How Children's Health Drove DEI Efforts with a Cultural Climate Audit

Children’s Health collected qualitative data to learn about employee attitudes, feelings, and experiences, with a focus on differences between staff and leader perspectives. Focus groups that were divided between mid-level “leaders” (supervisors, team leaders, directors, and senior directors) and “staff” (individual contributors).

To collect this data, a research team conducted 25 listening sessions with 260 employees across six locations. To ensure that the listening session results were representative of the entire workforce, the groups covered: night, day and weekend shift staff; clinical and non-clinical staff; and individual contributor and leader groups. The groups included a mix of employees of different genders, races, sexual orientations, functional expertise, and organizational tenures.

The research team first spoke with all the Senior Vice Presidents to understand their perspective on DEI. Because having senior leaders or direct managers could prevent open conversation, members of the D&I team led the focus groups.

Each group was asked the same set questions focused on DEI, including:

• How is diversity and inclusion demonstrated at Children’s/at your workplace?
• What are the Guiding Principles for D&I and Cultural Competence?
• If you raised a concern about fair treatment, are you confident that Children’s would do what is right? If not, why not?
• Do you believe Children’s values diverse opinions and ideas? If not, why not?
• At work, I am treated with respect. (Likert scale rating)

Following the completion of the listening sessions, the team compared the perspectives of the senior Vice Presidents, the leader, and staff groups. Understanding differences in these perspectives was essential for Children's Health to ensure that DEI initiatives could grow sustainably and receive buy-in across all levels of the organization

The sample quotes below illustrate patterns that Children’s Health found. Specifically, “team members want to feel safe when voicing issues, concerns, and opinions. In the current organizational climate, some team members are finding it difficult to be open in their communication with leaders.” This analysis informed Children’s Health’s decision to prioritize improving inclusion competencies across all levels, increasing accountability, and building sustainability in their DEI strategy.

Sample notable quotes

Senior leaders

• “Most people would agree that having a culture that is diverse and inclusive is the right thing to do. But connecting that body of work to how they actually deliver outcomes that they are all accountable for in the strategic plan—that would be Utopia.”
• “I need clarity around what we are trying to accomplish. Is it just cultural feeling? Is it just about seeing different skin-color and gender at the executive and senior leader level? In what way am I responsible for driving that?”
• “I sometimes get frustrated by thoughts of how we change the D&I culture and continue our journey in a practical sense.”
• “We have to figure out, as gently as we can, how to point out where we have opportunities for improvement.”

Mid-level leaders

• “We have standardization and best practices in place to ensure that every patient receives quality care, regardless of age, religion, or race.”
• “We need more people at the table with different opinions and considerations. If you have that diversity at that level, you have someone to speak for you."

Frontline staff

• “I think the upper management value the opinions of people who have been here longer, not always the new employees.”
• “The organization is diverse. But, in certain areas, there’s no diversity. The same people keep hiring people that are similar to them.”

Children's Health partnered with internal and external researchers to analyze the qualitative data. The University of Texas Health Science Center School of Public Health, one of Children's Health's external partners, helped pushed the audit forward. The university researchers, in coordination with an internal researcher, translated the qualitative data into 21 actionable themes for the organization.

For example, the themes included D&I Programs and Outreach, Support of LGBTQ Community, and Career Mobility.

• D&I Programs and Outreach: Staff expressed an appreciation for the current suite of D&I programs and outreach as well as a desire to be more engaged overall. Staff also suggested that programs be promoted more heavily, an action item that the team will be taking forward.
• Support of LGBTQ Community: Children’s Health has excelled in supporting and celebrating employees who are members of the LGBTQ community, according to staff.
• Career Mobility: Staff expressed concerns around career mobility and advancement for underrepresented colleagues. As such, the organization started working on initiatives to reduce bias including revising job descriptions to remove gendered adjectives and blinding certain identifiers on candidates’ resumes. The organization is planning to eventually have structured interviews with a diverse panel and standardized questions.

To gain quantitative data, Children’s Health included new inclusion-focused questions in their organization-wide 2019 employee engagement survey.

This allowed them to save time and resources by using a pre-existing resource to source additional quantitative data. Employees ranked the following statements on a Likert scale of 1-5 (1 – strongly disagree and 5 – strongly agree) to indicate how much they agreed with them:

• If I raised a concern about ethics and integrity, I am confident my employer would do what is right.
• My workplace is committed to building the strengths of each team member.
• At work, I am treated with respect.
• Everyone at this organization is treated regardless of ethnic background, race, gender, age, disability, or other differences not related to job performance.

For any employee who responded to a question with less than a 5 (strongly agree) on the Likert scale, the survey showed them follow-up questions:

• My supervisor creates an environment that is trusting and open.
• I always trust my organization to be fair to everyone.
• My organization treasures diverse opinions and ideas.
• If I raised a concern about fair treatment, I am confident my organization/employer would do what is right.

The organization asked the same inclusion-focused questions a second time in 2020 and saw improvements in agreement for all four questions.

6% increase in agreement: If I raised a concern about ethics and integrity, I am confident my employer would do what is right.

9% increase in agreement: My workplace is committed to building the strengths of each team member.

5% increase in agreement: At work, I am treated with respect.

7% increase in agreement: Everyone at this organization is treated fairly regardless of ethnic background, race, gender, age, disability, or other differences not related to job performance.

Because there was minimal improvement for the questions on demonstrating respect and fairness for all and raising a concern about ethics and integrity, the organization will be dedicating more focus to these areas in their future strategy.

Children’s Health disaggregated and analyzed employee demographic data for additional quantitative information on employee outcomes. Specifically, Children’s Health assessed and published their overall workforce and leadership demographics by gender and race/ethnicity.

Through this analysis, Children’s Health quantified striking imbalances in representation. For example, while 51% of the workforce was white, 73% of leaders were white. Hispanic or Latino employees made up 22% of the workforce but only 9% of leadership. And while men represented only 21% of the workforce, they made up 33% of the leader population.

Children’s Health also further cut the data by dimensions of identity to gain a fuller understanding of the disparities at play. For example, the organization looked at the intersection of gender and race/ethnicity.

The figure below shows some of these findings. For example, the organization discovered that while white men represented only 9% of the workforce, they made up 47% of the senior leader population.

Children's Health was committed to sharing the cultural climate audit data to build trust and accountability. They shared their results in a diversity and inclusion impact report, titled “Looking Inward. Taking Action. Diversity and Inclusion at Children’s Health,” publicly available for download on their website.

In the report, the organization shared their workforce and leadership demographics, calling out opportunities to expand diversity at the leadership level. In addition, the organization shared results from the inclusion index survey measures, key areas for development, and a summary of quotes, both positive and constructive, from the focus groups. The report’s inclusion of these results— both positive and negative—demonstrates the organization’s dedication to transparency and accountability.

To sustain momentum, Children’s Health used the results of the cultural climate audit to inform their DEI roadmap for the future. Based on their findings, Children’s Health identified six priorities, with specific goals attached to each one.

Current goals

• Increase representation of minorities in senior leadership: Recruit, retain, develop, and advance more underrepresented minority talent into senior leadership roles and other key feeder positions (such as directors and nurses)
• Foster an inclusive workplace: Execute comprehensive strategies that create shared ownership for advancing equity and inclusion for the purpose of transforming care delivery. This approach includes aligning programs and initiatives, optimizing and leveraging resources, and influencing policies and practices.
• Improve inclusion competencies at all levels: Better equip leaders with the skills and competencies for managing diverse teams and create more awareness around mitigating biases and microaggressions. As part of that work, the organization will be creating a comprehensive training plan that will include expert workshops, online training around topics impacting the LGBTQ community, and expanded education on unconscious bias.
• Establish key metrics: Create a regular review process of aggregate and business function data in order to consistently and accurately pinpoint gaps and develop solutions. As part of that work, the organization will be creating a Metrics Advisory Workgroup comprised of a multidisciplinary team responsible for strategic initiatives to help inform and ensure alignment with D&I metrics.
• Increase accountability: Strengthen commitment and ownership for diversity and inclusion at all levels, such that team members hold themselves and each other accountable for building and maintaining an inclusive culture.
• Build sustainability: Craft strong policies, practices, and systems that continue the transformation to ensure equitable care and maintain a balance of diverse representation at all levels and sustain a culture of inclusion for decades to come.