Hospices Integrating Cultural Competency into Recruitment, Retention

As hospices expand their diversity, equity and inclusion efforts, more are putting cultural competency at the forefront of their hiring and training processes. 

Understanding and awareness of cultural beliefs and practices makes a difference when it comes to attracting and keeping staff, according to Keith Everett, CEO of Louisiana-based Hospice of Acadiana Inc. A key is to remain focused on inclusivity and ingraining cultural competency practices into an organization’s workplace, Everett said.

“Once an organization has created a sense of belonging, and people are dedicated to the mission; it no longer becomes just words. It’s something that is ingrained in them, and they feel a part of the organization,” Everett told Hospice News. “Once that feeling is there, staff tend to stay longer because they become one with the organization.”


Where health equity fits in recruitment and retention

Incorporating cultural competency into hiring and training programs is an evolving and continuous process, according to Joyce Palmieri, senior vice president of clinical services at MJHS Hospice and Palliative Care. The hospice is part of the New York-based MJHS Health System, which serves the Manhattan, Brooklyn, Queens, Bronx & Nassau County areas.

MJHS Hospice and Palliative Care has had a diversity, equity and inclusion program in the works for roughly a decade, but in recent years this has become more integral to its recruitment and retention practices, said Palmieri.

“We have a diversity council and have annual training. We onboard staff with orientations for cultural competence. We also proactively discuss the demographic of patients that we serve during interviews, and also sometimes engage our diverse staff in the interview process,” Palmieri told Hospice News. “We understand that everyone doesn’t have cultural competencies in every different culture, religion, or race, but that they’re not afraid to ask and get the information they need to provide the best care to ensure a good death so that people feel they are heard, valued, and respected.”


To foster cultural competency, hospices can encourage staff to express their individual concerns, questions, and perspectives, Palmieri continued.

Having staff who are able to deliver inclusive health care can lead to improved retention in the long run, according to Ren Peir, head of marketing at Violet. The company offers a cultural competency training platform specifically for clinicians.

When it comes to workforce retention, hospices need to ensure that they are developing a way to measure the success of cultural competency programs across the board, Peir said.

“Having a framework for actually measuring that cultural competence is important to gauge where your organization is at and where to go from there,” Peir told Hospice News. “It’s creating the ability to have accountability. Without benchmarks, you can’t see the areas of opportunity. It’s always reevaluating all of your training, your organizational practices, and asking what your internal framework looks like to embody ongoing cultural competency. If you think you’ve completed this, then you’ve got a ways to go. You can never really be fully competent in someone else’s culture.”

Providers and payers double down on health equity

Diversity, equity, and inclusion has been a rising priority for hospices, particularly during the past two years.

For example, 67% of hospices polled in a 2022 LeadingAge/BerryDunn study indicated that they planned to hire a more diverse workforce. A quarter of respondents said they would set diversity goals in the future. BerryDunn polled more than 1,000 hospice and home health agencies in its National Healthcare at Home Best Practices and Future Insights Study.

Likewise, nearly 70% of 7,000 hospice and home health providers in a 2020 survey from Dallas-based technology provider Axxess indicated that they would be stepping up their health equity efforts in coming years.

This focus may intensify further as the U.S. Centers for Medicare & Medicaid Services (CMS) has indicated that health equity will be a part of all of its forthcoming payment method demonstrations. This includes the value-based insurance design (VBID) model and the forthcoming Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) program.

Ensuring that staff are well-versed in cultural competency is a key component of advancing health equity. But first, a hospice must define what they mean by “cultural competency.”

The U.S. Centers for Disease Control and Prevention (CDC) has developed guidelines for achieving greater cultural competence, which according to the agency involves a defined set of values and principles, and demonstrating behaviors, attitudes, policies, and structures that enable health care providers to work effectively cross-culturally.

Health care providers should have the capacity to conduct self-assessments, manage the dynamics of cultural difference, and adapt to diversity and the cultural contexts of the communities they serve, according to CDC.

These practices should be integrated into organizations’ policies and procedures, care delivery and community engagement, the CDC indicated.

For hospices, this has to start from the top with an organization’s leaders, according to Everett.

“It starts from the top, and it’s up to the board and CEO to set the tone of appropriate behaviors, attitudes, and any policies and procedures that need to be put in place to better sustain progress,” Everett told Hospice News. “Your cultural competency evolves with the needs of your community and organization. So, organizations have to constantly change what they are doing to keep up with what’s going on internally to ensure organizations are meeting needs of newly hired staff and externally to address community needs.”

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