Effective Use of Individual and Organizational Assessments to Design a Systems-Focused Diversity and Cultural Competence Organizational Change Process: Lessons from the NCHL National Diversity Leadership Demonstration Project

The National Center for Health Care Leadership's (NCHL) diversity leadership demonstration project, the first to employ pre-post intervention assessment of system-wide diversity and cultural competence change initiatives, evaluates the impact of a planned series of interventions on organizational performance in participating health systems across the nation. The project, funded by Sodexo, addresses the knowledge gap about evidence-based best practices identified by Curtis and Dreachslin (2008) in their comprehensive review of the management and health care literature on diversity interventions. The project emphasizes collaboration between researchers and professionals to build a stronger evidence base for best practices in strategic diversity management and the delivery of culturally and linguistically appropriate care. The demonstration project uses a quasi-experimental design, which includes pre-post intervention assessment. Two hospitals within each system are matched on several characteristics including size, workforce and community demographics, and service line and serve as the intervention and control hospitals, with the intervention hospital receiving the diversity interventions and the control not. Assignment to intervention or control status is random. A battery of pre-assessments, including interviews, focus groups, and individual and organizational-level surveys, were administered in accordance with the study protocol. The NCHL diversity coach and the experimental hospital CEO and leadership team used pre-assessments findings to develop an organizational level action plan for the project's eighteen-month intervention phase. Interventions include infrastructure development, executive coaching, training, individual-level action plans, and other interventions. The assessment battery will be repeated after the intervention phase to analyze pre-post intervention change. Participating hospitals are currently in the intervention phase. This paper describes the assessment battery itself, reports on the pre-assessment phase of the project and presents case examples of how assessment results were used to design organization-specific diversity and cultural competence interventions. Best practices in the selection, administration, and use of assessments are described.