Equity, Diversity, Inclusion: Easier Said Than Done?

Posted by on July 1, 2021

by Marcia Simon, APR

This article originally appeared in Strategic Health Care Marketing.

It’s complicated.

That’s the status for Diversion, Inclusion and Health equity initiatives across America.

It sounds easy enough to make a commitment to the mission, but it’s huge, and often lives beneath the mind’s surface.

How do you train your staff about biases toward patients and colleagues when they don’t believe they have any? We all grow up with assumptions and stereotypical views of the world and the people in it. For the health care industry, fair and equal access to quality education impacts the pathway to medical school and residency, career advancement, and the way physicians and staff relate to their patients and fellow workers.

For most other health networks nationwide, the need for a formal diversity, inclusion, and health equity strategy manifested during COVID. First came the obvious disparity in testing, then in telemedicine access. A year later it exists with vaccines, wrapping up a year when Black Lives Matter took center stage, and the nation elected a president during a pandemic that made it painfully obvious that not everyone has equal access to cast their vote.

To better understand the issues and how they are being addressed, I interviewed health Equity, Diversity, and Inclusion leaders from Johns Hopkins Medicine, University of Utah School of Medicine and UC Davis Health.

Johns Hopkins Medicine officially launched its Office of Diversity, Inclusion and Health Equity about five years ago. It’s grown to now employ eight people who have spent the majority of their time over the past year educating people about COVID disparities and promoting vaccines with the added challenges that affect Black and Brown communities, according to Karen Jones, Johns Hopkins Medicine’s director of Diversity and Inclusion.

“You also have disability inclusion barriers,” says Jones. “People with disabilities have concerns that no one is addressing. They feel left out because the focus has been on people of color,” she adds. Diversity and Inclusion is multidimensional, encompassing not just race and ethnicity but gender, sexual orientation, gender identity, religion, age, and more.

Johns Hopkins works very closely with community organizations, including faith-based leaders. Education is the biggest piece, Jones says, and in the wake of COVID and the death of George Floyd, its focus has also been on training to educate clinical staff on their unconscious bias as it relates to patient care.

“When confronted about unconscious bias, the biggest pushback is something to the effect of ‘Why are people so sensitive today?’ It’s more that people are speaking up now; they’re tired of being offended,” explains Jones.

“There is no one more blind than they who refuse to see,” says José Rodríguez, MD, associate vice president for Health Equity, Diversity, and Inclusion (HEDI) at the University of Utah School of Medicine in Salt Lake City. He says this is something his mother often told him as he was growing up: “It’s not that they don’t know, but that they don’t want to see. If they wanted to see, they would do things differently.”

A multicultural metropolitan area, Salt Lake City experiences disparities that affect Black, Brown, Hispanic, Native American, Native Hawaiian, and Asian American and Pacific Islanders (AAPI).

This year the University of Utah Medical Residency Program represents a more diversified profile than ever before. Still, minorities are only 20 percent of the overall medical staff population, according to Dr. Rodriguez, who says it’s got to change, because communication with patients depends on who takes care of them. Oil companies, farms, and factories employ a great number of low-paid, minimum-wage workers in the area; disparities became most evident as COVID vaccines started to roll out.

“All the science was showing clearly who had highest risk to have a bad outcome from COVID-19, and when the vaccine began its rollout, race was not a consideration,” says Rodriguez, a family physician.

“One thing we’re doing here on the systemwide side is diversifying the representation at leadership tables. If we invite one qualified underrepresented person to the table, it’s better than having none, but it’s not where you need to be, because one person isn’t heard. It’s the visible diversities that change the conversation,” Rodriguez adds.

“All the science was showing clearly who had highest risk to have a bad outcome from COVID-19, and when the vaccine began its rollout, race was not a consideration.”

Meanwhile, over at UC Davis Health…

“We want to make sure we are an organization that promotes health for the people who come through our doors and also throughout our community because this is where our patients come from. Hospitals need to think about more than patient care,” says Hendry Ton, MD, UC Davis Health’s associate vice chancellor for health equity, diversity, and inclusion.

Dr. Ton, a psychiatrist, points to multiple studies showing that personal health is determined not only by health care access and quality but also by socioeconomic circumstances such as wealth, employment, food and nutrition, and access to education.

The health gap between poor and affluent communities can be a difference of 10 or more years in life expectancy,” says Ton. “We can provide the highest state-of-the-art care, but if the patient can’t go home and exercise outdoors because of crime and safety in their neighborhood and can’t make it to a follow-up appointment because of lack of transportation, all the innovation at our hospital units is significantly limited.” He adds, “What if we shift operations to really help the local community?”

UC Davis Health, located in Sacramento, has rolled out the Anchor Institute Mission (AIM) for Community Health to support the thriving of Sacramento’s most diverse and most economically distressed communities, according to Ton. Investing in the community means procuring the majority of food that the hospital serves from within a 50-mile radius as a start. Spending local recirculates money within the community.

Understanding Bias

Addressing unconscious bias inside an organization means that education extends beyond the clinical staff. From procurement and finance to human resources and food services, UC Davis Health has a plan to help employees understand the dynamics of bias.

What happens when you unintentionally offend somebody? A training module explains how the situation can become worse when an employee becomes defensive about it.

To build the modules, UC Davis tapped students who had experienced culturally harmful behavior. Faculty members, many of whom did not recognize these behaviors as culturally harmful, were surveyed about challenges of managing cultural harm. How do you act when you see a colleague do something wrong?

Working with students and faculty, UC Davis developed a toolkit for self-management and relationship management. The process recognizes that engagement must include both communities that experience harm and the sources of that harm. Tools for training need to be well founded and may come from other frameworks that are not specific to Diversity, Equity, and Inclusion. As an example, UC Davis Health uses an emotional intelligence model. After the tools are developed and put into practice, they must be studied to provide evidence that the approach works.

“It’s very important that training doesn’t pigeonhole a person as a bad force without the ability to contribute to healing. If you foster the ability to heal the harm, it’s easier to engage,” says Ton, adding that trainings can be generalizable to other forms of mistreatment. Ton also served as director of education at the UC Davis Center for Reducing Health Disparities, and is the founding medical director of the Transcultural Wellness Center of Asian Pacific Community Counseling.

“For far too long, the burden to end racism has been placed on the shoulders of those most impacted,” says David Acosta, MD, chief diversity and inclusion officer of the Association of American Medical Colleges (AAMC) in a public statement on Dismantling Racism in Academic Medicine.

As health systems build out their departments to address disparities in the communities they serve, it’s clearly not a one-size-fits-all approach. But there seems to be total agreement on making sure that underrepresented groups have a voice — and also support.

Health Care

“Where’s the compassion? Where’s the care?” asks Jones. This is where Johns Hopkins’ Medicine’s Diversity, Inclusion, and Health Equity team comes in to work with executive teams. “We’re always trying to work from the top down to assure that every person has access to proper and decent health care. You’ll never be able to deliver equitable health care to everyone if there’s not civility and respect throughout the organization,” Jones adds.

Marcia Simon, APR, writes about health care, healthtech, and wellness. Email her at marcia@mseusa.com or connect at LinkedIn.com/in/marciasimon.