AHLA's Speaking of Health Law

Top Ten 2022: The Health Care Workforce IDEA (Inclusion, Diversity, Equity & Accessibility)

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Based on AHLA’s annual Health Law Connections article, this special series brings together thought leaders from across the health law field to discuss the top ten issues of 2022. In the sixth episode, Mouzhan Mangum, Principal and Chief Operating Officer, PYA, speaks with Tiffany Buckley-Norwood, Associate Counsel, Employment, Trinity Health, about the benefits of diversity in the health care workplace and industry. They discuss how defining diversity can help employers achieve equity, effective ways to use diversity statistics, and steps that individuals can take to improve diversity in their organizations and communities. Sponsored by PYA.

Watch the conversation here.

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Speaker 1:

A H L a is pleased to present the special series, highlighting the top 10 health law issues of 2022, where we bring together thought leaders from across the health law field to discuss the major trends and developments of the year support for a H a. And this series is provided by PPY, which helps clients find value in the complex challenges related to mergers and acquisitions, clinical integrations, regulatory compliance, business value, and fair market value assessments and tax and assurance for more information, visit pya, pc.com.

Speaker 2:

Well welcome everyone to our podcast. Uh, today we're gonna be talking about diversity equity and inclusion and the healthcare space. My name is Maja mango. I'm chief operating officer at P P Y a a national professional services firm. And today I'll be serving as moderator and speaking with Tiffany Buckley, Norwood. Tiffany, would you let the audience know a little bit about you?

Speaker 3:

Hi, thank you. Um, so I am an employment attorney. I have been an employment attorney for a little over 15 years now. I spent much of my career focused on diversity equity inclusion in addition to, um, traditional employment law. Um, I am currently with Trinity health as one of the system office employment attorneys. I joined Trinity health at the end of last year. Prior to that, I was with Jackson Lewis for over 10 years. Um, in my role with Jackson Lewis, I was one of the, uh, cos for our healthcare industry group. So I am really excited for our discussion today. I should note that while I work for a healthcare system, any opinions I share are my, and not necessarily the opinions of Trinity health.

Speaker 2:

Thank you so much. Well, I've, um, I've some questions for you today, so we'll just dive in. Um, there's a lot of learning in recent years about, uh, be the benefits of diversity in the workplace. So would you share some data in that regard for the healthcare setting?

Speaker 3:

So, you know, um, and I'll start with race and gender because that's, that's typically where we start, right? When we, we have a conversation around diversity, um, according to data from the association of American medical colleges, the AAM C and us census it as 64% of active physicians are male and 56% are white, you know, and to put it another way, 36% of active physicians are female. Uh, about 5% of physicians identify as African American or black, fewer than 6% identify as Hispanic. Um, the majority of nurse practitioners, physical therapists and other occupational therapists are female, but 25% are non-white to take, go a step beyond race and are, uh, while there isn't large scale data, for example, on LGBTQ plus healthcare workers, according to the AA C um, from 2017 to 2019, the percentage of graduating medical students who identified as gay or lesbian increased from 3.6% to 3.8%. And in the same time, the number of graduating medical students who had a different gender than that assigned at birth increased from 0.6% to 0.7%. So we're starting to collect more data, but there isn't a lot of data outside of race and gender at this point.

Speaker 2:

Um, so to be helpful to our audience, we thought maybe we, uh, talk through the topic in three main, um, three main areas. So we let's start by maybe defining diversity and then move towards unconscious bias and micro aggressions. Um, and then house does, you know, lends itself to this, this space. So, uh, in defining diversity, we know that in the past, you know, as you said, diversity was in large part around some overt characteristics, race, gender, religion, national origin, as, as we've learned, more diversity has expanded to those experiencing medical conditions, for example. So now the conversation has elevated to include equity as well. How can defining diversity help an employer in terms of equity?

Speaker 3:

Right. So first I wanna revisit something that you touched on, as you mentioned, that the definition of diversity has changed across the years. And as healthcare employers begin to implement diversity initiatives, it's important to define that term so that we know what we're striving for. Right? So one of the easiest ways to see this evolution related to that definition is how laws defining protected categories have changed. And we talked a lot about this in the, the AR companion article, um, but just to run through a few of them really quickly, you know, those early civil rights laws, um, such as title seven, the age discrimination and employment act, um, early presidential executive orders, they really focused on, on overt characteristics. So those things that we could see, race, gender, religion, national origin, and then that diversity discussion continued to expand to protections for medical conditions, such as disability, pregnancy, genetic information. As we saw through the pregnancy discrimination act, the Americans with disabilities act, family medical leave act, genetic information, non discrimination act. Um, and then that diversity conversation has continued to expand, um, to include discussions around pay equity, accessibility, sexual orientation. Um, you know, we saw that with the Lily led better fair pay act. We saw it with, um, even some of the provisions of the affordable care acts that aren't talked about as much included things like expression of breast milk, um, and also accessibility in physical spaces. And that definition of is going to continue to expand, um, to involve more lifestyle topics. And part of the reason for this evolution is, and this goes into the equity conversation, but part of the reason for the evolution is because of what we've seen from a societal standpoint, right? We talked about race and gender because of, of the laws that were harmful to individuals of different races of different genders. And so we created laws to protect those individuals, hence why we call it protected characteristics. When we're talking about these laws, we created these laws to protect those individuals, to assist those individuals in, to obtain some of that equity. And I'll, I'll get into that definition of equity in a little bit, but, um, so defining diversity by defining diversity, we're also looking at who needs that assistance, right? Who is starting from a place, um, that is somewhat hindered somewhere kind, that starting line. If we think about a race, you know, we might have some that are starting at that starting line. And then we have others who are starting maybe a mile, two miles back, how do we get them to that starting line so that they can thrive and progress

Speaker 2:

What yeah. Right. With additional support and, you know, to your point as organ, you know, the more, you know, the more you can, uh, help in that, in that conversation. So, well, that's a really good segue, as you were saying, you know, the, we hear terms like diversity equity inclusion, if you're not in that work, not, not all of us understand what those terms mean. So could you spend a little bit of time helping us understand what those three terms mean and how they work together?

Speaker 3:

Right. So when we talk about diversity, diversity is really the representation of different types of people based on any number of categories. Sometimes if you're in the space, you might see the iceberg with the, um, excuse me, the visible characteristics are on top, but then the bottom of the iceberg is all of the things that we don't see. So that iceberg might include race, gender, religion, socioeconomic status, education, even where you grew up. Um, it asked who is in the room. If you're talking about a conference room where there's a discussion being had who's in that room, um, how many more of X category of people do we have in the room this year than we did last year? For example, when we get into inclusion conclusion is that deliberate act. So that conscious act of creating a environment where all kinds of people can thrive and succeed. So again, if you're thinking about that conference room, has everyone's ideas been heard? Has everyone had the same opportunity to participate? Does everyone feel as if they are safe, such that they feel they belong? Um, and then when we get into E equity, which I will distinguish from equality, um, it's that quality of being fair? It's not the same thing as equality. When we talk about equality, we're talking about everything being equal, whereas with equity, again, going back to the,

Speaker 2:

The right

Speaker 3:

Who's the mile back is two miles back. That needs to be brought up to that line. So who's trying to get into the room, but cannot get into the room because of some obstacle, maybe that door is now locked. Um, who's in the room. But's not able to speak because they're not able to communicate in the same manner as the other, other individuals who are in the room, what conditions have we created to maintain, um, certain groups as the perpetual majority. And I'm not just talking about white or male, um, but it could be any other type of majority as well. It could be heterosexual, for example, it could be that, um, sticking to the dichotomy of male, female. So what conditions have we created that make it so that others are not able to thrive and succeed that inclusion? And how do we,

Speaker 2:

I love what you said about, you know, and I think we, we talk about that, you know, within our organization, if you, you know, offer us safe environment, a welcoming environment, and it all goes back to, you know, all of the core values that I think many organizations strive for the integrity, authenticity, respect, and listening, because not everyone needs or, you know, has the same desires. And to your point, there are people that, that need more to get to that starting point. Then, then I think you can then work together on, on what individuals need, um, you know, within a certain system. So I really appreciate you spending time on those three terms. So two other terms, we, we touched on it at the beginning of our time together, microaggression and I unconscious bias. What does that mean? And then how does that relate within the healthcare system?

Speaker 3:

So with unconscious biases, and this is one that we see quite a bit, um, not just in healthcare, but especially in healthcare. Uh, those are those automatic mental shortcuts that we use to process information and make decisions quickly. And it's not necessarily bad to have unconscious biases. We all have them. Um, in fact, we have to, it's kind of our, one of our tools for survival because we get so much coming at us each day. Um, and so we have these kind of automatic assumptions, these automatic things that, that we do that without even thinking about it consciously. Um, but where it becomes harmful is where those unconscious biases, those assumptions that we're making those automatic mental shortcuts lead us to doing something that is harmful to someone else. So for example, if we need assumption that someone with a physical disability is automatically unable to perform the job, even though they may have, they may be able to perform the job, they just need the tools to do so. Um, they may need a reasonable accommodation. Um, but by having that unconscious bias that simply because they have the physical disability, they can't perform the job, we never get to that discussion. And then that's somebody who's not able to actually try or get that opportunity to perform the job. Um, and I'm going to, I, I know we're gonna talk about this a little later, but we also see it in the healthcare equity space. And this is how, you know, it's important for us to not only have diversity in the workplace, diversity, equity and inclusion in the workplace for the workers, but it's also important for the populations that we're serving. Um, because those unconscious biases can also play into the way that we are treating our patients, right. Um, there might be certain assumptions by someone who's just about someone who's just walking in the door that later impacts the way that they're treated or the plan for treatment for that particular person that later becomes harmful. So it's important to be aware of those unconscious biases. Again, we all have'em, but you have to know what they are. You have to recognize them and realize when they could become harmful,

Speaker 2:

Right. And where, when they might tip a, a decision on hiring or promotions, or to your point, um, you know, in the, in the patient population that that we're serving. So that was really helpful. Um, so by law healthcare employers who are federal contractors are already required to utilize statistics, to create diversity goals as part of formal affirmative action plans. How is the use of debt statistics helping other employers who may not be mandated, mandated to have plans like that in place?

Speaker 3:

Right. So, um, and I didn't mention this before, but part of my experience in the past was in corporate diversity counseling. And one thing that I've realized is that the most effective diversity initiatives are focused. They have certain goals and that, again, this is where defining diversity comes into play, but I'm sure as many people who are listening have heard of smart goals, so specific, measurable, attainable, relevant, and time based, um, rather than, and you want to make sure that when you're setting those goals, they're based in something. So for example, you could just say, you know, we want a workforce that has 20% Hispanic workers or 20% Hispanic nurses. That's not based in anything. Um, instead of doing that where we're just guessing at a number we're just pulling a number, um, use the community around you, the workforce statistics to compare what the workforce looks like as it currently stands to what say statistical data says it should look like, um, and then set goals based on that. So I'll give a, a example of this perhaps, um, census data or other workforce statistics say that 40% of the nurses in that recruitment area where you normally hire from, um, 40% of those nurses are Hispanic that's then 40% is a more relevant goal than just saying 20%, right? If you say 20%, you're not really matching what the recruitment area says your workforce should look like. So using those statistics allow you to get more relevant goals in place.

Speaker 2:

So you touched on this earlier, we talked about it. Um, you've been, you've been, you know, weaving this throughout all of your comments, but, um, wanted to give you a chance to talk more about how this impacts patients and the, you know, population health, um, in terms of diversity and equity and inclusion. So how that, so how does that influence healthcare as a whole industry?

Speaker 3:

Yeah, so, um, I think I mentioned this before, but if the pandemic has taught us anything, health, inequity still exists, unfortunately. Um, one of the ways to mitigate against this is that diversity equity inclusion, you know, it's well known that DEI shorthand, um, increases, you know, patient comfort levels, for example, there's boosted creativity and problem solving. And that's not just in healthcare, that's in a lot of different workspaces. Um, there's an enhanced understanding of different cultures when you have a more diverse and inclusive workspace, increased trust, higher retention, which is really important right now, as healthcare is dealing with staffing issues, um, improved communication in medical decision making. So for example, if you have a patient who is, um, hearing impaired or deaf there, you need to think of alternative ways to communicate with them, whether that be through, um, an in-person interpreter, virtual, remote, remote interpreting, spare risk. Um, and one last one that I I can think of is, um, there's that improved retention and engagement, not only with, uh, the workforce itself, keeping your workers engaged, but also with the community and making the community feel safe to come and see you or whatever healthcare worker when they're feeling ill or when there's a problem before it gets to the point where it can't be resolved.

Speaker 2:

That's exactly right. And I think, uh, you know, as a result that that would really impact the health of many communities that, that maybe right now don't have, um, the access that they, they want to have. So we've talked a lot today about, you know, the system, the organization, um, and, and that's what we're here to, to do today, um, specifically within healthcare. But it, you know, if there's individuals out there, um, watching this today, um, what can they do, you know, is there, is there an individual initiative that they can take to improve diversity, uh, initiatives in their, in their company or community?

Speaker 3:

Right. So I think that the first thing is understanding if, for example, if there are organization already has diversity initiatives understand what those are, understand what the goals of those diversity initiatives are. Um, if you're in a position of decision making, making sure that the diversity initiative has goals, um, and making sure that their smart goals, um, you know, if your organization, for example, has employee, um, resource groups think about joining a group, not only for the one, not only the groups that you identify with, but also maybe a group that you just support. Perhaps you don't have a physical or mental impairment, but you support individuals who have physical or mental, and you want to be an advocate for those individuals go to the organ. Those, um, the group sessions, see what you can do to assist. How can you advocate? How can you be a sponsor, um, also be cognizant of unconscious bias or irrational assumptions, um, make sure in this kind of base level, but making sure that when you're communicating, you're seeking to understand, in addition to being understood, um, sometimes communication is the most important thing of, in terms of, um, getting to the root of an issue, whether it be trying to treat a medical condition or otherwise. So those are kind of three high level things. There are a lot of resources on the internet, even if you just type in diversity initiatives, there are a lot of resources that are out there, but those are the three kind of basic high level, um, things that I think would be helpful.

Speaker 2:

I love how, um, you know, your comments. It, it really is. You gave us some simple ways that we could, you know, starting today, um, put in place, um, to, to make all of our organizations and communities better. So really appreciate your time, Tiffany, and your expertise on these topics. Hopefully it's helpful to the audience as well.

Speaker 3:

Thank you.

Speaker 1:

Thank you for listening. If you enjoy this episode, be sure to subscribe to a HLA, speaking of health law, wherever you get your podcasts to learn more about ALA and the educational resources available to the health law community, visit American health law.org.