Strategies to Improve Culture
| Strategy . | Benefit . |
|---|---|
| Conduct comprehensive and connected onboarding | Onboarding is a critical opportunity to enculturate new hires. This is an opportunity to provide rules and initiate an effective mentorship or coaching relationship through that first, crucial year of employment. |
| Embrace alternative work schedules | Many women who choose to leave medicine cite the lack of flexibility, particularly when faced with dueling demands of child-rearing and caring for aging parents. Organizations should leverage part-time or flexible schedules for recruiting and retention and as part of physician reentry programs. |
| Conduct meaningful organizational assessments | Historically, when data are collected there is an overemphasis on quantitative data rather than qualitative data or focus group discussions. Qualitative insights from climate assessments, engagement surveys, and exit interviews can advance culture change in meaningful ways. |
| Create multiple leadership development pipelines | Mentorship and sponsorship programs like ELAM and other executive coaching modalities are extremely effective for mid- to late-career physicians. These can be replicated as pipeline opportunities beginning in medical school. |
| Acknowledge and combat affinity bias | Affinity bias can lead to creation of noninclusive teams, working groups, and informal work-related social activities, although the intent is not malicious. Putting out broad calls for membership, as opposed to selection from among those with whom we have inherent affinity, can counter this bias.26 |
| Create enhanced, safe reporting systems | Equity response teams can capture and address microinequities when they are witnessed or experienced, which allows organizations to create greater transparency and real-time course correction. |
| Conduct meaningful, regular evaluations | A well-executed 360 review process represents a missed opportunity in many organizations. Value is added when the evaluators are first asked, “have you ever spoken with this person about your concerns?” before completing the evaluation. This creates a culture in which clear and ongoing feedback is the norm rather than the exception. This allows opportunity to course correct early in careers. |
| Examine the organization’s definition of success and opportunity | When an organization believes it provides equal opportunities, there is a tendency to attribute lack of success to individual characteristics or motivation. This can lead to a stated commitment to change without a process for change and thus a devaluation of diversity. Organizations should examine whether typically “male” attributes are overvalued and examine themselves for the presence of a performance tax and motherhood tax that may limit advancement of equally qualified women.27 |
| Commit to compensation, transparency, and equity | Publicly posted salary data are useful for comparisons by position or title; however, they may not accurately reflect other sources of compensation. Women and physicians who are BIPOC are more likely to be involved in nonpromotable or uncompensated work. Deliberate examination and salary audits that assess total compensation can lead to a decrease in gender and racial disparities.28,29 Salary review should take into account race and ethnicity, sexual orientation, and other potential sources of marginalization. |
| Commit to gender and diversity in promotions and hiring actions | Deliberate commitment to proportionate gender and diversity balance is culture change. Health care organizations should seek to understand the gender assumptions that exist, which can be done by creating a culture in which it is safe to discuss gender issues. This also requires examination of which behaviors are rewarded and valued within the organization. Gender and race equity programs should be all-inclusive rather than focused solely on including women and people of color: this presumes that men do not have a role in gender equity and places the burden of fixing the lack of equity on the people experiencing inequity. |
| Value nontraditional contributions to excellence | Several academic organizations award clinical excellence.30–32 These clinician excellence awards are virtually cost free, other than the time invested in crafting the nomination. Physicians who are BIPOC carry a disproportionate load in often uncompensated and unrecognized diversity, equity, and inclusion work, which is usually not valued in promotions criteria. Diversity brings excellence to the mission and values of universities and medical settings and should be similarly rewarded within promotion criteria. In addition to recognition, this help |
| Conduct meaningful and consistent exit interviews | These are critical to gain insight into why personnel leave, where they are going, what real or perceived barriers existed to retaining them, and what else factored into their decision. If we are not collecting these data, we are left to speculate. Exit interviews can provide valuable insight into the hidden cultural norms that drive women and individuals who are BIPOC out of an organization. |
| Strategy . | Benefit . |
|---|---|
| Conduct comprehensive and connected onboarding | Onboarding is a critical opportunity to enculturate new hires. This is an opportunity to provide rules and initiate an effective mentorship or coaching relationship through that first, crucial year of employment. |
| Embrace alternative work schedules | Many women who choose to leave medicine cite the lack of flexibility, particularly when faced with dueling demands of child-rearing and caring for aging parents. Organizations should leverage part-time or flexible schedules for recruiting and retention and as part of physician reentry programs. |
| Conduct meaningful organizational assessments | Historically, when data are collected there is an overemphasis on quantitative data rather than qualitative data or focus group discussions. Qualitative insights from climate assessments, engagement surveys, and exit interviews can advance culture change in meaningful ways. |
| Create multiple leadership development pipelines | Mentorship and sponsorship programs like ELAM and other executive coaching modalities are extremely effective for mid- to late-career physicians. These can be replicated as pipeline opportunities beginning in medical school. |
| Acknowledge and combat affinity bias | Affinity bias can lead to creation of noninclusive teams, working groups, and informal work-related social activities, although the intent is not malicious. Putting out broad calls for membership, as opposed to selection from among those with whom we have inherent affinity, can counter this bias.26 |
| Create enhanced, safe reporting systems | Equity response teams can capture and address microinequities when they are witnessed or experienced, which allows organizations to create greater transparency and real-time course correction. |
| Conduct meaningful, regular evaluations | A well-executed 360 review process represents a missed opportunity in many organizations. Value is added when the evaluators are first asked, “have you ever spoken with this person about your concerns?” before completing the evaluation. This creates a culture in which clear and ongoing feedback is the norm rather than the exception. This allows opportunity to course correct early in careers. |
| Examine the organization’s definition of success and opportunity | When an organization believes it provides equal opportunities, there is a tendency to attribute lack of success to individual characteristics or motivation. This can lead to a stated commitment to change without a process for change and thus a devaluation of diversity. Organizations should examine whether typically “male” attributes are overvalued and examine themselves for the presence of a performance tax and motherhood tax that may limit advancement of equally qualified women.27 |
| Commit to compensation, transparency, and equity | Publicly posted salary data are useful for comparisons by position or title; however, they may not accurately reflect other sources of compensation. Women and physicians who are BIPOC are more likely to be involved in nonpromotable or uncompensated work. Deliberate examination and salary audits that assess total compensation can lead to a decrease in gender and racial disparities.28,29 Salary review should take into account race and ethnicity, sexual orientation, and other potential sources of marginalization. |
| Commit to gender and diversity in promotions and hiring actions | Deliberate commitment to proportionate gender and diversity balance is culture change. Health care organizations should seek to understand the gender assumptions that exist, which can be done by creating a culture in which it is safe to discuss gender issues. This also requires examination of which behaviors are rewarded and valued within the organization. Gender and race equity programs should be all-inclusive rather than focused solely on including women and people of color: this presumes that men do not have a role in gender equity and places the burden of fixing the lack of equity on the people experiencing inequity. |
| Value nontraditional contributions to excellence | Several academic organizations award clinical excellence.30–32 These clinician excellence awards are virtually cost free, other than the time invested in crafting the nomination. Physicians who are BIPOC carry a disproportionate load in often uncompensated and unrecognized diversity, equity, and inclusion work, which is usually not valued in promotions criteria. Diversity brings excellence to the mission and values of universities and medical settings and should be similarly rewarded within promotion criteria. In addition to recognition, this help |
| Conduct meaningful and consistent exit interviews | These are critical to gain insight into why personnel leave, where they are going, what real or perceived barriers existed to retaining them, and what else factored into their decision. If we are not collecting these data, we are left to speculate. Exit interviews can provide valuable insight into the hidden cultural norms that drive women and individuals who are BIPOC out of an organization. |
ELAM, Executive Leadership in Academic Medicine.