Our healthcare system must work hard to increase diversity within their workforce and create an inclusive environment. Diversity and Inclusion (D&I) strategies are necessary for health systems to provide the best care possible to an evolving population.
A sense of Belonging is equally as important. Just because an employee is working in an organization, it doesn't necessarily mean they feel they belong there.
The feeling of belonging is a fundamental human need. It is an extremely powerful force. Without it, your D&I strategy could fail.
The term Diversity, Inclusion and Belonging (DI&B) was created by Pat Wadors. She said, "D&I may capture your head, but belonging captures your heart.”
“When someone is different and insecure and they get to be authentic and are welcomed in a team, we can unlock their super powers and bring out the best—not only in that person, but the team and, therefore, the product, the service, the company, the world,” says Wadors.
Covering or masking is when someone tries to fit in with the dominant culture and downplay who they really are. Research from a Deloitte study of more than 3,000 people found that 61% of people cover at work, even more so if they are Black (79%) or LGBTQ+ (83%).
Neuroscience researchers have found that exclusion lights up the same regions of the brain as physical pain. “Being excluded is painful because it threatens fundamental human needs, such as belonging and self-esteem,” says Dr. Kipling Williams of Purdue University.
When someone feels excluded over a long period of time, and every day they have to return to an environment where they feel like they do not belong, they'll end up leaving.
Dr. Christine Cox of New York University’s Langone School of Medicine has identified six areas that are enhanced by inclusion and worsened by exclusion: intelligent thought and reasoning, self-care and self-improvement, prosocial behavior, self-regulation, a sense of purpose, and well-being. Each of these items represents real financial gains or losses for teams and organizations.
According to Wadors, in order to create a culture of belonging, teams and managers should reflect on three questions:
How does your organization celebrate differences?
As an employee, do you feel safe if you make a mistake?
Does someone at work care about you?
A Forbes article mentions, another way that a sense of belonging can be nurtured is by creating a stronger sense of community. A sense of community can be nurtured by regular interactions and collaboration. We tend to stereotype people less and are less fearful of difference when we are more familiar with them or spend more time with them.
But most importantly, there must be trust. Employees should have trust in the company's mission, in the leadership's vision and in their goals. Once every employee feels that they belong in the organization, this will lead to a more positive and inclusive workplace.
Health systems are working to increase the Diversity of their leadership team, board and staff. Each hospital’s workforce should represent the diverse populations of the community they serve. Many hospital teams are building a culture of Diversity and Inclusion (D&I) to better engage all employees and provide high-quality, equitable care for all patients.
Part of building a culture that is mindful of D&I is being aware of the National CLAS (Culturally and Linguistically Appropriate Services) Standards. As stated in the case for National CLAS Standards “Culturally and linguistically appropriate services are increasingly recognized as effective in improving the quality of care and services. By providing a structure to implement culturally and linguistically appropriate services, the National CLAS Standards will improve an organization’s ability to address health care disparities.”
A Diversity Best Practice report says, Minorities continue to experience discrimination in healthcare and have worse health outcomes than white individuals. Cultural differences, language barriers, and high rates of unemployment and poverty have created major disparities in health status and health outcomes for minorities and other marginalized groups. Lack of diversity in the healthcare workforce, poor provider-to-patient communication, and health literacy challenges further contribute to the problem.
The National (CLAS) Standards is a great strategy intended to advance health equity, improve quality, and help eliminate healthcare disparities, by providing a set of 15 action steps for healthcare organizations to implement.
Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership and Workforce
Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources.
Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.
Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.
Communication and Language Assistance
Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.
Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.
Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.
Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.
Engagement, Continuous Improvement, and Accountability
Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization's planning and operations.
Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities.
Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery.
Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area.
Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.
Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints.
Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.
According to Diversity Best Practices, from 2015 to 2030, the US population is projected to grow by 12 percent, from about 321 million to 359 million. Most of that growth will come from minority and immigrant populations.
In order to better serve this growing population there needs to be more diverse healthcare professionals in leadership roles that mirror a culturally competent workforce.
Modern Healthcare covered the industry’s lack of diversity in the C-suite mentioning, "Only 14% of hospital board members and 9% of CEOs are minorities, according to the most recent study by the American Hospital Association's Institute for Diversity and Health Equity—the same percentages as in 2013."
They created a survey that asked, "What do you perceive as the top three barriers for diversity Nurse leaders in advancing their careers to the executive level?"
The answers were:
Lack of equal access to inclusion.
Lack of mentorship and sponsorship.
Lack of opportunities for leader experiences.
Here are some ways to promote diversity in healthcare leadership.
In order to destroy these barriers, leaders of all backgrounds and ethnicities must first understand and accept that these barriers do exist. Those leaders can take that knowledge and their own personal cultural insights and use them to effectively address disparities within their own communities.
Mentoring programs are extremely important and should be implemented ASAP. As in any business, Nurses need leaders to help guide and inspire them. Representation of diverse Nurses in leadership positions creates positive influence and confidence in other Nurses looking to achieve leadership goals in the future.
Recruiting diverse candidates at every level increases representation in management, but also develops a diverse workforce and future pool of qualified candidates.
Utilize pro-diversity initiatives to reduce social isolation. Hire a Diversity & Inclusion Officer and appoint a diversity committee. There should be a diversity action plan, diversity training, social gatherings, and resource groups.
In healthcare, trust and representation matters. More diversity in healthcare leadership roles will create better patient outcomes.
Organizations put a lot of effort into their Diversity and Inclusion programs and yet few of these efforts yield results. What are some of the reasons why D&I programs fail?
Your Diversity and Inclusion programs should be a consistent part of your organization’s culture. It should not be implemented as a response to an issue because it might appear disingenuous. These programs should be used throughout all departments to show an overall belief and commitment that D&I is important to everyone.
Do not make the programs mandatory because when individuals feel like they don’t have a choice, this can lead to resistance and opposition to D&I programs.
Your leadership must fully support D&I for it to work well. Leadership must be committed to making D&I part of your mission, values and beliefs. It is important they understand D&I is beneficial in acquiring and retaining talent, offering culturally competent patient care, building employee engagement, and improving business performance. Your programs should always be evolving. If it's outdated, it will be ineffective.
Employees might believe that actual changes won't be made. So it is important to lead by example and utilize what these programs teach. There should be visible and committed role models on the leadership team.
Get your employees who are closely affected by Diversity and Inclusion involved with the design and assessment of the programs to ensure they will work and take hold. Remember, you want ideas and collaboration from employees who represent different cultures, religions, ages, educational backgrounds, etc. The programs must be custom tailored to each company, using its specific culture and goals to determine the best course of action.
According to DeEtta Jones, a diversity and inclusion strategy consultant"when developing an inclusion plan, organizations should keep two goals in mind. Any inclusion plan should be attainable and measurable. A lofty plan with goals that can never be achieved ruins employee morale and reinforces the idea that management is not willing to make meaningful changes. Without measurable goals, leaders and organizations cannot be held accountable for implementing the plan. Without accountability, any plan will be ineffective. Good inclusion plans are measurable and achievable. "
Your organization should be an inclusive environment where all employees feel comfortable and open enough to discuss and make real changes. In order to achieve this environment, we all must be aware of biases.
Kristen Pressner said in a Forbes article, "We all have biases, and it’s important to acknowledge them so behavioral tendencies can be headed off at the pass. Make a safe place for everyone to look in their full-length mirror and recognize their own biases so they can work on eliminating them. This can be as holistic as hosting training and workshops, and as personal as articulating and owning them one on one. Articulate how shifting the behavior will lead to better results. Recognizing one’s own biases is a great level set; everyone has them and can support each other in breaking them."
In a different Forbes article, Cat Graham recommends "acknowledging and recognizing great ideas, wherever they come from. Celebrate and communicate with your employees how diversity and inclusion have impacted creativity, engagement and results. Make room for different religious celebrations, and encourage staff to share their cultural heritage with others. Actively create groups that support and connect employees through their shared backgrounds."
The Diversity and Inclusion process can be difficult to perfect, but it is important to make it a major part of your organization's mission. If you have any helpful tips or experiences you’d like to share, please do so here.
Illness is blind to race, gender and ethnic origins. Since you are in the business of caring for others, it's critically important to ensure that clinicians, executives and even members of the governing boards, accurately represent the communities you serve.
There is room for considerable improvement in leadership diversity in healthcare. According to AMN Healthcare, A survey by American Hospital Association’s Institute for Diversity in Healthcare Management found that while minorities represented 32% of patients in hospitals, they comprised only 14% of hospital board members, 11% of executive leadership, and 19% of mid-level and first-level managers. On gender, despite a healthcare workforce that is 80% female, women occupy approximately 25% of hospital CEO positions. Representation by women of color is in the single digits.
There are clear benefits of promoting diversity in the C-suite and encouraging stronger representation from groups that have long been underrepresented in executive roles. Not only do patients benefit from having advocates who represent the full spectrum of the community, but it also makes good business sense.
Having a variety of opinions and perspectives among top leadership ranks leads to deeper discussions, more thoughtful and intentional strategies, and better decision-making. That, in turn, improves operational performance.
Diversity can be a competitive advance in recruiting, hiring, and retaining quality Nurses, Physicians and other healthcare professionals, including leaders. Like patient engagement, the engagement of team members and leaders is crucial to recruitment and retention, so diversity should be an important consideration to make all feel welcome.
Healthcare systems are aware that diversity among staff, leadership and board members is important to improving patient medical outcomes and reducing health disparities. Diversity also improves the bottom line. Companies with the most ethnically diverse executive teams are 33% more likely to outperform peers on profitability, according to McKinsey & Co.
Healthcare organizations should pursue diversity in their leadership and workforce to improve healthcare outcomes and their bottom line.
The eight-minute film, titled Purl, emphasizes the importance of workplace inclusivity and diversity. Writer and director, Kristen Lester, used her own experiences in the animation industry for Purl's story.
“It’s based on my experience being in animation”, says Lester, “my first job, I was like the only woman in the room and so in order to do the thing that I loved, I sort of became one of the guys. Then, I came to Pixar and I started to work on teams with women for the first time and that actually made me realise how much of the female aspect of myself I had sort of buried and left behind”.
This film emphasizes complaints about male-dominated industries and how they're still way behind in terms of hiring diverse teams, publicly reporting those figures, and properly onboarding a new employee. HR managers believe those things are key to preventing toxic or alienating work cultures.
Promoting diversity and inclusion within your workplace is one of the best ways to foster an open-minded company culture. When you have a diverse work force, they provide unique employee perspectives and when that work force mirrors the population of patients they're treating they can give you the patient's perspective as well. These insights should give you a better understanding of those colleagues and patients.
Operating any business in this day and age, especially a health system, requires a large degree of diversity within the organization to help provide culturally competent care to an ever growing and changing patient population. Larger well-organized health systems have entire teams dedicated to diversity and inclusion efforts.
Sometimes recruiting and hiring managers unconsciously target diverse candidates who act like the majority rather than seeking to bring true differences to their organization. When you hire people who think and act like you do, it is comfortable. You know what they look and sound like, and uniformity feels easier to manage. However, doing so stifles diversity, a sense of belonging and innovation. When people who all think alike come together, they consistently dream up similar solutions. High levels of innovation only happen when you leverage the insights of people who see the world differently.
Try to get feedback about the hiring process from the applicants themselves. They are the people who have experienced bias and cultural misunderstandings. They know how it feels and will have ideas about positive changes that can be made within the organization.
It is highly recommended that your organization provide all employees with diversity training. Employees should understand that hiring decisions are based on finding the best candidate and not only based on quotas. The recruiting process should be transparent to help ease the minds of skeptical employees. Also, be sure managers fully understand the benefits of a diverse workplace. They will be implementing HR policies and should be fully committed to supporting the practice.
Treat others the way they want to be treated. Understanding how different cultures… perceive a handshake, handle eye contact, and deal with the boundaries of personal space, can help to avert misunderstandings. When in doubt, ask. If you accidentally cause offense, apologize. Be respectful of personal and cultural boundaries. Encourage your colleagues to do the same through your example as this will make your workplace more welcoming and productive for everyone.
For diversity to bring strength, it must be valued and integrated into company practices and philosophy. This takes time and a commitment to celebrate diversity. It requires the willingness to be open-minded and non-judgmental about the value of differences.
Major health care giants like Dana-Farber Cancer Institute and Massachusetts General Hospital have pledged to improve diversity recruitment of health workers. Reports showed a lack of diversity in hospitals and care discrepancies among patients. The hospitals plan to increase resources, hire executives focused on improving diversity and inclusion in their organizations, and more.
The lack of diversity in the healthcare workforce can impact patient care. Minority patients are more likely to seek out and follow advice from health professionals who look, sound, eat, worship and share the same cultural customs and values like they do.
The U.S. population overall is changing and quite rapidly. In 2010, the number of residents age 5 and older speaking a language other than English at home had climbed 158% to 59.5 million from 23.1 million in 1980, according to the U.S. Census Bureau. By 2044, more than half the nation is expected to be made up of minority races or groups, according to a 2015 Census Bureau report.
Yet, statistics show healthcare isn't keeping pace with population changes. Minorities made up just 14% of hospital boards and only 11% of executive leadership positions in 2015, according to a survey from the American Hospital Association's Institute for Diversity in Health Management. This disparity exists even though minorities represent roughly 30% to 35% of patients in hospitals.
Dana-Farber Cancer Institute officials told Becker's Hospital Review they plan to hire a leader for diversity programs, and will require all faculty and administration to complete a bias awareness workshop, among other initiatives, as part of the institution's 2018 strategic plan.
Dianne Austin, workforce diversity program manager at Massachusetts General Hospital, told Healthcare Dive, "Mass General has an orientation where new employees attend a program on diversity and inclusion and learn about various resources available to employees, such as a citizenship program, careers days and school admissions officers. There are also multiple staff committees focused on improving diversity and inclusion."
Akron Children's Hospital supports a program that aims to improve Nursing diversity. The program's plan is to increase the number of interns in the program and provide tuition support during their senior year of college. The hope is that program participants will return to Akron Children's after graduation to begin their Nursing career.
"Nursing diversity is vital to ensuring a positive experience for our patients," said William Considine, CEO of Akron Children's Hospital. "Not only does this program provide a valuable educational experience, it also helps Akron Children's recruit more prepared Nurses and helps our workforce reflect the diversity of the patients, families and communities we serve."
UC Health intends to contribute $1.5 million to create University of Cincinnati scholarships designed to diversify the medical profession. The hospital system hopes the scholarships will help all local health systems diversify their workforce when hiring doctors, Nurses, pharmacists and medical technicians.
“We know through recent research that underrepresented adults in Cincinnati believe their race negatively impacts their treatment from medical professionals,” said Dr. Rick Lofgren, CEO of UC Health. “This investment is a step to improve health care for all of our patients and to foster a health care workforce that reflects the diversity of our population.”
Diversity & Inclusion initiatives can be difficult to sustain, but commitment to increasing D&I at all levels of your organization will bring new perspectives and values to your hospital/health system, which can help decrease health disparities across the board. Bravo to the healthcare leaders that are seriously acting on their D&I initiatives! Do you see progress in this area where you work or teach?
The eighth annual Diversity Impact 2018 Student Conference will be held June 7-10, 2018, on FNU’s historic campus in Kentucky. This event is hosted by the Diversity PRIDE student organization and is open to all attendees who want to become part of FNU’s legacy of providing care to rural and underserved communities.
Join Us for an Impactful, Sight-Seeing, Cultural Excursion!
The Diversity Impact event opens the door for nurses to foster and strengthen collaborative discussions to address health disparities to improve minority health among underrepresented and marginalized groups. Students engage in cross-cultural and inter-cultural workshop activities, along with leadership strategies on current diversity healthcare trends as it relates to patient-provider care.
Meet FNU's New Chief Diversity and Inclusion Officer Dr. Maria Valentin-Welch, DNP, MPH, CDP, CNM, FACNM.
Frontier Nursing University (FNU) is seeing yet another one of its diversity initiatives realized through Dr. Maria Valentin-Welch in her new role as Chief Diversity and Inclusion Officer. Maria’s new position, which she assumed on October 1, 2017, is designed to guide the institution on matters of equity, diversity and inclusion.
Dr. Valentin-Welch has over 30 years of teaching experience, including her role at Frontier as an assistant professor since 2013. Through extensive work with marginalized and underserved populations, Maria has garnered several awards and accolades. She completed her Doctor of Nursing Practice (DNP) at FNU in 2015. Her DNP capstone project was a national online tutorial pilot program for ethnically diverse student nurse-midwives.
Frontier spoke with Maria about her passion for diversity and inclusion, how she will strategize those initiatives at FNU, and the challenges she expects to face in her inaugural post as CDIO.
What has been your career path so far and how has it led you to your current role as Chief Diversity and Inclusion Officer?
“A medical encounter shaped my understanding of the need for diversity in the medical world. There was a man that was restrained; he was trying to pull his IV because he was trying to get to his true hospital. I advocated for this man, explained the situation…I was told, ‘Well, we don’t have a translator, so we didn’t understand him,’ which was unacceptable. We found a translator, and the man proceeded to have his IV removed and was transferred to the hospital where he belonged. This experience really taught me how to be a voice for the voiceless, and to be an advocate for those who need advocacy.”
How has your professional background influenced your passion for diversity and inclusion?
“While working with homeless pregnant women, I felt like I wanted to do more with my hands, and that was my inspiration, my calling, into nurse-midwifery. Also my love for education has influenced my passion for diversity and inclusion. I have always been a teacher in my heart. I have taught and precepted many students…teaching is in my blood.
Another changing encountered occurred during my first visit at Frontier. In 2012 I came to Frontier’s Diversity Impact Weekend for the Pride Program as a keynote speaker, and there I not only fell in love with Frontier, but I also fell in love with the students who encouraged me to go back to school and go back to teaching. Now, I am an alumni of Frontier; I went to their doctorate program, and my capstone project was on tutoring and mentoring students of color. So, all of this was instrumental in bringing me to this point in my life.”
Learn more about Maria’s journey to Chief Diversity and Inclusion Officer in this video.
Where did your passion for diversity and inclusion begin?
“My passion for diversity and inclusion began really by being raised in New York City. It was a wonderful, diverse area to be brought up in, and it taught me that we are more alike than we are different. Another encounter in my life that really brought passion of diversity in my life was being moved from New York to Boston, Massachusetts in the seventies during the busing times. A historical era with a lot of racism and hatred in Massachusetts which has definitely improved since. However, that time period was really sad and showed me how ugly division can be.
A school incident took place that taught me that I am neither white, nor black, nor ‘other.’ I am Maria, and no one can label me. I am myself and that goes for every single person; we are all each personally unique and individual.”
Learn more about Maria’s passion for diversity and inclusion in this video.
How do you define diversity and inclusion at Frontier Nursing University?
“When our differences come together in a respectful and appreciative way for what each of us bring to the table, that’s when we reach diversity and inclusion. Diversity and inclusion in a nutshell is the power of unity, and FNU will be more powerful for including it in its strategic plan.
Diversity is like a beautiful tapestry made up of each and every one of us. We are all different in so many ways, beautiful ways. However, when our differences are united in a positive way, we create a powerful, enhanced atmosphere that otherwise would be lacking due to missing parts. So, diversity and inclusion is the glue of unity.”
Learn more about how Maria defines diversity and inclusion in this video.
What are you most excited about with your new position?
“I am most excited about the programs I hope to establish for students. Initially, these programs that I’ll be implementing will be pilot programs for our nurse workforce diversity grant students. We’ll work out the kinks and basically expand them to all students.
I’m also excited about bringing diversity to the forefront of Frontier. Our Community of Inquiry model will be stronger for it.”
What strategies do you feel will have the most positive impact on the FNU community?
“The strategies that I feel will have the most positive impact on Frontier are building these excellent student services, as well as diversity and inclusion training strategies and tactics to enhance our courses by threading diversity and inclusion issues along the way. We want to thread the subject matter even further throughout the curriculum. We will be stronger individually and as a whole because of the introductions of these plans.”
Learn more about Maria’s planned strategies as CDIO in this video.
What are the biggest challenges that you will face in your new role?
“Uniting folks while our nation is receiving messages of division and promoting actions of division and lack of compassion – to me, that will be my biggest challenge. However, I feel midwifery and nursing have always held an important role in not only listening to people, but also advocating for what is right. Frontier is better and stronger than the division being promoted across the nation.”
Learn more about the challenges Maria anticipates in her new role in this video.
What is a fun fact about you?
“My intersectionality is a fun fact. What is intersectionality? Intersectionality is a diversity term that basically explains that an individual has many hats that they bring to the table, not just what you see in front of you. So I’m not just a latina, female professor of a certain age. I’m also a mother, a wife, grandmother, and – here’s the fun fact – I’m even a great-grandmother of three great-grandchildren!”