Diversity, equity, and inclusion (DEI) is increasingly a priority for provider organizations. And many leaders want to advance their approach beyond ad hoc short-term pilots to a comprehensive and effective strategy. To do so, organizations need a few things—dedicated leaders, staff, resources, metrics, and goals—but first and foremost, a clear vision.
That's easier said than done. The DEI space is complex, interlocking, and far-reaching, making it challenging for leaders to determine how to allocate limited resources. To help, we've laid out Advisory Board's framework for defining DEI in health care below.
- Diversity: Celebrating differences in identity, often of race, ethnicity, gender, age, national origin, religion, disability, sexual orientation, socioeconomic status; ensuring that the diversity of our organization—across all dimensions—reflects our community;
- Equity: Securing the fair treatment, access, opportunity, and advancement for all people, which requires identifying and eliminating barriers that have disadvantaged some groups while advantaging others; and
- Inclusion: Creating an environment in which all individuals are welcomed, respected, supported, and valued to fully participate, and in which we strive to create balance in the face of power differences.
Having this shared language can be useful, but the conceptual becomes practical when we apply these definitions through the lens of health care. A comprehensive, best-in-class strategy to advance DEI requires a multi-tiered approach that addresses the needs of three (often overlapping) groups: your workforce, your patients, and your community.
How to embed DEI in your workforce strategy
The employee experience for historically marginalized communities, especially for women of color, remains inequitable. In health care, these groups report less opportunity for growth and development, fewer options for mentorship, and a greater interest in leaving their jobs.
But research indicates that organizations with a diverse workforce (across race, ethnicity, gender, sexuality, gender identity, culture, language, ability, and more) and an inclusive culture are stronger businesses; they are more profitable, perform better, make better decisions, and have greater team collaboration.
And among provider organizations in particular, frontline staff who feel valued, supported, well compensated, and provided with equitable growth opportunities tend to be more engaged and better equipped to deliver high-quality care. They're also less likely to experience the adverse social determinants of health that could impact their own clinical outcomes. Further, when frontline staff represent the community they serve, patients receive better care.
To move the dial on workforce DEI:
- Ensure leaders understand the trade-offs necessary to advance structural, transformational change toward a more equitable workplace. Embed an equity lens in leaders' performance goals, behavioral expectations, and decision-making processes so that DEI is ingrained in everything the organization does;
- Don't rely on training alone to reduce workplace inequities. Root out bias from existing talent management processes (e.g. hiring, onboarding, performance management) by redesigning them with underrepresented employees at the center rather than defaulting to majority identities; and
- Foster a workplace where team members from underrepresented groups feel included, safe, and valued. Instead of putting the onus on underrepresented team members to make your culture more inclusive (or point out the gaps), shift majority staff from bystanders to advocates who use their power and privilege to reinforce a culture where everyone can thrive.
How to deliver equitable, holistic care to patients
Maintaining a diverse workforce and an inclusive culture is a key first step to improving equity in outcomes, but it's not enough on its own. All staff need to be able to care for all patients regardless of background, and all are at risk of relying on cognitive shortcuts in high stress situations. And even if staff can build trusting, patient-centered relationships, they can't make much headway if patients face non-clinical barriers, which can account for up to 50% of health outcomes.
These two factors—disparities during care delivery and care that doesn't meet the full range of patient need—lead to the inequitable outcomes that persist today. A significant body of research details how historically marginalized populations routinely receive lower quality, delayed, insufficient, and even prejudiced health care services.
And this has real consequences, even beyond the impact on the individual. Health disparities among a provider's patient population can lead to legal risks, accreditation failures, lower quality and HCAHPS scores, avoidable utilization, and increased total cost of care. Further, it can damage consumer confidence and the organization's brand.
To reduce disparities at the point of care:
- Establish organization-wide cultural humility by acknowledging the organization's role in contributing to inequities, assessing current performance, assigning executive-level accountability for progress, and elevating under-represented voices in decision-making; and
- Equip staff with the time, skills, and confidence they need to understand identity, power, and privilege; uncover how those dynamics manifest in the care team/patient relationship; and offer culturally responsive and patient-centered care.
To offer holistic care:
- Use trusting patient-provider relationships and universal screening tools to surface non-clinical needs that interfere with health outcomes and disproportionately impact historically marginalized communities;
- Partner with high-quality community-based organizations to help inform community-based investments, build community trust, and engage hard-to-reach patients; and
- Develop scalable interventions to meet the full range of social needs for patients; these can include food security services, supportive housing programs, community health worker programs, mobile health clinics, congregational health networks, and digital equity investments.
How to address community-wide social determinants of health and their root causes
There is a critical distinction between addressing the immediate need of one patient (e.g. a referral to a food bank or housing shelter) versus addressing the broader cause of that need (e.g. eliminating food deserts/swamps or building an affordable housing stock). To do only the first can be meaningful for individuals, but that alone is insufficient; to break the cycle, leaders must address the community conditions themselves—otherwise known as social determinants of health.
By now, it's well documented that your ZIP code is often more impactful on your health than your genetic code. But social determinants of health don't impact all demographic groups in the same way. Structural inequity (often racism) that tie communities to intergenerational poverty is the root cause of many health disparities; it determines who lives in areas that support health and who lives in areas that harm health. Without understanding, acknowledging, and addressing the structural root causes, we will never fulfill our mission and mandate as health care organizations.
To advance community-wide health equity in the long term:
- Understand how structural inequities manifest and persist, how provider organizations may have contributed to them, and why they have a role to play in addressing them;
- Reinforce and deepen relationships with community organizations and local leaders to build trusting partnerships that center community members as experts; and
- Embrace your identity as an anchor institution and support grassroots efforts by using the organization's scale to secure funding, convene stakeholders, develop expertise, and advocate for policies that improve your entire community's socioeconomic strength.
For most health care leaders, the scope of the mandate for addressing DEI in health care can be overwhelming, and reasonably so—it will take decades to advance on this vision. But our industry can't afford to keeping playing around the edges. AskAdvisory to help you figure out where to start.