staffs.

To recruit culturally and linguistically diverse staffs, healthcare organizations must take a much broader approach than relying on advertisements on employment websites, search firms, and so forth. A number of underutilized approaches are available to enhance recruitment, including a range of collaborative efforts.

Growing the linkages between academic institutions and the healthcare industry can lay the groundwork for recruiting individuals who are already preparing for healthcare careers. Potential approaches may include:

  • Providing internships, residencies, rotations, or fellowships focusing on preparation for serving culturally diverse populations
  • Offering mentoring programs and summer jobs in culturally sensitive services for younger students
  • Partnering with community-based organizations that serve immigrant, migrant, and refugee populations
  • Establishing incentive programs, such as bonuses or salary differentials to bilingual staff members or those who attain certification in cultural competence or interpretation
  • Becoming involved with programs like the National Health Service Corps, which provides incentives to primary care physicians who practice in underserved communities

Internal Staff Development
Rather than merely expecting community members to contribute their cultural and linguistic expertise as volunteers, healthcare organizations can cultivate staff diversity by offering training programs as interpreters and cultural brokers. Such programs may serve as a bridge to more formal training for a healthcare profession or related career. Community health worker jobs can grow into mulitfunctional “community advisor” roles by becoming case managers, community health educators, and liaisons to staff about the issues in their communities. Offering bilingual and bicultural individuals training programs to interpret in clinic settings and act as community outreach workers can help community members with limited knowledge of health issues learn communication and leadership skills and build careers.

To minimize the turnover of staff with bilingual or bicultural skills, healthcare organizations should develop job responsibilities that do not lead to inappropriate or excessive demands, which can be major factors in job “burnout.” Examples may include:

  • Assigning employees with specific language skills only tasks that are clearly within their defined job responsibilities
  • Not asking nonclinical support staff to act as cultural brokers without providing sufficient training
  • Promoting diverse staff members into administrative or managerial positions that utilize their particular skill sets, thereby avoiding a “glass ceiling” effect
  • Avoiding penalizing staff members in academic settings whose cultural-competence responsibilities may reduce their availability for more traditional assignments like research





Howard University College of Medicine AIDS Education and Training Center - National Multicultural Center