Diversity & Inclusion: Tough Decisions, Rich Rewards

What Would You Do?

Consider that your organization has a diversity and inclusion program, that leadership is committed to more diversity hires, and that you’re choosing between two candidates for a single job opening. Both are quality candidates, but the first clearly is more experienced and better-suited for the job. The other is a less-qualified minority applicant. Which would you hire? Which should you hire?

It’s a common dilemma in just about every industry today, but shared angst does not make this seemingly win-lose situation any less difficult — not when you are wondering if you should lower your hiring standards in order to meet company diversity objectives.

Michellene Davis, executive vice president and chief corporate affairs officer for RWJBarnabas Health in West Orange, New Jersey, was asked a similar question at a previous job: Does diversity and inclusion mean having to lower your hiring standards?

“Why in the world would you ever have to do that?” she replied. “Do you think the standards were lowered to hire me?”

No, the standards were not lowered, but Davis’ status as an African-American woman had been a primary determinant in her appointment as CEO of the New Jersey Lottery in 2005. Only later did she learn that minorities had been targeted for the position and, as a board member told her, she “certainly [was] at the top of that group.”

That group? What group was that? The African-American group? The women’s group? Both? If the latter, she certainly checked both boxes, but the only box that mattered to Davis was the one for “most qualified.”

She shrugged off the awkward exchange but admits now that it inspired her to prove to them that she was undeniably “the top candidate among any group — not just minority, not just woman, not just minority woman.”

Recently honored as one of the top 25 minority leaders by Modern Healthcare, Davis today supports diversity and inclusion (D&I) not as an “either/or” proposition but as a “yes/and” opportunity to identify and hire female and diverse candidates who truly are the most qualified candidates for the job.

It’s not a tradeoff. It’s a trade-up. And it has nothing to do with hiring diverse candidates for diversity’s sake.

“The first qualification is that they’re highly competent,” says Mark Lester, MD, MBA, CPE, FAANS, FACS, FAAPL, chairman of the board of directors for the American Association for Physician Leadership. “You don’t look at someone who isn’t highly competent just because they fit in an identity. That is not diversity and inclusion.”

Anne Pearson, MD, CPE, senior vice president and CEO of Physicians Memorial Hermann in Houston, Texas, agrees. “I firmly believe in picking the best candidate for the job. If it’s the right person and you’re confident you’ve been objective in the interviewing and selection process, then you pick the right person for that role. The selection might not match where you think your diversity gaps are, but … it’s not always about the identity of a specific gap; it’s a more holistic approach to diversity.”

If this sounds like an argument against D&I, it’s not. To the contrary, D&I brings great value to an organization, its people, its culture, its patients, and its standing in the community. To get there, it helps to understand what it is, why it’s important, and how to implement and sustain it.

To that end, the AAPL’s board of directors last year chartered a D&I task force chaired and co-chaired by Lester and Pearson, respectively, for the broader purpose of equipping and enabling physician leaders as agents of change in the advancement of internal and external D&I initiatives. (See related story on page 76.)

Believing that the diversity and inclusion of its broadly multicultural board and staff inspires innovation and creativity and helps develop better solutions for its team, members, and clients, AAPL fully embraces and advocates the initiative.

The AAPL began a process of contemporizing the association, with focused attention to increase the diversity of the AAPL staff, its board of directors, and its overall constituency of members and organizations. The AAPL believes with dedicated effort comes great value.

Defining Diversity

Often lumped together, diversity and inclusion are in fact two different concepts. For example, an organization might be remarkably diverse yet not at all inclusive.

Diversity and inclusion are most effective when working in tandem. Why? Because the true value of D&I comes not solely from diversity of staff but from leaders soliciting and tapping into the varied backgrounds, life experiences, and rich diversity of thought, ideas, and opinions staff members bring to an organization, representing its varied community of stakeholders. Scott E. Page, a scholar at the University of Michigan and author of The Diversity Bonus: How Great Teams Pay Off in the Knowledge Economy, calls this “cognitive diversity” — an expansion of thought — which is the fertile outgrowth of inclusion.

“Diversity is important, but I want to caution you: If we think that diversity is gender and race, and that by putting people of different races and genders together in an organization we have checked the diversity box and can move on, we’re totally wrong,” Lester insists, “because the task in diversity is broader than identity alone. The idea of diversity is integrating diverse identities and ways of thinking, creating the ‘cognitive repertoire’ of scholar Scott Page. And this cognitive repertoire brings much greater capacity and power than if you did not have diversity of thought.”

Diversity and inclusion are complementary and essential, Lester continues, “because inclusion creates a culture where all of those diverse people can interact in a constructive and productive way, where everybody is an equal part of the team, where their contributions are recognized and respected and they can freely share them with each other.”

That’s where the real work comes in, where leaders must exercise intentionality, consistency, perseverance, culture-building, and team-building; where understanding the lifetime of implicit bias various diversity groups faced — whether gender, race, ethnicity, sexual orientation, or religion — can optimize an organization’s ability to resolve complex issues.

The reciprocal benefit, Lester adds, is that “the equity principle provides additional support for mitigating these biases with behavioral design.” Behavioral design, as Iris Bohnet defines in her book What Works: Gender Equality by Design, is creating processes and methods that mitigate implicit bias.

“Diversity and inclusion have a practical, business side when dealing with complex situations, which are predominate in healthcare,” Lester says. “It also has an equity side, which means we have to do what is right and fair.”

That requires leadership to acknowledge and rectify past practices of inequity, including, for example, when an organization “does not have in leadership those who represent the greater microcosm of society,” Davis says, adding that such initiatives can’t be achieved with words alone. It doesn’t make a difference, for example, if a CEO says, “This is what we’re doing. This is who we are,” and then walks out without offering instruction or goals, leaving those in charge to their own devices.

“We’re wonderfully human with all of our own implicit biases,” Davis offers, “but unless you show me how, I do not know, and when the pressure is applied of trying to do more with less — as so many of us are merging and becoming these uber large organizations — our muscles atrophy. So, I return to what I’ve always done naturally. It’s better if I understand and can grasp goals you give me, then aid me with an assessment or tools that the organization adopts to lead me through the thought process.”

But again, as organizations strive to mirror the demographics of their communities, they accomplish little by hiring minorities simply to achieve diversity goals.

“Having [diversity] goals is not a bad thing,” Davis says, “but how you come up with your goals is important as well. You don’t want to have official, role-specific mandates because then you do two things: You insult the candidate that you’re hoping to secure, and you set them up for a difficult situation. I don’t think it’s always helpful when we’re flooded with candidates who may be diverse but, quite frankly, may not have the qualifying experience. So, you’re setting them up for failure, but checking off your list of diversity candidates for a search?”

That’s never the goal.

How to Find D&I Candidates

How many times have you attended a meeting and observed that everyone there looked pretty much the same?

Davis calls that a missed opportunity “because if you begin talking about how patients are cared for, how your service is delivered, how a new product is brought on board, about succession planning or a new hiring, but you do not have gender, racial, or ethnic diversity, then you are truly harming your organization’s ability to achieve all that it can possibly do to serve all that it possibly can.”

If it’s a missed opportunity, it’s also a wake-up call to leaders to look beyond their comfort zone, beyond their network of friends and colleagues if they’re truly serious about pursuing top-shelf diversity candidates.

Davis says finding such candidates is never an issue for her, but acknowledges that’s not the case for many who approach her with their frustrations. Her advice: Find another search firm or alter your search methods.

“I’m not trying to be funny, but why do I know so many and you seem to know none at all?” she asks them. “A lot of that deals with how we have historically placed people on boards and put them in pipelines because we socialize with them. It’s who we know. You’re at the club and you say to the person who was in your foursome after an enjoyable 18 holes, ‘I’d love to be sitting across the table from you. Why don’t you come to be on my board?’ ”

The problem is that networks tend to be analogous, resulting in a great deal of sameness. Her advice:

• Go online and take the Harvard Implicit Association Test (https://implicit.harvard.edu/implicit/education.html ) to become aware of your own bias.

• Ensure your hiring process is as objective as possible; unquestioned subjectivity often proliferates bias.

• Understand the difference between searching for and securing diverse candidates by ensuring that the job is attractive to the candidate.

“One of the things I’ve heard,” Davis says, “is, ‘Wow, we tried to secure them, but they’re asking for so much money’.” To which she answers: “And they’re going to get that from someone else.”

It’s important to first find the most highly qualified candidates early in the recruiting process. Then, all qualifications being equal, whom do you choose?

“In a situation where I’m intentionally adding to the gender diversity of my organization,” Lester says, “I’m going to choose the woman. [The candidates] are equal, but I’m going to choose the woman because of the identity diversity that she’ll bring to the table. You haven’t made a choice to not choose someone who’s more qualified. You’re choosing among equally qualified people.”

Create a Pipeline for the Future

As a member of the search team, Davis observed that one organization for which she was conducting a search was “extremely monolithic” and she wondered why. When she asked fellow search committee members about their track record of producing diverse candidates, they indicated that they had never produced diversity candidates for that particular organization. Davis recalls: “When I asked them why, they said because that client never expressed that it was an issue of concern or desire of the organization, nor was it their aim for the ideal candidate.”

Another missed opportunity, she laments.

It’s the same kind of missed opportunity that Barry H. Ostrowsky, president and CEO of RWJBarnabas Health, mentioned to Davis years ago, citing a clear lack of administrative diversity in the healthcare industry as a whole.

Not only did Ostrowsky understand the issue, he mandated diversity components for all hiring and retention efforts, required systemwide diversity assessments for senior-level management, and empowered Davis to create internal programs for recruiting, coaching, mentoring, and sponsoring diversity candidates and staff.

The results include a program that provides paid internships for college and graduate students and recent graduates from a variety of socioeconomic backgrounds (many of whom become full-time hires), and a formal women’s leadership program. Together, these in-house programs are grooming candidates and providing a sustained corporate pipeline of gender and diversity leadership.

“It’s not that hard,” Davis says.

There’s more value to these kinds of programs than just the depth of diversity leadership they provide; they also show a commitment and investment in diversity employees that goes a long way toward enhancing workplace culture and improving employee retention.

“The fact that we are losing millennials to Google, Apple, and Amazon isn’t just about the names Google, Apple, and Amazon,” Davis argues. “It’s about your most marketable, non-mainstream members leaving when they realize ‘I’m in an organization that’s not invested in me.’ Folks are looking for a particular experience, an experience that is made better by having a diversity of thoughts and individuals who have a different type of lens through which they view the world. I call it the kaleidoscope.”

Says Lester: “If we’re talking about the culture that enables a team with diverse cognitive repertoires to work together and share ideas, to be constructive together, to be accepting of each other’s differences, and to focus all of that in a common goal, that’s a real cultural aspect. Mentoring and internal leadership programs can foster that kind of culture.”

Failure to implement such programs “creates this hamster wheel of incredibly high turnover,” Davis cautions. Hiring high-quality diversity candidates is the first objective, but retaining your “most marketable talent” is equally important.

“The young [diversity] geniuses you hired, they’re still in entry-level positions and about to hit mid-level management, but if they see everyone else around them getting mentored, coached, and sponsored and they do not receive these same career benefits — this same level of investment — then your organization is sending them a direct and succinct message, one that conveys that they are not welcome there, that they are not welcome to grow and matriculate into senior ranks,” Davis says, “whether that is the intent of your message or not.”

Davis sounded her own message with the creation of the Young Professionals Advisory Council, which assists employees in their early- to mid-career ascension, fosters a sense of community, encourages their involvement in framing corporate culture, and makes clear the company’s commitment to invest in them.

The cost of such investments is minimal compared to what Pearson describes as “the huge value in career guidance and personal development.”

“It really helps to have mentoring that helps you navigate a new culture or shows you the resources that are available,” she says. “Even just the social factor is a huge bonus to people. For women in particular, role models can be harder to find because they’re under-represented in many leadership roles. A lot of people who move into leadership have had good mentors who encouraged them along the way. I think the best mentors are maybe not similar to you; they challenge you and have different perspectives to help push the way you think about things or open you to new ideas and opportunities. That’s the value of a mentor.”

A Bonus for Leaders

“When I look at the way I lead or build teams now, I’m really looking for that ‘diversity bonus,’” Pearson says. “I’m looking for people’s different strengths to come together, knowing that not everybody can be the best at everything and not everybody has the same background and perspective, and that finding ways that we can complement each other can really move us forward.”

“Like any big initiative, it needs to be driven by leadership,” she says. “They definitely have to buy into it. You have to have your senior-most executives believing that this is important and able to speak to it.”

Speaking to it and being intentional: Making diversity hires, welcoming them to the table, encouraging them to be part of the conversation, and enabling their ascension into leadership roles.

Without that leadership support, the windfall of a “diversity bonus” is lost.

“They lose out on evidence that shows that diverse work groups work harder, that they come together in a different way than a homogeneous group,” Pearson says. “Obviously that bonus is an advantage to any organization that wants to be productive and move forward as far as possible. Without that, they limit their capability. In looking at how complex problems are in healthcare now, if you don’t have that diversity to address the complexity, you’ll struggle — and it’s not going to get any easier.”

To make it easier, however, AAPL leadership is offering resources produced and compiled by its task force as a heightened call to action for industry leaders to adopt a more robust and balanced approach to the D&I ideals defined and embraced by the association.

It’s an approach that requires team-based healthcare leaders to view diversity within the broader context of cognitive diversity; to recognize that identity diversity enables cognitive diversity to achieve its fullest benefit; and to value inclusion among individuals who bring their unique cognitive and identity diversity to the team in a way that ultimately achieves equity through behavioral design.

Related Resources

• What Works: Gender Equality by Design by Iris Bohnet, Harvard Press, 2016

• The End of Diversity as We Know It: Why Diversity Efforts Fail and How Leveraging Difference Can Succeed by Martin N. Davidson, Berrett-Koehler Publishers, 2011

• The Person You Mean to Be: How Good People Fight Bias by Dolly Chugh, Harper Collins Publishers, 2018

• Just Medicine: A Cure for Racial Inequality in American Health Care by Dayna Bowen Matthew, NYU Press, 2015

• The Diversity Bonus—How Great Teams Pay Off in the Knowledge Economy by Scott E. Page, Princeton University Press, 2017

• Medical Apartheid by Harriet A. Washington, Doubleday, 2007

• Invisible Visits by Tina Sacks, Oxford University Press, 2019

• Blind Spot: Hidden Biases of Good People by Mazarin R. Banji, Delacorte Press, 2013

Diversity & Inclusion: A How-To Guide

As with any initiative on the scale of diversity and inclusion, success is defined by leadership: the foresight to recognize a need for change and the fortitude to make that change happen.

Of course, it helps if you know what you’re doing because “there’s a huge cost if you do it wrong,” warns Michellene Davis, executive vice president and chief corporate affairs officer for RWJBarnabas Health in West Orange, New Jersey.

“[Diversity and inclusion] really needs to be fostered and brought about within an organization through a design methodology,” she advises, “which means that we look at it, we tweak it, we look at it again, we roll it out, we tweak it. It’s got to be talked about. There’s a lot of socialization that goes into it. There needs to be a communications strategy around it. And there needs to be a lot of one-on-one discussions with asset leaders across the organization because everyone needs to own a little bit of it.”

The process for implementing an effective D&I program may vary from one organization to the next, but there are steps that can streamline the process and experience for all involved. Weighing in with their own reasoned ideas are three D&I experts: Davis; Mark Lester, MD, MBA, CPE, FAANS, FACS, FAAPL, chairman of the AAPL board of directors; and Anne Pearson, MD, CPE, senior vice president and CEO at Physicians Memorial Hermann in Houston, Texas.

Do an organizational assessment: Identify current gaps in identity and cognitive diversity, from the boardroom to the basement. Ask what you want to achieve and why. What is your organization and what are its priorities? If you achieve diversity and inclusion, what will that look like and what will it mean to your strategy and purpose?

Borrow ideas: Investigate what other organizations across the country are doing — both inside and outside of healthcare. “It’s uber important that you not begin this work by making it up as you go along,” Davis says.

Dare to compare: Compare your organization to the population you serve, then compare that to similarly situated organizations in comparably sized states. “How do they deal with an increasingly diverse population?” Davis asks. “What have they done in order to attach to them in a way that welcomes them into this space? What are some of the challenges?”

Build trust: “Your No. 1 resource is a leader or team who can get folks to trust them, who leads by example, who is collaborative and coalition-building,” Davis says. “They have to have the CEO’s inherent authority, shared authority … someone who understands that everyone comes from different spaces and places.”

Empower: “Make certain you’ve got as many people (on board) as possible,” Davis advises, “and then give them the opportunity to be leaders — to be ambassadors — to help you achieve the best-case scenario for the organization in this space.”

Recognize implicit bias: “We don’t want to admit that we feel certain ways that are built into us from our background and experiences and how that influences us,” Pearson says, “but acknowledging bias and moving forward can be powerful. To get past that you need to put a lot of structure, processes, and leadership development into shaping an environment that mitigates bias.”

Mitigate bias: A few ideas include:

1. Hide names at the tops of resumes to eliminate any unintentional first impressions that might result from “name bias.”

2. After panel interviews, have panelists render decisions and offer feedback independent of each other.

3. Provide standard questions with objective scoring for each candidate so that everyone gets fair consideration. “If you ask questions based on what you need or want for a role, you don’t end up talking about the fact that you both like golf,” Pearson says, “because that’s how interviews can veer off track.” And how decisions can be swayed.

Ensure area representation: Create an advisory board of individuals who can speak for organizations that represent the demographics and backgrounds of the region. “That means going to the leader of the Hispanic Chamber of Commerce or Hispanic Bar Association as well as a local civil rights organization,” Davis suggests. Just getting the minister of the local black church is not enough, she adds. Attract individuals who have a history of experience in your region, who will make you aware of current or developing issues and concerns, and who ultimately will serve as your ambassadors.

Use internal consultants: Some organizations create a specialty position just for D&I. “If you do that, be careful you’re not focused solely on demographics and identity,” Lester cautions. “Demographics and identity should be a pathway to cognitive diversity, and your goal is to achieve the cognitive diversity that benefits your organization.”

Lead by example: “There’s something to ‘seeing is believing,’ ” says Pearson. “Seeing someone (woman, minority) who has moved into a decision-making role can inspire others to believe that they can also contribute. That’s ideal.”

Garner leadership support: “What you really need is organizational leadership support to say this is important — to do this because it’s the right thing to do. Otherwise, it will be a struggle unless people really believe in it and are willing to self-diagnose the issues,” Pearson says.

Be intentional: Statistically speaking, the representation of women and minorities in leadership positions is proportionately less than it should be. Increasing that representation requires intentionality. “It has to be supported by leadership that is willing to allow people who think differently and challenge status quo to be at the table,” Pearson says.

Be committed: Know the market demand for diversity hires and prepare yourself accordingly if you wish to secure them. “What you can’t do is go to my friend, the MD from Harvard, and offer her less than what she knows you’re paying,” says Davis. “Highly sought-after diversity candidates know what the market demand for them is (via publicly accessible 990 forms and market research). Have a made-up mind about commitment and then follow through.”

Again, for a program on the scale of diversity and inclusion, “change requires time and a great deal of training,” Davis says, “but it really takes us back to what we learned in kindergarten: Treat one another as you wish to be treated.”

For more: “50+ Ideas for Cultivating Diversity and Inclusion in the Workplace You Can Start Today” by Jennifer Kim: https://medium.com/@jenniferkim/50-ideas-for-cultivating-diversity-and-inclusion-in-the-workplace-you-can-start-today-fd390683bc73

Special thanks to the following AAPL Diversity & Inclusion Task Force members:

• Diversity Task Force Chair, AAPL Board Chair Mark Lester, MD, MBA, CPE, FAANS, FACS, FAAPL

• Diversity Task Force Co-Chair Anne Pearson, MD

• AAPL Board Member Linda L Lawrence, MD, CPE, FACEP

• AAPL Board Member Lisa Laurent, MD, MBA, MS, CPE, FAAPL

• AAPL Board Vice-Chair Byron Scott, MD, MBA, CPE, FACEP, FAAPL

• Deepak Pahuja, MD, MBA, FACP, FHM