Diversity training might sound like the kind of thing that's nice to have, but not essential. However, a physician's cultural competence can have significant impacts, not only a patient's health, but also on a practice's bottom line.
Wikipedia defines diversity training as “instruction aimed at helping participants to gain cultural awareness in order to benefit the organization or company.”
According to data recently published in the Annals of Family Medicine, the need for diversity training is strong within the medical community—particularly among primary care physicians.
Research found that patients in socioeconomically deprived areas perceived their primary care physicians as less empathetic, and physicians displayed verbal and nonverbal behaviors deemed as less patient centered.
Christopher Harding, senior consultant for Halley Consulting Group, says diversity training is a critical element in healthcare today.
“Different diseases and healthcare conditions manifest in different populations bases, and in different socioeconomic levels,” Harding says. “So, the ability of a physician and their practice to understand this and adapt accordingly is one of the areas that's recently starting to get more attention in the field of medicine.”
An Implicit Problem
Harding explains that areas typically underserved by healthcare professionals are a microcosm of what occurs in the general population. That is, people who are not as fully understood tend to experience less connection and rapport with their physicians and other providers. And while some medical schools are now attempting to increase the number of diverse faculty they recruit, the problem goes deeper than that.
“Implicit bias suggests that there are things embedded within our culture, and therefore within our unconscious mind that prevent us from seeing clearly who the other person is,” Harding says. “This is one of the areas we look at, is to help physicians and their staff become aware of some of the implicit biases that are there.”
And biases, Harding explains, are not limited to more visible elements like ethnicity and religion. They also show up in terms of gender and how a person identifies themselves within their own culture.
“In some cultures, it’s inappropriate for a male physician to be alone in a room with a female,” he says. “That’s based on the perception within that culture of what’s appropriate from gender to gender.”
Those biases can translate into a feeling or perception on the part of the patient that their physician doesn’t understand them, or doesn’t care about them, and manifests in the extent to which they follow through on a prescribed medical regimen.
“When there’s a lack of genuine rapport between physician and patient, patients tend to not be as open, they tend to share less information,” Harding says. “And then there’s the emotional sematic factor as well. For example, if the experience of visiting the physician is overly stressful or traumatic in some way, it might actually impact the immune system and other stress related areas or systems in the body.”
Behind the Times
Implicit bias training and diversity training have existed for many years, but Harding says healthcare is one industry sector that has been “a little bit behind” in terms of learning and understanding the training’s direct application.
Part of that direct application is reimbursement.
“We work with a lot of billing departments,” Harding explains. “And what we hear is that if the relationship with the physician is strong there’s a greater tendency for the patient to make regular payments. So, there appears to be a direct correlation between this patient empathy and the patient’s tendency to pay, pay on time. And, another more important aspect of it is the patient’s tendency to litigate is far higher when the lack of empathy is present.”
So what can medical practices do? Harding says that diversity training comes in many shapes and sizes. Within the healthcare arena it falls into three general categories: developing cultural confidence; creating an inclusive environment; and understanding the impact of implicit or unconscious bias. In essence, diversity training teaches people—in this case, physicians and staff—to recognize, understand and productively adapt to a variety of differences that they encounter in their patients, and in collaborating with other physicians and their staff.
“From our standpoint, the end goal of diversity training should always be to improve the level of measurable outcomes from the patient experience to actual patient outcomes,” Harding says.
Accomplishing that goal depends on how diversity training is positioned. When posed to physicians from the standpoint of being the right thing to do from a moralistic view, the training isn’t taken seriously. But once diversity training is correlated to more measurable outcomes that can impact a physician’s practice—including the ability to attract, engage and retain the best staff, as well as improved referral networks and overall patient volume—physicians start to pay attention.
“There’s a direct correlation between an industry’s ability to understand and implement diversity inclusion and the ability to effectively utilize lean processes to run more efficiently and effectively,” Harding says. This connection … really does have a tremendous impact on the continuous improvement and overall success of a practice.”