Action items to operationalize DEI accountability

By Rachel Zuckerman

Many organizations have DEI goals, but what does it mean to actually meet those goals? Simply having a set of goals does not guarantee any skillful progress.

We wholeheartedly agree with Dr. Evelyn Carter's argument that it's crucial to hold involved stakeholders accountable for making progress on any DEI goal. When we say "accountability" we mean clearly articulating each leader's role in and responsibility for achieving DEI goals—and using a variety of levers (incentives, penalties, education, and supports, among other things) to enforce that responsibility. In an organization that has embedded accountability for equity goals across leadership, leaders are centered around a common purpose. This helps leaders understand their individual roles in achieving this purpose while taking personal responsibility for making progress and learning what happened when progress falls short.

As Dr. Carter notes, "behavior change is hard, and in many cases, the strategies that are going to yield change will also bring a little friction." Her three-part framework suggests strategies to reduce this friction. Below, we outline three action items to operationalize Dr. Carter's strategies.

Dr. Carter's step 1: Educate – Before telling people what to do, you have to tell them why.

How to operationalize: Embed equity considerations into the strategic priorities for the leaders who are already responsible.

Dr. Carter emphasizes the importance of highlighting how changes are "personally relevant" to the leaders you are trying to engage. Leaders often view DEI goals as separate from their day-to-day work or as an important but "extra" responsibility, falling outside of their real purview. But here's the truth: every leader can significantly advance—or hold back—progress on DEI in the work they lead.

To help leaders understand their role in advancing DEI, embed equity considerations into the strategic priorities for which leaders are already responsible. For example, if a clinical leader is responsible for reducing care variation, consider embedding a goal to reduce disparities in clinician adherence to care protocols by patient race. This picklist outlines other examples for twelve types of functional leaders, from finances to HR to nursing.

It's important to help leaders understand their "why"—ensuring a clear connection between their everyday behaviors and decisions to the overall goals of DEI.

Dr. Carter's step 2: Listen — Invite feedback, really listen to it, and iterate.

How to operationalize: Account for all types of loss.

Dr. Carter notes, "While it can be tempting to create a plan with goals and proposals around DEI, and then present that fully-formed solution to your leaders, people are more likely to adopt changes if they help create the solutions themselves."

We've heard about this firsthand. One health system we assisted was trying to implement a change to make their hiring process more inclusive and equitable. However, hiring managers refused to implement the new process and continued interviewing candidates in their own way. When leaders sat down with the hiring managers, they learned they feared the loss of autonomy in making decisions to create their own teams.

People fear loss, and most change carries loss. Of course, creating a more inclusive and equitable organization requires change. So how do you prevent loss from becoming an insurmountable sticking point?

First, listen closely to understand and diagnose the kinds of losses that at play—real and perceived, direct and indirect, material and abstract. The loss may be tangible, as in Dr. Carter's example of a manager wanting to make a hire as quickly as possible and fearing the loss of time when sourcing diverse candidate pool. The losses may be more intangible, as well—for example, even acknowledging that your current workforce or patient population experiences inequities may require some people to lose certain deeply-held perceptions of your organization. It's important to listen for and acknowledge these losses.

Ultimately, help stakeholders move through these losses by providing context, sharing the advantages of the new approach, and continuing to orient them to the broader "why."

Dr. Carter's step 3: Recognize – Celebrate your wins. But nudge those who need it.

How to operationalize: Set up system of incentives and consequences before you actually need them

Just as health care leaders are held accountable for safety and quality metrics with no debate, DEI should be treated as an equally undisputed priority: patients and employees deserve equitable and inclusive outcomes and experiences.

Try sending a strong message. For example, tie leaders' variable compensation to DEI goals. This demonstrates DEI goals are not simply words on a page but rather priorities that leaders are committed to advancing. It is also worth considering what you will do if a leader or employee does not embody your commitments to DEI or actively detracts from your goals.

Dr. Carter makes the excellent suggestion to "crowdsource accountability mechanisms" to "make accountability feel less punitive and more like commitment to a shared goal." But ultimately, accountability mechanisms are only useful if they're used and enforced. While it can be uncomfortable to enforce consequences, it can help to establish a clear protocol to intervene, when necessary, the same as you would for patient safety or quality violations.

I've curated a list of resources to help guide you further in your DEI efforts.

• How to instill accountability for equity goals across your leadership team
• How to embed equity considerations into existing strategic priorities
• 4 steps to uncover (and solve) inequities in employee outcomes
• What most people get wrong about diversity, equity, and inclusion