Creating a diverse, equitable, and inclusive workplace culture is not only a moral obligation—it’s imperative for business sustainability and delivering optimal health outcomes. The pandemic has caused a major staffing crisis across all roles in healthcare. While many factors have contributed to the emergency, new Press Ganey data on diversity and equity shows that employees’ intent to stay at an organization is associated with how they perceive the value their employer, managers, and peers place on the presence and treatment of people from different backgrounds. Notably, a diverse and equitable culture is correlated with a strong safety culture, which also impacts patient care outcomes.
Healthcare systems must support diversity and equity across the entire employee lifecycle or face even more turbulent years ahead. Better diversity hiring practices are only the beginning: Healthcare leadership needs to drive efforts to equitably and inclusively onboard, promote, and retain all employees so they flourish.
Employees need to see a culture of diversity and equity in action
Press Ganey performed workforce engagement surveys that included five Diversity & Equity questions at 118 health systems and compared employees’ perceptions with their intent to stay at their current employer for at least three years or if offered another job. At organizations with the lowest Diversity & Equity scores, twice as many staff members stated they were unlikely to remain in either case.
The Diversity & Equity questions measure employee perceptions of an environment in which both the organization and its people demonstrate that they value a diverse workforce, and where leaders actively support the success of every individual. Solutions to improve poor perceptions need to be developed with full commitment, because healthcare workers are highly impacted when they don’t feel their employer values employees from different backgrounds—in survey results gathered from 411,000 employees during 2021, individuals who responded negatively to that question were 4.3 times less likely to intend to stay at their organization for the next three years and 4.6 times less likely to intend to stay if offered a similar job elsewhere.
A sense of belonging is important, especially during a crisis
Keeping employee engagement high amid record levels of burnout has been an ever-present conundrum since COVID-19 overwhelmed the healthcare industry. Workers who don’t feel well-represented and don’t have a supportive community are at even greater risk than their peers of isolation. Without a sense of psychological safety and empowerment to voice their concerns or contribute to decision-making, they’re more likely to leave, and the people who remain lose the value of their diverse perspectives. A perceived lack of belonging has notably been a challenge for first-year nurses during the pandemic, but it’s just as alarming for service workers. Engagement survey results from 2020 show that, though service roles have the greatest diversity among their ranks, individuals in those positions offer the worst evaluations of Diversity & Equity, regardless of their racial background.
Source: Press Ganey Associates LLC
Strengthening your workforce requires awareness and improvement
Globally, 86% of job candidates say diversity, equity, and inclusion (DEI) is important to them. News headlines and clashes over racial issues in recent years have heightened awareness of systemic racism and lack of diverse leadership in industries, including healthcare. Individuals actively seek out companies that are truly invested in forming a diverse workforce and equitable career paths, and today are more apt to question token hiring decisions, uninspired diversity training, and uniformity in leadership ranks.
It’s not just individual employees who expect and benefit from better representation in decision-making. Developing a pipeline for people of diverse backgrounds to reach executive roles can increase profitability and your reputation as an employer that prioritizes equity. In fact, companies with high levels of cultural/ethnic diversity on executive teams are 33% more likely to have industry-leading profitability, another factor in attracting and retaining top talent.
A two-phase plan for establishing a fairer playing field
Transforming your healthcare system’s culture to one that welcomes and nurtures people regardless of race, ethnicity, gender, age, or other demographic factors requires long-term dedication from leaders and staff. It also means thinking about how to treat diversity, equity, and inclusion as distinct notions, each needing careful attention.
To address workforce diversity and equitable opportunity distribution, start by instituting a framework for how you attract and grow talent. Maintaining standards and ensuring all healthcare professionals feel included as they move through that framework necessitates open dialogue and listening, as well as metrics.
Develop a stronger talent management model
From the candidate stage to the boardroom, applicants to your company and employees require support as they join your ranks and grow their skills. Key components of a complete talent management model include:
Re-envisioning recruitment: To attract a diverse pool of candidates to open roles, consider modifying job descriptions with a paragraph on your institution’s DEI philosophy, and by avoiding gender-specific pronouns and removing gender-coded language. Post to job sites and recruit at schools in communities not previously targeted. Evaluate whether required skills and education on resumes may eliminate otherwise worthy candidates.
Increasing interview accessibility: The pandemic changed how interviews are conducted, but candidates may not have access to technology for virtual meetings, or disabilities may prevent them from meeting in person. Ask for interview preferences when they apply.
Standardizing interviews: Posing the same questions to all candidates minimizes bias. To further promote fairness, use a scorecard to grade their answers.
Implementing hiring practices that support diversity: Audit your existing practices to determine your strengths and weaknesses in hiring a workforce that reflects racial, ethnic, and gender diversity. Choose one key metric to improve, such as increasing the percentage of minorities in nursing roles in 12 months.
Requiring training for managers and workers: Regular education on implicit bias and microaggressions should be standard fare for everyone. Additional modules for managers include equity in hiring, reviewing, and promoting.
Providing formal mentoring: Employees’ unconscious bias toward mentoring people similar to themselves may stop some junior team members from getting fair opportunities. Create a program with intention, including goals that align with organizational DEI targets, a regular meeting cadence and expectations to hold participants accountable, a follow-up survey to gather feedback, and comparison of engagement and retention rates between participants and nonparticipants.
Enforcing equitable promotion processes: Evaluate promotion pathways and at what level the diversity pool becomes shallow to determine where changes need to be made. Managers should encourage self-advocacy for staff, and invest in development for all.
Involve leadership and expand communication and measurement
Leaders at each level must connect with their staff to create a sense of community and listen to a variety of voices to be truly inclusive. They must make everyone feel valued and, at the end of the day, answer to themselves. This means:
Being visible and speaking openly and honestly about DEI: Transparency and accessibility are two of the biggest factors in building trust with your employees, including the sharing of engagement survey results.
Regularly surveying the workforce: Use ongoing pulse surveys to learn what employees appreciate about the actions you’ve taken.
Creating steering committees and affinity and focus groups: Employees in underserved populations don’t always have a sense of psychological safety in the workplace. Give them a space to discuss common experiences, challenges, and solutions in affinity and focus groups, and include individuals from different backgrounds in steering committees to influence policy and decision-making.
Embedding DEI into goals and performance reviews: It’s up to executives and managers to hold themselves and others accountable for maintaining and increasing diversity, by working it into both their own goals and their direct reports’ reviews.
Preventing employee turnover is a high-stakes proposition—made even more difficult as healthcare organizations cope with, and begin to recover from, the COVID-19 pandemic. Not all contributing factors are easily tackled, but strategically enhancing DEI initiatives following the above steps is a start. Press Ganey offers additional tools to help, including the Diversity & Equity module described here; Flight Risk analytics to spot patterns when employees are considering leaving your organization; consulting offerings in the areas of diversity, equity, and inclusion; and the Equity Partnership, a collaborative of 200+ health systems working to better measure inequities and identify and share best practices to reduce them. Visit our website to learn more, or reach out to an expert to continue improving your existing work.