A Roadmap for New DEI Officers in Hospital Medicine Programs

In May 2020, the murder of George Floyd sparked a national call to action within the field of medicine. The goal was to promote diversity, truly include underrepresented populations in the workforce, and shift the focus from health equality to health equity. Studies have consistently demonstrated that diversity enhances the quality of patient care and financial outcomes.¹

A year later in April 2021, the Journal of Hospital Medicine published an article titled Advancing Diversity, Equity, and Inclusion in Hospital Medicine that detailed a pre- and post-intervention focus on gender equity with salary and full-time equivalent allocation.² In this article, a framework for implementation of DEI projects was illustrated, with the following sequential components: establishing a director of DEI, performing a literature search, meeting with stakeholders, engaging faculty and staff, planning strategically, forming subcommittees, developing a DEI checklist, and observing possible outcomes.

A literature search on guidance for DEI directors in hospital medicine also yielded the September 2021 article from The Hospitalist, Embedding Diversity, Equity, Inclusion, and Justice in Hospital Medicine, which identified three domains for future DEI efforts to take place: recruitment and retention; scholarship, mentorship, and sponsorship; and community engagement and partnership.³

Armed with these seminal articles on DEI within hospital medicine, I sought to make sure our DEI program would be outstanding. However, I did not have the specifics to enact changes within my division. I was left with the questions “What can I do?” and “What are things I need to do to ensure our division is leading the way in DEI standards?”

During my first year, I was confused, trying to read the limited literature, and performing Google searches that mostly yielded consulting companies, advertising services, and mission statements from other divisions of hospital medicine. The next year, I was able to partner with Dr. Ofodu, and finally create a roadmap for our division. Even though this process takes time, it is a luxury that not everyone in DEI positions is afforded. Historically these positions have been underfunded, and they are under attack in recent years, with employment implications for those involved in DEI work. In this article, I aim to offer specific recommendations for individuals starting DEI work in hospital medicine.

Hospital policies

First, a DEI director should look at institutional policies surrounding underrepresented populations. These could include salary parity, evaluation of diversity in leadership positions, coverage of family planning for those of advanced maternal age and LGBTQIA+ individuals, coverage of gender-affirming treatment for transgender and non-binary individuals, safe and private places for individuals who breast pump, and safe spaces to observe daily religious practices. These are starting points, but each division may need different adjustments. The mission statement and non-discrimination statement of both the hospital and division of hospital medicine should be evaluated for inclusivity. If groups have been excluded, there should be action to obtain equal protection. 

The workforce

In an ideal world with equal opportunity for all, the makeup of the workforce within a field would be proportional to the makeup of the population. However, due to a history of institutional racism, intentional sexism, political discrimination, and social stigma, this is often not the case. If the data do not exist, the division should be surveyed (provided it’s cleared by human resources) voluntarily, with the option to decline participation, to see which races or ethnicities, gender identities, sexual orientations, religions, and disability statuses people identify with. In addition, the division’s comfort and need for further education on DEI concepts (e.g., implicit bias, bystander training) should be evaluated in a short digestible survey. This will identify both the diversity of the division, to see if it matches the patient population, and knowledge gaps for future educational efforts. 

Qualified practitioners from underrepresented communities should be a target for recruitment and retention efforts. To eliminate bias from the recruitment process, previous articles have suggested using unbiased and ungendered language in job descriptions, having balanced recruitment committees, and screening letters of recommendation for potential bias from the recommendation writer.³ If there is a problem with recruitment and retention, a focus group should be created to evaluate what aspects of the division are driving people away (e.g., non-discrimination protections, unequal salary, implicit or explicit bias within the culture of the institution). 

Practitioner education

After knowledge gaps have been identified, practitioner education at all levels should be performed. Hospital medicine grand rounds occur monthly in our division, and through coordination with the organizer, two of the monthly lectures were reserved for DEI concepts for continuing medical education credit. Topics included a history of racism in medicine against African Americans, and trauma-informed care for populations, including the LGBTQIA+ population. 

With Dr. Ofodu’s help, approval was received to include 10-minute diversity segments during each division meeting, ranging from a colleague’s experience raising a transgender child to cultural competence in caring for patients during Ramadan. This keeps DEI education at the forefront of the hospital medicine division’s educational mission.

Implicit-bias training is a part of the core lecture series that new hospitalists receive, and the hope was to make this count twice. A one-hour online module that counts towards Maryland licensure credit is used, with a subsequent discussion of microaggressions, upstander training, and bias mitigation strategies for both practitioner-practitioner and patient-practitioner interactions. Another workshop that has shown promise in increasing awareness of personal bias vulnerability and taking action to reduce bias is the Bias Reduction in Internal Medicine initiative at the University of Wisconsin.⁴

Practitioner wellness

Although practitioner education is a cornerstone of DEI efforts nationally, practitioner wellness within the division is important too. This article previously discussed examining non-discrimination policies and DEI educational needs, however, part of the DEI acronym is inclusion, and efforts should be made to have practitioners feel included. In the past, our division created affinity groups: Women in Medicine, Underrepresented in Medicine, and LGBTQIA+. However, engagement with the affinity groups was low, in part because the positions for leading the groups were volunteer. As a DEI officer, one’s role should be to create safe spaces, and not force others to create them on personal time. Activities were created for the affinity groups which were well received and increased participation. Examples included online confidential chat sessions and in-person mixers with a neighboring medical campus to create a larger safe space with a larger community of practitioners.   

Inclusivity is also displayed by considering kosher, vegetarian, halal, and other diets in the observation of religious practices for event food catering. In addition, there should be at least email recognition of holidays celebrated by members of the division.

Community engagement

While DEI efforts should create a safe space for clinicians, they should be paid forward using knowledge to create a healthier community. Part of this is performing a needs assessment. This coming year, our division will be evaluating the hospital medicine group’s admission diagnoses, the need for an upgrade to the intensive care unit, and length of stay by patient-identified race or ethnicity, gender identity, primary spoken language, and zip code. The hope is that this data will uncover diagnoses and utilization measures to help target interventions in specific populations. For example, we may discover diabetes and uncontrolled blood sugar have a higher prevalence in a group we serve. The information can then be used for targeted interventions during hospitalization to create system programming that ensures adequate culturally appropriate information during hospitalization. Providing patients with the same level of care is equality, but working towards patients all having an equally healthy future is how we get to health equity. 

Conclusion

There is still more to be done to create an environment where DEI is at the forefront, especially at a time when legislation in certain states is decreasing or banning the teaching of concepts within DEI.⁵ It is simply not enough to have DEI in one’s mission statement, there must be action to show an organization’s commitment to espousing the values of DEI. Concrete examples, like those mentioned earlier, can be used by new DEI officers of hospital medicine divisions. It must be noted that these interventions help to create an environment with respect for DEI concepts. However, there will be work that needs to get done for a more inclusive and equitable future. It takes time, but steps can be taken now. I look forward to continuing to figure out the next steps in my role, having been re-appointed as the division’s DEI director next year. 

Dr. Khanijow

Dr. Ofodu

Dr. Khanijow (@gayhospitalist) is a hospitalist and assistant professor of medicine at Johns Hopkins Bayview Medical Center in Baltimore. He co-founded SHM’s LGBTQIA+ Health Task Force, which created the SHM LGBTQIA+ health series learning modules. In 2020, he led authorship efforts for the SHM DEI Statement. Since then, he has served as an inaugural member of the SHM DEI Committee, was appointed the chair of the SHM DEI Special Interest Group, and lectured internationally about culturally affirming care for hospitalized LGBTQIA+ individuals. Dr. Ofodu is a med-peds hospitalist at Bayview Medical Center and a clinical instructor for hospital medicine and pediatrics at Johns Hopkins School of Medicine, both in Baltimore.

References

1. Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019;111(4):83-392.
2. Pino-Jones AD, Cervantes L, et al. Advancing diversity, equity, and inclusion in hospital medicine. J Hosp Med. 2021;16(4):198-203.
3. Delaphena A, Barrett E, et al. Embedding diversity, equity, inclusion, and justice in hospital medicine. The Hospitalist website. https://www.the-hospitalist.org/hospitalist/article/246417/diversity-medicine/embedding-diversity-equity-inclusion-and-justice/. Published September 21, 2021. Accessed August 29, 2024.
4. University of Madison-Wisconsin. BRIM Initiative Overview. UW-Madison website. https://brim.medicine.wisc.edu/index.php/overview/. Updated 2024. Accessed August 29, 2024.
5. Saul S. With states banning DEI, some universities find a workaround. New York Times website. https://www.nytimes.com/2024/04/12/us/diversity-ban-dei-college.html. Published April 12, 2024. Accessed August 29, 2024.