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Rural Health Information Hub

Committing to Building and Retaining a Diverse and Inclusive Workforce to Improve Health Equity

Increasing diversity, inclusion, and representation in the healthcare workforce is a key objective of the U.S. Department of Health and Human Services' Health Workforce Strategic Plan. Rural organizations should consider the composition of the workforce throughout the organization, from staff directly serving community members to leaders with decision-making power. Rural organizations can commit to hiring staff who reflect the diversity of their local communities that experience inequities. In Ensuring a Diverse Workforce: A Guide for Inclusive Hiring Practices, the State of Colorado provides several recommendations for ensuring that the workforce represents the community it serves.

Some workforce recruitment and retention strategies to support a diverse workforce could include:

  • Offering job training to increase opportunities for individuals to access high-quality jobs
  • Examining hiring practices and processes to identify opportunities for recruiting prospective employees that reflect the community, such as posting job openings in different locations and partnering with community organizations
  • Making lived experience or experience working with populations that experience inequities a job priority or requirement
  • Including a commitment to diversity and inclusion in the job posting
  • Training staff to recognize how biases can affect hiring decisions and long-term retention of staff
  • Fostering an inclusive workplace culture that makes all staff feel a sense of belonging
  • Offering opportunities for training, mentorship, and advancement

Many rural organizations employ community health workers to serve their communities. Community health workers, such as promotoras/lay health workers, share characteristics and connections with the communities they serve. Rural communities are also investing in pipeline programs to develop the rural workforce. The Social Determinants of Health Toolkit discusses pipeline programs in the context of High School Completion Programs and Workforce Development and Human Capital. The Education and Training of the Rural Healthcare Workforce topic guide also provides an overview of programs to develop the health workforce.

Examples of Rural Communities Building Diverse and Inclusive Workforces

  • Southeast Arizona Area Health Education Center (SEAHEC) worked closely with community members of Winchester Heights in rural southeast Arizona to train and build capacity among CHWs to serve their community in various ways. The role of the CHWs has grown from disseminating health information to organizing for changes in community infrastructure to support the health of residents.
  • FORWARD NM Pathways to Health Careers in rural New Mexico offers several services to create a workforce pipeline. The program provides opportunities for rural middle and high schoolers to learn about healthcare professions and receive additional educational support. FORWARD NM has also hosted thousands of rural rotation experiences for students from a range of professional healthcare disciplines.
  • Dakota County in Minnesota is working to build a staff that reflects the diversity of their community. One strategy the county is using to support diverse staff is Employee Resource Groups (ERGs), which are voluntary groups based on common identities or characteristics that help create supportive spaces for employees and foster inclusion. ERGs can also offer opportunities for professional development. The six ERGs at Dakota County include 1) the Black Employee Network; 2) Women Offering Mentoring, Expertise and Networking; 3) Persons with Health Restrictions or Disabilities; 4) Saluting our Stars (focused on veterans, members of military, and their families); 5) United and Proud! (focused on LGBTQ+ communities); and 6) Young Professionals.

Questions for Consideration

  • What are the current hiring practices in place? Are these hiring practices attracting staff that reflect the community served in terms of age, sex, race, ethnicity, disability status, and/or veteran status?
  • Are there any existing partners that could help with recruiting diverse staff? Would any new partnerships help recruit staff from communities that experience inequities?
  • What are the current retention strategies in place? What is the retention rate of employees from different backgrounds? What additional retention strategies could help support staff from diverse backgrounds?

Program Clearinghouse Examples

Resources to Learn More

Common Choice Points
Lists common decision-making opportunities that leaders may face. Includes a set of questions focused on hiring that affect organizational equity.
Organization(s): The Management Center

Health Equity and Racial and Ethnic Workforce Diversity: How to Address the Shortage of Racially and Ethnically Diverse Health Professionals
Describes strategies for increasing workforce diversity with lessons learned from the Equality in Health (EIH) initiative funded by The Colorado Trust.
Author(s): Shimasaki, S. & Walker, S. F.
Organization(s): The Colorado Trust
Date: 2015

Health Equity Snapshot: A Toolkit for Action
Provides strategies to help hospitals and health systems advance healthcare equity. Discusses the importance of increasing diversity and inclusion in leadership positions, such as hospital boards.
Organization(s): American Hospital Association
Date: 12/2020

In Rural Oral Health, Equity Starts with Workforce Diversity
Interview with Eleanor Fleming, associate professor at the School of Dentistry at Meharry Medical College, on strategies to advance rural oral health equity.
Organization(s): National Rural Health Association
Date: 6/2021

Public Sector Jobs: Opportunities for Advancing Racial Equity
Discusses approach to improving workforce equity within local government, including workforce development strategies.
Author(s): Nelson, J. & Tyrell, S.
Organization(s): Local and Regional Government Alliance on Race and Equity
Date: 2/2015