Diversity and Inclusion at Your Workplace: Tell Us Your Story

A qualitative study

August 17, 2016

Kareha AgesaAna Bonilla MartinezCarlos Carmona

What would you do….?

Are you alone responsible?

Why does this matter to patient care?

5

Outline w Significancew Background w Project Overview w Methodologyw Findings w Lesson Learned

6

Significance

Differences, Disparities, and Discrimination: Populations with Equal Access to Healthcare. SOURCE: Gomes and McGuire, 2001

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Significancew Ongoing efforts to increase diversity in academic

medicinew Changing demographics in USw Lack of knowledge on what organizational factors

contribute to sustaining diversity

8

Background

Benchmark Survey

Validated 22-item Diversity Engagement Survey*14 medical schoolsN=13,694 students

Internal Survey

Employees, faculty, trainees, and students in health sciencesUsed validated instrument as previous studyN=3500

Our Study

* Person et. Al, 2015

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Understanding those findingsw Internal Survey – Deductive process w Results don’t explain why or howw Our objective: To understand what drove those

findings in efforts to explore how best to solve them

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Study AimTo better understand the extent to which faculty, staff, and students feel valued, respected, accepted, welcomed, and included at the University of Pennsylvania and to determine the best strategies to create an environment of inclusivity

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Background

Benchmark Survey

Validated 22-item Diversity Engagement Survey* (Person et. Al, 2015)

14 medical schoolsN=13,694 students

Internal Survey

Employees, faculty, trainees, and students in health sciencesUsed validated instrument as previous studyN=3500

Our Study

Target population same A call for narrative stories about inclusion and diversityN=315

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Project Overvieww Part 2 of mixed methods studyw Qualitative study involving campaign to collect

narrativesw Coding narratives by theme

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Office of Inclusion and Diversityw Established 2003

• Committed to increase diversity, equity, and inclusionw Investigators/Mentors:

• Jaya Aysola MD, MPH; • Eve Juliet Higginbotham, SM, MD

w Consultant• Fran Barg PhD, MEd

w Research Coordinator• Matthew Kearney, MPH

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Methodology

Call for Narrative Stories

Partial Responses

(n=1268)

Submitted Responses

(n=362)

Fully Completed Responses

(n=315)

Initial Coding (n=30)

Codebook Solidification

(n=285)

IRR Coding (n=33)

Coder 1 (n=84)

Coder 2 (n=84)

Coder 3 (n=84)

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Campaign For Stories of Inclusionw Campaign- “Please tell us your story of inclusion”w Broad call for stories across Penn health care

affiliated schools and hospitals w Using RedCap we solicited anonymous responses

to the following:• Two open-ended questions about experiences with

inclusion or lack there of• Series of demographic questions

Call for Narrative Stories

Partial Responses

(n=1268)

Submitted Responses

(n=362)

Fully Completed Responses

(n=315)

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Codebook-Iterative Process

w Randomly selected 30 narratives for initial codingw Preliminary codebook based on themes derived

from collective review of these narrativesw Reached 10% of coding agreement at this point

Initial Coding (n=30)

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Analyzing the Data

w NVIVO 11 usedw Developed coding

schemew 20% of narratives were

triple coded for IRR (Interrater reliability)

w Any discrepancies were resolved with consensus

w Codebook modified for subsequent coding

w Currently subcodingmain themes

Codebook Solidification

(n=285)

IRR Coding (n=33)

Coder 1 (n=84)

Coder 2 (n=84)

Coder 3 (n=84)

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Findings: Position

13

44

81

32

43

97

3

4

0 20 40 60 80 100 120

Undergraduate student

Graduate student/ Post-Doc

Staff

Staff-Manager

Trainee

Faculty

Executive leader

Missing

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Findings: Years at Penn

49

33

58

64

107

6

0 20 40 60 80 100 120

Less than 1 year

At least 1 year but less than 2

At least 2 years but less than 5

At least 5 years but less than 10

More than 10 years

Missing

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Finding: Where spent most of time

60

27

127

9

3

21

15

13

0

2

3

29

8

0 20 40 60 80 100 120 140

Hospital of the University Pennsylvania

Perelman Center for Advanced Medicine

Perelman School of Medicine

Penn Presbyterian Medical Center

Pennsylvania Hospital

Children's Hospital of Philadelphia

School of Nursing

Penn Dental Medicine

Penn School of Veterinary Medicine

Penn Social Policy & Practice

Philadelphia VA Medical Center

Other

Missing

21

Findings: Religion

151

23

9

5

5

15

0

1

80

15

13

0 20 40 60 80 100 120 140 160

Christian

Jewish

Muslim

Buddhist

Unitarian/Universalist

Hindu

Native American

Sikh

None

Other

Missing

22

Findings: Race/Ethnicity

159

38

22

47

0

0

39

12

0 20 40 60 80 100 120 140 160 180

Non-Hispanic White

Non-Hispanic Black

Hispanic/Latino

Asian

Native American/Alaskan Native

Pacific Islander

Other

Missing

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Findings: Gender Identity

109

188

0

4

6

10

0 20 40 60 80 100 120 140 160 180 200

Male

Female

Transgender

Do not identify as male or female

Other

Missing

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Findings: Sexual Orientation

239

31

11

7

0

19

10

0 50 100 150 200 250 300

Straight or Heterosexual

Lesbian or Gay or Homosexual

Bisexual

Other

Don't know/Not sute

Refused

Missing

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FindingswThe kappa range 0.6018 - 1.000. wThe mean Kappa score is 0.9295

• Indicating a high degree of agreement between coders

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FindingswDiscrimination NodewOverarching themes emerging:

• Regardless of the nature and type of discrimination, the degree of impotence individuals feel to address this is pervasive

• Stories reflect local or departmental problems and needs for targeted solution

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Discrimination Narrative Example

Disability“Although their division chief and department chair were

initially supportive, they became much less accommodating of her ongoing disabilities. The

environment at work became increasingly hostile, with her division chief being unwilling to make even minor accommodations. Eventually, the department demanded that they return to work at a certain level beyond their capabilities, forcing her to stop working

entirely. Due to the lack of support and accommodation, she is now leaving Penn.”

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Discrimination Narrative Example

Race/ethnicity

“Colleague knew I was Asian and kept making ethnic Asian jokes. She had a close relationship with upper management and I didn't feel I could say anything.

She worked next to me and my other friends in the office invited her to lunch so I started wearing noise canceling

headphones and eating alone.”

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Discrimination Narrative Example

Religion

“Although I was completely aware my religious holiday was not observed by the university, she felt the need to

remind me of that in such a degrading way. Her statement of not caring what holiday I observe,

furthermore made me feel excluded and devalued in the Penn community….After this incident I never felt

comfortable to approach my HR rep, even though that department is established to care and speak on

behalf of employees. Till this day I make sure to request my vacation days surrounding my religious holiday, to

ensure I wont have to explain myself again.”

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Discrimination Narrative Example

Gender

“Since having a child and returning to work, I have experienced several inappropriate interactions with

male colleagues. One in particular was highly concerning….He … stated that I was not included as an author on a paper to which I contributed before my leave because I ‘made it clear that I was not available to work

during my leave.’ I have never felt so devalued.”

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FindingswProblem-Solving NodeswOverarching themes emerging:

• Multiple actions sometimes taken and range from reporting to quitting

• Formal venues to problem solve do not appear to solve the issue (using external resources)

• Question whether lack of formal/external ways to address issues, results individual actions within the narrator’s control such as quitting or self-accommodation/self-sacrificing as the ultimate solutions

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Problem Solving Examples

Quitting/Leaving the Situation

“I left for another job because it was actually affecting my health working in such an unhealthy drama filled

environment.”

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Problem Solving Examples

Reporting (following protocol)

“When some of my colleagues voiced concern in constructive and thoughtful forums, they were essentially threatened with terminations of

employment.”

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Problem Solving Examples

Seeking Advice or Advocacy from Others

“Though my Chief was present for the comment, nothing was said to address the comment that had

been made.”

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Problem Solving Examples

Self-Accommodating/Self-Sacrifice

“The culture of intimidation is such that individual physicians and staff will not report incidents for fear of reprisal and

jeopardizing their careers and the expectation that nothing will change.”

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Findings

wSuggestions/Recommendations NodewOverarching themes:

• Increasing education/awareness• Implicit bias training• Increasing diversity in leadership positions• Increasing advocacy

wLack of recognition is an overarching problem and underlying theme across domains- yet there was not a suggested solution

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Suggestions and Recommendations Examples

Increasing Advocacy

“I think particularly older generation attendings do not handle racist/sexist interactions appropriately when they

see it - its not enough to not be racist/sexist yourself -if you have to stand up for other colleagues when

patients or coworkers make such comments.”

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Suggestions and Recommendations Examples

Increasing Education and Awareness

“I believe all professors, male and female, should receive unconscious bias training and learn how to interact with diverse

students.”

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Implications

wAdvancement of science • Large scale qualitative analysis • Methodology

wInternal quality improvement for OID • Organizational change• This is a way to examine institutional

provider bias

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Lessons Learnedw NVivow Working as a groupw Penn and the diverse experiences that are had here

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Acknowledgementsw Dr. Jaya Aysolaw Dr. Eve Higginbothamw Dr. Frances Bargw Matt Kearnyw Joanne Levy, Safa Browne, and LDIw Office of Inclusion and Diversityw Family and friends

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Q&A

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UniversityofPennsylvania Diversity EngagementSurvey

ENGAGEMENT CLUSTER AND INCLUSIONFACTOR SCORESUMMARY

Range

UPenn

Mean

(SD)

Benchma

rk Mean

(SD)

Upenn

Benchma

rk Mean

Differenc

e

UPenn

RANKI

NGVISION/PURPOSE CLUSTER (1050) 38.81 (6.88) 38.41 (7.26) +0.40 Middle Third

Common Purpose Factor (210) 8.08 (1.49) 8.05 (1.49) +0.03 Middle ThirdAccess to Opportunity Factor (210) 8.04 (1.75) 7.81 (1.87) +0.23 Top ThirdEquitable Reward and Recognition Factor

(210) 7.23 (1.98) 7.07 (2.06) +0.16 Middle Third

Cultural Competence Factor (420) 15.44 (3.00) 15.46 (2.98) 0.02 Bottom ThirdCAMARADERIE CLUSTER (630) 23.24 (4.43) 23.07 (4.61) +0.17 Middle Third

Trust Factor (315) 11.45 (2.67) 11.42 (2.73) +0.04 Middle ThirdSense of Belonging Factor (315) 11.79 (2.27) 11.66 (2.36) +0.13 Middle ThirdAPPRECIATION CLUSTER (630) 23.57 (4.55) 23.34 (4.66) +0.23 Middle Third

Appreciation of IndividualAttributes Factor

(315) 11.58 (2.52) 11.49 (2.55) +0.09 Middle Third

Respect Factor (315) 11.99 (2.32) 11.85 (2.36) +0.14 Middle Third43

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Background

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Components of an Inclusive Culture

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Cultural Competencyw In this institution, I have opportunities to work successfully in

settings with diverse colleagues.w I believe my institution manages diversity effectively.w In my institution, I receive support for working with diverse

groups and working in cross-cultural situations.w In this institution, there are opportunities for me to engage in

service and community outreach.