You work for a large healthcare delivery system that is rooted in high performance and boasts innovation and the highest quality standards. Its' executive leadership and governing board continue to generate strong patient care satisfaction scoring, along with positive financial results. From a regulatory perspective, The Joint Commission (TJC) has rated patient quality and safety in the top percentile nationally. Leadership turnover is minimal. However, some subtle changes are occurring in the workplace environment:

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• In the last five (5) years, there has been a shift in local population demographics. Russian, Chinese, and Muslim immigrants continue to move into communities around the city.
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• A large synagogue has been built on the outskirts of town and Muslims travel as far as 100 miles away to attend services weekly.
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• Population specific disease needs are being seen in the emergency department and primary care practices of the health system. Patient satisfaction has been slowly declining and root cause analysis shows patients are not happy with communications with the caregivers.
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• Hospital professional nurse staff turnover continues to increase annually, and normal recruitment strategies that have worked historically no longer generate candidates.
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• Physicians are increasingly unhappy with the shift in medical staff recruitment toward foreign medical graduates. New physicians coming into the market have expressed an inherent bias against hiring new foreign medical students in the community.
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• Overall employee satisfaction and engagement scoring are declining, partly due to post-COVID and staff burnout, but patient care managers are also voicing complaints about out-of-date employee relations; pay equity, race relations, and union authorization cards have been seen in the parking lot on cars reflecting on these issues.
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• Current HR leadership does not recognize issues of disparity, diversity, hiring bias, pay equity, LGBT discrimination on some floors of the hospital. Many of the hospital long term staff are uncomfortable with these issues and avoid the discussion when possible.
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• The CEO of the health system has recognized the workforce changes after hearing about the union authorization cards. The executive leadership wants a consultant report to provide an overview of how the health system can migrate from their current state, to one that is more "culturally competent."
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• You have been hired as the consultant to begin this engagement.

• Task

2. First, assume there are many structural inequities that need attention. (i.e.: bias, inclusion, stereotypes, equity issues, etc.) that might be occurring at varying levels of the organization. Assume that the organization needs to strategically migrate toward a vision of being a health system with ample "cultural humility." How do they get there?
4. Consider what an organizational assessment of cultural competencies should look like. Identify and define some of the key issues for this discussion, and who needs to be responsible for leading those discussions.
6. Identify several of the key success factors /issues that the CEO will encounter during this review using the traditional strategic operational pillars:
   2. Quality and patient care issues, physician issues, and metrics that we should watch?
   4. People issues, personnel policies, recruitment effectiveness, engagement scoring, and metrics to monitor the journey?
   6. Financial issues such as budgeting, training budgets, HR budgets, and discuss possible dashboard metrics you would suggest the organization track?
   8. Operations issues, such as organizational structure and responsibility for this new "culture" related issue? Do we have the right board membership? Is the management team properly educated on the issues at hand? What metrics should we be sensitive to going forward?
   10. Growth, and meeting the needs of the community for the next three to five (3-5) years. Does the governing board recognize the community demographic changes that are occurring? What metrics should we be sensitive to going forward?
9. Your response should be in the form of a memorandum to the CEO and address all five of the areas above, given the environment assessment described in the background above.

References:

https://www.advisory.com/en/topics/patient-experience-and-satisfaction/2021/03/the-case-for-cultural-humility

https://www.youtube.com/watch?v=Ww_ml21L7Ns

https://www.youtube.com/watch?v=mTVZHIlWkxE

https://sps.columbia.edu/events/dei-through-leadership-lens-conversation-chief-diversity-officers

https://www.advisory.com/Blog/2020/07/racially-diverse-workforce