Approaching Diversity, Equity, and Inclusion Through a Future-Oriented Lens

Black Female Doctor Teaching Nursing Students
A small group of diverse nursing students sit around a boardroom table as they listen attentively to their teacher and lead doctor.

Recent social justice movements (Black Lives Matter, #MeToo and the Women’s March, Stop AAPI Hate, and others) have spotlighted the need for diversity, equity, and inclusion (DEI) across all facets of our society. The workplace is no exception; even though DEI initiatives have been around in some form since the 1960s, in the months and years following early 2020 there’s been an explosion of organizations creating DEI offices, equity officers, and other commitments to formal improvement (both internally from a staff perspective and externally from a client or patient perspective). Between May and September 2020, the number of DEI-related job postings increased by 123 percent.

From a health care perspective, lack of equity translates to higher costs. “When we exclude particular populations, decrease access, increase barriers, or provide subpar care, then at the end of the day, those people are going to utilize health care dollars at a much higher rate,” says Mary Fleming, MD, president of the nonprofit Reede Scholars, Inc. and program director of the Leadership Development to Advance Equity in Health Care program at the Harvard T.H. Chan School of Public Health. A DEI representative or office can pinpoint these areas—like lack of access to public transportation, for example—and propose effective solutions that can lead (directly or indirectly) to better outcomes.

Since 2020, there’s increased interest in doing this work. “We’ve seen DEI offices in academic and healthcare settings, but that’s not unusual,” adds Fleming. “Now it’s moving into the corporate, non-traditional health care and academic spaces: we’re starting these offices, and the vocabulary around these issues has expanded as well.”

But beyond this important moment, where organizations see this as a hot button issue worth paying attention to, how are these groups or individuals set up—or not, as the case may be—for actual success? How have they been integrated into an organization? Is their work sustainable in the long term and, if so, what are effective predictors of success? Are adequate resources being allocated?

Common DEI Mistakes and Pitfalls to Avoid

In her work with health care organizations, Fleming has noticed that there isn’t necessarily a full staff or support system behind DEI representatives—with individuals potentially being hired in isolation to fit the name of the office instead of to do meaningful work. Keeping the person siloed, either nested within an HR office (and seeing the problem as merely a personnel issue) or as a separate part of the company is an ineffective way to help make change.

“For those of us who are entrenched in health equity work, we really want to change the culture and change people’s lives so that it’s sustainable. A singular person in a single office is not going to do that,” says Fleming.

Another problem is when executives create DEI positions but have no formal plan for how they’re going to execute the work. This could manifest as not giving the office or representative the correct resources, authority, or executive buy-in for them to make and carry out recommendations. On a deeper level, explains Fleming, DEI representatives are often Black, Indigenous, or people of color (BIPOC). “What does the rest of your organization look like—and how do you want to it to look in the future and why? Is your company ready to do the necessary work to create culture change? What is the overall recruitment and retention plan? Or will the DEI officer serve as the sole source of diversity?” she says.

What’s Important When Considering Formal DEI Programs

For those who are in a position to either create, scale, or contribute to DEI work within an organization, there are several important factors to consider:

  1. Understand the mission and purpose of the organization, and the mission and purpose of the office within that framework. Make sure to ask: Why are we doing this work? And how does it actually impact our organization?
  2. Consider the metaphorical “seat at the table” of this person or group. How do they integrate into the rest of the leadership structure? Is there an identified place for them? Do they have a voice and authority? Are they able to make policy changes? How much autonomy do they have?
  3. Think about how organizational infrastructure can support these changes. What does the rest of the organization look like? How are changes implemented? Is there a long-term plan (and financial resources) to sustain DEI work? Is there a culture change that should occur as a part of this work to be multiculturally supportive?
  4. Define what success looks like. What are the easy, short-term wins that can help demonstrate that this work is worth doing—and what are the medium-to-long-term goals? If these efforts are not working, what changes need to be made and how?
  5. What resources are available? How much is the organization investing in DEI initiatives?

The exact manifestation of this work varies depending on the organization. One way to implement DEI work, which Fleming has seen success with, is creating policy change in every department. “Then equity, diversity, and inclusion is part of the senior leadership’s responsibilities for each department, and not just one person’s responsibility in the organization,” she explains.

How to Build on Effective DEI Work in a Health Care Institution

Institutional change can be hard—especially when it contradicts existing norms and procedures. Looking at the health care system, it’s important to identify what Fleming calls “the mutually beneficial bottom line,” i.e., the principle that improving quality improves revenue. “Being more inclusive is going to bring you more business,” she explains, which can help executive leaders rally around the work as a financial incentive.

“When we think about the big public health interventions in our recent past: we have to consider that some people started wearing seatbelts not because it saves their lives, but because they didn’t want to get a ticket. What created the biggest decrease in the number of people smoking cigarettes? We started taxing cigarettes, preventing people from smoking inside, preventing people from smoking at work,” she says. “Sometimes, people have to be motivated in a different way. Because this is a systemic problem, we have to think about systemic solutions.”

Thinking about DEI work in a more holistic sense can also help with broader, more innovative initiatives. Partnering with non-health care companies (like getting a ride-share company to offer free rides for screening appointments) can also appeal to audiences who might not otherwise be exposed to these health care services. Collaborating with schools, food banks, and other institutions to dovetail with medical care can underscore the importance of preventative health interventions.

Fleming explains, “How do all of these things go together? The intersection of these health inequities can follow people for their whole lifespan. We need to continue to think about this outside the health care space, too.”

“Our health is affected by more than the care we receive in a hospital or clinic or our personal behaviors at home and at work. Improving health equity requires cross-sector interventions that address food insecurity, housing instability, lack of access to equal education, exposure to environmental pollutants, and so on. Improving health outcomes for our most vulnerable populations improves health for all Americans.”

Harvard T.H. Chan School of Public Health offers Leadership Development to Advance Equity in Health Care, an online course for health care leaders to pioneer innovation in policies, practices, and programs that advance health equity.