Embracing DE&I as part of your organizational culture is a long-term endeavor that requires a thoughtful strategy and a commitment to stick with it during challenging times.

Being a DE&I champion for your medical practice requires paying attention to things that may have gone unnoticed in the past.

• Do you expect people in a certain group to have similar behaviors or ideas? It's important to recognize your unconscious biases and work to overcome them.

Seeing people through the lens of their race or gender or religious background is judging them according to an identifying factor rather than their expertise or competence. They're likely to know when that happens and may give up trying to contribute.

Scheduling early-morning or late-afternoon meetings, knowing that working parents cannot attend because they have to transport their kids during those times, gives other employees an advantage.

A golf game with work colleagues is a good team-building opportunity, especially if work topics are discussed. However, those outings exclude staff members who are not invited or who would not feel welcome at a golf club that may primarily accommodate White men.

• Does your practice assure pay equity? Female physicians earn less than their male colleagues — on average, an estimated $2 million less over a 40-year career — even though female physicians make up nearly half of the physician workforce in many specialties. Conducting a pay-equity study and making the necessary adjustments is an essential DE&I practice.

• Have you worked to acquire cultural competency? Because the skills and knowledge needed to value diversity, as well as to understand and respond to cultural differences, are so important to patient care, many healthcare organizations mandate training for clinicians.

• Do you have cultural humility? The more you learn about diverse cultures, the more you realize how much is left to learn. Cultural humility — admitting that you do not know everything about a patient's values, culture, and life experience — is key to provider-patient relationships, as is being open to learning. DE&I champions model cultural humility for their colleagues and staff members.

• Do you make resources and information easily accessible to everyone in your practice who would benefit?

• Are you an inclusive ally? A bystander observes bullying or discriminatory behavior without comment, whereas an ally uses their position of privilege to support individuals from marginalized groups.

Allies listen to their colleagues and staff members whose voices often go unheard. And allies step into uncomfortable conversations to protest unfair treatment when they see it.

Formal training programs are frequent parts of DE&I initiatives. A survey of 1290 healthcare professionals in mid-2021 found that 62% were engaged in DE&I activities. Of those, 90% use staff training as a component of their programming, according to the Relias 2021 State of Healthcare Training & Staff Development Report.

The survey found:

• 79% of organizations require mandatory staff training on DE&I topics, such as cultural competency.

• 40% have mandatory manager training on DE&I topics.

• 32% offer optional staff training on DE&I topics.

• 18% offer optional manager training on DE&I topics.

• 9% provide tuition or reimbursement to attend external DE&I trainings.

The Relias report pointed out that mandatory manager training was used by fewer than half the organizations. "Yet supervisor attention to DE&I issues is crucial to promoting staff health and wellness, supporting staff retention, enhancing understanding of social determinants of health, and promoting sensitivity to diverse client needs," the report said.

There are many different types of diversity training, and organizations need to carefully assess the type that is right for their clearly defined DE&I strategy, says cultural competence expert Glen Guyton.

Here's his breakdown:

Basic diversity training promotes awareness and knowledge of issues related to culture and identity. Although basic training may not change workplace behaviors, it will provide a common understanding of terms and concepts and set expectations for all employees. Starting with basic training is essential.

Examples of basic training include:

• Training that defines terms, values, and priorities so everyone in the organization is on the same page.

• Town hall meetings, facilitated by a DE&I expert, allow people to be heard and give feedback about issues and challenges that staff members experience.

• Cultural sensitivity training educates coworkers about other cultures and identities with the goal of increasing empathy.

• Compliance training, which provides the legal basis for DE&I compliance, teaches staff members how not to get sued or fired for illegal behaviors.

Intermediate diversity training provides knowledge and skills needed to create an inclusive culture. Staffers who undergo these types of training should acquire tangible skills that help them work well with people from diverse perspectives and backgrounds.

• Unconscious/implicit bias training helps employees identify and work against biases in the workplace.

• Accommodation training shows how to make the appropriate workplace accommodations for coworkers who have different beliefs, values, or abilities.

• Microaggressions training teaches how to communicate in ways that avoid harmful stereotypes and actions that create a hostile workplace.

• Inclusive management and allyship training teach supervisors to identify and address overt and covert acts of discrimination.

• Intercultural communication trains staff members to understand how cultural expectations influence communication.

Advanced diversity training prepares organization leaders for actions and advocacy that create an inclusive workplace. Examples are:

• Anti-oppression training targets specific topics, such as racism, sexism, and sexual discrimination.

• Supervisor training teaches the skills needed to lead diverse teams.

• Senior management training/coaching supports leaders who need DE&I skills to effect change in their organization.

You may wish to hire a consultant to help with some aspects of your DE&I strategy. Not every organization needs outside help, but consultants can bring skills and knowledge that might not exist within your practice. Because they are independent and coming from outside your organization, consultants may identify challenges — and solutions — that practice leaders miss.

DE&I initiatives are getting so much attention that many people are hanging out their shingles as DE&I consultants. That gives you lots of options — and the challenge of making a good choice.

Deanna Singh, author of Actions Speak Louder: A Step-by-Step Guide to Becoming an Inclusive Workplace, identifies 10 attributes that a DE&I consultant should have:

• Expertise. Look for someone who has a mix of academic knowledge and experience working with organizations similar to yours. In addition to being able to teach DE&I concepts and skills to your staff members, the consultant should know how to evaluate individuals' prior knowledge of and willingness to engage with DE&I.

• Theoretical background. It's easy to throw DE&I terms into a conversation; it's another thing to understand the history that makes promotion of DE&I essential today. Candidates whom you consider should be able to demonstrate an understanding of how DE&I initiatives work and why they are essential to achieving health equity.

• Solution-oriented. DE&I work requires individuals to grapple with difficult and personal concepts. A good consultant understands how to spot challenges — for example, staff members who are unwilling to engage with the material — and offer practical solutions.

• Engaging teaching style. Embedding DE&I as an organizational value means all staff members must be on board. A consultant should be able to connect with people easily, hold their attention, and inspire them to engage with complicated topics. A boring teacher dooms success.

• Personalization. Beware the consultant who offers a "this is how I do it" template. Your medical practice is unique and requires a program that meets its particular needs.

• Technological proficiency, including virtual communication. Everyone learns differently, and passively listening to a speaker usually is not an effective way to absorb new information. Your consultant should be able to present information in different ways to make it as easy as possible for your staff to find their mode of learning.

• Bridge-building. A practice leader will have different DE&I responsibilities than the human resource manager, who will have different responsibilities than the patient access staff or medical assistants. The right consultant will be able to help each staff member understand how they support DE&I and how their efforts support those of other staff members.

• Understanding the varying degrees of knowledge. Your staff members have different life experiences and different understandings about DE&I concepts. The consultant you choose must be able to meet people where they are.

• Patience. DE&I topics require reflection and honesty, and they are uncomfortable for many people. A good consultant will be sensitive to this and able to handle difficult conversations with a calm and reassuring demeanor.

• Joy. Coaching organizations to make DE&I a priority is difficult. Choose a consultant who is passionate about this work and enjoys helping organizations on their journey.