title: How should health service organizations respond to diversity? A content analysis of six approaches.
abstract: BACKGROUND
  Health care organizations need to be responsive to the needs of increasingly diverse patient populations. We compared the contents of six publicly available approaches to organizational responsiveness to diversity. The central questions addressed in this paper are: what are the most consistently recommended issues for health care organizations to address in order to be responsive to the needs of diverse groups that differ from the majority population? How much consensus is there between various approaches?
  
  
  METHODS
  We purposively sampled six approaches from the US, Australia and Europe and used qualitative textual analysis to categorize the content of each approach into domains (conceptually distinct topic areas) and, within each domain, into dimensions (operationalizations). The resulting classification framework was used for comparative analysis of the content of the six approaches.
  
  
  RESULTS
  We identified seven domains that were represented in most or all approaches: organizational commitment, empirical evidence on inequalities and needs, a competent and diverse workforce, ensuring access for all users, ensuring responsiveness in care provision, fostering patient and community participation, and actively promoting responsiveness. Variations in the operationalization of these domains related to different scopes, contexts and types of diversity. For example, approaches that focus on ethnic diversity mostly provide recommendations to handle cultural and language differences; approaches that take an intersectional approach and broaden their target population to vulnerable groups in a more general sense also pay attention to factors such as socio-economic status and gender.
  
  
  CONCLUSIONS
  Despite differences in labeling, there is a broad consensus about what health care organizations need to do in order to be responsive to patient diversity. This opens the way to full scale implementation of organizational responsiveness in healthcare and structured evaluation of its effectiveness in improving patient outcomes.
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands. m.c.seeleman@amc.uva.nl.
authors.forename: Conny
authors.initials: C
authors.lastname: Seeleman
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands. m.l.essink-bot@amc.uva.nl.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands. k.stronks@amc.uva.nl.
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.affiliation: Centre for Social Science and Global Health (SSGH), University of Amsterdam, Amsterdam, The Netherlands. J.D.Ingleby@uu.nl.
authors.forename: David
authors.initials: D
authors.lastname: Ingleby
mesh_terms: D001315:Australia; D002983:Clinical Competence / Q000592:standards; D003256:Community Participation; D018864:Cultural Diversity; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D005006:Ethnicity; D005060:Europe; D006282:Health Personnel / Q000592:standards; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D015279:Organizational Culture; D016134:Organizational Policy; D009938:Organizations / Q000592:standards; D010358:Patient Participation; D028701:Patient Rights; D011787:Quality of Health Care; D014481:United States