Why this strategy matters

While there are national patterns of underrepresentation in the clinical workforce, this manifests differently at each organization. It’s important to start by identifying the specific gaps within your institution to inform where to focus your pipeline investments.

How to implement this strategy

Compare the demographic makeup of your workforce to the makeup of your community or local labor pool. This assessment should be as specific as possible (for example, focusing on specific racial/ethnic groups rather than aggregating all people of color) to generate actionable information. In addition, look beyond workforce or department averages to assess how demographics vary by role—for example, looking at the gender composition of aides and techs compared to licensed clinical roles compared to manager roles. This level of analysis can identify the areas of greatest need and opportunity to prioritize your efforts.

The hidden challenges and how to overcome them

In addition to technological or data barriers, you may run into other engrained challenges. For example, you may encounter resistance to acknowledging that such disparities exist at your institution or fear of the consequences of publicly sharing the results of the analysis. The reality is that these disparities exist and are experienced by your team members, patients, and community members, whether you acknowledge them or not. Acknowledging gaps in your workforce gives you a starting point to address the inequities, rather than letting them worsen over time—and transparency encourages accountability and can improve trust with employees and community members.

Reflection questions

• Has your organization compared the demographic makeup of your clinical workforce to the makeup of your community/local labor pool?
• If yes: How openly did you share the findings from the analysis? Was there any resistance to this level of transparency?
• If no: Aside from technological or data limitations, what barriers have prevented your organization from doing this analysis?

Recommended resource

4 steps to uncover (and solve) inequities in employee outcomes

Why this strategy matters

Even after identifying the gaps in your workforce, it’s not as simple as hiring more clinicians from a given group. Underrepresentation stems back to who can attend school and pursue clinical training. Rather than competing for a limited pool of talent, leaders must invest in expanding the number of people from underrepresented groups who become clinicians in the first place.

How to implement this strategy

Our research has identified three key strategies to design clinical paths for individuals from underrepresented backgrounds:

1. Build intentional recruiting relationships to encourage more people to enter health care. Seek out partners with deep community connections, from schools to local scout troops, to influence students earlier and introduce them to health care careers.
2. Partner to address non-clinical barriers to completing clinical training. Link students to partner organizations to address financial, academic, and other barriers that may get in the way of pursuing or completing clinical training.
3. Commit to playing the long-game to see results. An effective pipeline program takes years to see returns. Fragmented, short-term efforts reduce the impact of workforce pipeline strategies and can harm trust with employees, candidates, and community members.

The hidden challenges and how to overcome them

In today’s world, leaders often face resistance to making investments that don’t have a quantifiable or near-term payoff. However, expanding the clinical pool from underrepresented backgrounds will require long-term, sustained investment. Leaders must think differently about what “return on investment” means in order to enable sustained investment in this work. This may include:

• Committing to longer timelines, recognizing that pipeline investments may take five to ten years to positively impact an organization’s workforce numbers.
• Recognizing the impacts of pipeline investments outside of direct return on recruiting/hiring numbers, such as increased employee engagement or increased community employment rates.

Reflection questions

• Would your organization be willing to commit to investing in clinical paths for high school students? Why or why not?
• How would your organization need to think differently about “return on investment” to make this type of effort possible? (Or if your organization has already created a similar effort, how did you think differently about return on investment to make this possible?)
• If your organization does not invest creating a diverse workforce pipeline, what’s your alternative plan? Where will you be in ten years?

Recommended resources

How Family Care Specialists built a pipeline to increase workforce diversity

Innovation Showcase: Strategies to Advance Diversity (Dayton Children’s Hospital example)

Why this strategy matters

Organizations often rule out talent without realizing they’re doing so. Often, organizations have designed hiring processes around a “default” candidate identity, usually representative of the workforce majority, which creates barriers that deter other eligible candidates or influence who is ultimately hired into the organization.

How to implement this strategy

Assess how components of the role or hiring process may cater to individuals from certain backgrounds and present barriers to people from other groups. Then, intentionally redesign roles and hiring processes to center people from underrepresented groups.

For example, leaders at Johns Hopkins Medicine realized that by asking about criminal history on their organization’s initial application form, they were deterring many qualified candidates from even applying. In response, they removed this question from the application, so all candidates now go through the same application and interview process. If selected, candidates undergo a background check, and any criminal history is reviewed against internal guidelines that consider information like the type of conviction, age at conviction, and relevance to the role. This shift in the hiring process has significantly impacted Johns Hopkins’ workforce pipeline. For the past decade, 5% of all hires annually have had prior justice system involvement.

The hidden challenges and how to overcome them

These barriers are often invisible to leaders within the organization because it simply feels like the way we’ve always done things. You may encounter resistance to changing role requirements; leaders may feel the requirements are necessary or that changing the requirements will reduce the quality of applicants—a concern that comes from deeply-rooted and often flawed beliefs about who makes for a qualified applicant. It’s important to reflect on why you have particular requirements in place and question whether they’re truly necessary.

Reflection questions

• Think of a role you have trouble hiring for. How might your organization be making it more difficult to fill this role? Consider factors like criteria in the job description (including years of experience and educational background); steps in the interview process; working hour requirements; compensation and benefits; and growth opportunities.
• What could your organization do differently to address one of these issues?

Recommended resource

Johns Hopkins Hospital’s Success in Hiring Individuals with Justice System Involvement