Diversity, equity and inclusion are at the heart of the healthcare mission. Some leaders say DEI is the DNA of their health system. The core purpose of health systems is to provide quality healthcare to diverse populations and to play a key role in developing healthy communities.
A commitment to equity and mitigating healthcare disparities is inextricably linked to mission-critical continuous quality improvement and patient safety. Achieving the healthcare mission depends on diverse people working in an inclusive workplace, where they feel a sense of belonging and their well-being is seen as central to attaining the mission. All of this requires inclusive leaders who believe DEI is a strategic priority that involves strategic change to be successful.
What Is Strategic Change?
Strategic change is organizational change that is aligned with the strategy and addresses the cultural adaptation required to achieve it. DEI is more than a series of programs and initiatives. Programmatic change often does not lead to sustainable results. A seminal article “Why Change Programs Don’t Produce Change” by Michael Beer, Russell A. Eisenstat and Bert Spector, which appeared in the November/December 1990 issue of Harvard Business Review, makes this point. Diversity, equity and inclusion is a strategy that needs to be embedded in the mission, core values, vision and goals. Change leadership efforts focus on creating a diverse, equitable and inclusive organizational culture. There needs to be coherence and alignment of DEI goals, key performance indicators, priorities, decisions, and actions with the strategy and culture to attain sustainable results.
Leadership Practices for Sustainable Results
Leadership practices needed for sustainable DEI results has been the subject of research studies and articles. One example is the May 2021 Harvard Business Review Analytic Services and Society of Human Resource Management research report, Creating a Culture of Diversity, Equity, and Inclusion: Real Progress Requires Sustained Commitment, describing the survey outcomes from 1,115 organizational leaders. The study explored the extent to which DEI is a strategic priority, methods for implementing DEI initiatives and the level of success with developing a DEI culture.
Another example is the article “Diversity, Equity and Inclusion Lighthouses 2023” by McKinsey & Company in partnership with the World Economic Forum, which described the work of the Global Parity Alliance, a multi-industry group committed to advancing DEI worldwide. The alliance studies successful DEI initiatives (“lighthouses”) to determine common factors that yield scalable, quantifiable and sustained impact. In addition, my interviews with senior leaders at organizations such as Luminis Health and CHRISTUS Health about DEI leadership suggest effective leadership practices for DEI strategic change. The leadership practices and actions described here draw from these studies and interviews.
Top executive commitment to DEI as a strategic priority. Top leadership commitment includes the CEO, the executive leadership team and the board. Commitment goes beyond statements and is demonstrated by actions that model dedication to an inclusive and equitable organizational culture. Strategic change in DEI requires a long-term investment. For example, at Luminis Health and CHRISTUS Health, the DEI work officially began with signing the American Hospital Association’s #123 for Equity Pledge in 2015, and their leadership commitment continues.
DEI embedded in the organizational strategy and culture. Diversity, equity and inclusion are at the heart of the mission and core values. Strategic DEI initiatives are aligned with the organizational strategy and vision. This is the way the organizations that make sustainable progress do business; DEI is the culture—beliefs, values, behavioral norms and underlying assumptions—focused on being inclusive and equitable. Systems, policies, procedures, power structures, rituals and routines are aligned with DEI principles. The diverse workforce and health equity initiatives to serve diverse patients and communities are interconnected and interdependent. For example, CHRISTUS Health developed a DEI Strategic Multilevel Framework for Sustainable Solutions that embodies internal, interpersonal, institutional and systemic pillars showing the interrelationships to help leaders navigate complex strategic change.
Quantitative and qualitative measures of success. Clear definitions and measures of success are important. These measures are typically quantitative and qualitative. Quantitative measures may include employee engagement surveys and recruitment targets to increase senior executive diversity. Qualitative measures might include employee listening sessions to learn about lived experiences with DEI in the organization. Metrics and benchmarks for DEI establish performance expectations, evaluate progress and guide decision-making. Rigorous tracking of goals and performance scorecards help to identify change interventions and course corrections. The data informs learning needed to facilitate progress toward goal attainment.
Accountability and learning environment. Accountability for achieving DEI goals begins at the top. Some health systems have DEI accountability metrics linked to executive pay-at-risk or performance bonus programs. Clearly defined expectations are integrated into the performance management system. Rigorous tracking of key performance indicators enhances accountability and learning for continuous improvement. Accountability for achieving results works best in a learning environment in which mistakes and performance gaps are viewed as learning opportunities that help identify interventions for change.
Communication, transparency and engagement. When DEI is a core business priority, it is visible and integrated into the day-to-day operations of the organization. Engagement and inclusion of all stakeholders are critical for success. There is routine communication about DEI goals, achievements and opportunities to improve performance. These goals are frequent topics on executive and leadership team meeting agendas. Communication and dialogue about goal progress and improvement are the norm systemwide. People see DEI as an important part of their jobs to serve patients and communities. This inclusive and interactive communication boosts engagement on all levels of the system.
Resistance to change managed constructively. Resistance to DEI strategic change is expected. Successful organizations manage resistance to change constructively in a manner that maintains positive relationships rather than shutting them down. Leaders listen with empathy to understand negative reactions and use them as sources of learning that can inform the change strategy. Data and stories about disparities between goals and actual results are tools that facilitate learning and performance improvement. Everyone in the organization may not agree with DEI goals, but in an inclusive environment where diverse thinking is valued, people are more likely to participate in a constructive manner.
These practices work together in an inclusive transformational leadership approach to leading strategic DEI change. Inclusion means all people in the health system are treated with respect and are accepted and valued. People feel a sense of belonging. Transformational leaders inspire and develop leadership on all levels, stimulate innovation and encourage participation in achieving a mission that embodies DEI principles.
Inclusive transformational leadership removes barriers to DEI strategic change, such as tight hierarchy and siloes, to facilitate teamwork across boundaries and make the difference required for achieving sustainable results. This leadership approach increases knowledge and awareness and works toward an organizational alignment that ensures every team member plays a role in contributing to the work.
Diane L. Dixon, EdD, is a leadership and organization development consultant/adviser, educator and author (diane@ddixon.org), Columbia, Md., and an ACHE Member.