Money is tight at many health systems facing narrowing margins, staffing shortages and broad economic headwinds, which might encourage executives to scale back on initiatives that aren't part of their core missions. When it comes to diversity, equity and inclusion programs, however, some aren't backing away.
Trinity Health's diversity, equity and inclusion strategy has never been more critical, said LaRonda Chastang, senior vice president of DEI at the Livonia, Michigan-based nonprofit health system. "When it's stressful, you're pressed for time, and you are having to make cuts, we are more likely as human beings to be more reliant on our unconscious bias," she said. "That's when more safety events happen. We are more likely to cause unintentional harm."
That bias comes at a cost, said Dr. Zenobia Brown, senior vice president of population health and associate chief medical officer at New Hyde Park, New York-based Northwell Health. Racial and ethnic health disparities alone contributed to $451 billion in excess spending in 2018, according to a report the National Institutes of Health published this month.
And as healthcare organizations transition to value-based payment models that incorporate health outcomes, confronting disparities is part of the business plan, Brown said.
"Where we get reimbursed not just for how much we do, but the quality of work we do, addressing those inequities and DEI is a financial imperative," Brown said. "You will not be able to win in any of these models unless you are addressing the disparities and outcomes that are happening as part of the system."
For now, as budgets shrink and health systems balance priorities, executives can focus on simple yet effective strategies to sustain diversity, equity and inclusion in their workforce, Chastang said. "Do an internal review and get your own house in order," she said.
Focusing on culture
An easy place to start is in the human resources department, said Dr. Margaret Larkins-Pettigrew, senior vice president and chief clinical officer of diversity, equity and inclusion at Pittsburgh-based Allegheny Health Network and Highmark Health. Allegheny eliminated workplace dress code rules restricting tattoos, jewelry, hair and makeup, for example, she said.
"We can change the low-hanging fruit that will make a difference in the lives of our employees, which then will spill out into the lives of our populations and the communities we serve," Larkins-Pettigrew said.
To expand her reach throughout the 40,000-employee company, Larkins-Pettigrew launched the Enterprise Equitable Health Institute and hired 16 full-time workers focused on health equity, workforce development and company culture. Her team created a network of 79 "diversity champions" from each department to educate peers.
Integrating DEI strategies is critical to improving health outcomes, Brown said. Northwell mandates that executives undergo bias and leadership training that prepares them to facilitate broader conversations within their respective divisions. "We look for opportunities to infuse DEI in everything I touch," Brown said.
Brown launched Northwell's Center for Maternal Health last year to reduce maternal mortality rates, particularly among Black women, who are three times more likely to die from pregnancy-related issues than white patients.
The center studies how institutional bias and social determinants of health affect pregnancy-related outcomes. Its work has decreased pregnancy-related re-hospitalizations by 20%, Brown said. Northwell hospitals have also seen a 40% decrease in re-hospitalizations among heart attack and stroke patients. Among Black women, the rate of re-hospitalization due to serious morbidity concerns has decreased by 56%, she said.
"You have to draw a line in the sand and say: This is what we are focusing on. This is our priority," Brown said.
To address bias, many health systems implement training throughout their workforces. Northwell uses a curriculum from consultancy Be Equitable (formerly Cook Ross) that educates employees on unconscious bias and the positive impacts of institutional diversity.
Allegheny is developing a curriculum they plan to market to other organizations, after previously relying on a Northwestern University certificate program.
To make companywide training most effective, content should be tailored to specific roles and be conducted among peers in short sessions, Larkins-Pettigrew said. Allegheny has different curriculums for executives, clinicians and non-clinical employees.
It is essential to deploy bias training proactively and positively, not as a punishment, said Chastang. "Some people approach DEI and make it punitive. That is harmful," she said.
Setting expectations and identifying common goals can help win over skeptics, Chastang said. Collecting data and tracking progress is also critical, Brown said: "The numbers don't lie."
Healthcare workers need to be protected from bias and discrimination, Larkins-Pettigrew said. Allegheny recently changed its policy on patients who discriminate against employees. For example, if a patient does not want to receive care from a Black nurse, the health system formerly would remove the nurse from the care team.
Allegheny no longer does this, Larkins-Pettigrew said. "We don't honor those types of requests," she said. Instead, each facility uses staffing software to assign care teams. "This is the team that has the best expertise that will give them the best care," she said.
Allegheny also trains physicians and department leaders to confront patients and to support workers who are subjected to discrimination.
Northwell seeks to address the mental toll of bias in the workplace. In 2020, the health system created an internal support group in which employees could discuss job-based injustices and how to solve them, Brown said.
Northwell also operates a Center for Traumatic Stress, Resiliency and Recovery, which provides mental health support to workers. "If you don't deal with that, there's no way that's not going to impact the people they are taking care of," she said.