How Do You Tackle Equity? Start in the Middle.

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The Big Story: US News may add health equity to rankings – Why it took so long, and what analysts learned in the process

“Equity has not always been aligned with health organizations’ financial interests in a fee-for-service world. It is easier to observe inequity than to place blame for it. This has made it difficult to determine how much responsibility health systems should assume for improving equity.”

What It Means for You

What gets measured gets done.

That line – or some version of it – from management icon Peter Drucker could be the motto for health equity initiatives of every shape and size. Without measurement and people who can collect and respond to those numbers, progress on equity will continue to lag other strategic and mission-oriented efforts.

It can no longer lag behind. Long-running talk about equity is turning into action.  A cascade of recent moves reflects the remarkable convergence of energy and focus, shifting the topic of equity from well-intentioned talk to measurable imperative. New, metrics-driven pushes from organizations like U.S. News and Lown Institute, plus accreditation and regulatory directives from CMS and the Joint Commission, have set expectations and turned equity into a business imperative. There is lots to do and, appropriately, nowhere to hide from doing it.

As important as that focus is for both hospital operations and communications, we need to back up. Because health equity writ large cannot be achieved without laying the groundwork internally, through robust DEI work.

A strong workforce, built through comprehensive DEI efforts that are woven into the organization’s culture, is critical to then extend equity to the community it serves. If the makeup of your workforce doesn’t reflect the community you serve, and if your promise to your people doesn’t match your promise to patients, you cannot fully deliver on health equity.

How to do that? Start in the middle.

A recent Harvard Business Review article exploring DEI efforts within organizations maintains that middle managers are struggling to implement DEI strategies. This group of leaders is left with too many expectations and too little training, resources and autonomy. The result? DEI efforts continue to slog through molasses, leaving too many behind in the process. And in our experience, that sends ripples through a provider organization’s equity work.

Here are four thoughts on positioning your team to engrain and activate DEI efforts so that your workforce represents your community and that everyone is bought in, equipped and engaged.

Make the work action-oriented. A DEI strategy must extend beyond the board and C-suite to include physician leaders and clinical and administrative managers. They’re closest to your people, so involving them in the work and supporting them is necessary for any long-term success. They have the clearest perspective on the team, resources, partnerships and outcomes that are either in place or needed to get the job done. Bring them in to build and activate the plan.

Be specific but flexible. Give your managers clear directives about what you need them to accomplish. But let them decide how to go about accomplishing it. When communicating about a DEI strategy, be specific about what your organization is working to achieve, what your managers’ roles are in it and what resources are available to help them. Then afford your managers space to develop the action plan, deploy resources where they’ll be most effective and track both short and long-term success. Give them guardrails, then tools, then the space they need to operate.

Pick a number. Back to the Drucker quote. Peter Drucker said it best: “What gets measured, gets improved.” But don’t get carried away. Consider another axiom: “If everything is a priority, nothing is.” So, pick a couple of KPIs that feed into your larger strategy and work towards those specific benchmarks. That will keep your priorities crystal clear and avoid mission creep.

Bear in mind, though, that, metrics shouldn’t only be about final outcomes. There should be benchmarks for effort and progress. That’s especially true for internal DEI work where the expectations may not be as defined as they are for health equity. Involve middle managers. They can, for example, help you find ways to measure for inclusion, equity and engagement, not just diversity numbers.

Safety first. Support your managers with the right resources, tools and education. Then, per the HBR article, create safe spaces for conversations. Consider carving out time for managers to meet in closed groups to share experiences, connect on topics they may be dealing with and ask the hard questions. Forums such as these will show managers that their perspective and work is valued, and that the organization truly listens and supports them in that work. That, in turn, will encourage them to take even more initiative in advancing equity and DEI, spinning the flywheel ever faster both inside and out of the organization.

Throughout all this work, robust communications are a must. Be ready to strengthen internal communications to show everyone within your organization the work you’re doing, how each person has a role in it, any new efforts or responsibilities placed on a segment of your workforce – such as middle managers – and how the work will lead to more pride in your organization and greater service to the community. Communicate consistently so that people understand the work and begin to see DEI not as a standalone initiative but embedded within the organization’s mission.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

Jarrard Inc.
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