Answer to "How can I develop faculty and staff to ensure organisational change?"
To ensure organizational change, EDI must be implemented at several levels.
Encourage diversity in leadership and in the healthcare provider network.
A robust body of work has shown that cultural (e.g., racial/ethnic and language) concordance between the patient and provider can powerfully enhance the clinical relationship (Manson, 1988; Cooper-Patrick et al., 1999). Organizations must “practice what they preach” by ensuring that they implement inclusive recruiting and staffing practices. Moreover, a diverse workforce will encourage potential providers from underrepresented populations to enter and continue working in medicine. Building EDI into the very composition of the healthcare system can empower and advocate for both patients and providers. However, it is also important to recognise that one approach rarely suits all. Patients from small communities may not want concordant providers for fear of being judged or deviating from “cultural norms”. When judging if cultura, gender or sexuality or any other concordance is effective, it may be useful to identify the factors that enable the effectiveness. Patients and/or providers may assume inherent understanding based on a shared characteristic. When there are few or n shared characteristics an effective practitioner is more likely to ask the patient their perspective and may provide better care than one who assumes they already have an understanding of the patient.
Underscore the importance of structural EDI resources.
Training can, and should, be supplemented by various forms of organizational support. Healthcare systems can provide multilingual resources and literature, including critical interpretation services. They can also collect feedback, including through metrics such as patient satisfaction; partitioning out these ratings by cultural groups of interest may provide essential insight into pain points in the delivery of care. Once these systems are in place, administrators should take care to educate their providers about the resources. This is helpful for two reasons: First, it allows maximal utilization of these services, and, Second, it signals to providers that their employer has a vested and demonstrable interest in improving EDI.
Standardize training, including at leadership levels.
To achieve organizational “buy-in,” interprofessional key informants recommended that training be standardized and evidence-based. A large body of evidence supports the mandatory institution of training programs, as they demonstrate organizational investment and result in greater trainee effectiveness (Rynes and Rosen, 1995; Wentling and Palma-Rivas, 1999; Kellough and Naff, 2004; Paluck, 2006; Bell, Connerley and Cocchiara, 2009; Salas et al., 2012). Moreover, requiring participation will ensure that training does not simply self-select, but will reach those who most need EDI education (Ellis and Sonnenfeld, 1994). This is particularly important among leadership, whose perspectives and visions will guide policy and organizational culture. Teachers need to model the behaviours they expect of students. There are parallels in the relationship between a doctor and patient and a teacher and their student.
Bell, M. P., Connerley, M. L. and Cocchiara, F. K. (2009) ‘The Case for Mandatory Diversity Education’, Academy of Management Learning & Education, 8(4), pp. 597–609. https://doi.org/10.5465/amle.8.4.zqr597.
Cooper-Patrick, L., Gallo, J. J., Gonzales, J. J., Vu, H. T., et al. (1999) ‘Race, Gender, and Partnership in the Patient-Physician Relationship’, JAMA, 282(6), pp. 583–589. https://doi.org/10.1001/jama.282.6.583.
Ellis, C. (1994) ‘Diverse approaches to managing diversity’, Human Resource Management, 33(1), pp. 79–109. https://doi.org/10.1002/hrm.3930330106.
Kellough, J. E. and Naff, K. C. (2004) ‘Responding to a Wake-up Call: An Examination of Federal Agency Diversity Management Programs’, Administration & Society, 36(1), pp. 62–90. https://doi.org/10.1177/0095399703257269.
Manson, A. (1988) ‘Language Concordance as a Determinant of Patient Compliance and Emergency Room Use in Patients with Asthma’, Medical Care, 26(12), pp. 1119–1128.
Paluck, E. L. (2006) ‘Diversity Training and Intergroup Contact: A Call to Action Research’, Journal of Social Issues, 62(3), pp. 577–595. https://doi.org/10.1111/j.1540-4560.2006.00474.x.
Rynes, S. and Rosen, B. (1995) ‘A Field Survey of Factors Affecting the Adoption and Perceived Success of Diversity Training’, Personnel Psychology, 48(2), pp. 247–270. https://doi.org/10.1111/j.1744-6570.1995.tb01756.x.
Salas, E., Tannenbaum, S. I., Kraiger, K. and Smith-Jentsch, K. A. (2012) ‘The Science of Training and Development in Organizations: What Matters in Practice’, Psychological Science in the Public Interest, 13(2), pp. 74–101. https://doi.org/10.1177/1529100612436661.
Wentling, R. M. and Palma‐Rivas, N. (1999) ‘Components of effective diversity training programmes’, International Journal of Training and Development, 3(3), pp. 215–226. https://doi.org/10.1111/1468-2419.00079.