By Melinda Young
EXECUTIVE SUMMARY
Despite controversy over diversity, equity, inclusion, and belonging (DEIB) programs in recent years, case management leaders say these programs benefit healthcare professionals and align with the goals of patient-centered care.
- DEIB puts the focus on building a person’s cultural competency and promotes tools that improve case managers’ interactions with clients.
- The goal is to listen to patients and to understand what they are feeling and experiencing from the framework of their own cultural and personal perspectives.
- Health equity initiatives prioritize preventing neglect, promoting access to healthcare, and improving maternal health.
While academia and politicians debate the value of diversity, equity, inclusion, and belonging (DEIB) programs in education, these are seen as a positive for all employees and patients in the healthcare world.
DEIB is part of value-based and patient-centered care. It encompasses respect for all people, regardless of their backgrounds. A focus on DEIB’s ethical principles can help create a workforce where everyone feels heard and safe.
“My longstanding mantra has been that case managers have a primary obligation to make sure that every patient and their family, plus every member of the workforce feel safe, seen, heard, and valued,” says Ellen Fink-Samnick, DBH, MSW LCSW, CCM, principal at EFS Supervision Strategies, LLC, in Burke, VA. “Case managers should remember that DEI practices align with those values defined in their established resources of guidance, from licensure regulations to case management-specific standards of practice, and codes of ethics and professional conduct. It involves heeding seminal ethical principles of case management practice: autonomy, beneficence, fidelity, justice, and nonmalfeasance.”
DEI programs go beyond building a sense of belonging among staff, says Dianne Edwards-Barnes, DEIB coordinator at The Coordinating Center in Millersville, MD. “I was in case management prior to moving to DEIB,” she notes. “These programs improve competency and give case managers skills they need to promote the clientele they serve.”
Learning more about DEIB builds a person’s cultural competency and gives them the tools they need to improve their interactions with clients. “For example, we do internal classes on microaggressions and implicit bias. That is a skill and something they can use to be more aware of how they speak to clients, each other, and the world,” Edwards-Barnes explains.
Focus on Maternal Health
Another issue and educational session could focus on Black maternal health. Case managers, other healthcare providers, and clinicians can learn about the experiences of pregnant Black patients. In the United States, this group has the highest maternal mortality rate among all women in middle-income and high-income nations. Black women are three times more likely to die because of pregnancy or childbirth than white women. The maternal mortality rate is becoming worse in the United States.1 Understanding their experience could help physicians and providers improve their care and response to these patients. For instance, Black women who endured pregnancy crises often report that their healthcare providers did not listen to their concerns, says Erica Bostwick, MBA, MHRM, SHRM-CP, vice president of human resources at The Coordinating Center.
“I talk about Black maternal health as an African American woman who went through this experience,” Bostwick says. “I had a stillbirth at nine months of pregnancy.”
Bostwick tells healthcare professionals about her experience of reporting problems to her physician and not being taken seriously. “As a result, I was three weeks away from delivery, and I lost that child,” Bostwick says. “It’s very important for us as African American women to advocate for any woman.”
Case managers and other healthcare professionals can advocate for patients when they have concerns and teach them to speak up for themselves and understand their health and rights. Bostwick recalls telling her physician that her fetus, which had been extremely active, was suddenly not moving as much. She described feeling a pulling sensation and having the feeling that something was off. “I went to my doctor and called a nurse helpline, and they said it didn’t seem like an emergency,” she says.
Even after the physician performed an ultrasound and had to work hard to find a heartbeat, she said it did not seem abnormal. Bostwick went to the emergency department, where a sonogram revealed that the umbilical cord was wrapped around the baby’s neck. But it was a day or two too late to save her infant’s life.
“If she had listened to me that Thursday, I would still have my son,” Bostwick says. “I felt like she was rushing me out of my room.”
The Importance of Health Equity
This tragic experience has led Bostwick to believe that too many people in healthcare have a view that their patients — especially people of color — do not know what they are talking about. “[Providers] should stop looking at patients as if they’re just a patient and look at them as if they’re a human being,” Bostwick stresses. “Listen to all your patients. You don’t know what they’re feeling and experiencing, and to have that nonchalant attitude is why there’s such a disparity in care. Regardless of the color of your skin, you need to be valued as human beings.”
Health equity is important for every practice setting, Fink-Samnick says. “The five key areas of the latest iteration of the Equity Action Plan speaks directly to case managers across their industry and their role in ensuring successful outcomes for patients and their families,” she says. “Inclusive access to care for all is called out, along with improving maternal health outcomes across rural, racial, and ethnic minorities, and prioritizing behavioral health for marginalized communities.”3
The HHS Equity Action Plan features these five priority areas to advance equity:
- “Prevent neglect and improve care to help children thrive in their families and communities”;
- “Promote accessible and welcoming healthcare for all”;
- “Improve maternal health outcomes for rural, racial, and ethnic minority communities”;
- “Prioritize the behavioral health of underserved populations”;
- “Increase clinical research and trial diversity to support innovation.”3
The action plan’s goals reflect the understanding that inclusive healthcare and case management is not a one-and-done action, Fink-Samnick notes in her book, The Ethical Case Manager: Tools and Tactics.3 It is not as simple as providing Black patients a list of Black providers or documenting that health literacy was assessed. It also is more than a case manager asking colleagues and patients for their preferred pronouns.
“Inclusive case management is a methodical, intentional, and impactful approach to engaging professional practice by case managers and their leadership,” Fink-Samnick says. “It aligns with the Triple, Quadruple, and Quintuple Aim of providing patient-centric care at the right time, right cost, by those who embrace the work, and ensuring access for all.”
Fink-Samnick says case managers can take these actions to ensure inclusivity:
- Use certified medical interpreters or teletype systems to provide an interactive shared decision-making process about a patient’s treatment plan.
- Use person-first language, emphasizing the person vs. their diagnosis or disability, such as “patients diagnosed with autism spectrum disorder” or “patients with congestive heart failure.”
- Collaborate with community-based organizations on areas of common interest to bridge gaps in care for shared populations.
- Develop policies to reflect DEIB that are aligned with performance metrics and incorporate patient-reported outcome measures sorted by demographic.
States Target DEIB Programs
While the goals of DEIB would seem harmless, lawmakers in more than 30 states have introduced dozens of bills targeting DEIB efforts at public institutions, particularly in the past year.4
“It makes me both angry and sad to see it,” Edwards-Barnes says. “It honestly breaks my heart because of the rollback of [DEIB].”
DEIB programs were ramped up, particularly in corporate America, after the murder of George Floyd, Edwards-Barnes notes. “We put the ‘B’ in there because belonging ties everything together,” she says. “A lot of corporations, universities, [and] governments were trying to find something to do in response to that.”
Four years later, conservative states are rolling back diversity programs by banning state funding for them or prohibiting them at state colleges. Even private universities, including Ivy League schools, have found their DEIB programs under attack in the wake of the Israel-Hamas war. Some states have gone further, such as Florida’s bill banning discussion of LGBTQ people and issues in schools, the colloquially named “Don’t Say Gay” bill.
“If I was a teacher in Florida, I could not say that I’ve been married to my wife for 25 years,” Edwards-Barnes says. “If you don’t have buy-in of everybody [for DEI], and there are racists among you, they won’t be comfortable treating people equitably.”
Discomfort is no excuse for abandoning these principles, and DEIB should not be turned into a checklist, Edward-Barnes and Bostwick say.
“It’s not a checklist,” Bostwick says. “That’s what has happened with affirmative action and [equal employment opportunity] reporting: check this, check that. This has to become your life.”
Case managers and other employees need to know that they cannot keep up walls to societal change. The world is evolving as new generations are born, and everyone needs to stay current and ensure all patients and co-workers feel valued, Bostwick adds.
“‘Yes, we told people what microaggression is, so we’re done.’ It’s not that. It’s every day and every interaction you have,” Edwards-Barnes says. (For more information, see the story in this issue on how to follow DEIB principles.)
“These people who are rolling [the programs] back and taking them away are eliminating safe spaces for crucial conversations because they don’t want to have them,” Edwards-Barnes explains. “Growth is uncomfortable, learning new things is uncomfortable, and you’ve got to be comfortable with being uncomfortable. Some people are now willing to learn that work.”
DEIB could be viewed as a way for healthcare professionals to respect the people they serve and work with, Fink-Samnick says. “Respect for each other and the human condition are not new concepts,” she explains. “Diversity, equity, and inclusion are values that underlie the standards of practice and codes of ethics for every profession that comprises case management, [such as] counseling, nursing, and social work.”
For example, here are established resources of guidance for case managers:
- The American Case Management Association Standards of Practice and Scope of Services, published in 2020;
- The Commission for Case Manager Certification Code of Professional Conduct, published in 2023;
- The Case Management Society of America Standards of Practice, published in 2022.
“The learning in the DEI space is continuous and ever-evolving. It can be overwhelming to stay informed on new pronouns and considerations, but success involves being open to constant learning,” Fink-Samnick says. “The bottom line is a simple one: Every patient, their family member, workforce member, and other individuals deserve to feel safe, seen, heard, and valued. All case managers would expect the same treatment for themselves, their loved ones, and their family members.”
REFERENCES
- Taylor J, Bernstein A, Waldrop T, Smith-Ramakrishnan V. The worsening U.S. maternal health crisis in three graphs. The Century Foundation. March 2, 2022. https://tcf.org/content/commen...
- U.S. Department of Health and Human Services. HHS releases 2023 update to Equity Action Plan, outlines new commitments to advance equity. Feb. 14, 2024. https://www.hhs.gov/about/news...
- Fink-Samnick E. The Ethical Case Manager: Tools and Tactics. Blue Bayou Press. May 13, 2023.
- Adams C, Chiwaya N. Map: See which states have introduced or passed anti-DEI bills. NBC News. March 2, 2024. https://www.nbcnews.com/data-g...
Despite controversy over diversity, equity, inclusion, and belonging programs in recent years, case management leaders say these programs benefit healthcare professionals and align with the goals of patient-centered care.
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