Are you asking questions for 2009?

People who ask confidently get more than those who are hesitant and uncertain. When you've figured out what you want to ask for, do it with certainty, boldness and confidence.
Jack Canfield

It is New Year's Eve and as I do every year (and every Lunar New Year, too) along with many others I set a few goals. Although I don't really do New Year's Resolutions any more (too much self-induced pressure and suffering when I miss the mark set because my hopes are based solely on the outcome and not the learning that takes place while getting there so I used to miss all of the opportunities in between) I do set goals frequently and December 31 is as good a time as any to set a few more.

This year, my focus has been on creating solutions and setting goals around solutions that will make my clients' business move with great velocity and operate with clarity and resonate with trust. I began to think about what that would entail and realized that most conversations, research, relationships, great discoveries start not as: "I have a problem, now lets think about solutions. . ." but more so, a: "What if? What's possible when? How do we? How could you? Will you? Can you? Can we? Can I?" So, essentially great ideas and solutions start with questions about what you want.

It occurred to me that most of my goals traditionally set, are not coupled with questions, so this year I am encouraging myself, my clients, and my friends and colleagues to ask questions.

What does it take to formulate the questions that will lead you to where you want to go?

Here is a short list of how things you may consider in formulating your questions:

1) If you ask a closed ended question, it must be followed by an open ended one.
Am I living the life I want to live?; Is my business where I want it to be?; Am I satisfied with things the way they are in the world? The answer to these questions could be dichotomous. Therefore, if you answer them yes or no or maybe, a second question must follow. Respectively, No, I am not living the life I want to live--What will it take for me to live the life I want to live?; Yes, my business is where I want it to be--What have I learned that will allow me to expand my business and create something new for my customers that inspires me?; and No, I am not satisfied with things the way they are in the world.--What is my role in the transformation of my community, my city, our country?

While these examples may lean towards the general vs. the specific the point is to ask questions that you can build on and are oriented towards thinking about things broadly and with little to no limits.

2) After creating and asking the questions, don't begin to answer them immediately. One of the biggest challenges with most human beings is our propensity to want to resolve everything immediately. It goes like this,:your friend or colleague calls and begins to talk about something facing him or her. In some instances they want you to give them advice and in other instances, you want to give them advice. And I do and sometimes they did not want advice, they wanted me to listen and perhaps ask a question or two, but they were not looking for me to solve their problem.

If we can ask a question of ourselves or work with others to generate questions that are pertinent to their goals and dreams, we are not required to nor should we attempt to answer the question(s) at that moment. In fact, limiting the space that is created between the time the question is asked and the time possible answers emerge limits the magic that is created in that space. Without the broadening and deepening of that space, we limit the divine nature of nothingness. Only from nothingness is somethingness created. Ask your question(s) and then let nothingness reside and experience (like most of us have) how the divinity arises out of that space.

3) Ask your questions then ask them in another way and then ask them in another way and then ask them again. No, I am not advocating that you become annoying. What I am saying is that questions, like your goals, evolve. As the process of being with/pondering a question evolves, you begin to construct a new sense of what the deeper question might be. Within every question of significance, there are many more significant questions. After posing what I am naming right now, "the trigger question" (I hope that is not the name of someones book, if soon, I will attribute it to them once I know) there are myriad questions that can arise from it. Like composing a song, you try different combinations and chords and percussion, harmonies, melodies, lyrics, etc. and the different twists and turns lead you to possibilities that the original question just scratched the surface of.

4) When formulating your questions, know that you know everything--the purpose of the question will be clearer. Consider that you are all knowing. Now, I am not saying this to stroke you (I am happy to do that however, as I believe in ample acknowledgement of your greatness) but I am saying it because for you to pose a question, for the most part, I believe there is an answer that given the connectedness entity we are, as a human species, all answers lie within each of us individually and collectively. As the song says "There's not a problem that I can't fix." (Last Night a DJ Saved My Life, performed by Indeep). For both the DJ and for you if you ask the question, it can be answered. There is not a question you don't have the answer to so trust that it will come and as I stated above, let go of "trying" to find a solution. Ponder the question, be assured the answer is emerging from the moment it is asked and let it run its course.

5) You have to ask a question before the answer will be revealed. Here is where most of us miss the mark: We never ask the question. If you have a burning, urgent, question, whatever it may be ask it! Ask it not just silently to yourself, but ask it out loud. If you are not comfortable sharing it with others, ask it out loud with no one around. You need to hear the question in reality almost as if it was not just you who was generating it, but like it came from elsewhere for the answer to come to you to share with the person who asked it. Asking it aloud will generate the energy that will lead to the revelation that you are seeking.

Ask questions out loud that inside you don't feel are even probable, let alone possible. The energy generated from simply asking will blow you away.

Remember, you get what you ask for so ask with clarity and be thankful for what you get. You are going to get what you ask for. When you ask questions, be aware that if you are asking for something specific, you want to be very very clear about your purpose and objective of attaining what you desire. When you get it, in whatever form it comes, be grateful for it. Even if it is not quite what you expected know that what you received is exactly what you needed to learn what you need to learn and move you into a deeper understanding of what you REALLY want. Give thanks for all that comes, there is no good or bad that comes from your questions, only answers. All of them are worth appreciation and all of them open up the next field of dreams and possibilities.

Now, go ask some questions with certainty, boldness, and confidence, and let's make 2009 all we know that it can be. Thanks for all you do and all the beauty that you have revealed and inspiration I have received from you in 2008. I appreciate each and every one of you that are reading this and those who may not have the opportunity.

Make it a great 2009!

Amri

What do you expect BIG or not so big?

Life is too short to [play] small.
~ Benjamin Disraeli

It came to my attention a few weeks ago that I had been playing small.

No one said to me, "you failed", I didn't get a curt email.
I did not hear it in a book, not a soul gave me a second look.
The result I had was thinking flat, ideas were slow creativity sat
Tucked away in cold dark rooms, wondering about its pending doom.
Dawn then struck, a second look, innovation lying in a crook.
Woke up and saw the time had come, got back on the horse and it started to run.
Giant Steps are double timing, I am playing BIG again and now I'm rising.

Thanks for indulging me. Have you thought about whether you are expecting big things consistently vs. having a fleeting thought about something BIG, potentially happening for you then as quickly as it came it went?

I have had both and I have observed and began to talk to colleagues and clients about the nature of the phenomena. There are plenty of books about playing big and thinking big. One of favorites and where I got the Benjamin Disraeli quote is from the David Schwartz The Magic of Thinking Big. The premise is that you can only go as far as your thoughts take you. Many people that I have spoken to, said they never really thought about how big they were being in their work or in their lives.

So a couple questions for you:

• Are you in a job expecting that you will only go so far?
• Are you a manager that is concerned that your team is not doing things that will make you look good for your boss?
• Do you see your relationships growing powerfully?

If you are a yes to any of these situations or any other situation that is leaving you in a place where you feel that you have limited power, you are probably thinking, playing, or living in smallness. Trust me, you don't want to live there and that is not who you are.

I just put together a talk on inclusive leadership in health care and across all industries, and I illustrated that playing small as I will share with the audience--meaning not giving the people that you interact with every training and development opportunity, piece of information, freedom to share ideas, acknowledgement, and appreciative bit of coaching you can--leaves you smaller than you truly are. It has an impact on you and on those you interact with in an even more dis-empowering manner.

If you don't find ways to give people around you every opportunity within your power to be fulfilled, particularly those you manage or supervise, you are a leader limiting both your potential for greatness and that of those around you. The best surround themselves with the best and they do so by giving them every opportunity, every day to get better while they develop themselves to get better, too. They do this by listening to great people that they work for, work with, and those that work for them (especially the later).

In doing so, you will get more than you imagined!

What I am seeing in many so-called diversity problems where people are managing across difference whether it is generational, disabled vs. non-disabled, or situations with appararently little to know differences, is that managers are not challenging their teams to play bigger than they think they are able to. As a result instead of being inclusive managers pulling for their folks to grow and expand each and everyday with the result being innovation, fun, and mind-blowing results; they are finding their people constricting and holding back.

Whether it is a since of fear given the economy or fear of retribution, I guarantee it is costing your company money now or it will cost you later.

As an employee in this situation (and yes, you are part of the cause, too) not contributing ideas and insights for whatever reason will leave you overlooked and your contribution bundled up and sent to the Twilight Zone that no one will ever from again.

So, the anecdote: choose BIG! Contribute to your teams, your bosses, your families, your friends, your bowling partners, think BIG on their behalf or even better with them, and watch yourself develop the habit for yourself in the process. You will never feel more free and never accomplish more in every area of your life.

Make it a BIG day!

Strong Finishes

My observation the other day about finishing strong stands true.

What occurs to me though is a reason that may stand out beyond all other reasons to finish strong. I got this insight while weight training with my friend and stress management advisor Juju Poogie (http://www.jujupoogie.com/) and his brother and another long time friend of mine, John.

We were in the process of finishing our last few sets. We began to discuss a workout we did about a week ago doing lunges on a football field near our homes in Atlanta. We lunged the field and immediately lunged back and then did it once more. . .It wore me out. What I recall however, was how actually going harder at the end made it easier to finish. Juju said, push harder when he sensed me feeling fatigued.

Interestingly, I also recently heard a triathlon coach talk about the phenomena of "hitting the wall" in a race. He actually said rather than slowing down--SPEED UP! He instructed his athletes to do this and stated that 95% of them that in earnest speed up vs. slow down experience a greater ability to get past or over the wall better than when they slow down.

So today we are closing in on our second to last set with the weights and I determined that I would actually push harder on the second to last and last set than I had throughout the workout. (Don't get me wrong, I was working hard the whole time, I just stepped it up a little ;-))

In putting that idea into my mind, the weight that I was pushing seemed easier and I was left with a great sense of accomplishment and fulfillment with the workout. I always get something from a workout, but not necessarily fulfillment in the sense that I could transfer the energy of that commitment into other things that I am up to.

How strong are we finishing? If we understand that the whole idea of finishing is a temporary phenomena and while the concept of starting and finishing exists, we are always in perpetual motion. If we can understand the concept at its core we recognize this is all about momentum.

Within the dynamics of start to finish to start again an energy of commitment exists. President-elect Obama knows it. Finish strong: win the popular vote, win states democrats rarely win, dominate in the electoral college=move into the White House powerfully. Simple:

Strong finishes create strong starts.

When we finish strongly and do so consistently we can create an unstoppable energy of commitment that is so highly concentrated, that upon completion of one thing we are doing, it propels us powerfully into the next thing, regardless of what it is. You finishing strongly will start your next endeavor off in a way that gives you the the energy of success regardless of the outcome.

FINISHING STRONG=POWERFUL STARTS in whatever you are up to whether it is job seeking or studying for your boards, vying for a promotion, or running for public office. If you want an awesome career and an incredible life, finish strong without excuse every time!

Finishing the Race

The 2008 Elections have come to a conclusion and our new President-elect has made history in many ways. I am an Obama supporter so I am very excited, too. I am also aware that there is a lot of work to do and all of us as health care professional and those committed to diversity in health care.

One of the most powerful lessons I learned watching this election season was one that speaks to how we finish the races we run.

During the primary, Senator Clinton in her attempt to come from behind, winning several key states, would often reference Mr. Obama's inability to "close the deal". It was a challenge for Obama. Of course, he eventually one, but many headlines at the end of the primary stated, "Obama Limps to the Finish Line". Of course Obama finished with the nomination in hand and while doing so learned a very important lesson--Finish Strong and Take Nothing for Granted.

There was a point during the primary campaign in which Senator Clinton took for granted the nomination, in fact, she in some people's opinions she acted as if she was entitled to primary victory and the nomination and in a sense she took it for granted. Now, I am not sure if she relaxed and did not strategize in preparation for unknown threats or in search of unseen opportunities. Nonetheless, what it looked like was that she was not taking a 360 degree view and making sure all of her bases were covered. As a result, she gave her the opponent the chance to make his move.

Senator Clinton re-grouped and made a valiant come back, and if she had recognized that she was missing opportunities to finish each phase of her campaign more powerfully earlier, the outcome of the primary may have been different and perhaps history would have been made in another fashion. However, she missed finishing when she had the chance.

Fortunately, she taught our soon to be 44th president a lesson about finishing a race powerfully. During the general election, Obama dotted every proverbial "i" an crossed every proverbial "t". He never stopped campaigning up until election day and for everything thrown at him he had a response that met the specific need for each moment.

When you are looking for a job, candidate, or working on an important project, how well do you finish the race?

Where your diversity and cultural competency efforts are concerned, are you taking a 360 degree view and assuring that you are being inclusive of the needs of all patients, clinics, and staff? If not, get started now and know that there will be a series of races in front of us and that if we complete them, the possibilities of the kind of high-functioning organizations we desire. And of course, we can also move towards health equity.

The next time you get close to the finish line remember what Senator Clinton taught President-elect Obama: Take Nothing for Granted--go harder, it will take you to victory without doubt!

Abundance and The Job Search

In a tough economic climate, it is very easy to get discouraged about the prospects of finding work. It is challenging to think you are going to find a job that will allow you to pay the bills and keep a little something extra on the side to save, invest, etc. What I want to make sure you consider is give this dip we are in, what mindset do you need to be your most powerful in your job search activities.

Over the past couple weeks, I have been bombarded by many writers and speakers talking powerfully about the distinction between abundance and scarcity.

Let me first share Webster's (http://www.merriam-webster.com/) take on the two ideas and then a little from a couple of other writers:

ABUNDANCE
Pronunciation:
\ə-ˈbən-dən(t)s\
1 : an ample quantity : profusion 2 : affluence , wealth 3 : relative degree of plentifulness

SCARCITY (http://www.dictionary.com/)
 /ˈskɛərsɪti/ 1. insufficiency or shortness of supply; dearth. 2. rarity; infrequency.

Steven M.R. Covey in his book The Speed of Trust says, "Abundance means that there is enough for everybody. The opposite--scarcity--says that there is only so much to go around, and if you get it, I won't." He goes on to state that, "Abundance is a choice!"

I agree and I agree that you can make the choice to focus on what you can contribute regardless of your current situation.

It is likely that you are thinking that I don't know your situation. You are right and on the other hand we may be more closely related than you think. I have been in situations many times as an entrepreneur where I did not know where my next meal ticket was coming from. What I learned as a result is that the more I thought in scarcity the more scarce opportunities arose. (If you think that sentence sounded like a oxymoron and contradictory, try getting results with a scarcity mindset.)

On the other hand, when I thought in terms of what was possible and had clarity about the reality that I could always contribute to others, I was clear that what I needed to fill my tummy was right in front of my eyes.

What a mindset of abundance does is allows you to not be focused on what you think your current reality is and leads you to considering the needs of others. When you can meet the needs of others and do it in a powerful and credible way, a job, contract, revenue stream is coming your way very soon.

Scarcity scares, Abundance Attracts. . .You choose!

* * *

We are building the largest pool of diverse health care professionals in the world. Stay tuned to find out what a Wii, an iPhone, and a Flip camera have to do with diverse health care professionals!

First National Indian Nursing Conference Embraces Diversity, Excellence

From Nurse.com
by Lorraine Steefel, RN, MSN, CTN

Indian nurses in the U.S. have made huge contributions in shaping healthcare, says Donald Kautz, RN, MSN, PhD, CHRN, CRRNA, assistant professor at University of North Carolina at Greensboro School of Nursing.

To showcase those contributions, 11 chapters of the National Association of Indian Nurses of America participated in the organization's first national conference Sept. 26 to 28 in Skokie, Ill. The association was inaugurated in May 2007 and embraces nurses' change, growth, and development.

Whole Article

ANCC Magnet and Cultural Competency

This week I have been at the ANCC Magnet Conference in Salt Lake City, UT. Cook Ross had an exhibit and we were the only consulting organization of our kind (specializing in cultural competency/diversity and inclusion) there. It was very insightful to be with all of the nurses and other health care professionals there to learn about what was up in the world of nursing excellence and of course to see what people are thinking and saying about cultural competency and diversity in their organizations.

What I observed was that the conversation is really just getting started in most places (hospital and healthcare systems). It is also clear that the education that many have had around the subject is leaving them wanting to learn and know more. I heard numerous anecdotes about situations that were culturally oriented and how the nurses learned to deal with them, often times after great struggle--yet with a great deal learned from the experience.

One nurse talked about her experience with a Kurdish refugee family that fled Iraq after the first Persian Gulf War. The nurse was a student and new at caring for patients during her OB rotation. She took care of a pregnant Kurdish woman and observed that that the father was not helping with the child.

The nurse remarked that at first she was judgmental. However, when she learned from a Middle Eastern colleague familiar with Kurdish culture she realized that the dynamic may not be one of neglect but rather one of cultural norms. She later learned that Kurdish men are accustomed to families taking care of the mother and child and since they did not have extended family with them (many of them had stayed in Iraq or were killed) it never occurred to him that his wife would need help.

These sorts of conversations are crucial to the healthcare community in that while many people have these experiences, the stories are not often shared and therefore the learning is limited. Therefore, some healthcare professionals are clear and even passionate about cultural competency while others are desirous of learning more but don't have access to the conversation. In many cases both groups work with one another--how do organizations connect them?

I think this is critical in that a facilitated conversation about an experience is a learning experience on a variety of levels from the personal connection to a certain dynamic or situation that someone else has experienced or is experiencing to an organizational learning that can give health care clinical and non-clinical professionals and staff understanding of their colleagues in a way that lends to improved communication and connection--becoming more aware of how culture affects everything where human interactions are concerned.

Next time I write, I will also discuss a little bit that it coming to me in regards to children's hospitals and cultural competency. I am thinking that there are distinctive dynamics in cultural competency where children's health and the parental component is concerned. We will explore them next time. Make it a great day!

The Power of Collaboration

". . .much of what we've seen so far suggests that a large group of diverse individuals will come up with better and more robust forecasts and make more intelligent decisions. . ."
James Surowiecki
The Wisdom of Crowds

September 30 and October 1, I had the privilege to be invited to a gathering of about 35 diversity leaders from health care organizations throughout the country to have a very focused conversation about cultural competency in health care and all of the pieces that go along with that. In essence, we talked shop about something which all have a great passion for.

We started out Tuesday evening with dinner and speaker Dr. Francis Jackson. Dr. Jackson is a professor of nursing at Oakland University in Detroit. She spoke on health care disparities. Now, for those of us who have read and heard mountain stream on the subject the thought of this might be, "Okay and what's new?" I would honor the thought yet would be clear that Dr. Jackson had distinctions. She gave us a glimpse of the day in the life of her uncle with a plethora of co-morbidities who was not well versed in his diabetes care and was facing amputation. With her assistance he prevented the amputation of his leg. She contrasted this with a conversation about many others who have not been so fortunate.

She gave very real personal experiences that translated the research and statistics that we hear about into real life, anecdotal situations that potentially could have produced disparate health outcomes from clinical encounters that missed the mark.

I recommend Dr. Jackson as a speaker. She is as authentic as they come, as accessible (personality-wise) as she can be, and is going to deliver a message as real as it gets!

The second day, yesterday (the 1st--appropriate, as it was a first time gathering of these leaders in this format, hosted by Trinity Health and their team of SVP VeLois Bowers, Toni Green, and Chrishonda Smith) throughout the day we had the opportunity to hear from the wealth of knowledge in the room. It is too much to go into great detail, but we touched on everything from training and development, recruitment and retention, and supplier diversity to equity in patient care and health literacy.

I briefly talked about Health Culture Depot and Diversity HealthWorks, and it is likely that part of the proceedings will be published on the HCD site in the near future. I will blog that it is there when I get the write ups.

By the way, Diversity Health Works has been re-launched. Take a look and give me feedback on what is working. The content is coming so stay tuned. We will create the most content rich talent management site in health care! We will need your help to get there. . .

Yesterday, the richness of the conversation reminded me of how important collaboration is and the power that it brings to this conversation. Some of the people in the room may have considered themselves competitors, but for the purpose that we serve as healthcare professionals, we went further. It was powerful and I am grateful for having been a part of such a powerful learning opportunity!

A Quick Note on Leveraging Your Degree

I spent time with fellow Emory grads on Thursday and Saturday in the kickoff of Emory's $1.6 Billion dollar capital campaign. It was quite exciting with the normal pomp and circumstance, black tie, all of the large donors, and of course many alumni.

It got me to thinking about the value of our leveraging our degrees from the various schools we went to. Many people who went to Emory, have the feeling that Emory doesn't need any more money. "They got enough of mine the first time around". Now, this is not just Emory, but many schools with seemingly large endowments or proverbial pocketbooks. In fact, most of those sentiments are true. However, what we are not taking into consideration is the investment into the future of your institution(s) of higher learning and what that investment translates into.

Giving your time, talent, and money is important. Let me share with you three reason's why:

1) Many schools use money given by alumni for scholarships. If you are committed to a diverse student-body, contribute to the scholarship fund. It often allows students who otherwise could not afford to attend a school the opportunity to do so. This used to just be the case at schools like Emory and other expensive private schools. However, with the cost of all schools state-based or otherwise, it is a high-dollar conversation.

2) The more you give of your money, time, talent, you name it, the more people know you and the more people know you and what you are about (assuming it is positive, which is likely if you are contributing your time, talent, and money) the more opportunities and possibilities open up to you. I have had numerous opportunities for conversation about what I do open up as a result of my involvement with Emory. It is not direct business, but it is branding, personal and for my company. People know more about Cook Ross and learned more about me because I share myself with the school in a variety of capacities.

3) The law of cause and effect: you give something you get something back. Think about something in your life that you have contributed little to and got a lot from. Sure there are a few things, but lets take a macro view. Now, I know you paid a lot for your degree and you got it when you graduated. That was then, this is now. I am not saying that you have to spend half your time and a fourth of your money towards your school, but I am saying contribute something. It is an investment that has to be made if you want your degree to really carry some weight and give a boost at some point. You many not even know you got that boost, but believe you me, if you contribute, there will be a return in some shape or form.

Charitable giving gives you a stake. While you are a graduate and paid tuition while there, the value that your degree has now, is much higher than when you were a student. Schools are like businesses. If you work in a business and don't feel like you have ownership, your level of contribution is much lower than when you do feel like an owner. Colleges and Universities depend on their alumni for so much and we have a lot to give. Giving something each year gives you the empowerment of an owner and moves you on the court as a contributor to a broader dialogue.

So, that is my 3 cent on why to give to your Alma mater. Time, talent, or financial contribution, it all gets paid forward and paid back!

The Countdown Begins

The totally re-tooled Diversity HealthWorks re-launches on September 18th. That is a powerful day for my family in that my brother, Larry, who we lost in December 2004, was born on that day.

Larry had a stroke and died at age 40. The launch of the site is dedicated to him, one because he was my biggest fan :-) and two because the bottom line premise for Diversity HealthWorks as a vehicle is the elimination of health disparities/health equity. Larry died with many years of potential life left to give his energy to the world. Diversity HealthWorks is a stand to reduce years of potential life lost towards the achievement of health equity.

A little about Diversity HealthWorks:
Diversity HealthWorks™ is a comprehensive resource for healthcare professionals, educational institutions, organizations, and employers to utilize in meeting their respective employment, recruitment, informational, training, and educational needs.

First launched in 2005, Diversity HealthWorks was created to be the destination portal for healthcare talent management. Our premise is that diversity and talent management are integral parts of one another and cannot exist separately. Given this premise, we believe that if an organization intends to be a competitive and innovative market leader, cultivating top talent, diversity must be a central theme in its pursuit of success.

Diversity HealthWorks is the first on-line resource dedicated entirely to careers, employer branding, and the generation of information focused exclusively on diversity and cultural competency in health and healthcare. At the foundation of our mission is the creation of health equity and the elimination of disparities in health outcomes focusing on the workforce as central to the achievement of this goal.

Diversity HealthWorks features the following components:
-- Traditional Job board with wide variety of healthcare jobs from allied health and nursing to public health and research
-- Comprehensive resource (www.healthculturedepot.com), edited and contributed to by professionals focused on cultural competency and diversity in healthcare, disparities/health equity, and current issues
-- Features and best-practices in the healthcare industry
-- Pod casts, web seminars
-- Monthly and bi-weekly publications with interviews, current news and notes across the diversity and healthcare space, and opportunities to get involved

More to come on Diversity HealthWorks, stay tuned!

So, when do we really address diversity in the healthcare workforce?

It has been known for a long time that diversity in the health professions is not only the so-called "right thing to do" but it is also evident that it is the thing we need to do healthcare right.



In December of 1995 The Pew Health Professions Commission (Critical Challenges: Revitalizing the Health Professions for the Twenty-First Century) stated:

There is a substantial body of literature which concludes that culturally sensitive care is good care. This means two things for all health professional schools. First, they must continue their commitment to ensure that the students they train represent the rich ethnic diversity of our society. Important investments and many successes have been achieved, but this is an obligation that must be continued at each institution until it is no longer an issue. Second, diversifying the entering class is not sufficient to ensure understanding and appreciation of diversity. Cultural sensitivity must be a part of the educational experience that touches the life of every student.



About 10 years later, the Sullivan Commission on Diversity on Diversity in the Healthcare Workforce published Missing Persons: Minorities in the Health Professions stating:

Diversity in the health workforce will strengthen cultural competence throughout the health
system. Cultural competence profoundly influences how health professionals deliver health
care. Language is a critical component, with two out of ten Americans speaking a language at home other than English. The cultural challenges posed by a shifting patient demographic can
best be addressed by health professionals educated and trained in a culturally dynamic environment. . .


The business community has long recognized that workforce diversity is essential to success
and maintaining competitiveness in the marketplace. Corporate executives as well as local
chambers of commerce describe the economic benefits of developing a workforce that reflects the customer base.

After publication #1 (Pew) we were left with a greater understanding of the issue. In between the Pew report and the Sullivan (publication #2 above) report, there were myriad reports on this issue and related issues such as health disparities, other workforce-related studies examining diversity, numerous conferences, and a lot of conversation about the importance of it, how it is affecting health outcomes, etc. There have been other subsequent to Sullivan, too.

What I personally have not seen a great deal of is a publication of best practices: How to diversify and expand the healthcare pipeline?; "Where do we go from here in healthcare workforce diversity?"; and so on and so forth--in essence, action!

Now, my not seeing this much does not mean that it is not happening. So if it is, and you happen to pass by this blog and read some of it, please share your success with me and I will do my best to share it with my network, my clients, etc.

In the meantime, when do we really address diversity in the health professions; in the healthcare workforce? There are many steps that have been taken in states and by cutting edge foundations like the California Endowment. Check out what they are up to:

http://www.calendow.org/article.aspx?id=1382&ItemID=1382

You may also find programs taking place through educational institutions like the Summer Enrichment Program at the University of Michigan as well as another such program run by the Institute for Diversity in Health Management.

These programs are great, the question lies in the details and in the measurement of what is coming from them. I would say there are positive outcomes anecdotally, and I actually believe anecdote is measurable. However, we generally are not even capturing the stories that these programs produce in aggregate. As a result, the funding for them is usually sparse, running low, running out, and has already run away with little hope hope for renewal.

Don't get me wrong, I am confident that we can make continued and bigger strides towards understanding pipeline building in the healthcare workforce. To me it lies in moving towards a clear understanding that this is not "initiative-based". Initiatives come to an end. Diversity in the healthcare workforce is not something that some do and others don't if they want success long-term and it has no ending. Diversity recruitment is recruitment, period. If diversity is not being considered, quite frankly you are not really recruiting. You are selecting some folks that will meet your needs for the next few years, but you are not building the workforce that will add to bottom-line growth in the future of your organization, hospital, institution, etc. It simply won't lead to the innovation, connection with patients, market share growth, or any other aspect that you are looking to advance including cultural competency.

So, when do we really address diversity in the healthcare workforce? We are doing it now, but not nearly to the extent we need to. Do we understand the implications? I doubt it. Right now they are theoretical and not practical.

I am in search of a healthcare organization that has focused on diversity and has documented how it has positively affected them. If you hear of any, let me know, I would be thrilled to do an interview with them.

If you are interested in an interview talking about your talent management efforts, drop me a line at amrijohnson@gmail.com. We are in the process of creating our interview and publication schedule for Diversity HealthWorks. I am sure the world would love to hear about the great things you are doing. . .

New Mexico Taking a Lead In Healthcare Cultural Competency

Below is a link to a very nice article that speaks to the fact that cultural competency in healthcare is an issue that every state needs to be engaged. Looks like New Mexico is really engaged in the conversation. Other states like New Jersey and California have implemented similar legislation as it relates to culturally and linguistically appropriate care.

What state is next to push this to their healthcare workforce?

http://www.cnn.com/2008/HEALTH/08/08/cultural.medicine.ap/

You maybe want the Hot and Sour Soup

A few weeks ago, I was having dinner at one of our favorite vegetarian restaurants outside of D.C. My friend and I asked about the soup choices, in particular the Won Ton Soup. The waitress whom I have seen quite a bit, described the Won Ton Soup. She said, "Won Ton soup, the Won Tons are made of flour." She then paused. Not fully understanding what she was tying to convey I then asked, if it was good. She did not respond directly to the question, but she did make a suggestion, "You maybe want the Hot and Sour Soup." We looked at one another chuckled and the Hot and Sour Soup it was!

The conversation points to the dynamics that we see in cross-cultural interchanges everyday within healthcare institutions. Perhaps an American wait staff would have said, "I don't really like the Won Ton soup." However, she chose to not be critical of the food, the restaurant, the chef and instead suggested that we choose one that she felt we would like through experience. A very highly contextual response.

Consider the many times we encounter communication styles that are not in alignment with our world view. Are we even aware enough to know that our selective listening begins? Imagine how this could happen with a staff person, a physician, or a patient. We often emphasize language because of CLAS standards or simply because we have so many reminders of language barriers as the diversity of our organizations grow.

While we are aware of the fact that culture matters beyond language, and clarity in communication comes from context, and that we all have both. However, we don't necessarily examine our biases and how our context consistently occurs to others.

How do we begin this process?

1. My experience is first to begin to learn about cross-cultural communication. Generate an awareness of the nuances of how we relate to one another in communication and what types of questions ask.
2. Knowledge of all archetypal generalizations of cultures outside is not necessary (or possible) but it without doubt can help with our understanding of how we might be occurring to others based on their cultural lens.
3. Lastly, get engaged in the process of learning about effective communication. Any education in this topic should inherently include a module related to culture.

Our new healthcare diversity and cultural competency wiki Health Culture Depot is coming soon. If you have topics you would like to write about regularly, let us know. We are building our list authors as I write.

Cultural Competency and Diversity in Healthcare: A Healthcare Diversity Consortium

Cultural Competency and Diversity in Healthcare: A Healthcare Diversity Consortium

A Healthcare Diversity Consortium

There are a lot of people doing great work in the diversity and cultural competency space where healthcare is concerned. One organization (the whole team!) that is doing outstanding work is Trinity Health under the leadership of VeLois Bowers, Sr. VP. of Diversity.

They are hosting an event that is going to be awesome! It is not too late to RSVP although the note below says different. Reach out to Toni Green and be there. If you are in healthcare and have a diversity responsibility in any capacity, you have to be there!
________________________________________________
Greetings,

Today, diversity executives and practitioners in health care are faced with many factors impacting our diversity efforts. Recently, there has been an expressed interest in health care diversity professionals coming together to address initiatives in an industry where the diversity journey is just beginning. In this light, Trinity Health is pleased to host a health care diversity consortium to benchmark and share best practices from the industry across the nation. We will focus not only on recruitment, retention, and talent management but how diversity and inclusion initiatives impact responsive and respectful patient centered care.

Trinity Health's Office of Diversity and Inclusion would like to invite you to join us September 30 and October 1, 2008 at the Dearborn Inn located across from Henry Ford's historic Greenfield Village located near the Detroit metropolitan airport. The hotel logistics and an agenda will arrive under separate cover. We are planning a robust agenda that will include guest speakers and topics to stimulate dialogue and share best practices.

Please RSVP with your, or your designee's availability by Monday, July 28, 2008.

If you know of other healthcare diversity colleagues who may be interested in attending, please forward this invitation. Please contact me if you would like additional information.
I look forward to our meeting.

Best Regards,
Antoinette Green PHR
Director, Diversity & Inclusion
Trinity Health
34605 W. 12 Mile Rd, Ste 127
Farmington Hills, MI 48331
248-489-6371

Where do we need to go?

The AHA published an article on health disparities and its statement that was recently submitted to the House Ways and Means Committee. You can check it out an excerpt from their solicited statement at the link below.

http://www.hospitalconnect.com/ahanews/jsp/display.jsp?dcrpath=AHANEWS/AHANewsArticle/data/AHA_News_080707_AHA_racial_ethnic&domain=AHANEWS

Of course, the statement was well written and supported by thorough data and as practitioners, we can all stand up from the choir and deliver a resounding "AMEN". What I am left with in the process of a long standing need for health care transformation is a "where do we need to go?" question. This question is not new for anyone either. What has not surfaced however, are long-term strategies that can be adopted not just for public health practitioners, clinicians, and hospitals, but by every institution that is affected by disparate treatment and disparate outcome. Translation--everyone!

I am going to speak to this in more depth later; however, the premise is that our strategic hats need to be collectively worn more often than our execution hats. We have a great deal of data and we still need to collect it. In addition, we as practitioners dedicated to health equity need to be strategic on what each data point collected represents and how it can fit into a bigger framework that leaves us with a body of information that can longitudinally clarify what is working with whom and how and how can we duplicate, systematize, and hone it for long-term success. What is our success strategy as a body of health care folks who want to see our bottom-line for health care in this country improve while our top line of people rises it with it? Can it be done? You bet it can!

We will discuss more in the near future about this possibility.

Joint Commission Releases Revised Restraints Standards for Behavioral Healthcare--The Role of Culture

The Joint Commission released new standards in behavioral care in May that will go into effect January 1, 2009. Now, I don't need to go into the details of the new standards, but I did want to highlight one particular piece that was intriguing from a culturally competent care perspective.

The standard includes (paraphrased):
staff must demonstrate an understanding of the factors that influence behavior and may result in the need for restraints and seclusion.

What was intriguing is that many behavioral factors as we know are related to culture. For example, in my work with hospitals a client once told me that there was situation where a young 36 year old man was told that he had cancer and it was aggressive and then basically left there without the care of someone who would communicate with him. He was black and in a predominantly white staffed hospital facility. Upon being told he began to talk very loud and forcefully and demand some answers. His escalating tone and demands prompted the care staff to call security who immediately called the police. He was put into restraints which made him become more irate.

Later a black nurse came to him (after being requested) and he explained that he was scared, felt all alone, and no one was answering any of his questions. The less they responded, the angrier he became. He was released from the restraints almost immediately after the black nurse arrived and began to get his questioned answered.

Culture and behavior go hand in hand. If your cultural competency and cross-cultural communication skills are on par to where you want them to be this new standard the Joint Commission is putting into effect will be taken care of in the course of how your organization operates each and every day. Patient-centeredness and this new standard are very much in alignment; as such there is no patient-centeredness without cultural competence.

If you want to learn more about tools for Cross-Cultural Communication, email me at amrijohnson@gmail.com.

Institute for Diversity in Health Management

We've been away for a while. But are moving back to regular postings.

I recently had the chance to attend the bi-annual conference of the Institute for Diversity in Health Management. In attendance were a number of top hospital systems including Trinity Health, HCA, Community Health Network (Indianapolis), and Texas Health Resources.

The conference was a tremendous opportunity to network with some of the finest minds in the area of diversity and cultural competency in healthcare. I will write more later.

In the meantime, stay tuned for a BIG Project that you will be able to participate in!

Ulysses W. Burley III discuss cancer research and the challenges facing African Americans

THE BLACK COLLEGIAN Online's featured blogger and columnist Al "The Inspiration" Duncan is kicking off the new year by posting a new interview and hosting a dialogue with Ulysses W. Burley III, at 24 already a noted cancer researcher. The timely new dialogue gives insight into the career path and mind of a young man who is passionate about confronting a disease that, he says, "affect(s) black people twice as much as anybody else."

This theme has been explored on the IMDiversity.com/BLACK COLLEGIAN network of sites a great deal in the deal in the past year, becoming more timely as the election year has resurrected the issue of universal healthcare and who's falling through the cracks of insurance coverage in America. The topic's also coming to the fore through the increased media coverage and national discussion of the particular challenges facing African Americans in battling cancer.

As Dr. Burley observes, these challenges to African American cancer sufferers receiving the attention and treatment they need are both internal and external, social and psychological.

In terms of research, he observes that "There aren’t enough African Americans going into research period, let alone cancer research." Further, "only 13% of African Americans" who aim for them "end up graduating with science and math degrees. Only 3% of us are going to pursue graduate degrees in science and mathematics."

In the interview, he suggests that ethnicity can affect both which types cancer certain groups disproportionately suffer from ... and which types can receive (also disproportionate) research focus and funds. He believes that the upcoming elections may bring national and government leadership focus back onto cancer research, not only because of the attention to universal coverage, but because several of the presidential candidates from both parties have had direct, personal experiences with and suffered tragic losses from cancer.

At the same time, he acknowledges that ethnic disparities in research and treatment are not only caused by external obstacles. If African Americans disproportionately from certain kinds of cancer, he saks, “why is this and what are we doing to intervene? I believe that if you want to change something you need to become a part of it."

He says that research careers can draw lower salaries than many other paths in the medical sphere, which may dissuade some African Americans from pursuing scientific research as a vocation.

Further, there may be a stigma attached to cancer that is prevalent in the African American community, as well as cultural and spiritual aspects to how many Blacks deal with the disease that may not be widely understood by mainstream healthcare practitioners. This was a topic recently highlighted in a new book, "You Have Cancer": A Death Sentence That Four African-American Men Turned Into An Affirmation To Remain In The “Land Of The Living”, co-authored by THE BLACK COLLEGIAN founder Preston Edwards Sr. and three of his longtime best friends. They learned they suffered from the same disease at the same time later in life. They discuss the spiritual and psychological aspects of fighting the cancer, as well as the stigmas and social issues that can prevent Black men with cancer from seeking and embracing needed treatment and attention. They also discussed the book this past week on an episode of Weekend Today with Lester Holt focused on African Americans and cancer.

In the spirited dialogue with Burley that followed the interview, many readers voiced their appreciation for the young doctor, not only admiration for his dedication and his life and work choices, but for how he stressed the importance of research.

In one response from the dialogue, however, Dr. Burley took care to stress that the need for African Americans to become advocates for community health and to pursue science degrees and careers was not limited to cancer research.

"To answer a question asked earlier, I do believe that cancer and cancer funding will become more visible in the upcoming elections. Currently candidates are solely casting their respective health care plans mainly because this is what we the people have asked for. Therefore it is up to us to demand more from them. I am hopeful that the primaries will reveal worthy representatives for both parties, and that the narrowing of possibilities will produce more focused and pronounced plans within health care, not only for cancer intervention, but global AIDS, child obesity, and diabetes to name a few. Until then, we must continue to be advocates through initiatives such as the ONE Campaign that allow citizens to apply pressure on the government through letters, emails, and phone calls of demand and concern."

Join the continuing dialogue with Ulysses W. Burley III at Al's blog.