Special Report

What Gets Measured Gets Managed: An Update on DEI in Healthcare

by David Shifrin

Healthcare and society are now two years into a period of renewed focus on improving diversity, equity and inclusion for both those employed within healthcare and those served by it. The hope, after devastating inequity and bias were brought to light through the pandemic and George Floyd’s murder, is that this “period” will in fact be permanent. It’s well past time to finally solve the lack of diversity within the upper echelons of healthcare and the gaping chasms in access and health equity between white and Black (as well as brown) populations.

So, then, what progress been made in the past two years? Is momentum being maintained towards bringing more Black voices and experience into healthcare, not just in word but also in deed through investment of FTEs and financial resources?

With the second federally-recognized Juneteenth holiday just passed on Sunday, the Jarrard Inc. DEI team, which operates under the Kaleidoscope name, wanted to get a sense of what’s happening across healthcare.

To do that, we sent questions out to some of our expert friends from across the industry whose work centers on DEI in healthcare – and beyond.

Every contributor reminded us that representation matters – it’s table stakes. And several pointed out the importance of organizations and leaders meeting people where they are by developing initiatives that fit with how those affected already live. That, rather than trying to pull people in and putting the burden on them.

Here are six themes from our conversations. Full quotes from the interviewees can be found below.

General Themes

Data: What gets measured gets managed. DEI can’t be a nice-to-have or a soft goal or a PR stunt. It’s an imperative both for business success and fulfillment of mission. And leading healthcare organizations are using data to develop, implement, review and revise their DEI work. Otherwise, it withers on the vine.

Time: There aren’t shortcuts to getting DEI right at the institutional level. It takes patience and the intentional effort of seeking out every voice and then build effective plans. That holds true for one-on-one relationships, too. We can all stand to take time to build trust and find common ground with each other.

Resources: Progress demands the ongoing expenditure of resources and the commitment of talent. Not only that, but a reporting structure that makes sense and keeps DEI interwoven with the rest of the organization, not standing alone off to the side as a box-checking exercise. This looks obvious on paper, but for too long the dots have remained disconnected.

Mission: Leading organizations, and those making marked progress, connect diversity, equity and inclusion directly to their overall mission to serve everyone. Not that it doesn’t require intense, intentional effort, but DEI isn’t viewed as an initiative but as a fundamental element of who the organization is.

Workforce

Talent: There’s been some progress here. Healthcare organizations are building programs and forming partnerships to develop a more diverse next generation of healthcare workers and leaders from the beginning of their career or even before during their education. More work is needed, though – It’s time to double down, not level off.

Leadership: Increasing Black representation in upper leadership has stalled out. It’s a challenging effort because opportunities for Black professionals and other underrepresented groups to grow into those roles have been limited. We have an obligation to do more to dismantle barriers and invest more in creating those opportunities.

Nicole Mitchell, MBA, CDP

Chief Diversity & Inclusion Officer

Cedars-Sinai

How do you apply a lens of racial equity to your work?

The creation of my role and the Office of Diversity & Inclusion provided Cedars-Sinai the opportunity to bring inclusion and the racial equity lens to all aspects of the organization. This is important to ensure we are creating a sustained movement towards equity. Though we have more work to do, I do believe we are making strides by taking a step back and asking hard questions during our evaluation process of images, policies, etc.

As we continue our DEI journey, we are also creating a shared language across the organization around foundational terms in this space – diversity, inclusion, belonging, health equity, equity v. equality, etc. – and a recent part of our evolution we have recently started to adopt and utilize the AMA/AAMC Center for Health Justice Advancing Health Equity: A Guide to Language, Narrative and Concepts to guide our work.

What approaches have you found to be successful in helping to enhance DEI and belonging in an organization, and have those approaches evolved over the past couple of years?

Three things have been critical to our journey:

  1. Continuing to evolve, strengthen and review the data to help set goals, guide discussions, and hold us accountable for success. Historically, clear, data-driven metrics and goals were not thought about as relating to DEI. However, organizations now realize that DEI is a strategic business model, and we are seeing an evolution in the importance of measurement and focus.
  2. Consistent listening is vital. We’ve created open dialogues, led hard discussions and realized that we cannot make progress without ensuring all voices are heard. This is something that we did in the beginning of creating our strategy. We continue to look at survey data by demographics within the organization to understand where we can do better, launching employee groups and physician affinity groups to allow for community building and open discussions to direct our work and ensure we continue to listen to the community and patients – the reason we are in healthcare.
  3. Ongoing education around bias and inclusive leadership. In 2021, we created and implemented a mandatory annual requirement for unconscious bias (UB) education for every employee at Cedars-Sinai. There is talk in the community about whether UB education is effective, and I can tell you, it has helped us continue to create the shared language that empowers people to speak up and point things out.

Where are we seeing the most progress in the professional development of Black Americans in the healthcare industry?

There has not been as much progress as we would hope. My perception is that we are seeing either a plateau or decline in Black representation. There are some areas where we have seen improvements, for instance at Cedars-Sinai in our Director and VP levels of management we’ve seen more diverse representation, and specifically Black representation, but across the industry we have much work to do in the most senior levels of leadership and in the physician populations.

However, where I do see the most change and commitment is around pipeline development and engagement of BIPOC employees. Organizations like Black Men in White Coats, a group we are partnering with to bring their Youth Summit to Los Angeles, are working to expose youth to careers in medicine and healthcare in general. We’ve also done strategic resident and fellow recruitment to ensure we are helping to change the pipeline of physicians here in our own community. Community building related to the engagement of BIPOC and other diverse employee communities continues to grow, which helps bring more exposure of Black and other historically marginalized communities to healthcare which is very exciting.

How are you seeing socio-political differences mediated in politically diverse organizations going through DEI change?

This is a hot topic and something that is an ongoing challenge and debate. When it comes to DEI, it’s typically seen as “liberal” work, but being true to this work includes ensuring ALL viewpoints are at the table, which can be difficult and in these charged times very hard. From my perspective, the first step is to continually remind ourselves that diversity includes diversity of thought, experience, background, and, yes, political viewpoints. And whether you agree with a differing perspective or not, we must create safe spaces to listen and learn.

For Cedars-Sinai, what has been successful is coming back to the foundation of who we are as an organization. Cedars-Sinai was founded to ensure that the most marginalized individuals had a place to train and be cared for, when society was not as welcoming. So, during these difficult times, we’ve found ourselves reflecting, talking and reconnecting about why our organization was started. This has allowed us to ask different questions, institute full organizational unconscious bias education and find ways to have DEI discussions in many different respects. It has still been challenging, but this work is necessary for us to move forward and build bridges. And quite frankly, as an academic medical center, if we aren’t thinking about these things and finding ways to make progress towards retention, pipeline and recruitment, then we are not living up to our DEI vision. This means quality care and research for all, by all.

Talk about the “how” and “why” of your organization’s commitment to understanding and advancing the pursuit of health equity

The why is easy and goes back to a common language of defining health equity – working to ensure full and equal access to health services that allows for the attainment of the highest level of health for all persons with regard for their unique differences that enables them to lead healthy lives.

We know that when we begin to use a lens of racial equity, we begin to break down historic barriers that have led to health inequities. That, in turn, results in a healthy community. We have a health equity strategy focused on 4 populations – employees and volunteers, patients, community, medical staff – having goals around each area that affects health equity. We have also created and are evolving a health equity dashboard where we look at health metrics, such as stroke rates and colorectal cancer screenings, by race/ethnicity/gender.

Our commitment to this work continues to be deepened through the new addition of Dr. Christina Harris, who will succeed Dr. Linda Burnes Bolton as our Chief Health Equity Officer.  We will work closely to ensure equity and inclusion to build a healthier community together, which is exciting work and why we’re all here!

Robert Lawrence Wilson

Founding Partner & Chief Strategy Officer

Culture Shift Team

How do you apply a lens of racial equity to your work?

Culture Shift Team carries out DEI work for clients ranging from large corporations to small nonprofits. Racial equity is often a foundational or focus area with these organizations.

What approaches have you found to be successful in helping to enhance DEI and belonging in an organization, and have those approaches evolved over the past couple of years?

We tend to be very data-oriented as a first step. That includes both quantitative and qualitative approaches. The qualitative elements focus on listening to employee experiences, especially those of your most underrepresented populations.

How are you seeing socio-political differences mediated in politically diverse organizations going through DEI change?

It’s important that we build the skill of listening to and sitting with experiences different from our own. In a politically divided America, that is more important than ever. It is on all of us to hang in there with the conversation when something is hard to hear, and take the time to get to know one another well enough to find common ground.

Talk about the “how” and “why” of your organization’s commitment to understanding and advancing the pursuit of health equity

My organization works to create more equity within healthcare research trials. If we are truly committed to better outcomes, we can’t say we are truly committed to better outcomes and not develop an equity mindset in how we deliver care and how we think about researching and solving some of the endemic issues plaguing our communities.

Kathy Poston

Principle & VP Client Delivery

Just Health Collective

How do you apply a lens of racial equity to your work?

At an individual level, I work to increase my awareness of my unconscious biases and how they may be affecting my views. That awareness allows me to pause and reflect on how I may be thinking or reacting, which provides an opportunity to change. At a broader institutional or system level, I am always looking at opportunities to evaluate policies or processes that may have a disparate impact.

What approaches have you found to be successful in helping to enhance DEI and belonging in an organization, and have those approaches evolved over the past couple of years?

There are a couple of approaches that are most successful for organizations wishing to advance belonging (the intersection of diversity, inclusion and equity). The first is to educate employees at each level of the organization on topics that currently may be barriers to creating a culture of belonging (ex: unconscious bias, the power that privilege holds, the effects of system racism). Secondly, conduct a qualitative and quantitative comprehensive assessment, which serves to enable an understanding of current performance, identify gaps and create a plan for transformation. A natural evolution that we have seen is for those organizations that have executive leadership support and are making belonging and health equity initiatives a strategic priority, to begin their implementation journey of transformation.

Where are we seeing the most progress in the professional development of Black Americans in the healthcare industry?

Organizations are becoming increasingly more intentional in creating a path to leadership for emerging under-represented leaders through a greater understanding of the importance of equity as a foundation for leadership. This is being accomplished by developing competencies and capabilities of both emerging and current leaders, providing support through mentoring, allyship, and sponsorship and by supporting participation in leadership networks, providing learning opportunities and by promoting these emerging leaders outside of the organization as well.

How are you seeing socio-political differences mediated in politically diverse organizations going through DEI change?

When organizations work to establish a culture of belonging and embed belonging in every aspect of the institution, employees have a greater sense of psychological safety. This translates to an environment that allows seeing others through a lens of empathy, creates the ability to know colleagues as individuals, to listen to their lived experiences and engage in respectful dialogue from a place of non-judgement and willingness to listen to opinions that differ from our own. We see progress being made when leadership promotes the importance and expectation of belonging and puts appropriate resources in place to support it.

How do you apply a lens of racial equity to your work?

Empathy fuels my approach. I make sure I take the time to extend myself to others by trying to imagine things from their perspective. This helps keep me focused not on my own objectives and goals but rather the impact of what I do on others. And because Belonging is one of my core values, taking this empathy-centered approach stays top of mind for me and my team daily.

What approaches have you found to be successful in helping to enhance DEI and belonging in an organization, and have those approaches evolved over the past couple of years?

Incorporating inclusion and belonging as a philosophy or mindset, rather than a training. Many organizations put their teams through training sessions. People learn and reflect, but quickly go back to operating as business as usual. Brands that have made the biggest progress and achieved the most sustained transformation are those that not only conduct training but also take the time to build action plans, policies, goals, and engage in ongoing support to shift mindsets and help create internal shifts within the organization.

Where are we seeing the most progress in the professional development of Black Americans in the healthcare industry?

I don’t have numbers when it comes to healthcare. Broadly, though, we need to see more professional development in all areas. Representation matters – and thus there needs to be adequate representation in all areas of healthcare that impact patients – that exists both on the front lines, in industry, and other professional services.

How are you seeing socio-political differences mediated in politically diverse organizations going through DEI change?

The best conversations and transformations happen with the brands/organizations that have incorporated DEI into their core values. That’s the only way to move it forward and to de-politicize it. Otherwise, it feels like a distraction (according to a number of senior executives in a Momentive survey), and something that is reactive to what is happening socially, rather than a business imperative. When it is part of the company’s values it becomes connected to everyone’s job. It also makes conversations about DEI easier because it focuses the discussion on “advancing the business” rather than advancing an “agenda”. That, in turn, often makes it easier to enroll people who have been slow to get on board with DEI in the past.

Mark Wenneker, MD, MPH

Principal, Behavioral Health Segment Lead

The Chartis Group

What is the current state of health equity when it comes to behavioral health?

There is a growing body of research demonstrating the relationship between social determinants of health, particularly income, on both the prevalence of behavioral health conditions and access to care. For example, if you are between the ages of 20-54, your chances of developing a mood disorder is 1.8x (80 percent) higher if you are in a family with a lower household income. Suicide risk is also increased for lower income individuals aged 20-54.

COVID-19 has exacerbated the problem. A Kaiser Family Foundation Study found that Black and Hispanic adults were more likely than white adults to report symptoms of anxiety and/or depressive disorder during the pandemic.  Notably the rate for all racial/ethnic groups has significantly increased. In fact, it has more than doubled.  However, the discrepancies were most pronounced for minorities.

How are provider organizations responding to these disparities?

In our work supporting health systems in building more accessible behavioral healthcare programs, the issue of equity is receiving increasing attention. For example, in recent work we’re doing with a prominent children’s hospital, underserved communities are an important focus of where to add mental health resources, including school-based clinics.

What's happening in terms of the broader conversation around health equity and behavioral health?

On a national scale, it is notable that Behavioral Health Professional Organizations are now speaking out. The American Psychiatric Association issued a public apology for its historic role in supporting structural racism in psychiatry, including influencing how patients were diagnosed with severe mental illness such as schizophrenia. The American Psychological Association issued a set of guidelines to its professionals that emphasized greater awareness of how race influenced behavioral health and the care needed to addresses the real needs and issues related to racism.