REEDE: Historically, our conversations in medicine have been numbers-based. We need more African-American doctors because we have African-American patients. The belief was that we needed to match it up in some way. No thought was given to diversity in leadership, or whether these individuals could actually help the organization function better. Take me, for example. I’m an African-American pediatrician. My role is not to improve the health of the pediatric population in our community; it’s to help the people of the organization deliver better care to improve the health of the community. It’s a shift to think about what that person brings and what that person does. This thinking helps the organization to meet its goals. It’s not my sole responsibility, or that of other diverse clinicians. It’s a collective responsibility.

PARKER: We talk about the purpose of diversity, and it has many angles. Diversity helps to drive how we care for our patient population. It builds understanding of our unique populations and helps us to develop innovative ways to reach out and care for them. At Robert Wood Johnson University Hospital, we’ve made significant gains over the last three to four years. We’ve increased minorities in executive positions by 34 percent over a three-year period. That’s why I say it can be done.

Our system is at one of the peaks of its performance in our history. Several mergers are going on, there’s a great deal of significant growth and our margins are good. One of the things that’s different today is that our executive leadership team is more diverse than it’s ever been. I can’t say definitively that this is the reason for our success, but I can say that diversity drives the performance that we are experiencing. One barrier I see is that those of us who are doing the work, who are benefiting from the work and see the impact and the return on investment, could probably tell our stories better to build a broader understanding of the benefits of diversity.

BOLTON: You are absolutely right about that; we need to do a better job. The AHA’s Equity of Care Award is an example of lifting up organizations that have been successful. It enables organizations to share their journeys. Christy talked about intention and purpose, and we do more nay-saying than we do celebrating our successes.

I’m currently serving as president of AONE’s board of trustees and AONE celebrates the fact that we put a strategy in place to make sure we were inclusive on our board. And then other organizations came to us asking how we accomplished that. We gladly share our experience. We need to lift up where there’s been success and say, 'How might we scale it and do more of that when we are successful?’

REEDE: There’s got to be accountability in it, too, because we don’t have good accountability across our organizations. And I want to go back to the issue of metrics. What does it mean? What are you accounting for?
If you were to pick up your organization and place it in a different community with a different population mix, how would your organization proceed? Would your organization be adept at making the changes necessary to deliver high-quality, patient-centered care to the population effectively?

SMITH: At its basic level, we know that diversity drives employee engagement, and we know that a highly engaged workforce is a prosperous workforce. So, employee engagement is one metric that we can look at to support the call for greater diversity.

PARKER: That’s correct. And we are doing that. We stratify employee and patient engagement and we’re going against all national trends — minoroties and female employees are the most engaged, even before we started our journey. It’s more challenging to make a business case for the need for greater diversity and inclusion, when our patient and employee satisfaction numbers are so good. Everyone seems to be happy and satisfied.
That’s why I believe the qualitative stories are extremely important. When an employee says, 'I feel more valued,’ that, to me, goes much further than what we glean from the employee engagement survey. And when an employee says, 'When I walk into the organization, I see people who look like me wearing a suit,’ it gives them a sense of pride and it also helps us with building the pipeline because they see the possibilities.

REEDE: It’s more than just bringing people in; it’s making them feel valued. If you are bringing people in solely for the color of their skin, they will figure it out quickly and most likely will move to another organization. People want to contribute and they want to feel valued. The cost of recruitment and retention is significant. In an academic environment, the cost of recruitment and hiring of faculty is in the hundreds of thousands, if not more. It’s important to build an inclusive environment where everyone feels that they can contribute.

SMITH: The cost of hiring and recruiting is three times the cost of the salary. That is quite a significant number.

GUNN: Recruiting and hiring an operating room nurse costs about one and a half times the salary. It’s important to have everyone within the organization who is involved in hiring to be focused on building the right team and keeping them engaged in the organization. Having a turnover rate of greater than 10 percent will be a big drag on the organization. Building a high-performing workforce takes a leadership framework around diversity, inclusion and engagement.

GARCIA-THOMAS: A big piece is leadership development. It’s nice to recognize great nurses by moving them up to management positions. But that position requires a different skill set, and we need to set them up for success. We need to build leadership competencies across the organization. It’s a big part of the retention piece, and that has to be factored into the equation for long-term success.