Diversity-sensitive measures in German hospitals – attitudes, implementation, and barriers according to administration managers

Abstract

Background Populations have varying needs and expectations concerning health care that result from diversity characteristics such as a migrant background, gender identity, disability, and age. These needs and expectations must be considered to ensure adequate utilization and quality of health services. Approaches to address diversity do exist, however, little is known about the extent to which they are implemented by health care facilities. The present study aims to examine, which measures and structures hospitals in Germany employ to address diversity, as well as which barriers they encounter in doing so. Methods A mixed-mode survey among administration managers of all registered German hospitals (excluding rehabilitation hospitals; n = 1125) was conducted between May and October 2019 using pen-and-paper and online questionnaires. Results were analyzed descriptively. Results Data from n = 112 hospitals were available. While 57.1% of hospitals addressed diversity in their mission statement and 59.9% included diversity considerations in quality management, dedicated working groups and diversity commissioners were less prevalent (15.2% each). The majority of hospitals offered multi-lingual admission and exit interviews (59.8%), treatments or therapies (57.1%), but only few had multi-lingual meal plans (12.5%) and seminars or presentations (11.6%). While 41.1% of the hospitals offered treatment and/or nursing exclusively by staff of the same sex, only 17.0% offered group therapies for both sexes separately. According to the managers, the main barriers were a lack of financial resources (54.5%), a lack of incentives from the funding providers (49.1%), and organizational difficulties (45.5%). Other reported barriers were a lack of conviction of the necessity among decision makers (28.6%) and a lack of motivation among staff members (19.6%). Conclusions Administration managers from only a small proportion of hospitals participated in our survey on diversity sensitivity. Even hospitals of those who did are currently not adequately addressing the diversity of staff members and patients. Most hospitals address diversity on an ideational level, practical measures are not widely implemented. Existing measures suggest that most hospitals have no overarching concept to address diversity in a broader sense. The main reported barriers relate to economic aspects, a lack of support in organizing and implementing corresponding measures and a lack of awareness or motivation.

Participatory development of a manual for the implementation of diversity-sensitive palliative and hospice care in Germany: a mixed-methods study protocol

“…In addition, the potential effects of the manual will at first likely be limited to hospice and palliative care facilities generally interested in providing diversity-sensitive care. Although the project includes a dedicated dissemination strategy that is meant to increase awareness for the importance of diversity-sensitive care, other studies have shown that acceptance of diversity aspects in the German health system is still limited [ 24 , 25 ]. In addition, many healthcare facilities report a lack of incentives and insufficient financial resources as important barriers to implementing diversity-sensitive measures [ 24 , 25 ].…”

“…Although the project includes a dedicated dissemination strategy that is meant to increase awareness for the importance of diversity-sensitive care, other studies have shown that acceptance of diversity aspects in the German health system is still limited [ 24 , 25 ]. In addition, many healthcare facilities report a lack of incentives and insufficient financial resources as important barriers to implementing diversity-sensitive measures [ 24 , 25 ]. These challenges demonstrate the need for further dedicated health policies that can also be informed by the results of this project.…”

“…While a more recent guide offers some advice to better address the needs of vulnerable populations, this guide does not provide any support to implementing related strategies [ 23 ]. Studies have shown that aside from financial considerations, many healthcare facilities struggle with organizational difficulties and missing information on how to implement corresponding diversity-sensitive measures [ 24 , 25 ]. Therefore, the ParDiMi project, funded by the German Cancer Aid (Deutsche Krebshilfe), aims to develop a hands-on manual that enables providers of hospice and palliative care to implement measures and strategies for diversity-sensitive care, while taking into account the perspective of healthcare users and explicitly including vulnerable or minority patient groups.…”

Intersectional Differences in Health Care Outcomes among Patients with Musculoskeletal Disorders in Germany

“…Studies show that hospitals and rehabilitation facilities are well aware of the need for diversity-sensitive care. Yet, adequate strategies promoting diversity-sensitive care are rarely used [34,35]. This is largely due to a lack of practical hands-on overviews of suitable instruments that can be consulted for that purpose.…”