Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany.
Bielefeld University, School of Public Health, AG 3: Epidemiology and International Public Health, Bielefeld, Germany.
BMC Health Serv Res. 2022 May 23;22(1):689. doi: 10.1186/s12913-022-08058-3.
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.
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.
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%).
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.
由于移民背景、性别认同、残疾和年龄等多样性特征，人们对医疗保健的需求和期望各不相同。为了确保充分利用和提供高质量的医疗服务，这些需求和期望必须得到考虑。虽然已经存在解决多样性问题的方法，但对于医疗机构实施这些方法的程度，人们知之甚少。本研究旨在考察德国医院采用哪些措施和结构来解决多样性问题，以及在实施过程中遇到哪些障碍。
2019 年 5 月至 10 月，采用纸笔和在线问卷对所有注册德国医院（不包括康复医院；n=1125）的行政管理人员进行了混合模式调查。结果采用描述性进行分析。
共有 112 家医院的数据可用。虽然 57.1%的医院在其使命声明中解决多样性问题，59.9%的医院将多样性考虑纳入质量管理，但专门的工作组和多样性专员的比例较低（各为 15.2%）。大多数医院提供多语言入院和出院访谈（59.8%）、治疗或疗法（57.1%），但只有少数医院提供多语言膳食计划（12.5%）和研讨会或演讲（11.6%）。虽然 41.1%的医院只提供同性别的工作人员进行治疗和/或护理，但只有 17.0%的医院提供男女分开的团体治疗。根据管理人员的说法，主要障碍是缺乏财政资源（54.5%）、资金提供者缺乏激励（49.1%）和组织困难（45.5%）。其他报告的障碍包括决策者缺乏必要性的信念（28.6%）和工作人员缺乏动力（19.6%）。
只有一小部分医院的行政管理人员参与了我们关于多样性敏感性的调查。即使是那些参与调查的医院，目前也没有充分解决员工和患者的多样性问题。大多数医院在思想层面上解决多样性问题，实际措施并未广泛实施。现有的措施表明，大多数医院没有一个全面的概念来更广泛地解决多样性问题。主要报告的障碍与经济方面有关，缺乏组织和实施相应措施的支持，以及缺乏意识或动力。
