Create a Strong Workforce Through Diversity, Equity, and Inclusion

Healthcare executives share how their organizations have implemented a more diverse and inclusive space for their workforce and the community they serve, with results to prove it works.

Editor's note: This article appears in the September/October 2021 edition of HealthLeaders magazine.

Numerous hospitals and health systems have ramped up their diversity, equity, and inclusion (DEI) initiatives due to the COVID-19 pandemic, which has shined a spotlight on the glaring health inequities in the country, and the social unrest during 2020.

Alongside of this, healthcare leaders have become increasingly aware of how important it is to have a diverse workforce and C-suite that represents different perspectives in the workplace and reflects the diverse patient populations that an organization serves.

Three healthcare executives share how their organizations have implemented initiatives to create a more diverse and inclusive space for their workforce and the community they serve, with results to prove it works.

'Unwavering commitment'

RWJBarnabas Health, a comprehensive healthcare system in New Jersey, has been on its DEI journey for some time.

"One of the most exciting aspects of our journey to date has been the unwavering commitment and consistent progress we have made in advancing DEI strategies within our health system," Trina Parks, MHA, FACHE, executive vice president and chief corporate diversity and inclusion officer of RWJBarnabas Health, says.

The health system's corporate office of DEI was created in 2016. Its DEI team, which is led by Parks, has 11 diverse team members who focus on implementing systemwide DEI efforts.

"Since the inception, we have continued to harness a culture of inclusion and leverage the best of our employees to provide equitable and inclusive care to our patients and the communities we serve," Parks says. "As a DEI leader, and most importantly as a woman of color, I understand that this work can be uncomfortable."

Parks says this discomfort arises because the DEI team is addressing systemic racism and societal norms that have existed for centuries.

She adds, "It is also imperative for all employees, no matter the race, ethnicity, gender identity, or preferred spoken language, be seen and feel valued in every level of the organization. My job is to ensure that we can mitigate the risk of individuals feeling isolated or not enough."

Implementing diverse hiring practices

Following the tumultuous year of 2020, RWJBarnabas Health's CEO Barry H. Ostrowsky announced a systemwide initiative "Ending Racism, Together," which includes goals for patients, the workforce, communities, and operational processes "to identify and eliminate racism by modifying organizational structures, policies, practices, procedures and attitudes," Parks says.

"We ensure that these goals are communicated through partnerships with the system's DEI site leads in alignment with human resources leaders," she says. "We understand that we cannot accomplish change unless we adjust our lens; therefore, our DEI team has delivered and continues to deliver cultural competence and unconscious bias trainings to new and existing employees within our system."

As another best practice to promote a DEI culture among its employees, RWJBarnabas Health also requires that 50% of final leadership candidates, for director-level positions and above, are diverse in both race and ethnicity, she says. The health system also focuses on creating a workforce that represents the populations it serves.

In addition, Ostrowsky instituted an updated SBAR hiring practice (Situation, Background, Assessment, Recommendation) for the health system. This process ensures the promotion of DEI efforts in the workforce.

According to Parks, the SBAR process should include:

• Utilizing a diverse array of resources for finding talent
• The demographic breakdown of the candidate pool, including race and gender
• The premise for which the hiring decision was made

The SBAR process is used for vice president–level and above leadership positions, and "it challenges the hiring manager to cast a wide net to ensure that the candidates are of a diverse pool," Parks says.

In addition to promoting race and ethnicity diversity in its hiring practices, the health system also focuses on sexual orientation and gender identity.

"We are proud to say that eight of our hospitals have been recognized as Leaders in LGBTQ Healthcare Equality by the Human Rights Campaign (HRC) Foundation," Parks says. "In addition to offering equitable policies and practices to our patients and visitors, this distinguished honor also contains inclusive practices for employees to identify with their current gender identity and preferred names and comprehensive benefits inclusive of gender-affirming surgeries and family planning resources."

Parks says that while diversity and equity work is important, diversity without inclusion is "ineffective and unsuccessful." To promote inclusion, the health system has over 30 affinity groups, which are employee-led groups or employee networks defined by shared characteristics and life experiences.

"In general, [these groups] provide support for our employees, foster career development, and contribute to cultural sensitivity in the work environment," Parks says.

RWJBarnabas Health measures its DEI successes quantitatively and qualitatively. "While success is measured through percentage changes in leadership demographics and the demographic makeup of employees, it is also measured in the respect and understanding of other cultures that we have seen at RWJBarnabas Health," she says. "It is also measured in having creativity and innovation, in which we continue to excel. In addition, our success is measured by less language barrier challenges faced by our patients and families, which we address through our impressive diverse workforce and best-in-class language interpretation and document translation services."

From 2017 to 2020, the health system saw a 21% increase in hiring women for leadership positions and a 6% increase in ethnic minority hiring, Parks says. Additionally, in 2020, 27% of internal promotions to assistant vice president and above identified as minorities, and 78% of those promoted were women.

'A marathon with an invisible finish line'

The challenges of incorporating DEI in an organization can be numerous, including the amount of work it takes to change thinking and culture. 

"DEI execution continues to be a marathon with an invisible finish line," Parks says.

Creating and maintaining an environment where people are adapted to cultural humility is hard work, Parks says. "That often is a challenge because, as I like to mention, we are humans treating humans and, unfortunately, we don't always get it right. We all have unconscious and conscious biases that dictate our behaviors and responses."

The health system has a three-pronged approach to DEI for the workforce and the community; those prongs are awareness, exposure, and accountability to help the organization reach its destination. "Depending on the area of focus, [getting there] could be a quick race, a car ride, or like most times, an across-the-country bus ride, which requires patience and a much slower-paced approach, requiring collaboration and coordination. No one can do it alone."

While implementing DEI practices can be a big investment for organizations, Parks asks, "What is the expense and liability of not having a DEI leader and service line?"

"DEI touches every part of the business, including employee optimization, safety, quality, customer experience, community relations and partnerships, procurement, and population health," she says. "The investment associated with being visible, accessible, and trusted to be proactive and reactive in real-time is priceless."

She adds that this remains imperative to business when providing healthcare in a state as diverse as New Jersey.

"New Jersey is the fourth most diverse state in the country only behind California, Texas, and Hawaii. Diversity is not something we talk about, it is how we live," Parks says.

Leading with HEART

Focusing on DEI efforts in the workforce is not a new undertaking for Luminis Health, a nonprofit community health system headquartered in Annapolis, Maryland.

"We've been on this deliberate and intentional journey since 2015," Victoria W. Bayless, CEO of Luminis Health, says. "At that time, we were signing on to the American Hospital Association's #123forEquity Pledge to Act."

The pledge aimed to eliminate healthcare disparities and called for hospitals to do four things, Bayless says:

1. Use race, ethnicity, and language data to measure disparities in care or clinical outcomes
2. Increase diversity of leadership and governance
3. Focus on cultural competency training
4. Create deep community partnerships
    

Specifically related to the cultural competency training, Luminis Health's focus evolved to include cultural humility, listening, and learning, and evaluating the strengths the organization gains from its diverse leadership and workforce, according to Bayless.

The health system also focuses heavily on measurement success in its DEI initiatives for its workforce, she says. "Measurement was important in terms of the makeup of our boards, the makeup of our leadership team, [and] we put the Rooney Rule in place."

The Rooney Rule, originally a policy the National Football League put in place to require that team leagues interview and consider diverse candidates, has been adopted into hiring policies at numerous organizations, including hospitals and health systems.

Luminis Health measures DEI initiatives with dashboards that track hiring practices, promotions, disciplinary actions, aggregate diversity, and diversity of job classifications. A DEI scorecard was implemented in March 2018. By the end of June 2020, the diversity of Luminis Health's clinical professionals grew from 33% to 40%, the diversity of management grew to 26%, and the diversity of executive leadership grew from 14% to 17%. Diversity in new nurse hires also grew from 19% in March 2018 to 38% in June 2020.

Reflect the community you serve

Luminis Health found that to successfully create a diverse workforce, it had to implement DEI throughout the whole organization and its community. The health system's DEI efforts ramped up following the murder of George Floyd and the resulting social unrest in May 2020, Bayless says. This is where Luminis Health's focus on anti-racism "leveled up."

"We're certainly proud of the work we did and having won the Carolyn Boone Lewis Equity of Care Award [in 2019] from the American Hospital Association," she says. "But it wasn't enough."

In 2021, the governing board doubled down on its focus on DEI, and added anti-racism and social justice efforts, Bayless says, making its focus on DEAIJ (diversity, equity, anti-racism, inclusion, and justice).

"We need to be reflective of the community that we're serving. We need to be inclusive in our workforce," Bayless says. "When people see employees, nurses, doctors, techs, pharmacists, housekeepers, engineers, people who look like them and are from similar backgrounds, they feel more welcomed in organizations as patients."

The governing board has also created a Health Equity and Anti-Racism Task Force, or HEART Force, to address DEI in the workforce and in the community. The HEART Force, led by some of the health system's trustees, includes people in the community, the workforce (nonclinical staff), patient and family advisors, and medical staff, Bayless says. On June 11, the group rendered its set of recommendations to the governing board, she adds, which has 10 recommendations categorized under the following three focus areas:

1. Be an anti-racist organization
2. Partner with diverse communities
3. Integrate accountability and measurement
    

The health system also hired Tamiko Stanley in 2017 as director and head of DEI. She was recently promoted to vice president and chief DEI officer, where she sits in human resources but "has a broad view of the organization, not just on the workforce side, but also facilitating and supporting the work in the clinical arena and patient care," Bayless says.

The healthcare organization also formed several business resource groups for various cultures and identities, Bayless says. That includes an LGBTQIA group, an African American group, and a Latino group, so that people in the organizations "have a group of colleagues where they can share and learn."

The health system also created voluntary forums for team members across the organization to share their own experiences about equity and justice, she says. This has included work around the books White Fragility by Robin DiAngelo and How to be an Antiracist by Ibram X. Kendi, which has created a safe space for staff to come together and communicate about difficult subjects, including personal dealings with racism.

Luminis Health also created a Coming to the Table chapter, where team members can "encourage dialogue and learning around the history around racism and discrimination, and that people can listen and learn from each other," Bayless says. "We were the first hospital health system in the country to form our own chapter of Coming to the Table," creating a more inclusive and communicative culture.

She adds that some of the conversations are "deeply personal experiences of people who have experienced discrimination and who have grown from it, or who many are continuing to suffer from it."

The organization also implemented a creative interactive theater group in addition to cultural competency training, where the group acts out scenarios that demonstrate real-life situations that have happened at Luminis Health where there's been discrimination or inappropriate use of language, Bayless says.

"[Following the presentations], we react to it, and we have a dialogue about the skit, whether it was a manager being insensitive, inappropriate use of language, somebody singled out, people applying stereotypes, making assumptions about people because of the way they look, talk, dress, etc. It's a little more interesting than just doing 'mandatory training,' [and] that's made it more lively," she says.

The organization has made significant investments in DEI throughout the system. "I don't have an exact figure for you, but it is a major investment," she says. "It gets woven into the organization, rather than it's a budget that sits discretely off to the side."

Vision 2030

Implementing DEAIJ into the health system's work has become a part of Luminis Health's DNA. "It's reflected in our values," Bayless says.

The health system crafted a new strategic mission for the next decade called Vision 2030, with a focus on community, wellness, and experience for the workforce and the patients they serve.

"The vision speaks to our mission, values, and what we want to be in the long term," she says. "That vision statement includes that Luminis Health will become a national model for health equity, anti-racism, inclusion, diversity, and justice."

Anne Arundel Medical Center and Doctors Community Medical Center merged in 2019, then rebranded in 2020 as Luminis Health to unify the organization. Since then, the healthcare system has acquired another hospital and opened a new mental health hospital, Bayless says.

"For Luminis Health, we have a collective set of values now that honor and respect the legacy organizations but also pull us together as a system," she says. "Those values are the acronym RISE, which stands for Respect, Inclusion, Service, and Excellence. It is important for us to be focused on that, that every voice matters, and that those set of values needs to drive the behaviors that we exhibit regularly."

The organization has also implemented specific goals in its annual operating plan for quality, community service, and workforce development, Bayless says. It will further infuse the goals with the elements of the HEART Force recommendations to ensure those recommendations receive action.

"We don't want to focus on diversity, equity, and inclusion as some side gig," she says. "It needs to be part and parcel of all the work that we're doing. [It's] infused in all of the work that we're doing. There are layers of goal setting and measurement that we've been deliberate about."

'Resist the resistance'

When it comes to implementing DEI initiatives into your own organization, Bayless says that an open mind is key.

"We changed our procedures and how we go about recruitment, and there was some resistance to that [because it's different]," she says. "Sometimes people just don't like change. They don't want their process to be slowed down by having to take these 'extra steps,' but in the long run, the benefit is greater diversity, more inclusiveness, the diversity of ideas, backgrounds, interests that come to the table and can make us a stronger organization."

Bayless adds that a trustee once told her, "You have to have the strength to resist the resistance."

When it comes to wanting to make steps in DEI, the whole organization must be committed, Bayless says. "It has to start at the top," she adds. That includes the CEO, the governing board, and the executive leadership.

"You have to be truly committed to it; you have to measure; you have to be willing to make the investment. You can't just say it's important but then not put any resources or time and attention to it. If it doesn't show up in your annual operating plan and you're not measuring it, you're not really doing it."

Ensuring DEI Is in the DNA

Highmark Health and Allegheny Health Network is a nonprofit integrated delivery network, headquartered in Pittsburgh, with a deep focus on workforce and community DEI initiatives.

"[DEI] goes directly to our mission, which is to ensure that people have a remarkable healthcare experience and they're free to be their best," says Robert James, JD, MBA, MHA, chief diversity and inclusion officer for Highmark Health.

According to James, research shows that diversity in a clinical care workforce improves health outcomes for the community it serves, which is why the payer-provider organization is building DEI best practices, including utilizing the Rooney Rule for interview panels; tracking metrics; and setting goals.

"We're looking at initiatives to stem turnover. We are adopting mentor and protégé programs into our hiring process, all across the organization for almost all of our positions," he says. "Our goal is to reflect the customers, members, and our patients so that we can provide them with the best products, services, and experiences."

Having a diverse workforce brings new ideas and fresh perspectives into the workplace, he says. It also allows for innovation, which makes the organization a more competitive and valuable commodity to its customers.

Partnering with the community

As part of Highmark Health's DEI efforts, it is partnering with its community to create a diverse workforce pipeline for its own organization and other community organizations. 

Earlier this year, Highmark Health announced it would commit $1.5 million to increase diverse leadership in Pittsburgh through The Advanced Leadership Institute (TALI Institute), a new nonprofit organization to help build pipelines for African Americans to executive leadership positions in and around Pittsburgh.

"It's part of our goal of aligning on corporate giving with our DEI initiatives. TALI is a program that was started by a former senior executive at Highmark, who saw disparity in the number of black senior executives in the city of Pittsburgh and decided to form an organization that would help mitigate that disparity," James says.

The executive then developed a training program associated with Carnegie Mellon University's Tepper School of Business "to train executives who were mid-level executives to prepare for senior and C-level executive roles in companies," he adds.

TALI has had three cohorts so far, James says, and about 80% of the participants have either received a promotion or have added significant higher-level assignments to their work responsibilities.

"At this point about 80 participants have graduated from cohorts in TALI. The $1.5 million goes to help ensure the institute will be around in the years to come and can continue to build a bench of ready mid-level executives to ascend to the senior levels, and now they've expanded to include a program for supervisors and managers as well," he says.

James adds that, "There's no program like it in the United States, and Highmark was there from the beginning as one of the anchor sponsors and has continued to be there as a sponsor at the highest levels to try to combat this disparity here in Pittsburgh."

Additionally, Highmark has implemented numerous other initiatives within the past year:

• Highmark Health hired Margaret Larkins-Pettigrew, MD, MEd, MPPM, FACOG, to serve as Allegheny Health Network's first chief clinical DEI officer
• Additionally, two VP leaders, one of whom is James, were hired under Dr. Larkins-Pettigrew
• Pettigrew to support DEI initiatives across Highmark's affiliate companies
• The organization consolidated all its DEI initiatives under one blended organization and called it an "innovative next practice," to ensure that DEI is being evaluated and implemented across the entire
• enterprise

"Most companies maintain their DEI initiative under their HR department. DEI isn't embedded anywhere else in their organization," James says. "The way that we decided to structure ourselves is going to allow us to ensure that DEI is going to be a part of how we approach things [in all departments]."

The DEI team created an Enterprise Institute of Equitable Health, where they developed a six-pillar framework to address social justice, equity, and structural racism, as well as "the other '-isms' that exist, including sexism," James says.

The six-pillar framework includes the following action items:

1. Educate
2. Innovate
3. Investigate
4. Advocate
5. Disseminate
6. Invigorate
    

Additionally, Highmark Health is bringing in an outside organization to survey the entire enterprise and obtain a sense of where the organization is on its DEI journey, James says. The health system will also conduct "inclusivity resets" where each workforce team unit will determine its members' sense of belonging and inclusion.

"Our goal is to ensure that each unit be able to have a sense for what would they like us to look like at the end of the day and in terms of that sense of belonging and sense of inclusion," he says. "We are hitting the reset button when it comes to inclusion across our enterprise, and we'll also ensure that each business unit has a champion that will train the rest of the team and they will engage in train-the-trainer unconscious bias training."

The workforce will also have opportunities to engage in book clubs and meetings related to DEI, where they will learn about structural racism and the data behind structural racism, so that they understand it exists and action can be taken to correct it, he says.

In addition to the TALI Institute, Highmark Health also developed other intentional pipeline programs to hire more diverse nursing and clinical care staff. The organization created a program called White Coats for Black Professionals with a grant, where the organization will pay back the loans for trainees, doctors, and nurses. Allegheny Health Network has also partnered with the Community College of Allegheny County to support nurses with diverse backgrounds. The organization also established a new partnership with Inroads, a 50-year-old pipeline organization, to help attract students and alumni from historically black colleges and universities, as well as Hispanic-serving institutions, he says.

[sub-subhed] 'No matter where you are in our enterprise, you're going to feel welcome'

James says, "You have to have buy-in from the top" when it comes to implementing DEI work into your organization. "Our CEO is our biggest champion on diversity, equity, and inclusion," he adds. "It's one of the top priorities of our company."

"Through the Enterprise Institute of Equitable Health, we are not just moving forward at the top, but we are embedding it across our enterprise at all different levels," James adds. "No matter where you are in our enterprise, you're going to feel welcome, a sense of belonging, and included in our company."

The organization's broad array of DEI initiatives in 2021 aim to ensure that DEI is in its DNA, he says.

"When I look at the successes we've had over the years, we've had successes with our veterans, our LGBTQ community, and for people with disabilities," he says.

Highmark Health has received awards from the Human Rights Campaign, including winning Best Places to Work for LGBTQ Equality for three consecutive years.

"Every company should have a degree of diversity at the table," he says.