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Use the readings listed in Moodle and lecture notes to answer each of the following questions with supporting details. Please do not use AI tools (ChatGPT, Course Hero, etc.) to answer discussion forum questions because they will not help you personalize your answers and have been known to give misinformation. Use first person language (I, me, my, etc.). Number answers
1. What observations have you noted regarding underrepresented populations in healthcare leadership roles and/or in your organization and how do your observations compare with Salsberg’s (2021) findings?
2. Goleman (2017) contends that emotional intelligence distinguishes great leaders from merely good ones. Of the five emotional intelligences, which one are you currently working on (or would like to begin working on) to strengthen your abilities in this area through persistence, practice, and feedback from colleagues? Please explain.
3. What purposeful and intentional design aspect of the ChicagoCHEC program [Taylor (2019)] did you find useful in removing barriers that address underrepresented populations and why?
4. Marcelin et al (2019) list seven strategies for mitigating unconscious bias in Figure 2. Which of the seven strategies are you currently using within your organization and why did your organization choose to use this strategy? If your organization is not using any strategies, which of the seven strategies would you like to see implemented in your organization and why?
5. Use the Kaiser Case Study (2021): Who did Dr. Pearl invite and engage to be part of the team that frames the problem and solution(s) and why did Dr. Pearl select these members to be part of the Guiding Coalition (step 2)? Use specific details from the article to support your conclusion.
6. Use the Kaiser Case Study (2021): How did Dr. Pearl Develop the Strategic Vision (step 3) for this work and subsequently Communicate the Vision (step 4) to support and enact the vision? Use specific details from the article to support your conclusion.
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Original Investigation | Health Policy
Estimation and Comparison of Current and Future Racial/Ethnic Representation
in the US Health Care Workforce
Edward Salsberg, MPA; Chelsea Richwine, PhD; Sara Westergaard, MD, MPH; Maria Portela Martinez, MD, MPH; Toyese Oyeyemi, MPH, CHES;
Anushree Vichare, MBBS, PhD; Candice P. Chen, MD, MPH
Abstract
Key Points
IMPORTANCE The COVID-19 pandemic coupled with health disparities have highlighted the
disproportionate burden of disease among Black, Hispanic, and Native American (ie, American Indian
or Alaska Native) populations. Increasing transparency around the representation of these
populations in health care professions may encourage efforts to increase diversity that could improve
cultural competence among health care professionals and reduce health disparities.
Question Are Black, Hispanic, and
Native American (ie, American Indian or
Alaska Native) populations
underrepresented in the health care
professions in the US, and does the
educational pipeline show greater
OBJECTIVE To estimate the racial/ethnic diversity of the current health care workforce and the
graduate pipeline for 10 health care professions and to evaluate whether the diversity of the pipeline
suggests greater representation of Black, Hispanic, and Native American populations in the future.
representation of these groups in the
future health care workforce?
Findings In this cross-sectional study of
2019 data from the American
DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used weighted data from the
Community Survey and the Integrated
2019 American Community Survey (ACS) to compare the diversity of 10 health care occupations
Postsecondary Education Data System,
(advanced practice registered nurses, dentists, occupational therapists, pharmacists, physical
Black, Hispanic, and Native American
therapists, physician assistants, physicians, registered nurses, respiratory therapists, and speech-
people were underrepresented in the 10
language pathologists) with the diversity of the US working-age population, and 2019 data from the
health care professions analyzed.
Integrated Postsecondary Education Data System (IPEDS) were used to compare the diversity of
Although the educational pipeline
graduates with that of the US population of graduation age. Data from the IPEDS included all awards
shows some limited improvement,
and degrees conferred between July 1, 2018, and June 30, 2019, in the US.
underrepresentation of these groups
persists.
MAIN OUTCOMES AND MEASURES A health workforce diversity index (diversity index) was
developed to compare the racial/ethnic diversity of the 10 health care professions (or the graduates
in the pipeline) analyzed with the racial/ethnic diversity of the current working-age population (or
average student-age population). For the current workforce, the index was the ratio of current
workers in a health occupation to the total working-age population by racial/ethnic group. For new
graduates, the index was the ratio of recent graduates to the population aged 20 to 35 years by
racial/ethnic group. A value equal to 1 indicated equal representation of the racial/ethnic groups in the
current workforce (or pipeline) compared with the working-age population.
Meaning Results of this study suggest
that additional efforts are needed to
increase the representation of Black,
Hispanic, and Native American people in
the health care professions; measuring
and reporting on representation of
these groups in the health care
workforce and educational pipeline may
encourage these efforts.
RESULTS The study sample obtained from the 2019 ACS comprised a weighted total count of
148 358 252 individuals aged 20 to 65 years (White individuals: 89 756 689; Black individuals:
17 916 227; Hispanic individuals: 26 953 648; and Native American individuals: 1 108 404) who were
working or searching for work and a weighted total count of 71 608 009 individuals aged 20 to 35
Author affiliations and article information are
listed at the end of this article.
years (White individuals: 38 995 242; Black individuals: 9 830 765; Hispanic individuals: 15 257 274;
and Native American individuals: 650 221) in the educational pipeline. Among the 10 professions
assessed, the mean diversity index for Black people was 0.54 in the current workforce and in the
educational pipeline. In 5 of 10 health care professions, representation of Black graduates was lower
than representation in the current workforce (eg, occupational therapy: 0.31 vs 0.50). The mean
diversity index for Hispanic people was 0.34 in the current workforce; it improved to 0.48 in the
(continued)
Open Access. This is an open access article distributed under the terms of the CC-BY License.
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Estimation and Comparison of Current and Future Racial/Ethnic Representation in the US Health Care Workforce
Abstract (continued)
educational pipeline but remained lower than 0.50 in 6 of 10 professions, including physical therapy
(0.33). The mean diversity index for Native American people was 0.54 in the current workforce and
increased to 0.57 in the educational pipeline.
CONCLUSIONS AND RELEVANCE This study found that Black, Hispanic, and Native American
people were underrepresented in the 10 health care professions analyzed. Although some
professions had greater diversity than others and there appeared to be improvement among
graduates in the educational pipeline compared with the current workforce, additional policies are
needed to further strengthen and support a workforce that is more representative of the population.
JAMA Network Open. 2021;4(3):e213789. doi:10.1001/jamanetworkopen.2021.3789
Introduction
Recent reports describing the health disparities faced by racial/ethnic minority groups during the
COVID-19 pandemic has added to decades of literature demonstrating differential access to health
care services and health outcomes by race and ethnicity.1-7 This unequal burden extends to health
care workers; studies have revealed that Black, Hispanic, and Native American (ie, American Indian or
Alaska Native) frontline health care professionals have been disproportionately affected by
COVID-19.8,9
A substantial body of literature suggests that fostering a diverse and inclusive workforce is
critical to increasing access to care and improving aspects of health care quality among underserved
populations.10-13 Studies have demonstrated that physicians and dentists from underrepresented
minority groups are more likely to practice in high-need specialties and in underserved
communities.14,15 Student body diversity has been associated with better overall student preparation
to care for minority populations and an endorsement of equitable access to care.16 Some studies
have suggested that a diverse workforce may improve health care professionals’ cultural competence
and better prepare them to respond to the needs of the entire population.17 Literature on patientphysician concordance suggests that diversity may be important for quality of care with regard to
patient communication, preventive care, and patient satisfaction.18,19 A diverse workforce with a
broader set of experiences in leadership roles can also aid in shaping research and policy agendas.20
Although studies have informed policies to improve diversity, most focus on the medical
workforce, with fewer studies examining the racial/ ethnic diversity of other health care
professions.19,21-23 Furthermore, few studies have systematically assessed the diversity of multiple
professions or compared performance over time.
By examining the racial/ethnic diversity of the current workforce, this analysis explores the
representation of Black, Hispanic, and Native American people in the current health care workforce.
Although other racial/ethnic populations are of interest and play important roles in the health care
system, this analysis focuses on population groups (Black, Hispanic, and Native American) that have
been historically identified as underrepresented in health care professions that require a higher level
of educational attainment. This analysis also estimates the representation of these minority groups
among recent graduates of health care professional programs (ie, the educational pipeline into the
health care professions) to ascertain whether these graduates may change representation of Black,
Hispanic, and Native American populations in the future workforce.
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Estimation and Comparison of Current and Future Racial/Ethnic Representation in the US Health Care Workforce
Methods
Data Sources
In this cross-sectional study, publicly available data from the 2019 American Community Survey
(ACS) and the 2019 Integrated Postsecondary Education Data System (IPEDS) were used to estimate
the current racial/ethnic profile of 10 health care occupations: advanced practice registered nurses,
dentists, occupational therapists (OTs), pharmacists, physical therapists (PTs), physician assistants
(PAs), physicians, registered nurses, respiratory therapists (RTs), speech-language pathologists.24,25
The ACS is the US Census Bureau’s survey of all individuals in the US; it samples about 1% of the
population annually. Population data are weighted by the Census Bureau to make the information
representative of the nation. Race/ethnicity were self-reported. The IPEDS is operated by the
National Center for Education Statistics within the US Department of Education. Data, including the
race/ethnicity of graduates, are collected annually from nearly all postsecondary educational
programs. Data from the IPEDS included all awards and degrees conferred between July 1, 2018 and
June 30, 2019 in the US. We compared programs reporting to the IPEDS with accredited programs
in selected health care professions and found that data were available in the IPEDS on all accredited
programs. The programs collected data on the race/ethnicity of graduates according to degree type
and major or area of study. Because this study used publicly available data sets, the institutional
review board of The George Washington University did not not consider this study to be human
participant research, and the requirements for review and informed consent were waived. This study
follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)
reporting guideline.26
Both the ACS and IPEDS use separate questions to collect data on race and ethnicity. For race,
both databases list the following categories as options: American Indian/Alaska Native, Asian, Black
or African American, Native Hawaiian/Pacific Islander, and White. For this analysis, we use the
categories of Black or African American (referred to as Black in this article) and American Indian/
Alaska Native (referred to as Native American in this article). To ascertain ethnicity, the ACS asks if the
individual is of Hispanic, Latino, or Spanish ethnicity, whereas the IPEDS asks if the individual is of
Hispanic ethnicity. Herein, we refer to individuals in both data sets as Hispanic. The IPEDS also
collects data and reports on the number of non–resident individuals, which is not a category in the
ACS; therefore, we excluded these individuals from this analysis. We also excluded individuals who
self-reported race as mixed, other race, or multiple races.
This analysis focused on the 10 largest health care professions defined by the US Bureau of
Labor Statistics’ Standard Occupational Classification as being health diagnosing and treating
practitioners who require a postsecondary degree.27 To estimate the racial/ethnic diversity of the
current health care workforce, we used data from the 2019 ACS. To estimate the diversity of the
educational pipeline, we created a crosswalk of likely degrees that lead to the previously mentioned
professions and used the 2019 IPEDS data to determine the number of graduates with
those degrees.
Development of a Health Workforce Diversity Index
To quantify the extent of racial/ethnic representation in the health care workforce compared with the
general population, we developed a health workforce diversity index (hereafter referred to as
diversity index). For the current health care workforce, this index was calculated as the ratio of
current workers in a health occupation to the total working-age population (ie, individuals aged
20-65 years who were working or searching for work) by racial/ethnic group. The diversity index for
new graduates was calculated as the ratio of recent graduates to the total population (aged 20-35
years) by racial/ethnic group. Although the typical age of graduation varies by profession, most
graduates fall within the age range of 20 to 35 years. Some professions, such as respiratory therapy
and nursing, require an associate degree, and some students begin after graduating from high school.
Other professions, such as medicine and dentistry, require a postgraduate education, and many
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Estimation and Comparison of Current and Future Racial/Ethnic Representation in the US Health Care Workforce
graduates are in their early 30s. For example, 12.1% of the current US working-age population is
composed of Black individuals (95% CI, 11.99-12.16); therefore, if 12.1% of practitioners in a health
care profession are Black, the diversity index would be equal to 1. If 6% of practitioners are Black, the
diversity index would be equal to 0.5. Hispanic people comprise 18.2% of the working-age population
(95% CI, 18.08-18.26). If 12.1% of practitioners in a health care profession are Hispanic, the diversity
index would be 0.66, and if 6.0% of practitioners in a health care profession are Hispanic, the
diversity index would be 0.33.
Occasionally, we noted the number of professions with a diversity index lower than 0.5 or lower
than 0.33; this is an a priori benchmark showing how far the current diversity level is from parity (ie,
diversity of the health care workforce would be equal to the diversity of the population). New
graduates reflect the inflow of individuals into a profession and are referred to as the educational
pipeline. We compared the diversity index of recent graduates of health care professional programs
with the diversity index of the current workforce to ascertain whether the future health care
workforce is likely to be more or less diverse than the current health care workforce. The use of an
index to measure the extent of diversity with parity equal to 1 was recently described in a study of
faculty diversity at academic medical centers.28
Statistical Analysis
We calculated SEs and 95% CIs for the population estimates from the ACS using Stata, version 16
(StataCorp LLC). We assumed that the sample was representative of the population if the SEs were
small (eg,
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