By Melinda Young
Diversity, equity, inclusion, and belonging (DEIB) principles in healthcare have multiple benefits to an organization. They can cultivate a culture of innovation by embracing diverse perspectives, says Erica Bostwick, MBA, MHRM, SHRM-CP, vice president of human resources at The Coordinating Center in Millersville, MD.
“We believe DEI initiatives promote continuous learning, constantly learning, and immersing yourself in this information,” Bostwick says. “You challenge assumptions and adopt new perspectives, and this ultimately leads to a workforce that is more adaptive and open to innovative thinking.”
These are some techniques to improve diversity initiatives and acceptance of these efforts among staff:
• Create a safe space for staff and address implicit bias.
When case management departments begin to pay attention to DEIB, it can be challenging for staff. It is important to allow people to have a safe space to share their thoughts, Bostwick says. This is important for obtaining buy-in and making sure everyone feels included.
“Even though there may be challenges — and some people may not like training their brains to think a different way — we can communicate the tangible benefits,” Bostwick explains. “We can dispel some misconceptions they may have.”
Everyone is responsible for staying aware of their own implicit biases and how these affect their interactions with patients and colleagues, says Ellen Fink-Samnick, DBH, MSW, LCSW, CCM, principal at EFS Supervision Strategies, LLC, in Burke, VA. Case management leaders can talk about how diversity can improve the workplace culture.
“It helps to get staff to buy-in to those new ways of thinking,” Bostwick says.
For instance, leaders can give staff examples of their own biases and what happened when they opened their minds to the possibility of looking at a situation inaccurately because of their bias.
“When I came to this company, I had come out of management and was used to being the leader, and I was looking forward to being a case manager and not the program manager overseeing all the cases,” says Dianne Edwards-Barnes, DEIB coordinator at The Coordinating Center. “My first manager was 10 years younger than I was, and I had never worked for someone younger than me. She ended up being one of the best supervisors I ever had, and I’m grateful she still works for the organization.”
Edwards-Barnes tells the story to show how a bias, such as believing that younger managers are not as capable, is not rooted in evidence. By opening one’s mind to the idea that a good manager can come from any demographic, one can have a good experience with a manager who is not the boss some people might expect.
“My implicit bias was that someone younger than me couldn’t teach me anything or couldn’t possibly know how to lead me,” Edwards-Barnes says. “But she flipped the script: She brought out the best in me and probably started my awakening, challenging my own thoughts.”
Working for someone younger forced Edwards-Barnes to challenge herself about her other assumptions and biases. “I made a point to start talking to more people who don’t look like me or think like me,” she adds.
• Be authentic.
“In creating belonging, you have to be authentic,” Edwards-Barnes says. “If you are not authentically you, or [do not] show a little vulnerability and authenticity to people around you, then it’s tough to get people to trust you.”
The more authenticity and space a leader or staff member creates, the more inclusive and deeper the sense of belonging will be. “I am an open book and will admit my shortcomings and admit my strengths and say all quirky, wonderful things that make me me,” Edwards-Barnes says. “Being consistent about that, I have built a sense of trust, and it’s trust for people who might look like me or might not look like me.”
Sharing one’s authentic self does not mean sharing all secrets. But it does require one to be vulnerable and admit to challenges in the workplace. It is letting colleagues know that what a person says is what they mean, and this will not change when they are talking to different people in a different setting.
• Learn about code switching.
“Code switching” refers to people changing their dialect or language during a conversation. Or it could be that someone speaks one way or behaves one way with a similar group of people and another way with another group of people.
“Code switching is huge in the African American community — even when it comes down to our hair,” Bostwick says.
For many years, African Americans have not believed they could be their authentic selves in the business or professional world, she notes. “We had to change the way we spoke, looked, and wore our hair to be acceptable in corporate America,” Bostwick explains.
For instance, organizations that allow Black employees to wear their natural hair and not straighten it help create a safe and welcoming space for their workers. “I tell our co-workers to not be anything other than who they are. You can only leave those masks up for so long,” Bostwick says. “Eventually, the real you will come out, and if you’re suppressing the real you, you’re going to be unhappy in the workplace.”
Through the adoption of DEIB principles, a healthcare workplace can welcome people’s authenticity and not expect them to pretend to be something they are not. (For more information, see the story in this issue on hairstyles and goals of belonging.)
“We’re asking you to be yourself,” Bostwick says. “That does not mean you get to say things that are offensive to your co-workers. But within rules, guidelines, and regulations, we want you to be yourself.”
• Acknowledge and reduce microaggressions.
Microaggressions are statements and actions that discriminate against vulnerable groups. These could be indirect and unintentional actions or attitudes, but their effect can create stress and fear in people who are already marginalized in society.
Case managers need to keep in mind that microaggressions are in the eye of the beholder. Their unawareness of a comment or action being a microaggression does not mean it did not happen. They also can include comments about how a person dresses, styles their hair, or whether they have body piercings or tattoos.
“It involves staying humble when microaggressions are pointed out, and they are [pointed out] even to the most seasoned DEI specialists I know,” Fink-Samnick says. Knowledge is power, and like exercise, learning is a lifetime endeavor, she adds.
“Microaggressions are harmful to people’s mental health,” Edwards-Barnes says. “Microaggressions are described as deaths by 1,000 cuts. They can be tiny.”
Microaggressions also can be masked as compliments, such as a white person telling a Black colleague that they are articulate. But the idea of complimenting a peer on speaking well is offensive. It also is offensive to tell someone with a last name suggesting ancestry from another country that they speak English so well when the person giving the praise did not bother to find out that the speaker is from the United States.
Among gender minorities, a common microaggression is to use incorrect pronouns, such as referring to a transgender person who uses “he” or “they” pronouns as “she” or “her.” Calling a transgender person by their dead name, which is the name they abandoned and not their correct name, also is a microaggression.
“Using correct pronouns and preferred names is gender-affirming care,” Edwards-Barnes says.
Everyone can make a mistake. DEIB programs can only give some of many examples of these. But the key is to learn from one’s mistakes when the colleague or patient explains that the question, statement, or action was offensive.
“Take it with grace and put it in your toolkit,” Edward-Barnes suggests. “Don’t do that again and share your knowledge with others.”
Diversity, equity, inclusion, and belonging principles in healthcare have multiple benefits to an organization. They can cultivate a culture of innovation by embracing diverse perspectives.
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