Appendix G

Diversity as an Organizational Strength

Rose Rivers, Ph.D., R.N., C.N.A.A.
Vice President of Nursing and Patient Services
Shands Hospital, University of Florida
Gainsville, Florida

SHANDS at the University of Florida (Shands UF) established in 1958 is the flagship hospital for Shands HealthCare. Shands UF is a 570-bed academic medical center offering highly specialized services and complex medical and nursing care. Four Centers of Excellence include cancer, cardiovascular, neurological, and transplantation services. Shands UF includes the SHANDS Children's Hospital (168 bed hospital within a hospital) established in 1996 and the SHANDS Rehab Hospital (40 bed rehabilitation and physical medicine hospital) established in 1987.

The SHANDS HealthCare Mission is to provide excellent patient care, to collaborate in improving community health and to create an environment that supports education and research in the health sciences. In order to achieve our mission, we realized that as an organization we must be prepared to serve in a very diverse environment from the perspective of staff and patients.

Shands UF defines "diversity" as "all the ways in which people differ, and how those differences affect the way we think and act. By managing and valuing diversity, our goal is to create an environment which ensures that all employees and customers are respected and included, that utilizes the full potential of every employee to improve productivity, and that is flexible enough to adapt to change." We began our journey to recognize diversity as our strength in 1998. Our human resource department provided leadership for the journey. Members of the executive team played an essential role in demonstrating support for diversity in both words and actions. The Vice President for Nursing served as the co-chair for the Diversity Steering Committee.

Our initial actions were based on the results of an employee survey. The results from the Diversity Questionnaire (April 1998) showed the majority of the respondents felt positively about change and diversity, felt that teams and group with diverse membership worked harmoniously, felt that managers and policies were flexible and fair, and felt that turnover was low.

Although the overall results were positive, respondents identified improvements needed in methods and procedures for dealing with language differences, clashes in culture, jokes and slurs about ethnicity and gender, participation at meetings by all employees, hiring and promoting a diverse staff, and training managers about diversity.

Armed with this information, the Diversity Advisory Team (DAT) began their work in November 1998. The DAT was challenged to build on our strengths and address issues identified by respondents. Given that the DAT was responsible for designing a diversity strategy, team members represented many diverse cultures as well as all employment levels and areas of Shands UF.

The DAT participated in a 2-day workshop with diversity consultants in January 1999. The Team chose the title, Diversity Ambassadors and selected the motto, "Our Differences Are Our Strength."

The Diversity Ambassadors' initial focal areas were : (1) create an atmosphere of openness and trust, where employees are encouraged to say what they feel, and create an internal reputation for fairness, respect, and humane treatment for all employees. and (2) increase awareness of the positive impact of diversity and empower managers to make diversity an asset.(These started out as two separate focus areas, however based the similarity between the two, these areas were combined into one;)

A Diversity Awareness Campaign was kicked off in 1999. One of the Shands awareness building activities included an "Express Yourself" Art Contest where employees submitted various art forms conveying what diversity means to them. One of the art submissions from members of Shands Publications Services department included a recipe for embracing diversity.

Diversity ambassadors participated in Diversity Train-the-Trainer Workshops for Managers in January 2000. The purpose of the training was to enhance the skills and confidence of the ambassadors to deliver diversity training. The primary objectives were for ambassadors to learn how to develop self as a diversity trainer, create a productive learning environment, deal with difficult diversity situations, and role play to practice and receive feedback.

After ambassadors were trained, diversity training for managers and staff was initiated. The focus of this training was to enhance participants' awareness and understanding of how cultural programming impacts the way we think and act as well as how we communicate with and interpret the actions of others. After managers were trained, additional diversity educational programs were developed and implemented. Educational programs are summarized in Table 2.

To complement traditional educational programs, other diversity activities were encouraged and supported (summarized in Table 3). For example, the Diversity Store was developed to promote and financially support diversity activities. This on-line intranet virtual store promotes the awareness of diversity at Shands by offering a variety of quality diversity-related products at affordable prices, e.g., mugs, golf shirts, t-shirts, and limited edition items. Profits from the Diversity Store are used to sponsor employee diversity events and support the diversity training programs.

With continual focus on "Diversity Is Our Strength," our primary goal was to create an environment that is open and accepting of individual differences and in which all employees can maximize their potential. The results of our efforts to date include diversity training provided for over 3,000 employees and managers; positive responses received from employees and managers regarding diversity training and activities. Managers and/or staff are voluntarily developing unit-based diversity initiatives with support of the ambassadors; employees are comfortable suggesting revisions to policies and procedures to accommodate diverse perspectives; increased number of employee-sponsored diversity groups and cultural awareness events; enhanced trust between managers and staff evidenced by less formal union grievances and complaints to employee relations department; and increased effective informal problem-solving at the department level evidenced by fewer requests to escalate diversity-related issues to senior management.

Since beginning the program in 1998, we have a greater awareness and appreciation for diversity as an organizational strength. We are aware that diversity is much more than race, ethnicity, and gender. Diversity refers to all the ways in which we differ. Understanding and valuing diversity is an essential component of employee and patient advocacy.

Although we are pleased with our progress to date, there are many challenges ahead. We are challenged to sustain the momentum year after year. We must consider the ongoing training needs of a diverse community. We are grappling with concerns such as, is there a place in the institution for dissenters, i.e., employees whose fundamental beliefs are antithetical to the concept of valuing differences? What are the organizational implications of embracing minority populations, e.g., homosexuals?

In the year 2003, we are expanding our diversity strategy to include community outreach, development and support of sanctioned employee support groups, further integration of diversity principles in the job descriptions and expected behaviors for managers and staff, and overall broadening of training and awareness events.

Based on our experiences, the following recommendations (tips) may be helpful to others who are beginning the journey to use diversity as a tool to improve the practice environment: (a) strong and visible support from executive leadership is a must so that managers and staff understand that a focus on diversity is not a fad but a sound organizational strategy to improve performance; (b) use a consulting firm to assist with education of senior leadership and to kick off the initiative. Expertise in diversity is critical to uncover blind spots and place sensitive issues on the table; (c) educate leadership before developing training materials, benchmark for best practices, use the services of a consultant to help develop training materials/methods. Multiple strategies are necessary to teach diversity. It is much more complex than reading an article or module. Given that leadership support is required to maximize the benefit of training, these individuals require education before initiating the training program. This is necessary in order to get support for funding as well as access to employees for reasonable amounts of time to participate in training activities. Diversity training is a one-hour commitment; (d) engage a committed group to work with consultants and prepare to carry the work forward as diversity training is more than a classŠ it¹s a journey; (e) ensure that leadership is in it for the long haul as diversity must remain a priority; (f) train managers first and set expectations for staff training and the managers¹ role as coach. Be prepared to provide ongoing support to managers as not all management individuals are ready to serve in the role of diversity coach. Make it safe for managers struggling with diversity issues to get assistance without blame and ridicule; (g) train significant numbers of current employees and then incorporate training into hospital orientation for all new employees; (h) begin with the basics, i.e., awareness training, including working with diverse co-workers; focus on differences in communication styles and not just the traditional cultural differences, e.g., food, language, etc.; (I) follow with skill building training regarding caring for diverse patient populations use available resources, e.g., the CRM learning video, Patient Diversity: Beyond the Vital Sign.; (j) set and reinforce expectations for managers to "talk the talk and walk the walk"; (k) encourage unit-based and departmental level diversity activities in staff meetings; (l) sponsor cultural awareness celebrations; (m) publish diversity articles in institutional newsletters; (n) review policies and procedures for alignment with value of diversity, (o) involve medical staff in diversity training; and (p) show the human side of the workforce, e.g., personal stories, testimonials, etc.

A key point to remember is that training alone does not enhance culture, climate, morale, behavior, or productivity. Respecting diversity must be a clear institutional value. Offer communication through a variety of media. Remember that one size does not fit all. Where possible link diversity messages in all training classes, newsletters, special events, websites, etc. to increase awareness and maintain focus. Focus on the people, not just the corporate message. Employees are sure to pick up on behaviors inconsistent with the diversity message.

All things said the main thing is to START. You do not need everyone on board to begin. Start where you are and with whom you can. Don¹t underestimate small impacts as they become large impacts over time. I have learned that patience is one of the keys to success. People are where they are based on years of cultural conditioning and this does not change overnight. Vision becomes reality through perseverance. By virtue of the organization focusing on diversity, diversity awareness will increase and as a result of increased dialogue, employees will become more aware of the impact of existing practices and issues. Therefore, be prepared to manage the situations that may arise. Once people know that they are not expected to suffer in silence, they get a voice and their expectations change!

Conclusion

Managers and staff morale is impacted by how well diversity issues are managed thus impacting recruitment and retention and ultimately, quality patient care. Valuing and appreciating diversity is a powerful tool for improving collaboration and productivity in the practice environment. However, diversity awareness and appreciation training is a long- term investment requiring commitment from all levels of leadership and especially executive leadership. The organization must be prepared to venture beyond surface level awareness if the desire is to create an environment where all employees feel recognized and appreciated for who they are and are given the opportunity to maximize their talents. The organization must be prepared to address issues that are uncovered in the pursuit of valuing and appreciating all employees otherwise the efforts will be viewed as another fad that will go away within a short time. The goal is to address issues in a manner that is blame free and yet enforce clear behavioral expectations in the work environment.

Table 1: Diversity Program Developmental Summary

Table 2: Description of Diversity Training Programs

Table 3: Summary of Other Diversity Activities