Fostering Healthy Work Environments: Diversity and Health Equity Competencies for Managers

Friday, 25 July 2014: 11:05 AM

Rani Hajela Srivastava, RN, MScN, PhD
Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
Janet Mawhinney, MA
CAMH, Toronto,, ON, Canada
Kristin Cleverley, RN, MSc, PhD, CPMHN
Centre for Addiction and Mental Healtlh, Toronto, ON, Canada

Although it is well recognized that 21stcentury health system transformation requires a foundation of equity and cultural competence, this goal continues to be challenging and elusive.  Healthcare providers and organizations need to navigate complex, intersectional layers of diversity and social determinants in order to develop effective strategies to achieve equity and quality care for all. The purpose of this interactive presentation is to describe an innovative approach to equity education being used to guide the development of individual and organizational capacity for cultural competence and equity.  The initiative was undertaken as part of the Best Practice Spotlight Organization initiative to foster a healthy work environment.  The initiative consisted of a one day interactive workshop which was evaluated through a pre and post -test design. The pre/post survey is a self administered tool that focuses on application of awareness and knowledge on diversity and equity issues. The tool is based on existing literature and was developed for this initiative to specifically focus on the best practice guideline recommendations.

Pedagogy is the art and science of how something is taught and how students learn it.  Our innovative approach to equity pedagogy is based on a broad understanding of diverse identities and marginalized communities and reflects an understanding of culture as patterns and culture as power.  Our model combines three key paradigms: 1) a human rights foundation and analysis of privilege, power and marginalization; 2) an anchoring to professional practice expectations and quality care; and 3) an integration of adult education principles and a developmental approach to the acquisition of   knowledge and skills on issues of power and inequality.   It recognizes that individuals always bring a range of knowledge, life experience and skill on diversity issues and it engaging multiple levels of learners to disrupt prejudice and bias, while maintaining a positive learning edge for all is both challenging and necessary.  Our approach is grounded in evidence of health disparities and concepts of privilege and marginalization.  It invites students /health care providers to explore strategies for navigating the layers and intersections of both privilege and marginalization at the same time, while avoiding the too frequent pitfalls of diversity education which can (inadvertently) reinforce simplistic identity silos, hierarchies of oppression or a guilt response – none of which are useful for health practitioners or service organizations.   We have found that this approach resonates with health professionals and provides a clear ‘bottom line’ of equity practice expectations while equipping staff to recognize the complexities of the application of principles into practice.  The deeper level understanding and ability to apply in practice is fundamental to health system transformation.

 Our model and approach has been developed over several years of diversity education in a large urban hospital as well as academic settings.  Our context is one of the most diverse cities in the world that is home to the largest Aboriginal and LGBT  populations in Canada; where almost 50% of the city residents are racialized people and immigrants who speak over 160 languages.  In this context diversity must be understood as a complex multiplicity of identities and effectively educating staff (and students) in a framework on diversity and health equity is requisite to ensuring quality care.

 In a health care context managers have a dual responsibility for cultural competence in clinical care to achieve health equity while effectively addressing issues of workforce diversity.  This can be particularly challenging in a unionized environment where fairness is often translated into “treating everyone the same”.  The core objectives for the workshop included: understanding the impact of health inequities on diverse and marginalized groups; identifying the impact of power dynamics and diversity in managing teams and fostering a healthy workplace; and developing strategies and approaches to addressing diversity and health equity in leadership. Strategies were grouped under three key domains: self awareness, cross cultural communication and translating awareness of health equity into actions to promote inclusivity.

 Results indicate that the approach is effective in increasing awareness, knowledge, as well s the ability to apply it to practice, Diversity & Health Equity Tool illustrated increased knowledge, skills, and competencies of managers and the gains were maintained over time