Healthcare’s labor pains supplant COVID-19 as key reason for diversity work stalling

Editor’s note: Amanda Jensen, MGMA membership program manager, contributed significantly to this article.

Through new technologies and the natural trends in how people move, we are increasingly connected to others and exposed to cultures, ideas and experiences that we may not be familiar with, requiring the capacity to approach this information with openness and curiosity rather than fear and antagonism.

One of the popular approaches to building this emotional intelligence and awareness has been via diversity programs, which saw renewed focus since 2020 amid nationwide calls for social justice and a reckoning around cultural inequities.

Two and a half years after major protests in most major American cities and the emergence of a staffing shortage across several roles within healthcare provider organizations, the focus on diversity appears virtually unchanged: A Feb. 21, 2023, MGMA Stat poll found that 34% of medical groups report having a formal diversity program, compared to 62% that do not and 4% that are considering one.

These results show only a slight shift from a similar MGMA Stat poll from July 2021 that found 32% of medical practices had a formal diversity program at the time, with nearly two-thirds (64%) without and only 4% considering adding one.

The rationale for considering the implementation of a diversity program seem straightforward for many poll respondents: Some view it as a staff development initiative, while others see it as helpful “to serve our whole community,” as one practice leader told MGMA. But those in the planning stages cited two main reasons why they had not yet put a program in place:

1. Uncertainty on how to proceed;
2. Staffing shortages and other high-priority challenges pushing the work off into the future.

Among practice leaders with a formal diversity program, the sophistication of their efforts varied:

• A majority (53%) do not have specific metrics or goals tied to their programs.
• Another 4% were unsure.
• Just more than 4 in 10 (43%) of respondents said their organizations either had metrics or goals tied to diversity programs, or they were in the process of developing them.

Some of the most common efforts to measure success in healthcare provider organization diversity programs from the respondents were:

• Ensuring bilingual staff to serve communities in which a significant number of patients do not use English as their first language.
• Completion of DEI educational offerings/credit hours for a given quarter or period.
• Representation metrics among faculty and leadership positions in an academic medical center.
• Patient access and health equity improvement goals.

Defining diversity, equity, and inclusion

While the recent poll only sought information about diversity efforts, it’s important to understand its role in a broader diversity, equity and inclusion (DEI) strategy, even though each piece is distinct and should be considered and operationalized as such.

• Diversity: These are characteristics that can be used to differentiate individuals and groups from one another. As noted by DEI strategist and author Lily Zheng noted in their recent book DEI Deconstructed, diversity is defined as the workforce composition that “is achieved through actions that explicitly counter present-day and historical inequities and meet the unique needs of all populations.”
  In many instances, these characteristics include race, ethnicity, gender, sexual orientation, socioeconomic status/class, physical ability/attributes, mental ability, and religion.
• Equity: Following Zheng’s emphasis on how these components are achieved, equity is defined as structural success, well-being, and enablement — along with the absence of discrimination or mistreatment — for all stakeholders, especially underserved and marginalized populations. In other words, equity is achieved by eliminating structural barriers that resulted from historical and present-day inequities and meeting unique needs of individuals and the organization.
  Underpinning that achievement would be acknowledgement of the root causes of the disparities in society and systems, as well as consistent awareness and responsibility for one’s own privilege, unconscious bias, and agency.
• Inclusion: Zheng puts this definition around the achievement of trust from all stakeholders that the workplace environment will be respectful and accountable, which specifically is achieved through actions to counter inequities with sustained effort, involvement, and empowerment.

More resources around DEI in healthcare

• Read our Battling Bias series from 2020:
  • Part 1: “How intuition and unintentional biases can shape how decisions are made”
  • Part 2: “Building diversity in recruiting and hiring”
  • Part 3: “Sustaining inclusion through organizational culture”
  • Part 4: “Racial bias and its effects on patient care”
• “How medical practices can continue the journey toward diversity, acceptance and inclusion”
• Harvard University’s Project Implicit offers an Implicit Association Test to better understand your attitudes and beliefs on these topics.

The role of DEI amid an evolving labor market

While several health systems are shedding payroll amid rising costs, the broader economy is witnessing rapid growth of several people-centric roles in the C-suite, according to LinkedIn News’ Workforce Report: Chief diversity and inclusion officer (up 168.9%) and chief people officer (up 144.3%) are two of the three top C-suite positions for hiring grown from 2019 to 2022.

However, the most recent year showed that the percentage growth in hires largely favored the more generic “chief people officer” (32.9% growth from 2021 to 2022) versus “chief diversity and inclusion officer,” which saw a 4.5% decline in hiring growth in the same period.

But healthcare providers typically struggle with turnover and intense competition for non-executive roles on the clinical team and at the front desk, as well as in revenue cycle management. Recent Women in the Workplace studies by McKiney underscore the issue across healthcare and other industries: Women are underrepresented at every job level, and senior management-level underrepresentation is not explained by a higher rate of women leaving the workforce than men.

Another report from the University of St. Augustine for Health Sciences combined data from the U.S. Census Bureau, Data USA, and the Association of American Medical Colleges to reveal (among other findings):

• Even though the majority of nurse practitioners (NPs), physical therapists and occupational therapists are female, only 25% are non-white.
• Only 5% of physicians identify as Black or African American despite 13% of the population is Black.
• Only 6% of physicians identify as Hispanic whereas this group makes up 19% of the population.

This is where a diversity program can be a positive influence on efforts to attract and hire candidates from candidate pools that your existing efforts might miss.

Consider: A Press Ganey survey of more than 400,00 healthcare works from 2021 found that valuing employees from different backgrounds was the No. 1 driver of engagement among nursing personnel, and that other DEI-related traits — such as demonstrating a commitment to workforce diversity, treating employees with respect, and valuing individuals with different backgrounds — also ranked highly in terms of influencing engagement.

How to approach DEI work in healthcare

A 2021 study by Deloitte on the state of DEI initiatives in healthcare found several encouraging signs from existing efforts, including leadership’s respect of individual differences and willingness to fund DEI initiatives and connect them to the organization’s strategic direction.

However, the results pointed to perceptions among DEI leaders that there are still differences in how some employees feel they are treated differently/unfairly — especially in terms of the recognition of their work’s impact — based on traits such as gender, race and/or ethnicity. About three in four respondents in the Deloitte study also felt that accountability and meaningful measurement for DEI efforts were “lacking.”

Four strategies for operationalizing DEI work and ensuring its sustainability emerged from the research:

1. Making it an enterprise effort with the full C-suite involved
2. Cultivating employee resource groups through executive sponsorship
3. Making a serious effort around DEI goals in talent evaluation and leadership pipelines
4. Measuring and leading with data about DEI goals.

Additional resources

• “DEI policies won’t stop discrimination in hiring. That requires fighting unconscious bias” (STAT News)
• “Improving DEI with a Focus on Diversity Recruitment” (Lever)

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