As health care organizations strive to cultivate inclusive workplaces, many could use a comprehensive structure to keep their efforts in check. A ‘first-of-its-kind’ study from the Perelman School of Medicine, which is part of the academic medical center Penn Medicine in Philadelphia, has given way to a taxonomy that other health care leaders can use to do exactly that. 

Published in JAMA Network Open, the study outlines a template to identify, measure and address the issues that contribute to inclusive learning and work environments. A team of researchers narrowed these factors down to six: presence of discrimination; silent witness; interplay among hierarchy, recognition and civility; effectiveness of leadership and mentors; support for work-life balance; and perceptions of exclusion from inclusion efforts. 

“Regardless of the factor, the underlying thread among [them] was the need to belong and feel recognized and valued,” the researchers wrote

The framework is a “relatively easy and incredibly insightful way” for health care leaders to conduct inclusivity audits, said lead author Jaya Aysola, M.D., assistant professor of general internal medicine and assistant dean of inclusion and diversity. 

A forum that works

Penn researchers decided to come up with their own study to better understand the recommended diversity engagement surveys of the day.

Rather than conduct a focus group, “which puts people on the spot,” or attempt internal surveys that could compromise participants’ anonymity, Aysola and her team used a method developed by Penn’s Frances Barg, M.D., a professor of family medicine and community health. 

They asked, through a private online platform, two open-ended questions of employees, faculty, and students across Penn’s health science schools and hospitals about their experiences with inclusion. They asked respondents to divulge moments in which they or a colleague was treated in a way that made them feel either included, valued, and welcome or excluded, devalued, and unwelcome, and were also asked to comment on how the respondent perceived the general climate at Penn as it pertained to inclusion and respect.

Three hundred fifteen people responded, and the results were “striking” in their candor, Aysola said. Respondents felt safe to share in this way, she said, which made all the difference.

“We were shocked at the appetite for people to want to tell their stories,” Aysola said. “The length of stories we received, the time of night they were submitted online, the emotion, the analogies, the quotations… it was amazing how much [respondents] gravitated toward this forum.”

When you see something, say something

The research team identified themes in the responses and then developed improvement strategies. Their recommendations, which included inclusivity education for existing leadership, developing advocacy campaigns across the health system and encouraging leaders to diversify their professional networks, addressed changes at the system-level, since most respondents referenced problems with a systemic culture that influenced their group and interpersonal dynamics. 

Penn has already begun rolling out those initiatives, starting with a series of 12 leadership workshops, with help from external consultants, that focus on understanding implicit bias, managing diverse employees and highlighting discrimination. Penn also is testing a “bystander advocacy” campaign to encourage staff to speak up when they witness discrimination. 

“When you hear a discriminatory remark, or you hear an off-handed joke, in a meeting, in a clinical setting or in medical school or the C-suite — it doesn’t really matter — everyone is encouraged to point that out on-the-spot,” Aysola said. “We provide a tactical set of tools to highlight that and move on.” 

In addition, Penn plans to “continue this ongoing measurement of inclusivity” through a permanent cultural audit, she said. 

Scaling the study to the field

Although the study responses may not be nationally generalizable, the resulting template may be widely applicable. Aysola urges hospital leaders who wish to adopt this methodology to integrate their solutions into existing initiatives. 

“There are so many ways in which to take this template and say, ‘how can we make our current and already operational standards and policies reflect inclusion as well?’”
Aysola said. “Right now, inclusion is often a siloed activity, or it’s often relegated to a diversity officer in a hospital system or an office of diversity within a medical school. It’s really not integrated into the normal operations within a health care infrastructure.”

Aysola cited human resources’ policies around family leave and compensation, as well as wellness initiatives, as areas where inclusion efforts could blossom. Doing so makes it “mainstream,” she said, which also normalizes it for those who typically feel exempted from traditional diversity efforts.

“If inclusion was part-and-parcel of all your wellness initiatives, it wouldn’t be seen potentially by a subset of the population as something that wouldn’t benefit them,” she explained. 

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