The Business Case for Diversity

Most top executives “talk the talk” of diversity. They’ll avow the importance of their institutions’ management and employee ranks reflecting the racial, ethnic and gender mix of the communities they serve. But fewer “walk the walk” because of the costs and challenges they perceive to be involved in creating a truly diverse healthcare facility and service provider.

However, one institution that does “walk its talk”—in the fullest sense of the phrase—is the Robert Wood Johnson Health System (RWJ). Located between New York and Philadelphia, RWJ (annual revenues: $1.6 billion) serves a six-county population of approximately 1.6 million people with 10,300 employees, 3,250 medical staff and 1,733 total beds. Its flagship facility is Robert Wood Johnson University Hospital (RWJUH), a 965-bed academic medical center with campuses in New Brunswick and Somerville, NJ.

It is fair to say RWJ is a living, teachable example of enlightened diversity management in action. The proof: In 2014, RWJ was named “Best in Class” for Diversity Management and Strengthening the Workforce by the American Hospital Association’s Institute for Diversity in Health Management. Last year RWJ was ranked #19 in Diversity MBA Magazine’s rankings of 50 Out Front Companies for Diversity Leadership: Best Places for Women and Diverse Managers to Work and was one of two recipients of the AHA’s Equity of Care Award. In addition, in both 2015 and 2016, RWJ was named a Human Rights Campaign Foundation LGBT Healthcare Equality Leader.

These accolades reflect RWJ’s many years of work on improving diversity among the organization’s leadership and reducing demographic disparities among the communities and populations it serves.

The 4-C Model

The decision to improve RWJ’s diversity came directly from the top, says Cheri Wilson, RWJUH’s director of diversity and inclusion. “In 2010 the RWJUH Board of Directors requested hospital leaders to create a diversity and inclusion plan,” she says. To make this happen, “RWJ partnered with the Institute for Diversity in Health Management to create the first three-year strategic plan (FY12–FY14) that focused upon people—defining diversity, implementing diversity and integrating inclusion.”

In creating its first diversity strategic plan, RWJ applied what’s called the “4-C model” to improve its diversity and inclusion employment policies. The four Cs stand for:

• Human capital (recruitment, retention, engagement);

• Community engagement (market positioning, business growth, partnership development);

• Patient care (culturally and linguistically appropriate services, health equity);

• Corporate alignment (accountability, training, diverse suppliers).

“Initially, the 4-C model involved a continuous cycle of leadership alignment and buy-in, strategic planning, clear metrics, shared accountability, organizational culture, engaged employees and package best practices,” Wilson explains. “Diversity and inclusion originally was a separate operational pillar that comprised 15% of the organizational goals, the successful achievement of which was linked to executive compensation.”

As RWJ gained experience in developing and applying its programs, the scope of the 4-C model broadened. Today the concept of diversity and inclusion now crosscuts all of the operational pillars of its healthcare organization, including finance, growth, service, quality and academics. This, in turn, is tied into what RWJ calls “Operation: Excellence,” says Wilson: “This is the continuous cycle of improvement that guides the organization and is still linked to executive compensation.”

As a result of RWJ implementing its 2012–14 diversity and inclusion strategic plan, the representation of racial/ethnic minorities and women on its board and in executive leadership positions increased substantially. The numbers tell the tale: “Racial and ethnic minorities now comprise 22% of the RWJUH board, and the percentage of underrepresented minorities in executive leadership positions has increased 34%,” Wilson says. “In addition, 42% of RWJ’s executive leadership team is women.”

Business Resource Groups

Central to RWJ’s progress in enhancing its diversity is succession planning. Under this approach, RWJ actively identifies employees who have leadership potential; creates mentoring programs to help them grow those skills; and provides other opportunities for them to engage in professional development.

To bring this about, RWJUH has seven Business Resource Groups (BRGs), basically employee resource, network or affinity groups that are central to its succession planning activities. These are:

• ASIAN (Asian Society for Impact & Advocacy Network);

• AWARE (Advancing Women Through Advocacy, Recognition and Empowerment);

• BPN (Black Professionals Network);

• ELN (Emerging Leaders Network);

• PROUD (Promoting Respect, Outreach, Understanding and Dignity), for the lesbian, gay, bisexual and transgender [LGBT] communities;

• SALUD (Service and Advocacy for Latinos United for Development);

• VETS (Veterans Engaging Through Service).

“Each of the BRGs has one or two cochairs and is assigned an executive sponsor,” says Wilson. “Stephen K. Jones, president and CEO of RWJUH and RWJ Health System (and RWJ’s first and current chief diversity officer), serves as the executive sponsor for VETS since he is a veteran of the Air Force himself. Each of the BRGs is engaged in activities that support employees, patients and community members, and each identifies an annual business impact project.”

Of course, RWJ has bills to pay. It does this in line with the Triple Aim: optimizing population health, reducing per capita cost and improving the patient experience. To ensure the organization’s Triple Aim efforts mesh with its diversity/inclusion programs, the hospital has created a new employee orientation presentation, “Where Diversity and Inclusion Meets the Triple Aim: Population Health, Cultural Competence and Health Equity.” This training is being rolled out staff-wide in addition to other cultural competency training in areas such as overcoming language barriers and caring for LGBT patients.

Evidence of Progress

When it comes to assessing RWJ’s progress in achieving its diversity and inclusion goals, the organization relies on hard evidence. This is why “RWJUH collects patient demographic data related to race, ethnicity, preferred language, age and veteran status.” says Wilson. “Payer status is used as a surrogate for socioeconomic status.”

The collected data is used to identify health disparities and then design targeted interventions to reduce them. “Metrics pertaining to quality, safety and patient experience are reviewed, stratified and reported to senior leadership,” she notes. In addition, RWJ maintains a “diversity and inclusion dashboard,” says Wilson, “which is a combination of the annual organizational diversity goals and the chief diversity officer’s annual goals.” This helps keep everyone focused on the task at hand.

Make no mistake: Achieving its diversity and achievement goals translates into healthcare that is better attuned to RWJUH’s actual patient mix and their specific needs. It also results in lower operational costs. For example, thanks to the creation of RWJUH’s Delivery System Reform Incentive Payment (DSRIP) Transitional Care Clinic (an initiative that arose from RWJ’s diversity and inclusion efforts), the hospital lowered its overall 30-day readmission rate for low-income patients from 13% in 2013 to 5.2% in 2014.

Focus on Patients

Today RWJ is implementing its second three-year diversity and inclusion strategic plan (FY15–FY17). This time the focus is on patients and achieving health equity.

“In this regard,” says Wilson, “the RWJUH Community Health Promotions program, which serves the diverse needs of underserved communities, partnered with St. Peter’s University Hospital, also in New Brunswick, to create a joint community health needs assessment and implemented its first Community Health Improvement Plan in 2014.”

As well, RWJUH is using a July 2015 grant from the New Jersey Innovation Catalyst Initiative to improve emergency department service for Spanish-speaking patients and those with limited English. This is a sensible project given that RWJUH’s home city of New Brunswick is 49% Latino/Hispanic. “In addition, RWJUH is committed to supplier diversity, with nearly 10% of its annual spending devoted to contracts with minority- and women-owned business enterprises,” Wilson says.

Thanks to its diversity and inclusion efforts, RWJ has improved the racial, ethnic and gender mix of its management; better targeted the services offered to its patient base; and reduced 30-day patient readmissions. The conclusion: A committed, well-executed diversity and inclusion policy enhances a healthcare provider’s corporate culture, quality of service to staff and patients, and bottom line.

James Careless is a freelance writer with extensive experience covering computer technologies.

Sidebar: Things Not to Believe

A February IHI blog by Jo Ann Endo cited six common myths about cultural competency in healthcare:

1. One good seminar or training session can impart cultural competence—“It’s not a ‘one and done’ kind of thing,” Endo writes. “It takes practice to shift how we think and how we process our perceptions of others.”

2. Cultural competence applies only to interactions with minorities—Actually, every single person belongs to multiple cultural groups. Don’t focus exclusively on external physical characteristics; we can’t understand what’s important to patients until we get to know them as individuals.

3. Being a person of color automatically makes you culturally competent—People of color are just as prone to stereotyping, making assumptions or forgetting to treat people as individuals as anyone else, Endo notes. Nor are they even necessarily interested in the topic of cultural competence.

4. One person or team should be responsible for diversity and inclusion—Assigning one person to oversee diversity and inclusion efforts shouldn’t mean they’re the only one responsible. Cultural competency should be part of every interaction with patients and families.

5. Cultural competence is too big to tackle—You don’t have to learn everything about every culture. Build competency by using fundamental communication skills that let people communicate respectfully and effectively with others.

6. I don’t have time to address cultural competence—“Just as our work to improve our interactions with patients contributes to both better patient engagement and cultural competency,” Endo writes, “it also helps us avoid errors and harm, reduces the likelihood of an unnecessary readmission, and increases our understanding of the people in our service population.” This is compatible with the goals of the Triple Aim.

Find the full column at www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=204.