Trends & Ideas

March 1993

Managing Diversity

Across the United States, an increasing number of corporate leaders have decided that fostering diversity in the workplace is critical for their organizations’ future growth.

The new emphasis on workplace diversity represents an important shift in attitude, reports Lena Williams in the New York Times. "Only a few years ago, the idea of diversity in the work place was being dismissed by employers as an amorphous theory with little or no relevance to production and profit," she writes. "Today, more and more employers view diversity as good business as well as good public relations."

"Workforce 2000," a 1987 study conducted by the Hudson Institute for the U.S. Labor Department, has helped raise awareness about the importance of hiring more women and ethnic minorities at every level. The study predicts that by 2005 the overall work force will increase by 26 million people, 85 percent of whom will be women, immigrants, or members of minority groups.

But creating a truly diverse organizational culture can be difficult. Many companies learned this in the late 1960s and early 1970s, when they failed to follow up on affirmative action hiring practices by addressing the internal problems that resulted, Williams notes. Employers have learned that fostering diversity often requires a fundamental transformation of an organization’s culture.

Employers have also begun to turn to consultants who can help them manage a diverse work force. To evaluate the workplace situation, Williams writes, consultants often interview employees about how they "are selected, assigned jobs, and promoted; whether extroversion is valued over introversion; and whether employees’ ideas are routinely sought." Managers then "review the information to identify perceived or real obstacles to advancement."

Managers in many companies are now enrolling in conferences and university courses on managing diversity. And, in the past few years, a growing number of books and videotapes on the topic have become available.

Despite the strong interest, however, many women and minorities are skeptical about the extent of corporate America’s commitment to workplace diversity. A 1990 survey by international consulting firm Towers Perrin revealed that companies are not progressing as quickly as they had hoped in creating a more diverse corporate culture. And Williams reports even consultants who specialize in the field concede that "unless a company’s management accepts what it has learned and applies it daily, the impact will be negligible."

The Endangered Human Spirit

Each time a species becomes extinct, it not only lessens the world’s biodiversity, it takes a bit of our human spirit with it, according to Harvard professor E. O. Wilson. And although "humans are reassured by the thought of untrammeled wilderness," each year we destroy 42 million acres of tropical rain forest, write Betsy Carpenter and Bob Holmes in U.S. News & World Report.

As a result of our evolution and our basic genetic makeup, we have a natural affinity and reverence for living things--an attitude for which Wilson has coined the term "biophilia." University of Washington zoologist Gordon Orians and psychologist Judith Heerwagen support Wilson’s biophilia theory, as does Roger Ulrich, Texas A & M University environmental psychologist.

Orians and Heerwagen have found that landscape painters "harbor the aesthetic instincts of prehistoric hunter-gatherers." This is revealed in their works: They typically add water and make their forests more savannalike. And Ulrich reports that gallbladder surgery patients require fewer strong painkillers and recover more quickly if they can see trees, rather than brick walls, from their hospital rooms.

Although Wilson believes the most compelling reason to maintain the earth’s biodiversity is for our emotional health, another factor is important as well: the preservation of our ecosystem, which "we depend on to enrich the soil, modify the climate, even create the air we breathe."

Wilson admits that most ecosystems could lose a large percentage of their species yet continue to function, "at least in the short term." But he argues that ecosystems which remain diverse will flourish if the global climate changes.

In addition, Wilson sees each species as "a treasure trove of biological information encoded in its genes." If a species disappears, so does its biological information. We cannot afford to lose any species, each of which "is very good at something," note Carpenter and Holmes. "In destroying them we block the development of a host of potential medicines, crops, petroleum substitutes and fibers." Indeed, 40 percent of prescriptions filled by pharmacies are derived from plants, animals, or microorganisms.

Covering Uninsured Children

Incremental approaches to increasing the number of children with healthcare insurance can work, but the most effective policy changes may also be the most difficult to implement politically, according to a study published in JAMA.

In a simulation based on data from the March 1991 Current Population Survey and a 1991 survey by the Health Insurance Association of America, M. Susan Marquis and Stephen H. Long estimated the increase in the number of insured children that would result from three policy initiatives:

  • Mandatory employer-provided insurance. Of the three alternatives, this would have the biggest effect. The authors estimate that in 1991 "a broad mandate requiring all employees working 25 hours or more per week and their dependents be provided with health insurance . . . would have reduced the number of uninsured children by about 80%--from 8.96 million uninsured children to 1.81 million." However, exempting firms with 25 or fewer employees would significantly weaken the policy’s impact, reducing the number of uninsured by only about 40 percent.
  • Subsidies to lower the cost of family coverage. Because only 18 percent of uninsured children have parents with employer-provided insurance, this approach would have only a small impact, the authors predict. In 1991 subsidies cutting parents’ costs by 50 percent would have reduced the number of uninsured children of insured parents by only 13 percent--from 1.65 million to 1.44 million. A 75 percent subsidy would have lowered the number 20 percent, to 1.34 million.
  • Expanding Medicaid eligibility. An additional 2.7 million children would have been insured in 1991 if 1990 OBRA mandates extending coverage to most children in poor families had already been in effect. Expanding this mandate to include families with incomes below 150 percent of the poverty level would have extended coverage to "50% of all uninsured children and 75% of uninsured children of nonworking parents," the authors estimate.

Marquis and Long note that the politically attractive policy of creating incentives for voluntary participation in group insurance programs can have only a modest effect and that policies "targeted to the insurance status of the parents" are likely to have a greater impact. They suggest, however, that perhaps a more effective approach to healthcare reform might be "to sever the link between eligibility for health insurance coverage and its financing altogether," as in a single-payer national health plan. "The intricacies of the more incremental plans," the authors conclude, "and the eligibility gaps they would leave . . . explain the appeal of such alternatives."

Physicians Want More Time with Patients

Most patients would tell you their physicians do not spend enough time with them, especially when explaining new concepts. What these patients may not know is their physicians would also like more time to talk with them about issues such as treatment options, pharmaceuticals, and how to avoid certain diseases.

In a national study, public relations firm Manning, Selvage & Lee and Medical Advertising News found that only one-third of physicians responding to their survey are "fully satisfied with the amount of time they can spend with their patients." On average, physicians spend only 11 minutes talking with patients. Of the 210 physicians responding to the survey, 50 percent reported spending 10 minutes or less with patients. And 92 percent of respondents believed their patients "have some difficulty understanding their advice." The physicians estimated that only 45 percent of their patients "really understand what they tell them."

Many physicians blame their difficulty communicating on a lack of training. Only 21 percent indicated that their "medical school training in communicating with patients was completely adequate."

To better explain issues such as disease prevention and treatment, 89 percent of responding physicians give patients journal reprints, consumer magazine articles, and printed material from pharmaceutical companies and other sources.

Physicians also look to pharmacists as partners in patient communication. Respondents to the national survey estimated "that no more than 15 percent of their patients read package inserts for over-the-counter or prescribed drugs." Physicians noted that they appreciate it when pharmacists explain to patients how and when to use medications, describe side effects caused by certain drugs, and work with patients to prevent adverse drug interactions.


Copyright © 1993 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Trends and Ideas-March-1993

Copyright © 1993 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.