Developing Diversity Leadership Competencies 273 ARTICLES Pilot of a Diversity Leadership Competency Course for Graduate Students in Healthcare Administration Valerie Myers, PhD Abstract Health services administrators need a range of competencies to manage diverse workers and serve diverse patients. This article describes cutting edge research used to create the theoretical foundation for a competency- based approach to diversity management education in the health services administration curriculum. Detailed implementation steps of the course pilot are provided, including pedagogical methods and outcome evalua- tions, which are largely absent from the diversity management education literature. Recommendations for refinement and replication of the class are also discussed. Introduction Sweeping demographic shifts are underway; the implications for patient care and the healthcare workforce are well documented (Gordon, 2009; Dreachslin, 2007; Myers & Dreachslin, 2007; Dreachslin & Myers, 2007; U.S. Census Bureau, 2004). In recognition of demographic trends, healthcare governing bodies have modified their expectations and requirements. The American College of Healthcare Executives (ACHE) asserts that diversity management is both an ethical and business imperative; Culturally and Linguistically Appropriate Standards (CLAS) (Department of Health and Human Services, 2001) and the Baldrige National Quality Program (2008) Please address correspondence to: Valerie L. Myers, PhD, Assistant Professor, University of Michigan, Health Management & Policy, 109 S. Observatory, SPH-II, M3523, Ann Arbor, MI 48109, Phone: 734 763-3058, E-Mail: [email protected]. 274 The Journal of Health Administration Education Fall 2008 prescribe specific diversity management practices to improve the healthcare delivery system related to the community, patients, the operating structure and human factors in the workforce (NIST; See Appendix); and the Com- mission on Accreditation of Healthcare Management Education (CAHME) now requires that graduate health administration programs include diver- sity in the curriculum. These agencies agree that leaders now need specific competencies to attract and retain diverse workers, to cultivate that talent to improve quality of care and to reduce racial disparities in patient care. Changing demographics and professional standards prompted a review of existing courses to determine the extent to which diversity management competencies were part of the curriculum for the Master of Health Services Administration degree. The review revealed that, while numerous courses addressed factors such as racial and ethnic disparities in patient health and access to care, epidemiology and social determinants of health, and ineq- uitable health policies, no course explicitly presented strategies to manage diversity in a healthcare organization. Organization theory courses teach general management constructs such as leadership, teamwork, conflict, culture and strategy, but not relative to workforce diversity. Nor did any course teach students skills such as how to negotiate interpersonal challenges or align the organization with a diverse environment. Hence, graduates matriculated with some cognitive knowledge of diversity, but few behavioral or leadership competencies. These gaps in the curriculum were the impetus for creating a new course. This article describes the competency-based approach to planning and implementing a diversity management course for the Master of Healthcare Administration (MHSA) curriculum at the University of Michigan. First, extant literature on cultural competence and diversity training in healthcare is summarized to provide a theoretical rationale for the proposed approach. Then detailed information about course planning, content, pedagogical methods and targeted competencies is provided. I conclude by present- ing evaluation data from two pilot courses and discussing suggestions for replication, further refinement and more rigorous evaluation. Background In order for organizations to thrive in a multicultural society, leaders must skillfully mitigate the threats of diversity, while capitalizing on its potential to yield competitive advantages (Cox, 1993; Cox & Beal, 1997; Thomas, 2006). Healthcare has made important strides in this direction, but has not yet ar- rived. In fact, a review of the literature shows that healthcare management trails general management in the area of diversity. Developing Diversity Leadership Competencies 275 First, cultural competence and diversity training in healthcare has largely focused on awareness raising, primary dimensions of difference (e.g., race, ethnicity, gender, disability), the need for racial concordance between providers and the community, the “business case,” and the requirement to provide interpretive services (Brach & Fraser, 2002; Dreachslin, 2007). Curtis, Dreachslin & Sinoris, (2007) found that few interventions focus on behavioral change and skill building. Further, few explain how the putative “ROI” in the business case will be achieved. How does diversity translate into better performance? How are conflicts managed? Curtis et al. (2007), suggest that a leader’s perseverance and commitment will help to diminish others’ discomfort with diversity to achieve results. This is unquestionably true, but it falls short of describing specific processes that leaders use to embed evidence based diversity management practices in the organiza- tion, which is vital for sustained quality improvement (Shortell, Rundall & Hsu, 2007). Second, dominant “competency” models such as the NCHL (2005) Diversity and Cultural Proficiency Assessment Model are actually check lists for attending to structural organizational factors like workforce de- mographics, adding diversity to a strategic planning, having a diversity champion, conducting audits, offering training, and reinforcing the leader’s vision with rewards and policies. Such lists mimic other industries, with a few patient-related variables added. While this top-down view of di- versity is fundamental, it does not provide details about day-to-day skills that leaders and workers use to navigate diversity from the bottom up and laterally; lists explain what to do but not how to do it. This omission is significant given that CLAS requires leaders to both influence and monitor the organization’s culture and climate. Checklists are ideal for monitoring outcomes, but are not well suited for identifying corrosive elements of the climate, impediments to performance or using influence strategies to eliminate them. Leaders need specific competencies to close the knowing- doing gap between checklist activities and diversity competent behaviors (Pfeffer & Sutton, 2000). Finally, a considerable amount of healthcare diversity management literature is produced by a small subset of authors who continue to cite literature that is now more than a decade old. While age of the citations is not inherently problematic, those old notions of diversity and cultural com- petence have not resulted in significant improvements relative to diversity in the healthcare workforce (Weill & Mattis, 2001; Dreachslin, Jimpson & Sprainer, 2001) or a reduction in healthcare disparities, which have actu- ally worsened (AHRQ, 2007). Empirical evidence of a knowing-doing gap 276 The Journal of Health Administration Education Fall 2008 suggests a serious need to integrate older knowledge with other studies that track improvements in healthcare and diversity scholarship (Griffith & White, 2005). For example, Dreachslin’s (2007) article narrowly focuses on primary dimensions of difference (e.g., race and gender) and posits a negative view of diversity conflicts. However, focusing on primary differ- ences ignores other “isms” that contribute to diversity incompetence, conflict and poor quality of care. One example is rankism, which Fuller (2004; 2006) proposes as an underlying reason for unproductive diversity conflicts. Rankism is linked to a little discussed dimension of difference that Harrison & Klein (2007) identified -- status asymmetry and abuse of power. Studies show that failure to manage occupational status differences and create psychological safety has profoundly negative implications for patient safety (Nembhard & Edmondson, 2006; Tamuz & Thomas, 2006). Patient safety is further endangered when rankism, racism and other dimensions of difference collide. However, Fuller (2006) and Meyerson (2001) propose remedies to rankism and behavioral strategies to navigate through conflicts in ways that promote learning. Moreover, others have found that some di- versity related conflicts enhance performance (Page, 2007; Jehn, Northcraft & Neale, 1999). Finally, diversity is often described as an asset that can enhance orga- nizational learning and effectiveness (Thomas & Ely, 1996B),. But few have explained how its benefits are realized. Page (2007) however, empirically shows the processes by which diversity enhances complex problem solv- ing -- when the context is inclusiveness. Recent advances in the diversity management literature suggest that, as with other performance improve- ment initiatives, healthcare must continually avail itself of new knowledge beyond its boundaries. My goal was to integrate contemporary diversity research and health- care imperatives into a new course that enhances healthcare administrators’ diversity leadership competencies. The ultimate aim of enhanced diversity leadership competency is to improve multiple performance outcomes (e.g.,