Contributions to the literature
-
Provides a detailed examination of how DEIB top-level leaders implement DEIB interventions that are a part of healthcare delivery organization’s strategic plans.
-
Identifies the top-level DEIB leader as the champion of implementing organizational DEIB interventions.
Background
Theoretical framework
Strategy implementation framework
Methods
Participant eligibility, recruitment, and data collection
Interview guide
Analytical approach
Results
Characteristic | % of recorded respondents |
---|---|
Gender | |
Female/woman | 59% |
Male/man | 41% |
Race | |
Black/African American | 70% |
White | 7% |
Latino/a | 7% |
Asian | 7% |
Multiracial | 7% |
Sexual orientation | |
Heterosexual/straight | 88% |
Homosexual/gay | 8% |
Other | 4% |
Degree type | |
Business (MBA, MHA, MHRM, PhD) | 42% |
Other non-PhD (MPH, MSW, etc.) | 23% |
Non-Business PhD | 19% |
MD | 12% |
JD | 4% |
Direct supervisor | |
Chief Executive Officer/President | 48% |
Chief Human Resources Officer/Chief Administrative Officer | 19% |
Not applicable—Consultant Role | 7% |
Chief Diversity Officer | 7% |
Vice President of Community Health | 7% |
Chief Physician Officer | 4% |
Vice President of Population Health | 4% |
Vice President of Strategy | 4% |
DEIB implementation strategies | Examples identified by participants | Mapping to ERIC implementation strategies | Relevant literature |
---|---|---|---|
People | |||
Talent recruitment, and retention: | - Tailor recruitment and retention policies and incorporate inclusive practices to these policies - Provide technical assistance and consultation to writing job advertisement and job descriptions to ensure language is inclusive - Change guidelines to include equitable search processes - Develop a formal implementation blueprint for how the organization will embody inclusive strategic human resource management | - Provide ongoing consultation, conduct educational meetings - Develop a formal implementation blueprint - Recruit, designate, and train for leadership | |
Employee learning: | - Develop and distribute corporate learning materials to support DEIB interventions to train and educate stakeholders - Integrate DEIB-related training into the existing corporate learning system - Develop incentives to encourage DEIB corporate learning within the organization | - Distribute educational materials - Alter incentive/allowance structures | |
Employee resource groups: | - Formalize ERGs within organization to support DEIB dissemination - Allocating budget to ERGs - Adopting ERG representation within corporate governance to serve as champions | - Use advisory workgroup - Utilize financial strategies - Identify and prepare champions | |
Formal workforce development and talent pipeline | - Develope resources that allow employees from minoritized populations to develop skills that will enhance their future job growth and enter leadership roles - Lead leadership training programs targeted at employees who are part of minoritized populations and/or traditionally under-represented within leadership - Adopt mentoring and coaching programs for employees from minoritized populations to identify | - Distribute educational materials - Conduct educational meetings - Recruit, designate, and train for leadership | |
Engaging top-level leaders: | - Promoting importance of the DEIB interventions to other health system leaders, such as the Board of Trustees and CEO through formal and informal channels - Developing one-on-one relationships with board members to share knowledge and expertise related to DEIB topics and gain support | - Facilitation - Obtain formal commitments - Involve executive board - Build a coalition | [48] |
Health Equity | |||
Reduce disparities in clinical outcomes, access, and patient experience | - Establish a committee of clinical leaders to identify barriers minoritized populations experience when equitable health care in their organizations - Inform clinical leaders of expectations regarding the incorporation of health equity into clinical care - Establish a regular operating routine for reviewing health disparities and health equity data from their organization - Identify and document what mid-level leaders and frontline staff are already doing to address disparities in clinical outcomes and access and establish future goals for these initiatives | - Build a coalition - Inform local opinion leaders - Identify early adopters - Capture and share local knowledge - Change records systems | |
Health equity research | - Creating a research center for Health Equity with a mission to support research focused on alleviating healthcare inequities - Creating systems and providing research support for clinicians engaging in health equity research - Identifying research agenda for the organization that advances the DEIB interventions | - Build a coalition - Capture and share local knowledge | |
Language translation services | - Evaluating outcomes and experience utilizing existing translational services and identifying opportunities for growth - Incorporating translation services outcome metric into organization scorecard - Conduct a needs assessment to identify opportunities for creating patient-related materials (handouts, signage, patient portals) that are easily understood and use inclusive language - Ensuring that health system translation services are equitable and accessible to all patients - Managing translational services staff | - Audit and provide feedback - Change record systems - Facilitation - Conducting local needs assessment | |
Community health outcomes evaluation | - Identifying metrics to monitor population health outcomes within underserved communities or communities with large minoritized populations - Incorporating community health metrics into the organizational performance evaluation - Reporting community health outcomes of under-served populations or minoritized populations | - Develop and implement tools for quality monitoring - Change record systems - Audit and provide feedback | [54] |
Monitoring and Feedback | |||
Board engagement | - Presenting at board meetings on key DEIB priorities and/or initiatives within the organization - Establishing relationships with board members and board sub-committees to support the engagement of boards of DEIB issues - Serving as DEIB subject matter expert to board | - Facilitation - Promote adaptability - Involve executive board - obtain formal commitments | [55] |
DEIB scorecards | - Developing key metrics that provide evidence of DEIB implementation success in the organization - Establish sources of data and reporting routine to regularly obtain data on health equity outcomes on time - Mapping data within systems to support scorecards | - Purposefully reexamine the implementation - Develop and organize quality monitoring system | [56] |
Listening sessions | - Events with organization leaders and employees present to support opportunities to voice thoughts about organizational culture and areas for improvement - Engage in listening sessions after critical events | - Conduct local needs assessments - Obtain and use patients/consumers/and family feedback | [57] |
Operational Planning and Communicating | |||
Negotiating the DEIB leader role | - Working with other organization leaders to demarcate specific responsibilities of DEIB position and determine workplan for areas of overlap between roles - Negotiate with other top-level leaders on how to partner on implementation strategies which require collaboration | - Facilitation - Inform local opinion leaders | [58] |
Building collaboration to support sustainable change | - Meeting with employees across the organizational hierarchy to support buy-in - Developing buy-in with top-level leadership team | - Build a coalition - Conduct local consensus discussions | |
Developing DEIB personnel infrastructure | - Hire and train DEIB leader direct reports - Establish staffing needs to support DEIB implementation strategies - Gain access to funding to hire DEIB staff through organization’s budget process | - Centralize technical assistance - Develop a formal implementation blueprint - Access new funding | [61] |
Developing governance structure | - Building a framework for the implementation and maintenance of DEIB interventions - Establish DEIB leadership committee and document guidelines for committee - Building routines/processes and organizing meetings that support effective decision-making of DEIB issues | - Use Advisory boards and work groups - Provide interactive assistance | |
DEIB consultation to support DEIB strategies | - Meeting with organization leaders to support other leaders’ specific DEIB priorities or initiatives - Engage in tacit knowledge to support change management processes - Serve as a consultant and subject matter expert to support systematic integration of DEIB into all levels of organization - DEIB top-level leader establishes themselves as the DEIB resource and subject matter expert | - Provide local technical assistance - Facilitation - Inform local opinion leaders - Centralize technical assistance | |
External Engagement | |||
Community engagement | - Meeting with community leaders to assess social needs and creating a plan to alleviate them - Collaborate with the organization’s existing community engagement team to identify opportunities to improve engagement with communities with large populations of minoritized populations | - Build a coalition - Conduct local consensus discussion | [54] |
Supplier diversity | - Sourcing hair and skin care that meets the needs of minorized populations - Collaborating with finance/purchasing team to diversify organization’s suppliers - Establishing sourcing targets related to engaging with a diverse group of 3rd party partners | - Mandate change - Change physical structure and equipment |
DEIB leader as the champion
DEIB implementation strategies led by the DEIB leader
People
From a talent acquisition perspective, we want to make sure we have the broadest reach that we possibly can we're casting our net we're focusing on recruiting within our communities, so that the people that we recruit look like the communities that we serve. (Participant #7)
So, for instance, last year, part of one of our balanced scorecard priorities was providing bias awareness training to all colleagues, so my team in conjunction with our learning and organizational development team select the content and then came up with the method through which we were going to distribute that to people across the system. (Participant #4)
I am someone now who can help with that and create a strategic plan for those employee resource groups that is tied to our strategic, [organization’s name] overall strategic plan, so they’re not just clubs hanging around hanging out going to happy hour, they have the business case and business initiative, that are connected to what we do as a system. (Participant #15)
We have been able to identify and develop high potential employees, so we are creating a talent pipeline, so trying to figure out like, we have a CEO development program that we want to diversify. And because that we’ve identified our key hospital management positions as those having an opportunity to have more diversity. (Participant #13)
So, I learned my first year that our leaders were not comfortable. So, this year we’re focused on leadership development around these topics because they’re not comfortable talking about culture, talking about race and ethnicity, talking about inclusion or any of those areas. I mean I'm not saying all leaders, but we got quite a few that are not... (Participant #23)
Health equity
kind of like what the DEI looks like for our patients and families, and then even our community so like, you know, a large scope of my job right now is really thinking about health equity, you know what would that look like for [organization name removed], how do we think about, you know, launching or at least, creating an inventory of all the health equity work across the hospital (Participant #22)
And I envisioned that the Center for Health Equity would become the research and evaluation arm of this work. Given that we have talent all across campus, my hope is to be able to tap into that talent and interest, including you, obviously, so that we can begin to create a vibrant phase of work of scholarship and in the broad areas of health equity across social and economic, psychological, and physical health domains. (Participant #24)
I am fully responsible for language services across the system, so interpretation and translation. (Participant #19)
We do robust measurement of the community health, I’ll call it the dashboard that we use that we ourselves developed in partnership with a with a nonprofit organization, is all about underpinnings of equity and health related disparities, so not just medical care disparities, but more particularly social and economic disparities, health behavior disparities, physical environment disparities, as well as disparities and clinical care which is primarily… Access and quality related based on social and economic factors to include race, ethnicity, sexual orientation, gender, all those things, right. (Participant #8)
Monitoring and feedback
Sure, I have presented both to our system level boards and we also have hospital advisory boards that I’ve done some presenting with as well. And so far, because of the timing that has happened virtually, I look forward to the opportunity now that we can start kind of having those meetings in person to be able to do so in person. And so you know I think it’s I was a good experience that I was invited back (Participant #10)
So, we have a balanced scorecard that we use to govern our entire organization. In one of the quadrants is the culture quadrant, and so our DE&I and culture data is input into that quadrant. And that is reported out on a quarterly basis, and then on an annual basis. And the metrics in that quadrant drive compensation. (Participant #12)
We did [removed] listening sessions… And it was really leaders that had to get out of their comfort zone because they didn’t know me, and so I was a complete stranger telling them that they had to do something that they’ve never done and do it in a very vulnerable, authentic way because it was a real moment right and so not to oversell what we were going to do, but we accelerated what we had to do because out of those listening sessions. (Participant #18)
Operational planning and communicating
I think my responsibility is to help identify ways to support and amplify the work that’s working that’s going well, and also to measure what’s working well, and to be able to be really transparent about where we need help by looking at the numbers of like retention and things and courses. So but I don’t feel like I’m in it by myself. I feel like everybody is kind of doing stuff, and but they what they really could use is some support in terms of knowing what other people are doing and coordination across all of these different elements (Participant #29)
I would say I wouldn’t have any success if I didn’t have the relationships that I have... and when I mean collaboration, I really want folks to understand that this is critical to not just my role, but also the roles that they are individually serving as well (Participant #17)
So, it’s just a matter of how you organize it, but I would say unequivocally we’re not adequately resourced now based on the breadth of what we want to do, but we do have some open positions that we’re trying to get filled. (Participant #8)
I’ve recruited a number of individuals to create a governance structure … and so we created a governance of diversity and equity committee for them, share the framework, um, walking hand in hand with them in terms of setting goals for their campus that are aligned with the overarching goals of the equity plan at the organization (Participant #21)
I’m a part of a huge organization and there’s only two of us, so I can’t lead everything, I can't be a part of everything. So, that’s why I really kind of want to act as a consultant to some of these leaders to help get them up to speed (Participant #13)
External partners
I help to inform a strategy, support the synergies that are necessary because what we find is that the community wants certain things, and the hospital designs things in a different way. So, how do we make those much more closely aligned, so that there is more impact for the limited resources that we actually have, both the community in organization. (Participant #21)
The supplier person has kind of a dotted line to me and I consult a lot on the way they’re collecting those kinds of data and then how they’re thinking about a long-term plan for some of our suppliers. (Participant #30)