Healthy Diversity and the Center for Women & Work

The Healthy Diversity team is excited to be sharing the final report for our year-long study on community health center efforts to diversify their work forces. The report entitled Healthy Diversity: Practices that Support Diverse Staffing in Community Health Centers (pdf), details the findings of our team at the Center for Women & Work at the University of Massachusetts Lowell. By surveying and interviewing administrators and key personnel from CHCs across the state of Massachusetts, we gathered important information about challenges as well as about best practices. We also propose some recommendations for action.

Healthy Diversity in Massachusetts:

Supporting our Diverse Healthcare Workforce through Innovative Partnerships

In the first phase of our work, we identified entry-level workers’ lack of access to training and development opportunities as one of the primary barriers faced by CHCs for sustaining higher level workforce participation among diverse workers. Some CHCs, however, have been successful in addressing this challenge by developing innovative educational partnerships with colleges, universities, and/or hospitals that can serve as models of workforce development. These partnership models, while seemingly rare, appear to be promising avenues for helping CHCs to diversify their workforces, one of the key elements of providing culturally competent community-based health care.

Phase 2 Project Goals:

1. To develop a comprehensive overview of approaches adopted by Massachusetts CHCs to support the educational development of their current multi-cultural, multi-lingual workforce;
2. To document the history, successes, and challenges of 5 particularly successful educational partnerships from the perspectives of both the CHCs and partnering community-based organization, hospital, community college, or university, and;
3. To broadly disseminate this information to critical stakeholders who can facilitate further adoption of such programs/partnerships throughout the state.

Background:
Despite the federal mandate that healthcare organizations meet culturally and linguistically appropriate service standards (U.S. Department of Health and Human Services Office of Minority Health, 2001), healthcare delivery settings often struggle to work with the broad range of cultural, ethnic, and linguistic groups that are in need of care. To do so requires not only finely tuned clinical skills but also in‐depth knowledge of local cultural practices on the part of all medical staff. Moreover, developing truly sustainable approaches to culturally responsive care also requires that attention to cultural/ethnic diversity permeates the organization. Such an effort involves employing a diverse workforce at all levels, adopting workplace practices that support cultural understanding and positive relations among diverse workers, and developing creative approaches to recruiting and retaining diverse medical providers.

The challenges around health care accessibility for diverse populations are particularly evident in community‐based health centers, which deliver services to the most needy in often multi‐cultural, multiethnic communities. CHCs are a critical community service utilized by many new immigrant families and thus provide services to groups with widely ranging traditions and beliefs about health and health care. Additionally, with the implementation of new healthcare legislation, the 39 federally‐qualified CHCs in Massachusetts have seen significant increases in their patient populations. According to a 2009 Kaiser Commission report, “CHCs and safety net hospitals continue to play a crucial role in caring for the newly insured and in providing a safety net for the uninsured.”(U.S. Department of Health and Human Services Office of Minority Health, 2001). The need to foster an effective community‐based health care workforce that is both multi‐lingual and multi‐cultural is particularly salient in these settings and critical to the health of communities across the commonwealth.

Through our current work with CHCs across the state, our Healthy Diversity Project Team has identified some of the core challenges to diversifying these workplaces. We found that in contrast to the relative ease of recruiting diverse individuals into entry level positions, it can be difficult to attract skilled ethnically diverse workers into higher level medical and administrative leadership positions. Therefore, in order to increase diversity for higher level positions, a promising solution is to invest in the professional development of entry level staff. While most CHCs have a strong commitment to promoting current staff, and many such employees are highly motivated to advance in their careers, a variety of factors can hinder these employees from developing their full potential and thus deprive their CHC employers from benefitting from the full range of their talents. For instance, significant family obligations, combined with the need to work full time, often create barriers that prevent many entry level staff – particularly those from low income communities ‐ from taking advantage of educational opportunities that occur outside of normal work hours. Further, many specialized academic programs have minimum requirements for entry, which can feel like insurmountable obstacles to staff who have never had access to such educational opportunities. Lastly, educational opportunities are costly. While there are financial programs and incentives available to lighten the economic burden, it appears that many individuals – and indeed entire centers ‐ are often unaware of such programs and how to access them.

One particularly creative set of strategies adopted by a few thriving CHCs involve partnerships with hospitals, colleges, and universities to provide training for professional development and pathways to higher level licensure. These partnerships have the potential to not only lead to the much‐needed promotion of diverse workers within CHCs, but to also contribute to overall community development, through the employment of local workers, improved cultural relevance of healthcare delivery, and engagement of academic institutions in the local community . Furthermore, when paired with tuition reimbursement or student loans through the CHC or partnering organizations such as the MLCHC, these programs become more accessible. These models can suggest lessons for other healthcare and human service organizations.

Although the benefits are numerous, CHC educational partnerships tend to be uncommon. An in‐depth analysis of how existing partnerships began, the challenges encountered, and strategies for sustainability would lay the ground work for expanding this approach to workforce development. We plan to document these approaches and others that we may uncover during our discovery phase.

Methodology:
To address the study goals, we will:

1. Survey 39 federally qualified CHCs in the state.
2. Conduct follow-up interviews regarding 5 programs that represent varying models for more in-depth study. This will include interviews with the people who are charged with coordinating the programs both at the CHC and at the partnering institution.
3. Share the findings and resulting recommendations with:
1. All participating organizations
2. Members of the MLCHC
3. Policy makers
4. Academic audiences

Updates:
We are currently finalizing our survey instruments for review by our IRB. We hope to gain approval, and begin distributing surveys shortly.

Our Research Team and Advisory Group

Principal Investigators:

• Meg A. Bond (Psychology, Center for Women & Work)
• Robin Toof (Center for Family, Work, & Community)
• Michelle Haynes (Psychology, Center for Women & Work)

Project Manager:

• Michelle Holmberg, M.A.

Research Assistant:

• Tracey Jackson,  (Master’s candidate in Community Social Psychology)
   

Advisory Group:

• Laura Punnett, Sc.D., CWW Senior Associate and Co-Director of the Center for the Promotion of Health in the New England Workplace (CPH-NEW)
  
• Dorcas Grigg-Saito, CEO, Lowell Community Health Center
  
• Mary Leary, Program and Policy Analyst, Massachusetts League of Community Health Centers
  
• Craig Slatin, Professor, Department of Health & Sustainability; Director, Center for Health Promotion & Research
  
• Angela Nannini, Associate Professor, Department of Nursing, University of Massachusetts Lowell

If you are interested in learning more about this project, please contact Michelle Holmberg at 978-934-2727 or e-mail: Michelle_Holmberg@uml.edu.

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