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Employment and Economic Inclusion

New Hampshire Healthcare Employer Research Initiative

The Healthcare Employer Research Initiative is a partnership with the NH Office of Minority and Refugee Affairs (OMHRA) and New Hampshire health care providers.  In October 2011, IASP was awarded a four-year University Partnership grant from the U.S. Department of Health and Human Services, Administration for Children and Families (ACF), for the Study of Employment and Advancement of Racial, Ethnic and Linguistic Minorities, referred to as the Healthcare Employer Research Initiative. This study focuses on workforce diversity opportunities and challenges in health care in New Hampshire to help inform the Health Profession Opportunity Project (HPOP) administered by OMHRA while advancing broader knowledge related to workforce diversity in all the health care sectors. The federal OPRE brief, HPOG University Partnership Research Grants, presents an overview of this and four other university partnership grants awarded by ACF.

New Hampshire’s population is becoming more diverse and the state’s health care workforce is not keeping pace with this trend. A workforce reflective of the patient population results in improved access to care, patient satisfaction, patient-provider communication, and health outcomes. All providers and patients benefit from a culturally effective, diverse environment focused on delivering high-quality care. There are economic benefits as well. Diversity: improves business performance and competitiveness; reduces interpretation costs; decreases the cost of care; and stimulates medical and public health innovations. Published in September 2012,  Strategies for Diversifying Your Healthcare Workforce: A Tool for Healthcare Providers is based on national best practices and is a resource for organizations to increase the proportion of underrepresented racial, ethnic, and linguistic minorities among health professionals in their workforce and maximize the human capital the state has to offer. 

In November 2013, Perspectives and Practices of New Hampshire Health Care Employers: Improving Quality, Reducing Costs, and Planning for the Future by Building Culturally Effective Health Care Organizations was released. Drawing from over 50 interviews, this report gives voice to what New Hampshire health care employers and workers are saying about how the health care system can better serve the growing minority patient population and all New Hampshire residents through increased diversity in the workforce.

Workforce development initiatives traditionally focus on increasing access to education and training for low-income individuals. The Healthcare Employer Research Initiative has found that a successful response to changes in demographics and the health care environment includes an increased focus on preparing the workplace, together with cutting-edge preparation of the workforce. In December 2014, IASP released Strengthening New Hampshire's Health Care Workforce: Strategies for Employers and Workforce Development Leaders, which presents four key strategies to enhance the workforce, including a new concept of inter-organizational pathways for advancement. Developing a quality health care workforce in order to deliver quality care to all will require the collaboration and investment of employers, educational institutions, workforce development agencies, and community organizations.

To assist New Hampshire healthcare employers working to provide quality care to a diversifying patient population, IASP and its research partner, OMHRA, developed a framework for culturally effective healthcare organizations grounded in literature from nationally-recognized healthcare entities. The brief, Culturally Effective Healthcare Organizations: A Framework for Success, released in April 2015, outlines strategies that organizations can take to embark on an ongoing organizational process of improvement to keep pace with changing patient and workforce demographics, and to achieve health equity. See executive summary here. In 2017, the NH Office of Health Equity created an Action Plan to Create a Culturally Effective Organization to assist leaders in health and human service organizations in implementing this framework.

High performance in the areas of staff cultural competence and workforce diversity and inclusion can result in an enhanced bottom line linked to patient satisfaction-based performance incentives. The brief, Improving Quality and Performance: Cultural Competence and Workforce Diversity Strategies, documents the multiple benefits of these strategies in such areas as  increased employee retention, more efficient use of interpreter services, and a reduction in unnecessary care and avoidable readmissions that can occur when communication and cultural understanding improve.  The brief provides links to resources and tools to measure success and case studies that demonstrate the results that have been achieved.

The Healthcare Employer Research Initiative found that efforts to support workforce diversity are more likely to be supported by all members of an organization if they are part of a broader package of strategies to achieve organizational cultural effectiveness and quality care.  In recent years, hospitals across the United States have pursued patient and family engagement strategies to improve satisfaction and quality of care. One of the leading engagement strategies is to develop Patient and Family Advisory Councils (PFACs) – groups of current and former patients and family members who collaborate with a hospital’s staff to address pressing challenges confronting the organization. Diverse PFACs support a process of organizational improvement that positions healthcare organizations to deliver quality health care to current and future patient populations. Patient and Family Advisory Councils: Advancing Culturally Effective Patient-Centered Care provides guidance for healthcare organizations that seek to identify successful approaches to the development of diverse and effective PFACs.

Becoming a Culturally Effective Organization: A Case Study of the Manchester Community Health Center was published in October 2016. Manchester, New Hampshire is home to an increasingly diverse population, where disparities in access to care and health outcomes are prevalent.  These health disparities are exacerbated by racial and socio-economic inequities in educational attainment, access to quality jobs, and neighborhood resources.  Since 2013 and with funding from the Endowment for Health, the Manchester Community Health Center (MCHC) has been working on a project to become a Center of Excellence in Culturally Effective Care.  IASP partnered with the health center to provide technical assistance and study the implementation of a range of organizational change strategies that move MCHC along their path to becoming a culturally effective organization.

Healthcare organizations around the U.S. – in small communities as well as large urban centers – will increasingly seek to implement strategies that improve quality and equity.   This case study sheds light on strategies appropriate for community health centers in communities becoming ever more diverse that are ready to embark on an organizational change process to deliver high quality care to all.  

The Healthcare Employer Research Initiative, a federally-funded research partnership with the NH Office of Minority Health and Refugee Affairs, and the study Beyond Supply and Demand, funded by the Endowment for Health, resulted in a comprehensive set of findings summarized in IASP’s new report, Good Jobs Good Health: Diversifying the Workforce through Policy and PracticeFindings point to a need for new collaborative program models and innovative policies for employment and economic inclusion.  This report draws together the findings from issue briefs produced over the last 4 years and focuses on five key policy areas:  building culturally effective organizations; diverse workforce training, retention, and advancement; network development; improving quality and performance; and patient and family engagement.

 Good jobs and good health are mutually reinforcing policy areas. When employers and other key partners strive to develop a more diverse and inclusive workforce, it increases opportunity in the healthcare sector and is good for communities.  Diversity also has positive impacts in the workplace.  This research contributes to a mounting body of evidence demonstrating that workforce diversity and cultural competency improve quality care, patient satisfaction, and return on investment – all of which have major roles in driving the industry today.  Policies and practices designed to create culturally effective organizations also produce positive impacts for those who obtain jobs in health care:  equity and access to good jobs is a key determinant of good health.  The healthcare sector is well positioned to lead the charge in developing a more diverse, productive, and sustainable workforce in tandem with more inclusive, adaptable, and culturally effective workplaces. The five key areas of policy and practice reviewed in this report comprise a new and broader way of approaching quality workforce and workplace development.

Beyond Supply and Demand

A companion initiative, Beyond Supply and Demand, funded by the New Hampshire Endowment for Health, offers insights into how healthcare professionals access opportunity and navigate career paths through networks. 

Nationally, it is well known that African Americans, Hispanics, American Indians, and certain members of the Asian/Pacific Islander population are underrepresented in certain segments of the U.S. health care workforce. This mismatch between the patient and provider population contributes to health disparities and excludes minority professionals from jobs that pay well and offer advancement opportunities. For the first time, Missing Persons? Health Care Workforce Diversity in New Hampshire, released in March 2014, examines available data to assess whether the health care workforce in New Hampshire mirrors national trends.

This brief answers two questions: To what extent is New Hampshire "missing" certain groups of people in its healthcare workforce? What are some key trends by race and ethnicity in southern New Hampshire's health care workforce?  Findings demonstrate that racial and ethnic minorities are over-represented in nursing and residential care facilities and underrepresented in hospitals and ambulatory care settings, indicating that workers of color may be missing out on jobs that pay well and offer opportunity for advancement.

Human capital is a driving factor for career success and advancement, and skill development is a priority area for workforce development policymakers. However, the report The Networked Workforce: Maximizing Potential in Health Careers, released in August 2015, found that healthcare professionals achieve career success and advancement through strategic relationships and connections with individuals, institutions and programs — their networks. Health professionals who are embedded in quality networks are more likely to end up on a path to good jobs and long-term economic security over the life course. Implications for policy and practice include the need to move "beyond supply and demand" through strategies that address and strengthen healthcare professionals' networks and social capital in addition to their human capital.  

Contact Janet Boguslaw at (781) 736-3738 or Jessica Santos at (781) 736-8680 for more information.

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