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Getting health care right

Diversity, Equity and Inclusion: Getting It Right for Patients and Employees

For most organizations, there’s a strong business case to be made for prioritizing diversity and inclusion in the workplace.

But for the health care industry, it’s not just good business — it’s a life-and-death imperative.

So in late 2020, when Veronica Villalobos left her U.S. Office of Personnel Management position — and her 20-year career in the federal government — to help lead the Allegheny Health Network (AHN) diversity, equity and inclusion team, she understood the gravity of the challenges that lay ahead.

Study after study shows that people from minority and marginalized communities have poorer health care outcomes, uneven access to health services, and are more likely to be uninsured or underinsured. In Pittsburgh, where AHN is headquartered, black residents suffer disproportionately by nearly every quality-of-life measurement, according to a 2019 study published by the city’s Gender Equity Commission.

In other words, a black man, woman, or child could leave Pittsburgh and move to virtually any other comparably sized American city and experience better health care outcomes. Notably, the study reported that Pittsburgh’s rate of infant mortality for black babies is more than six times higher than it is for white babies — 13 deaths per 1,000 births, compared to two deaths for white babies.

“Without diversity and inclusion, there can be no health care equity,” says Villalobos, vice president, Diversity, Equity and Inclusion, AHN. “Creating that equity, and mitigating those disparities, are obligations that AHN and its parent organization are tackling with energy and sincerity.”

Building trust

Veronica Villalobos, vice president, Diversity, Equity and Inclusion, Allegheny Health Network

Veronica Villalobos, vice president, Diversity, Equity and Inclusion, Allegheny Health Network

Bill Toland: Pittsburgh obviously has a lot of work to do when it comes to providing equitable health care for all communities. Where do we start?

Veronica Villalobos: One of the first steps the AHN Equitable Health Institute is taking is working on the issue of infant mortality among African Americans. We’ve recently received a grant from the Highmark Foundation, and we’re in the process of pursuing another, to establish a “First Steps and Beyond” program that monitors the health and well-being of African American babies through their first year.

It’s obviously an important issue for all of us, not just the black community. Because we know that if we decrease infant mortality for African American babies, it’ll decrease for everybody. The same behaviors that keep my baby or your baby healthy keep all of our babies healthy.

Frankly, we’re not doing enough comprehensive monitoring to ensure that African American babies are making it to their first birthday. There are a lot of people out there tracking different pieces of data, but as a region, we haven’t been connecting the dots. So that’s something we’re going to do better.

We also received a grant to establish a “White Coats for Black Professionals” program. It’s going to be a loan-repayment initiative for trainees, doctors and nurses, eight people per year across those three professional groups. It’s a program for all underrepresented populations.

Bill Toland: Your team also played a role in AHN’s COVID-19 vaccine distribution campaign, working to ensure that minority populations received adequate and proportional access to the vaccine. Tell us about the goals you set and the tactics you used.

Veronica Villalobos: When Dr. Margaret Larkins-Pettigrew, AHN’s Chief Clinical Diversity, Equity and Inclusion Officer, got here last year, she immediately began reaching out to these communities. She knew we’d need to start building trust early on, and educating them about the vaccine early on. The African American population was disproportionately affected by COVID-19, so delivering vaccines to those communities and making sure they were agreeable to receiving the vaccine was a top concern.

Of course, if we were going to build trust, we had to deliver on that trust, and that meant ensuring that we were delivering an adequate supply of vaccine. From the beginning of our vaccination campaign, we earmarked 15% to 20% of vaccines for underrepresented communities.

Right now, we’re at almost 18% of the vaccine going to underrepresented groups, which is proportional to the region’s demographics.

I was new to the region, but I immediately learned that we have great community organizations around here that all want to help and contribute. And they have. As vaccination rates slow, we’re going to have to lean on those relationships and redouble efforts to make sure we’re still getting into these communities.

Bill Toland: It sounds like much of the work your team does will occur outside of the hospital’s four walls.

Veronica Villalobos: Absolutely. We just hired a new director of Community Impact and Diversity Programs, and a lot of that work will be about strengthening our ties to the community. We won’t necessarily be running the programs, many of which naturally require clinical leadership, but we will help to facilitate the breadth and the scope of the programs, to ensure that we are reaching as many people as possible, across the entire organization.

We are also establishing community advisory committees, just to make sure our perceptions are aligned with their everyday realities. And ultimately, based on that feedback and our own research, we hope to develop specific clinical models for all the different underrepresented groups, so that we know what the needs are and that we’re meeting them. All of that involves interacting with the community — and with specific populations within our communities — in a way that we really haven’t done historically.

Diversity and inclusion: Everyone’s responsible

Bill Toland: Do you need to build the diverse, inclusive workforce first, before tackling health care outcomes equity? Or can you work on both issues at the same time?

Veronica Villalobos: There’s certainly a bit of a chicken-egg element to it. We are trying to come at it from both sides — health equity is absolutely one of our main goals. How do we provide better care for marginalized c’ommunities? How do we conduct research in this space, and advance AHN as one of the premier academic contributors in this area? How do we attract the very best clinical talent?

That said, we are certainly aware that we need to focus on our own house. We need to make sure that we’ve educated our employees and enabled our workforce to have the empowerment they need in order to treat our patients with the very best care.

And then finally, we have to put accountability on top of the whole strategic plan. Everyone’s got to be held accountable, from the doctors and nurses, to the environmental services team, all the way up to the CEO. Everyone’s responsible for getting diversity and inclusion right.

Bill Toland: You have used a Noah’s ark analogy to illustrate approaches to diversity that are too narrow. Can you talk about that?

Veronica Villalobos: It’s diversity without any effort. We end up hiring two of everything and we think we’ve established a diverse workforce. But that’s not true diversity and inclusion — it just means that we’re tolerating each other on the boat, so to speak.

All of us have a lot of unique characteristics that go beyond the way we look. But if we’re only serving the role of being that “one thing” in the workplace, then we don’t fully benefit as an organization. Inclusion allows us to be the full scope of everything we are, and bring it to bear in the workplace so that the whole organization benefits. It’s that true sense of empowerment and belonging.

That’s where so many organizations fall short. You might look around the workplace and see all the different groups and say, “Sure, we’re doing a great job, we look pretty diverse.”

But what we’re not always great at doing is making sure everybody is being developed to their full potential. Like the saying goes, diversity is being invited to the party; inclusion is being asked to dance.

Bill Toland: What does a truly diverse workforce look like to you?

Veronica Villalobos: First, we absolutely need to consider the surface characteristics that make us who we are — our race, national origin, sex, disabilities, LGBT status, veteran status. Those are all things that make us unique and make our experiences unique.

But the research also tells us that intellectual and emotional diversity can be just as important. How we think about things, how we attack different problems, is a combination of where we grew up, where we’ve lived, our educational background, and then how people interact with us because of how we look.

And so based on those things, if we can get the right mix, we’re going to be able to solve more complicated problems, and we can better serve our patients and their families.

Bill Toland: If you have a bunch of people from diverse ethnic backgrounds, but they all went to Yale, it’s still not super-inclusive, right?

Veronica Villalobos: You bring up a really good point. In Washington, D.C., there were certain government agencies — especially the white-collar agencies — that recruit almost exclusively from four or five prominent universities. And that means they lack diversity, in a way. Even if folks look different on the outside, if their educational experience is the same, if their professors are the same, then their thinking on a particular topic might be the same.

That doesn’t mean every hire has to be external, or from a different school, but it’s about that balance. Because when you bring in people from a variety of backgrounds, including educational and professional backgrounds, the viewpoints will be different and the problem-solving will be different.

Bill Toland: So after you build a diverse workforce, how do you make it equitable and inclusive?

Veronica Villalobos: My sweet spot — the area I love — is inclusion. I think sometimes what we end up doing is telling people, “Yeah, bring your full self — but not that one part. Please do leave that one small part of yourself at home, the part that really makes you unique.”

And then people don’t respond as well to that. They’re not as engaged. When you’re being fully inclusive, when you let employees bring their whole selves to work, they end up bringing their best selves to work. And that’s where you want to be as an organization — everybody is contributing, everyone is at their best.

When I was in government, we created what we call the New Inclusion Quotient, or the New IQ. We found that there were five different areas that, if you can create the perception of these qualities, people believe it’s a more inclusive workplace, and then they’ll act accordingly and react more positively.

The five qualities are fair, open, cooperative, supportive, and empowering. It’s almost like a hierarchy of needs, and at the top is empowerment. But at the bottom you have to have fairness for people to have a true sense of inclusion. And employees won’t think a workplace is fair if you’re not allowing them to bring their true selves to the job.

Bill Toland: How do you get to a point where all the pieces fit together?

Veronica Villalobos: First, you get the engagement from the leadership. They make it very clear to everyone by what they say and what they practice that diversity and inclusion is important to them. And then you want to get the employees engaged, because they are the ones putting the energy into action.

The one group that I think always gets forgotten in this is the managers and supervisors — we have to get them educated and trained on how to meet both needs. Because what your leadership expects from them might be one thing, and what employees want to see from them is going to be another. And the reality is that they’re the glue that gets those two expectations met.

Bill Toland: That’s so true. While HR might present a diverse slate of job candidates, managers are still the ones who do the interviews and hiring. How do you break free from people’s tendency to hire people who worked for them previously, or look like them, or went to the same college?

Veronica Villalobos: Yes, the “like-me” bias is real. You often go out to hire someone who’s going to think like you think. Being on the same page, sharing the same broad philosophies, is of course important, but there will inevitably be times when you don’t need another “you” in the workplace — what you need is someone who can approach problems differently.

A “unique historical moment”

AHN’s “First Steps and Beyond” program will monitor the health and well-being of African American babies through their first year.

AHN’s “First Steps and Beyond” program will monitor the health and well-being of African American babies through their first year.

Bill Toland: Employers have been talking about workplace diversity for decades, but now it seems like there is a heightened urgency to getting it right. Why is that?

Veronica Villalobos: What I think we’re experiencing right now is a unique historical moment. They come around every generation.

Think about what’s been happening over the last 12 months, the recent verdict in Minnesota — it’s an important moment, and we want to make sure that we’re honoring that aspect of diversity at this time. Not just honoring it, but participating in it, and being on the right side of it.

It starts at the top, with our leadership and our boards of directors. I think there’s a lot of sincerity there. There’s been a willingness to take risks, which I think is important in this climate. And it’s meaningful to the employees. Frankly, whether the employees agree or disagree with the position that we’re taking, I think most everyone appreciates that at least we are taking a position.

Bill Toland: With 20,000 employees at AHN, being on the “right side” will mean different things to different people.

Veronica Villalobos: Of course. From my perspective, sitting in the diversity and inclusion space, it’s not our job to get everyone aligned politically. But it is our responsibility to make sure that as people really get to know the program, they understand that it surpasses political party or belief system, and that it’s about the best possible management and outcomes for the patients and for the employees.

It doesn’t matter who you are. You can be a white, middle-aged male, and by the time you’ve worked with us for a little bit, you should come out of it feeling like, “Hey, diversity and inclusion is important to me, it’s important for our organization, and I’m excited to engage.”

Bill Toland: Is that harder to do in cities, and workforces, with less built-in diversity than, say, Washington, D.C.?

Veronica Villalobos: Washington, D.C. is incredibly multicultural, so yes, it’s a little different here.

But it’s incredibly important that we create a workforce that looks like our communities and understands our communities, so that everyone feels that comfort at all levels.

It helps that AHN is becoming known nationally, and people are excited about a lot of the work that we’ve done. I do think there’s an opportunity to bring people from all over the country. And it’s a lovely place that has a lot to offer. It brought me here, and I think we can bring others here as well.

But bringing them here is just step one. That’s why it behooves us to make sure that we’ve built an inclusive environment, so that once they come, they want to stay.

Bill Toland: Why leave D.C. and the federal government after more than two decades to come to AHN?

Veronica Villalobos: Partly, I was tired of the political aspect of my work. In the last 10 years, I’d had about 10 different leaders, because of various political changes. You have competing priorities — I was trying to make sure that we were prepared for the workforce challenges of 20 years from now, whereas political appointees are looking for more immediate returns and quick wins.

For them, that might make sense, but when you’re doing strategic planning, that’s a conflict. So I started looking around, and someone told me to check out AHN. I came here, I loved the place, I loved everyone I met, and I knew I could thrive here and make a difference.

Bill Toland: I’ve heard the federal government described as a battleship — extremely powerful, but hard to turn around. AHN is a big company, but I’d think you’d have an easier time changing directions or speeds here.

Veronica Villalobos: You’re absolutely right. Things took longer — we often had to get the buy-in of all the different agencies and offices, and often the White House or the Office of Management and Budget.

Here, it’s so nice to have an open door with the CEO. When something needs to get done, we go in, talk with Cindy Hundorfean, and we get a yes or no.

She, Dr. Larkins-Pettigrew, and everyone else who is a part of this team are committed to improving health equity and attacking health disparities. Our communities and patients are depending on us to do better, and to get it right. We’re absolutely moving full speed ahead.

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Highmark Health and its subsidiaries and affiliates comprise a national blended health organization that employs more than 35,000 people and serves millions of Americans across the country.

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