Promoting Diversity, Equity & Inclusion
Improving and promoting diversity, equity, and inclusion (DEI) is a crucial contributor to employee experience and retention. While fully addressing DEI in healthcare organizations is largely beyond the scope of this National Framework, we highlight some of the leading resources for promoting DEI in healthcare organizations in two key areas:
- Increasing health workforce diversity
- Establishing equitable and inclusive environments that address discrimination
Evidence
Health workforce diversity – including, but not limited to, racial, ethnic, and gender diversity - is associated with improved quality of care, increased innovation, better team communication and collaboration, and reduction of health disparities.1,2 Healthcare workers who are female and from marginalized racial/ethnic groups are more likely to experience discrimination and mistreatment. Physicians and residents from underrepresented minority (URM) groups reported experiencing microaggressions and facing greater scrutiny and harsher consequences relative to their non-URM counterparts.3,4 A recent report from the National Commission to Address Racism in Nursing found that 63% of nurse respondents reported that they have personally experienced racism and 64% of nurses who challenged racism in their workplace said their actions resulted in no change.5 Experiences of discrimination are further associated with a greater likelihood of experiencing burnout, greater turnover, and lower job satisfaction.6-8
Resources
Increasing the Diversity of the Health Workforce
Urban Universities for HEALTH is a partnership between the Coalition of Urban Serving Universities/Association of Public and Land-grant Universities, the Association of American Medical Colleges, and the NIH National Institute of Minority Health and Health Disparities. Featured resources include:
- Metrics Generator is an interactive, web-based toolkit to help university leaders measure efforts to build a diverse and culturally responsive health workforce.
- Holistic Admissions in the Health Professions is a report describing a nationwide study of the impact and use of holistic review.
- The Nurse-led Equitable Learning Framework offers guidance on growing, bolstering, and diversifying the nursing and public health workforces.
The American Association of Colleges of Nursing (AACN) provides resources for DEI, including:
- Supreme Court Decision on Affirmative Action: The National Response and Resources to Move Forward, which provides resources to help health professions institutions understand the impact of this decision and plan accordingly.
- Holistic Admissions page, which includes, AACN’s Holistic Admissions Tool Kit, Holistic Admissions Review Training, and Diversity and Inclusion Workshops
The Urban Institute report Improving and Expanding Programs to Support a Diverse Health Care Workforce discusses pathway programs as a promising strategy for increasing diversity in medicine. It describes academic enrichment programs, financial supports, social supports, and institutional policies necessary to support students from historically excluded groups.
Nguyen, et al.’s Revolutionizing Health Professions Admissions to Achieve an Inclusive Workforce recommends strategies across four key themes: admission metrics, aligning admission practices with institutional mission, community partnerships to fulfill social mission, and student support and retention.
Cultivating an Inclusive and Equitable Culture
Boatright, et al.’s A Roadmap for Diversity in Medicine During the Age of COVID-19 and George Floyd provides 6 recommendations for academic medical centers to acknowledge their roles in systematic discrimination, commit budget to support DEI, cultivate future talent, use a restorative justice framework, educate physicians to address the social determinants of health, and dedicate resources to recruit and retain faculty who have been historically underrepresented in medicine.
The Wharton School report Improving Workplace Culture through Evidence-Based Diversity, Equity, and Inclusion Practices examines seven categories of DEI practices and 12 workplace outcomes. It includes case studies and recommendations for organizations and middle managers.
Ibarra and von Bernuth in Harvard Business Review’s Want More Diverse Senior Leadership? Sponsor Junior Talent provide guidance on sponsoring junior talent for a more diverse leadership.
The National Association of Colleges and Employers provides resources for advancing equity, including:
- Conducting Effective Equity Audits Requires Asking Hard Questions, Planning to Address Findings website includes examples of the hard questions organizations should be asking and how to develop a plan of action to address equity issues.
- Diversity & Inclusion Self-Assessment, a tool to assess organizational diversity and inclusion. The Equity and Diversity Audit Tool for Canadian Medical Schools is a similar tool designed for medical schools.
For Good Measure: Current Best Practices in Tying Diversity, Equity, and Inclusion Metrics to Executive Compensation: This article discusses how some companies have incorporated DE&I metrics into their executive compensation design as a potential mechanism of accountability.
Spotlights
Holistic Admissions at UC Davis—Journey Toward Equity: UC Davis showcases they have been able to utilize holistic admissions to increase the diversity of their student population and recruit more students who are community-minded and interested in eventually practicing in underserved communities.
Atrium Health has been recognized as a best company for women and people of color to advance based on the organization’s policies and practices, which include conducting a formal pay equity plan, offering flexible work arrangements, prioritizing skills over formal educational credentials whenever possible, and establishing employee resource groups for employees of color and leveraging their feedback in policy and decision-making
Several universities have created systems for reporting instances of discrimination, harassment and bias, including University of New Hampshire and University of California- Los Angeles. Both systems allow anonymous reporting.
UCLA Health’s Health Equity Dashboard, which monitors the health system’s hiring, promotion, training, and contracting practices, including racial and other differences in patient and employee grievances, promotions, and vendors providing goods and services.
Emory University integrated a DE&I competency into their performance management process for managers and staff.
References
1 Gomez LE, Bernet P. Diversity improves performance and outcomes. Journal of the National Medical Association. 2019;111(4):383-392.
2 Farrell J, Brantley E, Vichare A, Salsberg E. Who enters the health workforce? An examination of racial and ethnic diversity. Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University. May 2022.
3 Osseo-Asare A, Balasuriya L, Huot SJ, et al. Minority Resident Physicians’ Views on the Role of Race/Ethnicity in Their Training Experiences in the Workplace. JAMA Netw Open. 2018;1(5):e182723.
4 Koech H, Albanese J, Saeks D, et al. Minority Resident Physicians’ Perspectives on the Role of Race/Ethnicity, Culture, and Gender in Their Surgical Training Experiences. Journal of Surgical Education. 2023;80(6):833-845.
5 National Commission to Address Racism in Nursing. Survey Shows Substantial Racism in Nursing. ANA. Published January 25, 2022.
6 Dyrbye LN, West CP, Sinsky CA, et al. Physicians’ Experiences With Mistreatment and Discrimination by Patients, Families, and Visitors and Association With Burnout. JAMA Netw Open. 2022;5(5):e2213080.
7 Hu YY, Ellis RJ, Hewitt DB, et al. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. N Engl J Med. 2019;381(18):1741-1752.
8 Nunez-Smith M, Pilgrim N, Wynia M, et al. Health Care Workplace Discrimination and Physician Turnover. J Natl Med Assoc. 2009;101(12):1274-1282.
