Infusing Belonging Into DEI Work

Healthcare leaders whose organizations are adding the concept of “belonging” to their ongoing DEI work tend to echo, at least in so many words, the analogy proffered by Sandra Ogunremi, DHA, vice president, diversity, inclusion and belonging at Monument Health in Rapid City, S.D.

“I have heard it said that diversity is being invited to the party, inclusion is being asked to dance, and belonging is dancing like no one is watching. And I agree,” she says. “You can bring your whole self to work and be authentic—be real. It is OK to be you.”

That sentiment around belonging is growing in corporate settings as companies tweak their approaches to diversity, equity and inclusion efforts. It also is becoming an increasingly important part of healthcare leadership as hospitals and health systems build it into their dual focus on employees and patients alike.

Monument Health, for instance, has been focused on DEI since it signed the AHA’s Equity of Care Pledge in 2015, Ogunremi says. Like many in the field, the organization has focused more on belonging as its DEI efforts have evolved and the work spurred by the signing of the AHA pledge has taken hold.

“Belonging is when people are seen, heard, understood and have psychological safety,” she says. “Without a sense of belonging, people withdraw. They become disengaged, they quit quietly and then ultimately leave. A sense of belonging is crucial to our overall well-being. It impacts our physical, mental, emotional and spiritual state.”
“Attracting and retaining our teams is critically important,” adds Paulette Davidson, FACHE, president and CEO of Monument Health. “If we create a culture where people from different backgrounds feel comfortable and can thrive, then we have the optimal environment where we all feel a strong connection and know we belong. I am very passionate about ‘belonging’ as a component to our culture.”

Northwell Health, based in New Hyde Park and Lake Success, New York, started its DEI work focusing on patient care and later expanded its focus to the workforce, says Maxine Carrington, JD, senior vice president and chief people officer. She sees belonging as an outcome of inclusion, starting with keeping tabs on workforce insights, including sentiment and turnover. “For example, we assess belonging based on what folks tell us, and whether we see retention happening,” she says. “Often, there’s been a focus on the recruitment of historically underrepresented groups. Most companies are starting to equally focus on retention.”

Minneapolis-based Allina Health aligns and integrates its DEI and belonging principles and practices at both the system and operational level, says Jacqueline Thomas-Hall, vice president and chief diversity, equity and inclusion officer. Allina Health added the concept of belonging to its work to be more intentional about underscoring the representational aspect of diversity, turning the concept into tangible action in large and small ways. 

Employee resource groups “have engaged employees in courageous conversations and executive listening sessions, which have become safe spaces to share lived experiences, highlight differences and address some unconscious biases,” she says. Gender-neutral bathrooms, respect for pronouns, artwork that reflects diversity, and highlighting heritage months are other ways “we continue the quest to ensure as many people as possible feel seen, heard, welcomed and respected—key aspects of belonging.”

DEI-B in the Workforce
On the employee-facing side, Leon Caldwell, PhD, senior director, health equity strategy and innovation at the American Hospital Association, sees organizations forming employee resource groups  that convene across title or position lines, acknowledging the hierarchy within the organization but without letting titles hinder climate and culture. “You’ll have racial and ethnic groups, you’ll also have LGBTQIA+ and employee resource groups for other dimensions of commonality in your organization,” he says. “The key part is that the organization celebrates what staff and patients bring to the organization. You bring your own uniqueness.”

More broadly, Caldwell sees more AHA members being upfront about differences and uniqueness. “They’re connecting people and creating a space for that to happen,” he says. “We see more hospital- or system-sanctioned activities. They’re no longer seen as adjuncts to the organization, or an adjunct to the role of the employee, but they’re kind of embedded.”

Main Line Health, located in suburban Philadelphia, looks at the career pathways for entry-level staff, such as housekeepers, pharmacy technicians and nursing assistants, to see whether an upward trajectory exists for them—both overall and by subgroups. For instance, last year, the organization launched a leadership development program for high-performing individuals who have an interest in growing their career at Main Line Health. “This program is open to all entry-level employees and has resulted in 32 promotions to date,” says Karen F. Smith, system director, Diversity Respect and Inclusion.

Another area of focus at Main Line Health that targets belonging is the LGBTQ+ population. 

“If the organization isn’t committed to respecting and embracing differences, it can be very easy for someone in the LGBTQ+ community to feel like, ‘I don’t belong here. They don’t value me as a person, the way they value other people who are more like them,’” says Jack Lynch III, FACHE, president and CEO, Main Line Health. “All these things are the right thing to do, from the heart, and quite frankly, you can’t be successful in business without making people feel like they belong. They will go somewhere else.”

To strengthen its culture of belonging, Main Line Health created LGBTQ+ inclusive care centers within identified physician practices. Those practices receive training and guidance from the director of LGBTQ+ services to ensure each patient of that community has an exceptional experience. Additionally, the LGBTQ+ & Allies employee resource group, provides employees with a connection, resources and support to ensure their needs are being met. They have held several lunch-and-learn sessions for all employees to learn more about the needs of the community and how each employee can make a difference.

“Many of our employees enjoy using their volunteer days to support these communities and enhance their sense of belonging by providing to others in need,” says Smith.

Main Line Health has also provided opportunities for all its employees to  be part of the organization’s diversity, respect, equity and inclusion, or DREI, work and enhance belonging. While employee resource groups aren’t new to many industries, they were a recent addition to the organization’s structure. “We have a variety of groups that offer something for everyone to get involved,” says Smith. Group examples include Black/African American & Allies, Substance Use Disorder Allies and Neurodiverse & Allies.

“Starting these groups during the COVID pandemic was challenging, but it also provided an opportunity for us to bring employees together from across the organization with a shared purpose,” says Smith.

Davidson of Monument Health—a member of the Mayo Clinic Care Network that serves 12 communities across western South Dakota with five hospitals and more than 40 medical clinics and specialty centers—says her organization starts teaching the concepts of DEI and belonging with every new caregiver in the organization during their orientation. Monument then follows up on a monthly basis with a training luncheon, and weekly with e-newsletters and other communication vehicles.

“It’s their favorite part” of onboarding, she says. “It is an opportunity for them to learn about the organization, and their fit, and they feel connected.” At the monthly luncheons, she adds, “hundreds of people come, and we have panel discussions about gender issues, about ethnic differences, about ageism.”

A board-appointed corporate responsibility committee is ultimately responsible for DEI-B efforts, and Davidson underscores the importance of that high-level involvement. She says evidence includes net revenue growth from about $650 million to $1 billion over the past several years along with improvements in quality outcomes, patient experience scores and diversity in the workplace. When a caregiver makes a nonclinical error in judgment and uses inappropriate language, Monument Health seizes on the opportunity for a teaching moment, she says. “It’s a very alive education process. What it creates is a voice for our caregivers.”

As an organization that serves a five-state region with a rural geography, Monument is very intentional in setting this tone to attract and retain diverse staff, not to mention leaders and board members, Davidson says. “This is a business strategy. This is the right thing to do. This is about meeting our mission and taking care of the region,” she says. “It’s not as easy to recruit as in an urban setting, where there’s a higher population.”

For Northwell, DEI-B on the workforce side starts with aiming to ensure a diverse slate of candidates for every vacancy through programs with schools, community groups and youth employment agencies, Carrington says. Next, the organization targets advancement and retention through development and mentorship programs aimed at women, people of color and other diverse groups. 

Northwell also fosters a culture of inclusion and belonging through centralized education on issues like microaggressions, allyship and inclusive leadership, as well as through its nationally recognized business employee resource groups, or BERGs, that focus on women, different racial and ethnic groups, LGBTQ+, people with disabilities, caregivers and veterans. Groups soon to be added: multigenerational, interfaith and multicultural.

“[They] support our business objectives through their contributions to our strategies, as well as serving as a leadership pipeline pool,” Carrington says. “We support their programming and have learned so much from them. It’s pretty amazing.”

With more than 85,000 employees and flagship hospitals North Shore University Hospital, Long Island Jewish Medical Center and Lenox Hill Hospital, Northwell talks not only about diversity but valuing, Carrington says. 

“Celebration sounds like an event—like a one-time thing,” she says. “Value sounds long term. We are saying, ‘This is critical to our business success and sustainability.’” Northwell has three teams that captain its belonging efforts: Fair Employment Practices, which sits in human resources; the Center for Equity in Care, which is patient-focused; and Community and Population Health, which looks upstream to engage and support communities while addressing social determinants of health. 

Allina Health’s Thomas-Hall wants to ensure employees feel as though they have true connections and allies. For example, she says, if someone is transitioning their gender, “We want to make sure we meet those needs and be a conduit for how they share their information with colleagues, patients and others. We also want to learn how different parts of our communities feel about diversity, and to make sure they know this is a place where we do not tolerate disrespect or exclusion.”

Allina Health, a nonprofit with 12 hospital campuses, more than 60 primary care clinics, 20 same-day and urgent care centers, and 28,500 employees, creates opportunities for employees to be allies of one another through such vehicles as employee resource groups, Thomas-Hall says. Currently those focus on Native American, Latino/Hispanic, Black, immigrants, LGBTQ+, women, veterans, and mental health and disability groups, the last of which plans to split into two separate groups. 

“If we’re looking at [providing care] in a population we have little familiarity with, we can use the ERGs to understand and navigate those communities, and become a champion as we think about our ability to show up and present in specific communities,” she says.

The Patient Experience
On the patient side, Caldwell sees a connection between employees bringing their best selves to the workplace and their overall feeling about their work with patient satisfaction. “If you have a workforce that feels engaged, invigorated, inspired because they can work in a place that allows all of them to show up, it could [impact] how they treat patients, and even each other as colleagues. That has implications for health equity, DEI, quality of care and patients who need to feel familiar with care providers. You’ve introduced humanity back into the system.”

Rather than talking about cultural competency, Caldwell prefers the term “cultural humility” because he sees the former goal as always evolving, with no real endpoint. “One doesn’t become culturally competent, and stop,” he says. “It’s a dynamic realm when it comes to understanding culture. The appropriate training is around being culturally agile. That allows one to confront differences and seek commonality with a sense of humility, and empathy, and openness to learning.”

Patients are seeking caregivers who look like them or otherwise understand where they’re coming from, Lynch says. About a decade ago, Main Line Health opened two family practices that the organization labeled “LGBTQ+ Inclusive” and focused on making sure that population felt welcomed. “They wouldn’t be stared at. They wouldn’t be asked ‘What do you mean?’” when describing how they identify, he says. “We have gender-neutral restrooms and social services supports specific to the needs of that population.”

Main Line Health digs into patient satisfaction dashboards provided by third parties beyond the top-line numbers, Lynch says. “If you don’t look at them stratified by ethnicity, race, gender, age, payer and ZIP code, you’re missing some very critical data,” he says. “One of the more challenging is sexual orientation identity data. We don’t capture that as easily in the registration process.” The organization added a couple of optional questions in its patient satisfaction survey and, after “a handful of angry patients” reacted badly, Lynch wondered if they should remove the questions. His staff insisted the misunderstanding and anger would blow over, and it did.

Main Line Health also has adopted the AHA’s “Why We Ask” training to assist staff on how to comfortably collect this information at point of registration. Lynch says a Black patient entering the ED might ask, “Why do you want to know?” He adds, “We trained people to explain, ‘I want to make sure that, as we care for our patient population, we’re meeting the needs of all our patients.’”

It’s well-documented that in the U.S., the rate of maternal mortality and morbidity for Black women is more than twice the rate of mortality for white women. “At Main Line Health, we do not have any maternal mortalities in our patient population. Thus, we have focused on complications and related factors,” says Rosangely Cruz-Rojas, DrPH, vice president/chief diversity and equity officer.“We found that Black women were delivering via Caesarean at 1.7 times the rate of white women. We implemented interventions and have reduced that gap.”

Monument Health likewise encourages staff not to make assumptions about patients’ ethnicities—or anything else, Ogunremi says. “Some of our brothers and sisters are blonde and have blue eyes—and they have Native American heritage,” she says. “We need to capture that.” The system also encourages cultural appropriateness, recognizing that a patient may prefer limited eye contact, or want a gentle touch instead of a firm handshake, she adds. Caregivers “need to understand some patients communicate differently.” 

Included in Monument Health’s service area is the Pine Ridge Reservation, home to the Oglala Lakota Nation. Native American families have become less likely to wait until a medical problem requires a trip to the ED, Davidson says. “Instead, they’re getting preventive medicine,” she says. “We’ve changed their perception of our organization by being welcoming and being respectful of cultural differences. The goal for all is to receive the care they need.”

The system’s Healthcare Equity Governance Team recently focused on patients with congestive heart failure who returned to the hospital within 30 days and found that Native Americans were more likely to do so, Davidson says. “We’ve developed a program where community health workers and nurses are following up more frequently, going to patients’ homes, checking up on them, and making sure that they’re seeing their doctors and taking the right medications,” she says. “That’s leading us down the path of improving the health of our families and communities.”

Northwell, similarly, has rolled out the “We Ask Because We Care” campaign that supports the capture of demographic data, while at the same time explaining to patients why such data is so valuable, Carrington says. “Whether it’s reporting for regulatory reasons or helping to understand patient populations, health equity is certainly central to everything we do,” she says. “We have a council focused on improving health and quality outcomes. We have a transgender care team, with a focus on LGBTQIA access.”

Patients visit the hospital during their most vulnerable moments, at a time when emotions are high, says Thomas-Hall of Allina Health. “We want to make sure that our words and deeds match, and that as we begin to navigate what brings them to the hospital, and having a conversation about what their main concerns are, it cannot be one-size-fits-all. That’s why cultural competency, moving to cultural intelligence, is truly important,” she says. “We need to make sure our own biases are in check. We spend a lot of time training to understand bias.”

Allina looks at its experience score outcomes and strategizes using the data to find opportunities for improvement, Thomas-Hall says. “We think about how we walk with them, and let them guide us,” she says. “What do we need to do to meet the needs of our community? So they feel, ‘Allina Health understands who we are, they understand our unique needs, and they are working with us to provide the right services.’”

Ed Finkel is a freelance writer based in Chicago.