Say their names. Know their names.
There has been a business case for inclusion for quite some time. But after the 2020 protests of the George Floyd, Breonna Taylor, and Ahmaud Arbery deaths, there was a new focus on inequities and injustice leading to a new business case for inclusion. Companies could no longer wait for external or internal situations to spark change. Inclusion needed to drive what businesses were doing every day. Why? Consumers, job applicants, the media, and even investors demanded accountability — to know what companies are doing to build inclusive workplaces. Stakeholders wanted to see intentions manifest in inclusion policies that foster a sense of community and belonging.
Five Forces Driving the New Business Case for Inclusion
Five forces are driving the new business case for inclusion: global factors, public policy, enterprise demands, the need to better serve customers, and talent competition. We will tackle the first four forces here. Talent — the people-powered drive for inclusion policies — will be addressed in a future article.
Global Forces. The world economy is not changing. It has changed. Even if, post-pandemic, businesses bring supply chains closer to home, U.S. companies will forever compete on a global scale. Worldwide economic and demographic shifts demand intercultural competency and dexterity for mission effectiveness. According to McKinsey, the top-quartile companies of ethnically-diverse companies outperformed those in the fourth quintile by 36 percent in profitability.
Public Policy. Policymakers now compel businesses to build inclusive workplaces. According to Santa Clara University government ethics scholar John Pelissero, “Environmental, social, and governance (ESG) policies are being adopted by state and local governments at a steady pace.” Even school boards are adopting inclusion policies and rules and, to the extent local and state leaders are not, taxpayers are demanding action, said Pelissero.
Federal policymakers are also acting. In September 2021, the U.S. Securities and Exchange Commission approved Nasdaq rules requiring each Nasdaq-listed company to have at least two diverse board members or to explain why they do not. On his first day in office, President Joe Biden issued an executive order mandating a “whole-of-government” approach to advancing equity. In reaction, in April 2022, the U.S. Department of Health and Human Services (HHS), published the HHS Equity Action Plan.
Enterprise Demands. Investors are now acutely interested in company-level inclusion data. Shareholders at Nike and Walmart have demanded those companies publicly release the workplace discrimination data they report to the Equal Employment Opportunity Commission. They want this data because they know effective inclusion policies create the culture and connections that help employees identify consumer trends and opportunities. According to the Center for Talent Innovation, diverse companies are 158 percent more likely to understand target customers. Creating a sense of community and belonging internally drives revenue.
Industry’s Need to Serve. Understanding customers is particularly important in medicine. Health care disparities are real — and we now know one reason they exist is lack of diversity in the industry’s own ranks. Health care organizations have a growing responsibility to improve inclusion policies not only for employees, but as a public health imperative.
Ready to Build Inclusive Workplaces? Start with “I”
Inclusive leadership is a journey that begins with recognizing we all have biases. Sigmund Freud outlined two distinct functions of the human mind:
- Conscious, the area of the brain that control things we knowingly do; and
- Unconscious, the area of the brain that controls automatic behaviors.
The area of consciousness is small; we are aware of why we do things only fraction of the time. Unconscious action is more frequent. Here is a poignant story reported by The Washington Post:
A young woman had what she thought was a migraine. The pain was terrible. Her left eye drooped, her right side was numb, and she could not swallow. An ER physician examined her, but when tests concluded the patient was not having a stroke, they sent her home. The migraine continued to rage so the patient’s family took her for a second opinion. “Do you believe me?” she pleaded. Within two hours, doctors determined she had suffered a stroke, admitted her, and started treatment.
As The Post reported, if you are having a stroke, there is a 9 percent chance you will be misdiagnosed in the ER. Those numbers soar, however, for certain groups. Being a woman raises the risk of a missed stroke by 30 percent. If you are in the 18-to-45 age group, you are seven times more likely than a 75-year-old to be misdiagnosed.
Clinicians have biases about race, weight, gender, and sexual identity and what they mean for health. Studies show bias means clinicians are more likely to dismiss chronic pain in women and less likely to recommend bypass surgery for Black patients. Providers’ unconscious bias also leads to patient fear and shame. A Pediatrics study published in 2018 found transgender and gender nonconforming teens reported a lower rate of preventive checkups compared to cisgender peers. Why? Because transgender teens fear being misunderstood.
In the workplace, biases reduce morale and creativity, increase turnover, and erode trust.
Inclusive leaders examine their own assumptions and behavior. According to a study published in TPM – Testing, Psychometrics, Methodology in Applied Psychology in 2016, one of the most effective ways to eliminate unconscious bias in the health care sector is positive and frequent intergroup contact with different historically marginalized groups. Even better if those interactions happen within the workplace because there are inclusion policies that enhance diversity and foster a sense of community and belonging.
How to Build Inclusive Workplaces that Reduce Bias
The following strategies will help you create workplace inclusion policies that create a sense of community and belonging and improve patient care.
Assess current organizational culture. Are most leaders and employees skeptical of inclusion policies or do they understand the business case for inclusion? Answering this question will help define what actions must be taken and what systems need to be put into place to ensure every person is accountable for inclusive behavior.
You could start, for example, by asking all leaders to assess unconscious bias. Between 1998 and 2006, Harvard University, University of Virginia, and University of Washington researchers conducted more than 4.5 million Implicit Association Tests (IAT), a computerized assessment that examines unconscious bias. They found unconscious bias is pervasive and predicts behavior. According to The Joint Commission, an organization dedicated to continuously improving health care for the public by evaluating health care organizations, IAT has been embraced by the health care sector.
Identify indicators of success. Inclusion policies should be data-driven and have clearly-defined success metrics. Effective measurements ensure you are using factual evidence, and not bias, to evaluate programs.
Use both qualitative and quantitative data to evaluate success. Of course, you will want to know whether people of color have a better shot at promotion, but you also will want to measure whether people in non-dominant groups feel safe to share ideas, questions, and problems. Creating a system where colleagues can celebrate teammates who are supportive allies is one way to generate qualitative feedback.
Incorporate small changes for big impact. While the new business case for inclusion demands sweeping change, small shifts do often have big impact. Create opportunities for teammates to have courageous conversations where dominant groups are challenged by non-dominant groups. Sponsor town halls where employees have the opportunity to engage leadership and question inclusion policies and data.
Implement inclusion policies at all levels. At RSM, we lead by example. We have a full-time culture, diversity, and inclusion (CDI) team. Our Inclusion Council is an executive-level CDI advisory board, made up of executives who lead, advocate for, coordinate, inform, and monitor our strategic diversity management process. Thousands of RSM professionals devote time to internal and external initiatives and marketplace and community programs like corporate citizenship and supplier diversity. And our national employee network group leaders support our inclusion and diversity goals by bringing together people with diverse experiences through enriching activities and experiences.
Though the country struggles with its domestic differences externally, and internally industries work on new concepts of understanding perspectives, the 2020 incidents caused an international awakening. Businesses are responding to this new business case for inclusion. I am encouraged by the courageous conversations I have with people in the health care sector who are determined to build inclusive workplaces and foster a sense of community and belonging. Together they will create change that will improve public health for all Americans.