Does Your Hospital Reflect the Community It Serves?

Strategies for Leadership


According to the U.S. Census Bureau, in 1900 only one in eight Americans was of a race other than white. Today, that ratio is one in four, and by 2050, an estimated one in three Americans will be African-American,Hispanic,Native American or Asian/Pacific Islander. In California,Hawaii,New Mexico and the District of Columbia, minority groups already make up more than half the population. Nearly one in five people over five years of age speak a language other than English at home. And in 2001,Hispanics comprised 12.5 percent of the national population, surpassing African-Americans as the largest minority group in the U.S.

These dramatically shifting demographics of the U.S.population affect communities—large and small alike—across the nation and compel health care and hospital leaders to ask the questions: Does our health care workforce reflect the faces of the community we serve? Who are the people who make up our health care workforce—the nurses, technicians and executives responsible for delivering the high quality care that is the hallmark of America’s health care system? How can we ensure that we deliver the highest quality,most culturally sensitive and proficient health care?

These changes also provide challenges and opportunities—the challenge to provide care equitably to all and the opportunity to create a diverse workforce and provide culturally proficient care.


A 1992 study by the American College of Healthcare Executives (ACHE) found an astonishing lack of diversity among health care's top management, and spurred the creation of the Institute for Diversity in Health Management (IFD), founded by the American Hospital Association (AHA),ACHE and the National Association of Health Services Executives (NAHSE). Over the last decade, the AHA,IFD,ACHE,NAHSE, the Association of Hispanic Healthcare Executives and the Catholic Health Association of the United States have continued efforts to increase diversity in the health care workforce, including conducting two additional studies on diversity in health management and sponsoring numerous conferences and seminars.

Increasing the diversity of the health care workforce is a critical first step. But health care workers and leaders also must have the “know how” to embrace diversity of all types, be aware of cultures and customs and how they affect the way patients view health and care, and be sensitive to that diversity in health care delivery.

In 2003, the National Center for Healthcare Leadership (NCHL) commissioned a study to identify specific strategies to advance careers of women and racially/ethnically diverse individuals in health care management, and, once identified, to encourage America’s health care organizations to either emulate or develop similar activities for their organizations. The project,“Study of Factors Affecting the Career Advancement ofWomen and Racially/Ethnically Diverse Individuals in Healthcare Management,” conducted by Janice Dreachslin, Ph.D., and co-author Ellen Foster Curtis, DBA,1 at the Penn State Great Valley School of Graduate Professional Studies, discovered not only what health care organizations were doing to promote women and racially/ethnically diverse individuals within health care management, but also uncovered overall diversity and cultural proficiency programs aimed at the entire health care workforce.

In cooperation with the NCHL, the IFD, AHA and ACHE developed this Diversity and Cultural Proficiency Assessment Tool for Leaders and Case Studies, based on Dr.Dreachslin’s findings.

The Diversity and Cultural Proficiency Assessment Tool for Leaders has four parts:

  • Assessment Checklist: A tool that hospital and health care leaders can use as a starting point in evaluating the diversity and cultural proficiency of their organization, and identifying what activities and practices are in place or need to be implemented. This checklist is based on Dr.Dreachslin’s research.
  • Action Steps: A suggested “to do”list for how to use this tool to raise awareness within your organization.
  • Case Studies: Examples of successful diversity and cultural proficiency programs from America’s hospitals—large and small. You’ll find a description of their activities, as well as information for the key contact,within each organization so you can learn more.
  • Bibliography: Resources to help you and others in your organization learn more about diversity and cultural proficiency.

We hope this tool helps you get a sense of where your organization is today on the road to both mirroring the community you serve and providing culturally proficient and sensitive health care to all patients.

Contributing Organizations

American Hospital Association

The American Hospital Association (AHA) is a not-for-profit association of health care provider organizations and individuals that are committed to the health improvement of their communities.The AHA is the national advocate for its members, which includes about 5,000 hospitals, health care systems, networks, other providers of care and 37,000 individual members. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information, visit the AHA Web site at

National Center for Healthcare Leadership

The National Center for Healthcare Leadership’s (NCHL) mission is to be an industry wide catalyst to assure that high quality, relevant, and accountable health management leadership is available to meet the needs of 21st century healthcare. The NCHL goal is to improve the health status of the country through effective healthcare management leadership. For more information, visit

American College of Healthcare Executives

The American College of Healthcare Executives (ACHE) is an international professional society of 30,000 healthcare executives.ACHE is known for its prestigious credentialing and educational programs; its annual Congress on Healthcare Management, which draws more than 4,000 participants each year; its Journal of Healthcare Management; the magazine Healthcare Executive; and ground-breaking research, career development and public policy programs.

Institute for Diversity in Health Management

The Institute, founded in 1994, is an affiliate of the American Hospital Association and is sponsored by the American College of Healthcare Executives, the Association of Hispanic Healthcare Executives, the Catholic Health Association of the U.S. and the National Association of Health Services Executives. The Institute is committed to expanding health care leadership opportunities for racially and ethnically diverse individuals entering and advancing in the health care field.

1. Accepted for publication by the Journal of Health Administration Education, Special Issue, July/August 2004.