Prepare yourself, because not everyone in your medical practice wants to start a journey toward greater DE&I.

This doesn't mean that someone who resists DE&I is a bad person or against diversity as a concept. Rather, just as we all have unconscious biases, we have certain mindsets. The mindset of "I am eager, well-prepared, and motivated to engage in difficult conversations about sensitive topics to improve my workplace for everyone who works here" may apply to some of your staff, but probably not all.

According to an article by Trisha Rai titled, "How to Navigate Pushback to Diversity, Equity and Inclusion Efforts," resistance to DE&I efforts typically shows up in three ways.

• Denial. "We all get along in this office, so I don't see a problem. This is a waste of time."

• Disengagement. "If somebody else has a problem, that's for them to figure out. This isn't any of my business."

• Derailment. "The only problem here is Mary's behavior. HR needs to get involved because she's causing problems. We were doing fine before, but she makes everyone uncomfortable."

Staff members who resist DE&I may view it as a threat to their self-image. We all want to see ourselves as good people, and being asked to attend a training on, say, unconscious bias may make some feel they are being called out as racist.

Or some employees may feel DE&I initiatives threaten their social leverage. For example, a male employee might fear that improving gender equity will reduce advancement opportunities for men.

You may not be able to head off resistance, but if you recognize it and are prepared for it, you will be able to overcome it.

A one-time training or DE&I discussion will not create meaningful change. Like any other major transformation, embedding DE&I into your organizational culture requires a strategic plan and a steady commitment to implement that plan — probably with many tweaks as you gain experience — until you have reached your goals.

Your plan may include these steps:

1. Determine your DE&I goals.

Different organizations have different needs and priorities, so what's right for another practice may or may not be appropriate for yours.

Common DE&I goals include:

Building a more diverse workforce. The most effective healthcare organizations mirror the communities they serve. If a medical practice exclusively employs young providers and staff members, older patients may feel that no one understands their concerns. A homogenous staff may seem unwelcoming to patients from diverse backgrounds. Patients from groups that distrust healthcare providers because of historical mistreatment may be more open to a practice in which some providers share some of their identifying characteristics.

Reducing bias. Implicit, or unconscious, biases may be influencing the treatment of patients in your practice. Do providers prescribe the same pain relievers to all patients — or do they assume that some patients feel less pain than others? Are patients from some groups labeled as "complainers" whereas others are treated with compassion?

2. Create the team.

The responsibility for advancing DE&I in your practice cannot reside with one individual. A team of equity champions should be appointed to identify tactics, define metrics, implement the plan, and keep everyone informed of progress and lessons learned.

The team must include leaders with authority to provide resources, such as money to hire a consultant or time for staff to attend training sessions. The team should also include coworkers from all levels of the organization, representing the broadest possible range of perspectives.

Members of this team are designated change agents. By leading the charge, they embed DE&I as a value that extends to all employees, rather than a top-down initiative. Their enthusiasm and excitement for making DE&I a priority will encourage others within your practice to want to be a part of the change.

3. Measure progress.

Determine what success will look like and how you will monitor progress toward your goals.

If a diverse workforce is your goal, you might want to set tangible targets with realistic due dates – for example, hire three female clinicians over the next two years. That goal might need to be supported by several tactics, such as developing new recruiting practices, developing a retention strategy for providers, and conducting training sessions that will help all staff work well with an increasingly diverse group of colleagues.

4. Make a training schedule.

Most DE&I programs require training. Your team will need to decide what types of training will be offered, who will be asked to attend, and whether participation is mandatory.

Some staff members will be uncomfortable with training sessions and discussions, but these are opportunities for individuals to consider whether they have biases they are unaware of.

5. Consider forming resource groups.

Some practices might benefit from employee resource groups. These voluntary employee-led groups encourage employees who share a characteristic — for example, gender, ethnicity, religious affiliation, or LGBTQ+ status — to come together for mutual support, career development, and camaraderie.

6. Seek input and feedback.

At every step of a DE&I program, the team and organizational leaders must seek input. For instance, rather than announce that you will host a taco bar on Cinco de Mayo, ask the DE&I team to gather ideas from employees on the best ways to honor and celebrate Hispanic heritage throughout the year.

Request feedback systematically through staff surveys or open forums in which employees can feel free to be honest. Well-intentioned actions may fall flat; you need to know what is working and what isn't. Challenges are a part of progress.

7. Be transparent.

Transparency about hiring practices, job opportunities, and the processes that lead to promotion and advancement help everyone see a fair playing field in which a particular group is not getting specialized treatment.

8. Stay steady.

Take the DE&I journey one step at a time. Embracing DE&I as an organizational value is not a race to see who can tick off the most boxes in the shortest amount of time. Creating a lasting and meaningful change in your practice requires DE&I programming to be delivered to your employees at a pace they can handle.

It's easier for employees to change over time instead of forcing behavior changes overnight. A slow but steady approach allows time for discussion and self-reflection. It also gives leaders the opportunity to address concerns along the way and make the adjustments needed to succeed.

Change is difficult, and the first way to make emphasizing DE&I easier is to help your colleagues and staff understand why it is needed. You and other practice leaders might not be the best people to conduct training or facilitate discussions about DE&I topics, but you must be able to communicate why DE&I is important for your practice.

You also should be able to convey a few basic concepts:

• The broad scope of the term "diversity."

• How unconscious bias shows up in the workplace, why unconscious biases may make some people feel uncomfortable, and how that discomfort can limit their growth in the organization.

• How research shows that embracing DE&I makes organizations more innovative, collaborative, and productive, and increases the likelihood of long-term financial success.

Support your case for DE&I by auditing your organization and sharing the data with colleagues and staff. Among other things, the audit should include:

• What does your leadership structure look like? What percentage of leaders are men? What percentage are women? What percentage are individuals from marginalized groups, and how does this compare with the overall staff diversity?

• Does your staff diversity accurately reflect the community in which you work? What percentage of staff members come from marginalized groups?

• What does your organization do to make sure that all staffers see themselves as valued members of the team?

Another tactic to overcome resistance is to make the legal case for DE&I. Ask your attorney to speak to your staff to explain the state and federal laws that address discrimination, bullying, and harassment. The presentation should stress the potential legal ramifications of disregarding those laws.

What works? Different approaches for different organizations. In 2021, the Deloitte Center for Health Solutions asked senior healthcare executives about their strategies for improving health equity by driving change within their organizations.

Here's what they found out:

Leaders must lead. Mid-level or frontline staff members may be urging — or inspiring — you to promote DE&I, but don't ask them to take the lead. Culture change must be driven from the top. Practice leaders must set the DE&I vision for your organization, the strategy to work toward that, and the resources needed to do so.

Promoting DE&I is the right thing to do and a business imperative. Becoming a more diverse, equitable, and inclusive organization is doing your part to address America's ongoing problem with health disparities. It also will help you recruit and retain a top-quality workforce. That, of course, will lead to better clinical outcomes, patient engagement, and ultimately better financial performance.

Promoting DE&I will require funding. Your DE&I strategy will determine what kinds of expenses you will incur. Don't expect this work to be a zero-budget initiative. You may need to hire consultants, trainers, or facilitators. Staff members will need to be given time to participate in training sessions. Some policies may need to be rewritten. You may want to invest in new recruiting strategies for new staff members.

DE&I work needs a clear governance structure. Hospitals and health systems typically hire a C-level position — chief equity officer, chief diversity officer, or a similar role. Depending on the size of your practice, that might be appropriate. Regardless, a named leader should be responsible for carrying out the DE&I plan, monitoring and reporting progress, and making sure everyone contributes to its success.

Progress should be measured and evaluated. Embedding DE&I into your practice will take a long time, and it will be easy to lose momentum. Have clear goals, deadlines, and measures so that the effort keeps moving forward. Some things you try will not work; be sure to analyze those situations and use the "lessons learned" as you adjust your plans.