Making Healthcare More Inclusive

For all of us in healthcare, the journey toward equity, inclusion and belonging has never mattered more. According to The New England Journal of Medicine:

“The murder of George Floyd on May 25, 2020, the killing of six Asian Americans in Atlanta, Georgia, on March 16, 2021, and numerous other troubling events have set in motion a wave of self-examination and needed actions on racism, diversity, inclusion, and equity in the United States. In the world of health care, the ensuing discussions focused attention on issues that have long been recognized but never addressed—that health care is far from equitable for patients or health care workers, and that the cultures of health care organizations are far from inclusive. The sense that health care organizations are not inclusive is not limited to Black people or other racial/ethnic minorities; it is shared by other groups that do not believe they are reliably treated with respect and fairness, including women and people with disabilities.”

Another group that can sense a lack of belonging is older adults. Not only is our society aging rapidly but the ratio of diverse elders is just as quickly growing, according to the U.S. Administration for Community Living. The number of older adults from minority populations is expected to rise by 217% in the coming decades—a staggering number that should cause all healthcare leaders to ask just how prepared their organizations are to meet the needs of the increasingly diverse populations we serve.

Efforts at Duke University Health System Toward Inclusivity

Duke University Health System (DUHS) is on a journey to create a more inclusive culture, where every member of our talent force can feel a strong sense of belonging.

When we feel we belong, we have a strong sense of security and support, because we know that we, and every aspect of our identities, are accepted. Belonging is engendered by the practice of inclusion, which invites all of us to be our authentic selves.

In the words of author, lecturer and podcast host Brené Brown, “Belonging is being part of something bigger than yourself. But it’s also the courage to stand alone, and to belong to yourself above all else.”

It’s also much more than something “nice to do.” Creating a sense of belonging can bring measurable, meaningful results. Research published in the International Journal of Health Policy Management has found that “engaging diversity meaningfully through inclusive leadership—that embraces staff across hierarchies and engages different perspectives so that all healthcare workers of all kinds feel they can speak up and participate—can save lives.”

‘Creating a sense of belonging can bring measurable, meaningful results.’

Here at DUHS, we have been examining and strengthening our organizational culture in an effort to become an even better version of ourselves. As an elite healthcare system whose brand is recognized across the world, we have a responsibility to help lead the way in delivering healthcare (and an employee experience) that is ever more inclusive.

Change of this magnitude starts with our leaders, so we have created an Inclusive Leadership Experience (ILE) to equip them to create a workplace that practices inclusion, creates a sense of belonging, and strives for equity. ILE is a significant investment in our ongoing learning and development and will play a key role in our overall cultural transformation. The new learning opportunity is a natural progression of Moments to Movement, Duke Health’s public pledge to stand for health equity and against racism and hate following the murder of George Floyd.

Our Moments to Movement courses equipped more than 2,000 Duke Health leaders to speak openly about the personal, professional and societal impacts of racism. As DUHS leaders, many of us have grown as a result of this training, and the organization is seeing the benefit: Our recent employee engagement survey indicated that 78% of respondents felt their leader modeled open and honest dialogue about race and social justice, and 76% felt they belonged at Duke Health. While we are encouraged by these results, we won’t be satisfied until that number reaches 100%.

Exploring Biases Beyond Race

As a natural progression of our Moments to Movement coursework, ILE is moving beyond race to include other dimensions of bias. It’s built upon the idea that inclusive leaders are self-aware, empathetic, and curious [and] intentionally amplify the diverse strengths and motivations of their teams by forming and honoring relationships built upon trust. Through ILE, participants will learn to understand their assumptions and biases, assess their reactions to all forms of human difference, explore the concept of privilege, and facilitate inclusive conversations.

The ILE will not focus on any one racial or gender group but will instead help leaders foster climates of psychological safety where everyone can feel safe, valued, and respected, so that everyone can contribute their very best.

As a leader who brings a number of intersectionalities (African American, gay, immigrant, etc.) to my own humanity and in the workplace, I value organizational cultures that create the environment where I can be authentically me.

‘We exist to serve all people, and that worldview starts with our team members.’

I am very open about the differences that I bring but I can imagine the reality of millions from another demographic—older Americans, who, according to both the UCLA School of Law Williams Institute and the Journal of the Royal Society of Medicine, on a daily basis find themselves feeling isolated and alone. The Institute further states that loneliness and social isolation are serious public health issues. These issues can affect older adults’ feeling that they don’t belong. Psychology Today’s blog argues that “a sense of belonging to a greater community improves one’s motivation, health and happiness.” This is why the work we are doing at DUHS on inclusive leadership is so critical to our sense of humanity.

What has been most exciting about our ILE efforts here at DUHS is the commitment from leadership that is propelling it forward. Our leaders strongly believe that creating a more inclusive environment is critical to our success. In a Harvard Business Review article, readers are reminded that “companies are increasingly relying more upon diverse, multidisciplinary teams that combine the collective capabilities of women and men, people of different cultural heritage, and younger and older workers.” The article further argues that merely throwing a mix of people together doesn’t guarantee high performance; success depends upon a culture that practices inclusion—a DUHS leadership behavior.

Practicing inclusion for us means engaging the hearts and minds of others—not just their hands—and including them in decisions and communications. It is about leveraging the power of our diversity by asking questions sincerely and by seeking out new perspectives and by developing, sponsoring, hiring, and promoting with an eye toward equity and inclusion. In doing so, we seek to “put people first,” another leadership behavior here that helps us foster a culture of listening to understand, giving full attention, and assuming positive intent. This is part of our organizational aspiration to ensure all team members feel valued, treated respectfully and fairly, and are confident and inspired.

The communities and populations served by Duke University Health System are extremely diverse and becoming more so, with significant numbers of patients and their loved ones who identify as older adults, people of color, LGBTQIA, gender diverse, differently abled, neurodivergent and more. We exist to serve all people, and that worldview starts with our team members. We cannot lead the culture if we are not leading our teams, and we cannot lead our teams if we are not leading ourselves.

Being a truly inclusive leader requires a deep sense of self-awareness—and that means knowing all parts of ourselves, leading up to who we are today (even those parts we may not be proud of). It requires us to understand our strengths and weaknesses, emotions, motivations and reactions, and how we are perceived by others.

When we reach that level of self-awareness, we are capable of delivering a healthier world—for our patients, their loved ones, the communities we serve and one another. Isn’t that what healthcare is all about?

Ian Lee Brown is a vice president and chief employee experience officer at Duke University Health System. In his role, he leads strategies that drive culture and well-being, diversity, equity, inclusion and belonging, and serves as the executive sponsor for the system’s efforts to prevent workplace violence.

Photo caption: Left to right, Maria de los Angeles, Serena Gage, Paul Joenk and Josephine Adigwe.

Photo courtesy Duke Health.