Joan Y Reede< MD, MPH, MS, MBA Harvard Medical School March 4, 2015

Transcription

1 Advancing Diversity Inclusion: Achieving Excellence in Academic Medicine Joan Y. Reede, MD, MPH, MS, MBA Office for Diversity Inclusion and Community Partnership I have no potential conflicts of interest pertaining to associations with industry. There is no offlabel use of drugs in my presentation. Learning Objectives Frame benefits of diversity; Describe the demographic landscape of workforce diversity in medicine; Increase awareness of challenges experienced by diverse individuals across subgroups in academic medicine; and Describe Harvard s programmatic and research response and lessons learned by the President and Fellows of Harvard College 1

2 Why is diversity important? Realize Values Address Complex Issues Enhance Viability Diversity Inclusion Charter of Medical Professionalism Principle of Patient Welfare Principle of Patient Autonomy Principle of Social Justice Realize Values Crossing the Quality Chasm, IOM Health care should be: Safe Effective Patient-centered Timely Efficient Equitable 2015 by the President and Fellows of Harvard College Realize Values Mission Statement To create and nurture a diverse community of the best people committed to leadership in alleviating human suffering caused by disease. Diversity: A Cornerstone of Excellence A Prerequisite for World Leadership A n Imperative to Transform Culture Dean Jeffrey S. Flier 2

3 Realize Values: ACOG Diversity Statement February 2014 promote an environment of respect, fairness, integrity, and inclusiveness in all of their dealings. ACOG respects and values the diversity of its members. ACOG also recognizes that diversity and inclusiveness in volunteer and leadership positions strengthen the vitality of ACOG and are fundamental values of our organization. Source: DiversityStatement.pdf?dmc=1&ts= T downloaded 3_2_ by the President and Fellows of Harvard College Realize Values: Multiple Dimensions of Diversity Gender Sexual Orientation Information/ Skills Culture Disability Race / Ethnicity Relationships / Values / Preferences Networks 2014 by the President and Fellows of Harvard College Realize Values: ACOG Diversity Statement ACOG Diversity Statement February 2014 February 2014 without regard to race, color, religion, national origin, gender, perceived gender, disability, age, military or veteran status, marital or domestic partner status, sexual orientation, personal appearance, family responsibilities, type of practice, and/or political affiliation. Source: DiversityStatement.pdf?dmc=1&ts= T downloaded 3_2_ by the President and Fellows of Harvard College 3

4 The Value of Diversity in Addressing Complex Issues Diversity Toolbox Unpacked Diverse Perspectives: ways of representing situations and problems Diverse Interpretations: ways of categorizing or partitioning perspectives Diverse Heuristics: ways of generating solutions to problems Diverse Predictive Models: ways of inferring cause and effect Source: The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools, and Societies, Scott Page, by the President and Fellows of Harvard College The Value of Diversity in Addressing Complex Issues: Finding Solutions, Making Predictions and Creating Change Research Health Outcomes Building diverse research teams Addressing disparities and that cross disciplinary and improving health and the methodological boundaries delivery of health care Education & Training services among diverse populations Ensuring health professional education and training meet the Societal Obligation needs of diverse patients, Meeting current and future families, and communities health care needs within a Patient Care pluralistic society while increasingly addressing Providing access to health care global health issues providers representing multiple disciplines and to culturally competent quality health care 2014 by the President and Fellows of Harvard College Enhance Viability: Capturing the Potential Benefits of Diversity Inclusion 4

5 Enhance Viability: A Changing Landscape 2012 US 37% Minority >40% Minority population 25 States plus DC Majority Minority <5 years old 13 States plus DC In 5 years, among children <18 years of age, >50% minority 2060, US population projected 57% minority Immigrant Children fastest growing segment of population 25% children in US (18.4 million) live in an immigrant family 89% of immigrant children born in US US citizens Source: Pediatrics 2013; 131:e2028-e2034 Distribu(on of US Physicians by Ethnicity and Sex, 2013 Source: AAMC, Diversity in the Physician Workforce, Facts and Figures 2014, Table 1, Downloaded 3/2/2015 Distribu(on of US Medical School Faculty by Rank and Race/Ethnicity Source: AAMC, Faculty Roster, December 31, 2014, Table 3 Downloaded 3/2/2015 5

6 Distribu(on of US Medical School Faculty by Sex, Race/Ethnicity, Obstetrics and Gynecology Source: AAMC, Faculty Roster, December 31, 2014, Table16 Downloaded 3/2/2015 Societal Policies Politics Economics Environment Resilience Preparation Opportunity Resources Individual Barriers to Diversity Inclusion Culture Policies Practices Organizational Barriers of Many Shapes and Sizes Rules of the game Sticky Floors Swimming with sharks. Brick walls Glass ceilings 6

7 Diversity Taxes: Roles that Pioneers Must Play More than competent to do the job Able to fit into the organiza(on an its culture Willing to take responsibility for making other members of the organiza(on feel comfortable Able to represent your iden(ty group Capable of disproving colleagues preconcep(ons about members of that iden(ty group Source: F. Miller and J. Katz, 2007 Willing to accept and work to overcome colleagues discomfort, inability Able to deal with constant ques(oning as to whether the job was auained because of competence or difference Serving on commiuees, task forces and public appearances related to you iden(ty (none of which is in your job responsibili(es or considered in your performance appraisal Assist as needed in recrui(ng and outreach The Push and Pull to Identify, Homogenize and Choose Sides Are women of color members of a gender group or members of a minority group? Faculty Self- reported Experience with Racial and Ethnic Discrimina(on in Academic Medicine N. Peterson, et al, 2004 Purpose: To determine the frequency of self- reported experience of racial/ethnic discrimina(on among faculty of US medical schools Sample 24 Randomly selected medical schools 1,979 full- (me faculty, stra(fied by medical school, specialty, gradua(on cohort and gender 60% Response rate 82% non- Hispanic white, 10% URM, 8% non- URM (NURM) 7

8 Faculty Self- reported Experience with Racial and Ethnic Discrimina(on in Academic Medicine: Percep(on & Experience of Racial/Ethnic Bias by Minority Status N. Peterson, et al, 2004 Respondents who perceived R/E bias in the academic environment Reported (%) Adjusted OR 95% CI URM to 7.8 NURM to 3.7 Majority Respondents who personally experienced R/E bias in professional advancement URM to 18.7 NURM to 10.5 Majority Respondents who personally experienced R/E discrimination by a superior or colleague URM to 18.2 NURM to 7.8 Majority Faculty Self- reported Experience with Racial and Ethnic Discrimina(on in Academic Medicine: Career Sa(sfac(on by Personal Experience of Racial/Ethnic Discrimina(on N. Peterson, et al, 2004 Outcome Mean career satisfaction score * Felt like a welcomed member in institution Likely to leave academic medicine within 5 years Personally Experienced Discrimination (N=230) Did not Personally Experience Discrimination (N=1,603) Adjusted P Value 3.2 ± ± 0.02 < ± ± 0.03 < ± ± * 1=very dissatisfied, 5=very satisfied 1=unwelcome, 5=fully welcomed 1=not at all likely, 5=very likely URM Faculty and Promo(on, Allopathic Medicine Median ins(tu(on- specific promo(on rates White Hispanic Black Assistant to Associate 30.2% 23.5% 18.8% Source: Nunez-Smith, et al, Am. J. Public Health, May 2012 Associate to Professor 31.5% 25.0% 16.7% 2012 by the President and Fellows of Harvard College 8

9 URM Faculty Sa(sfac(on and Reten(on URM faculty are nearly four (mes more likely to report dissa(sfac(on with diversity Three (mes less likely to believe networking includes minori(es URM faculty are less likely to report they would be in their current ins(tu(on in five years Price et al. Improving the Diversity Climate in Academic Medicine: Faculty Percep(ons as a Catalyst for Ins(tu(onal Change. Academic Medicine, 2009 Source of slide: Eve Higginbotham, MD, 2009 Medical Faculty and Disability No systema(c evidence Findings from Faculty Interviews A desire for respect, approba(on and acceptance from peers and supervisors Backdrop of school disinterest neither medical school faculty nor students are expected to have disabili(es The hero moniker as a problema(c message Conscious overcompensa(on Source: Steinberg, Iezzoni, Conill, et al, Reasonable Accommodations for Medical Faculty with Disabilities, JAMA 2002 Gay Discrimina(on S(ll Exists in Medical Schools, AAMC 07_discrimina(on.htm Group on Student Affairs (GSA) and Organization of Student Representatives (OSR) Surveys GSA 15% respondents aware of mistreatment of GLBT students during preceding year 7% social, personal and learning environments hos(le toward GLBT students OSR 17% self- reported GLBT students reported hos(le environments GLBT students named hospital clinical faculty, residents and interns, and nurses as the top sources of discrimina(on 9

10 Response Office for Diversity Inclusion and Community Partnership HMS Office for Diversity Inclusion and Community Partnership Continuity Consistency Collaboration Creativity Communication Consideration Commitment 10

11 Barriers to Achieving Workforce Diversity Identification, Entry, Retention and Advancement Career Goal A Sampling of HMS Diversity Inclusion and Community Partnership Programs Educational Outreach Two Year Summary Middle School Students 2136 Harvard Affiliates - Arnold Arboretum of Harvard University High School Students 972 Middle & High Schools 96 Harvard Graduate, Medical & Dental Students 100 Harvard Post-docs 14 Harvard Faculty Beth Israel Deaconess Medical Center - Brigham and Women s Hospital - Cambridge Health Alliance - Center for Blood Research - Children s Hospital Boston - Dana Farber Cancer Institute - Forsyth Institute - - Harvard Museum of Natural History - Harvard School of Dental Medicine - Harvard School of Public Health - Harvard University, FAS - Massachusetts Eye & Ear Infirmary - Massachusetts General Hospital - McLean Hospital 11

12 Educational Outreach Community Partners Corporate & Association Tailored Communications Whole Foods Merck American Hearth Association American Lung Association FAVOR Doral/MassHealth Education Berklee College of Music Boston Public Schools Boston Science Partnership Cambridge Public Schools Harvard University School of Dental Medicine Massachusetts College of Art Massachusetts College of Pharmacy and Health Sciences MIT Museum Northeastern University ODCP Program Alumni Simmons College University of Massachusetts at Boston Public Health Boston Public Health Commission Cambridge Department of Public Health Health Beth Israel Deaconess Medical Center Boston Area Community Health Centers Boston Area Health Education Center Boston Public Health Commission Boston Medical Center Brigham and Women s Hospital Cambridge Health Alliance Children s Hospital Dana-Farber Cancer Institute Delta Dental of Massachusetts Dimock Community Health Center Immune Disease Institute Joslin Camp for Children with Diabetes Massachusetts Eye and Ear Infirmary Massachusetts Hospital Association Whittier Street Health Center Human Services Boston Center for Youth and Families Mayor s Youthline Fine Arts Museum of Fine Arts Boston Pro Arte Chamber Orchestra S.P.A.C.E An Artistic Community, Inc. Summer Clinical and Translational Research Program, Gender 20 Male 30 Female Race/Ethnicity 25 Black 14 Hispanic/Latino 6 Asian 1 American Indian 2 White 2 Unknown Institutional Affiliation 7 HSI 10 HBCU 5 MARC/MBRS Undergraduate Majors Biochemistry Biology Biophysics Biomedical Engineering Biomedical Science Physiology Public Health/Nursing 8 Published or Submitted 13 NESS Participation 2015 by the President and Fellows of Harvard College Biomedical Science Careers Program (BSCP) 1991 Established 1994 Incorporated as 501(c) 3 Internal Collaborations Individuals, Offices, Departments, Institutions External Collaborations Academic Medicine, Hospitals, Higher Education, CBOs, Professional Organizations, & Private Industry Participants ~ 9,500 Students, Post-docs, Residents, Jr. Faculty 12

13 New England Science Symposium Attendees Gender 60% Female 34% Male 6% No Response Ethnicity 36% African American 13% Asian 1% Native American 16% Hispanic 8% White 5% Other 18% No Response 2% Multiple Educational Levels Community College 5% College/Post Bac. 47% Graduate 16% Med/Dent/Other 7% Post doc/rsch. Fel. 10% Other 15% States Represented 33 States 14 Countries Abstracts Submitted 2001 n = n ~ 250/yr 2014 by the President and Fellows of Harvard College Visiting Clerkship Program ,159 Students - 59% Women - >151 US Medical Schools Matches to HMS Internship, Residency or Fellowship - >390 HMS Faculty Advisors 52 HMS Faculty Appointments 2015 by the President and Fellows of Harvard College HMS Dean s Postdoctoral Fellowship Offerings: $50,000 stipend per year for 2 years $1,250/year professional development funds Programmatic offerings: Community for Diversity ~ HMS STARs (Society for Translational and Academic Researchers) DCP and OPF career and professional development offerings Mentoring Initiated Fall current fellows by the President and Fellows of Harvard College 13

14 Mongan Commonwealth Fund Fellowship in Minority Health Policy To prepare physicians for leadership roles in transforming health care delivery systems and promoting health policies and practices that improve access to high quality care for minority, disadvantaged and the most vulnerable populations Women = 58.9% 2015 by the President and Fellows of Harvard College Alumni Fellow/Scholars Outcomes, March 2015 (N=112) 93.4% serve on national/federal committees or advisory boards or state/local committees 73% have been invited for interviews on TV, radio and newsprint to discuss public health and minority health issues 70% have published 100% engaged in policy, research and/or service delivery related to minority health 78% have held academic appointments at schools of public health and medicine 2015 by the President and Fellows of Harvard College Resilience Preparation Opportunity Resources Individual Societal Policies Politics Economics Environment Barriers to Diversity Inclusion Culture Policies Practices Organizational 14

15 Converge: Together Building Change Research and Evaluation Converge Evaluation Research Translation 2014 by the President and Fellows of Harvard College Reede-Hill Diversity Inclusion Capacity Paradigm Productivity Entry Mentors Connections Networks Retention Advancement 2014 by the President and Fellows of Harvard College 15

16 Lessons Learned Lessons Learned Leadership Leadership is committed to devoting the staff and resources necessary to implement recommendations Terminology surrounding diversity effort is unambiguous Boundary of change effort is well defined in terms of who and what parts of the campus are involved Consistent with formal structure, rules and roles of institution i.e. with established procedures Source: Will your campus diversity initiative work, G. Ingle; Toward a model of inclusive excellence and change in postsecondary institutions, D. Williams, J. Berger & S. McClendon 2012 by the President and Fellows of Harvard College Lessons Learned Leadership Explicit goal or set of goals Realistic time frame Rationale has been put forward with initiative seen as critical to the long-term mission of the campus Driven by a recurring cycle of assessment using multiple methods Process exists to identify, approve, implement and evaluate the changes for effectiveness Source: Will your campus diversity initiative work, G. Ingle; Toward a model of inclusive excellence and change in postsecondary institutions, D. Williams, J. Berger & S. McClendon 2012 by the President and Fellows of Harvard College 16

17 Lessons Learned Programs Build talent pipeline through seamless articulation of programs both internally and externally. Create opportunities for multiple points of entry and exit. Have flexibility in programming that is responsive to emergent environmental and policy changes and to local needs. Engage community (internal and external) as vehicle for affecting student outcomes. Be willing to cross disciplinary boundaries. Recognize the importance of systems. Attend to career development that is coupled with mentoring and skill attainment at all levels across the academic continuum. Build in tracking, monitoring and evaluation by the President and Fellows of Harvard College Lessons Learned - Diversity Inclusion and Research Values Move toward evidencebased Novel ideas & innovative approaches SMART metrics Specific, measurable, actionable, relevant, timely Populations Disaggregation Intersectionality Complexity Context is important Interdisciplinary teams Multiple stakeholders Viability Leadership buy in Willingness to change 2014 by the President and Fellows of Harvard College Lessons Learned Individuals Embracing Diversity Inclusion History and context matter Data are important We will be challenged to recruit, nurture, retain and work with a diverse workforce. We will need to create work cultures where individuals can feel valued, comfortable and able to contribute their individual perspectives and skills. We will need to deal with our own toolbox and perspectives and the isms that each of us bring to the table by the President and Fellows of Harvard College 17

18 Thank You 18