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Why Diversity Matters: Better Healthcare for 'Every Patient,' CNO Says

Analysis  |  By Carol Davis  
   August 09, 2021

Children's Minnesota has placed itself at the forefront of diversity, equity, and inclusion for the sake of its patients and staff, chief nursing officer says.

Long before COVID-19 revealed disparities in healthcare, Children's Minnesota in Minneapolis, Minnesota, had been working for more than five years to eradicate disparities by improving diversity, equity, and inclusion.

"This is not new for Children's Minnesota," says Caroline Njau, MBA, BSN, RN, NEA-BC, the hospital's chief nursing officer (CNO) and senior vice president of patient care services. "Our organization has taken a trendsetting approach to diversity, equity, and inclusion … so we can make healthcare better for every patient."

Being respectful of a patient's cultural, spiritual, and psychosocial values demonstrates cultural competency, enabling "healthcare workers to understand their patient's expectations about the care, treatment, and services they receive," according to a Joint Commission report on cultural diversity.

HealthLeaders talked with Njau about why diversity matters and how her hospital is embracing cultural competency.

This transcript has been edited for clarity and brevity.

HealthLeaders: From the patient's perspective, why is diversity in the healthcare setting so essential?

Caroline Njau: We serve people when they need us the most. Nobody plans to really be in a hospital setting or even in a clinic setting at any one point, and I think about the people that we serve, and how different our populations are. If you show up at a hospital setting, you look for a resemblance of what the world looks like to you. It's important to match the patient populations that we serve because it's an expectation.

If we have a child who we're caring for at Children's Minnesota that comes from a [particular] community, and we have a nurse who's similar or who is familiar [with] or of the same community, the time it takes to make a connection is significantly faster than if you have somebody who does not have this perspective.

It makes the overall care we provide much, much better; much, much more meaningful; and a better experience. That's why diversity matters.

HL: Can you give an example of how you're diversifying Children's Minnesota's nursing workforce?

Njau: One example is through our internship program. We have metrics that we've set on the internship program in which it needs to achieve a certain rate of diversity within the candidates. They end up becoming our future workforce as nurse[s].

HL: Why is diversity important to a hospital's nursing staff?

Njau: Diversifying is not just saying, "Let's go out there and get people." You have to get the right people who are qualified and equip them with the right skill sets to make sure they do a great job in providing safe, effective care that also matches the perspective and the experience of the community.

For nurses or any care member within the hospital setting to stay at Children's, there has to be something that they look forward to and a sense of belonging, especially now, when there are so many healthcare places. Back in the day, there was probably one hospital per county; now, we have hospitals and clinics everywhere and for somebody to choose to stay within our organization, the sense of belonging is even more important and that creates that retention factor.

The things we do internally to create an inclusive culture that fosters that belonging are as important as it is to diversify the workforce. That's how I look at it; it's a journey, not a destination.

HL: What are some of the unique backgrounds and experiences that should be included when a hospital or health system is working to create more diversity in its staff?

Njau: Diverse experiences are very important. As a nurse, or any provider, somebody here at Minnesota Children's might have practiced in a different setting than a pediatric setting, and by allowing that person to work in that position, they bring a different perspective.

I emphasize a lot on race. It's very important because people see that quickly and that's going to be one of the ways to really break the systematic racism that we have experienced for many, many years.

Diversity in education gives different perspectives. Nurses are prepared differently, and healthcare roles are prepared differently with different curriculums and that brings a richness to the care we provide.

Gender diversity is highly important, especially in a healthcare setting. We want to diversify by gender because there is a [patient] expectation that, "We'll see somebody who looks like me," from a gender perspective.

Now, our patients and our families have become more savvy; they look for those things. All those dimensions of diversity are critical in helping create a more robust experience for our patients.

HL: What are some of the risks that hospitals and health systems take when they lack diversity?

Njau: I see it a lot when you have homogenous societies where there isn't a different perspective and where you tend to not learn from others' experiences and continue to have the same way of thinking, the same culture—good or bad—and the same decision-making that might not propel the organization to keep making improvements.

It becomes more of a status quo—'this is just the way we do things,' 'this is the way things are always done,' 'this is who always makes the decisions,' 'we always look like this'—and that doesn't help propel improvement.

Accepting status quo really means that you do not see yourself as an organization that should be continually improving and that's why diversity is so important. Because that difference in perspective,  having multiple people look at things differently, propels a case for improvement, and that means that we continue to make healthcare even better.

HL: What should nursing schools be doing to bring a more diverse workforce into the healthcare system?

Looking at the pipelines where the nursing schools are getting their students. One thing that nursing schools should be doing is looking to partner with the K-12 education system, diversifying where we accept students from, and how we speak about the career to K-12 from a nursing perspective.

If your nursing college matches your [homogenous] city, you're not seeing the bigger world. It might mean that you look at a different community or county that is more diverse to try to see how you can bring in those students to your institution.

HL: How about nursing school curriculum? Are there ways to tackle disparities through nursing instruction?

Njau: Nurses have a big role to play in reducing disparities and preparation in nursing school helps make those improvements. The curriculum [has to] look at things differently.

If you look at a treatment, it may look similar, but to different communities and different groups, the outcomes look different. Let's talk about myself; there are medications that don't react very well with me compared to others. It doesn't mean that medication is wrong; it just means that there are other offerings that I could be offered that will make my care better.

In teaching those things in nursing school through the curriculum, [you ask,] what are the options, what are the questions you might ask to make sure that you're being effective and not just say, "Hey, here's a medication for you. It should work because it always worked." Let's talk about effectiveness from [each patient's] perspective.

“It's important to match the patient populations that we serve because it's an expectation.”

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.


Being respectful of a patient's cultural, spiritual, and psychosocial values enables healthcare workers to understand their patients' expectations.

When patients see nurses who come from their cultural community, it creates a quicker connection and, in turn, better care.

Diversity creates a sense of belonging for nurses, which in turn helps with retention.

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