Building a Culture of Diversity, Equity, and Inclusion in Healthcare

I recently had the opportunity to attend the first of four sessions in the AHIMA 2022 Mark Dietz Leadership Series, “The Inclusive Healthcare Leader.” One of the first things the presenter did was ask us to think about a time that we felt excluded from work and why. While some people may think about this from a race, gender, age, or other perspective, I thought about it from another perspective: feeling excluded from a functional workgroup. In other words, being left out from a discussion or a meeting, or possibly being present for the discussion but not addressed because the functions are not seen as important to the topic as other functions in the workgroup, department, or organization.

I am sure that, in one way or another, we have all had moments when we felt we were excluded because we were perceived as being “different” or “not as important.” Exclusion can lead to many outcomes, some of which include detachment from the team, not feeling valued, loss of interest in work or relationships with others, or depression.

Many organizations have created diversity, equity, and inclusion committees to focus on this important topic, to bring understanding to what can be done to create more inclusive teams, and to further promote equity throughout the organization—not just for employees but also for our patients, visitors, vendors, and other external customers. It is important to understand, as pointed out during the presentation, that diversity comes in two different forms:

• Surface-level diversity, which is more extrinsic or physical in nature (e.g., gender, race, age)
• Deep-level diversity, which includes more intrinsic traits such as values, beliefs, and attitudes.

Diversity initiatives by healthcare organizations can also support population health by identifying social determinants of health and creating plans to address disparities. This may include such issues as access to healthcare or genetic predisposition to certain chronic illnesses.

It is also important to note that we may have a bias that we are not aware of, also referred to as unconscious or implicit bias. While we can more easily address a known bias, an implicit bias is harder to correct if we aren’t aware of it. Acknowledging that implicit bias exists is important so that steps can be taken to address and intervene. For instance, assuming that all patients of a certain race have a genetic predisposition to a chronic illness based on data and algorithms might be incorrect. Acknowledging this bias creates an awareness that further testing for each patient might be needed when particular symptoms are present, regardless of race.

Simply acknowledging that diversity and bias exists is not enough. When implementing a diversity, equity, and inclusion (DEI) program, it is essential that the program be embedded, and behaviors modeled, by leaders at every level in the organization. No practice or company is too big or too small to develop a DEI program; organizations may take different approaches to program development to create a culture supportive of diversity, equity, and inclusion. What works for one team may not necessarily be effective for another. It is important to monitor the effectiveness of the program and be open to making adjustments if needed. Examples of programs include diversity training, which may be voluntary or mandatory, resource groups, DEI councils, policy and procedure development, and celebrations to recognize each other’s uniqueness. Any of these examples may be used alone or in conjunction with other initiatives.

The company that I work for, Banner Health, is headquartered in Phoenix, Arizona, has operations in six states, and has over 52,000 team members. Our portfolio of services includes an insurance division; ambulatory care, including primary and specialty care, urgent care, surgery centers, imaging centers, occupational health, and cancer centers; acute care, including academic medical centers, urban and rural hospitals, children’s medical centers, a behavioral health hospital, and a heart hospital; post-acute care inpatient/outpatient rehabilitation, skilled nursing, home health, hospice and palliative care, home infusion, and home medical equipment; and pharmacy, lab, and telehealth services. The size and span of these provided services lend to a diverse workforce. At the end of 2020, 76 percent of our workforce was female, and 24 percent was male. The workforce included 60 percent of employees who identified as white and 40 percent who identified as non-white race or ethnicity.

Banner Health’s Diversity and Inclusion (D&I) Council was created in 2015, and since that time, the department has grown and expanded the awareness of diversity and inclusion throughout the organization. Leaders at Banner Health have access to a D&I toolkit, which includes resources to build conversations into team meetings or huddles, team-building exercises, worksheets, talking points, and workshops. Leaders may schedule a workshop for a team, or an employee can individually sign up to attend a virtual workshop.

Banner Health currently has six active Team Member Resource Groups (TMRG) with 2,175 members: Banner Unidos (Hispanic/Latinx), Black Excellence Network (African American/Black American), DIVE (Diverse Individuals Valuing Everyone – LGBTQ+ and allies), Diverse U (multicultural), Veterans & Friends, and Women @ Banner. We recognize heritage months and team members both internally and on our social networks. Banner Health’s D&I program extends into our communities, including partnerships with other organizations, as well as volunteering at events and attending, hosting, and presenting at diversity conferences and educational webinars. We have policies and procedures to address the diversity and inclusion of our team members, patients, and visitors.

In the session, “The Inclusive Healthcare Leader,” three tips for leading inclusivity were provided:

• Create a culture where employees speak up.
• Assign work fairly.
• Don’t just mentor; sponsor.

By incorporating these practices, employees feel valued; they see work as meaningful. Engagement increases. Teams collaborate and operate more efficiently. Uniqueness and differences are recognized and celebrated. We begin to understand and appreciate each other for the talents each of us brings to a team. We should feel comfortable knowing that it is OK to ask questions, as long as it is done so in a respectful manner.

As leaders, we should be engaged in the diversity, equity, and inclusion initiatives in our organization; and if your practice or organization has not yet taken this step, do not be afraid to lead the way. There are many resources, such as “The Inclusive Healthcare Leader” session as part of the Mark Dietz Leadership Series that can help you get started.

Jami Woebkenberg (jami.woebkenberg@bannerhealth.com) is the senior director of HIM operations at Banner Health and serves as a director on the AHIMA Board of Directors.