While the latest research suggests COVID-19 may be reaching an endemic level, as it isn’t burdening the healthcare system or spreading at the rate it once was, some experts think we have yet to see the end of it, adding the “new normal” of nearly 2,000 deaths a week is still cause for concern.
Regardless of where we stand today, one thing is clear: the pandemic heightened health disparities across marginalized communities, highlighting the need for healthcare systems to persist in closing the health equity gap, especially in Black, Indigenous, and Latine communities. To provide equitable healthcare for all patients, despite their race, ethnicity, sexuality, or socioeconomic status, healthcare networks and health practitioners have to start at home.
As the vice president of diversity, equity, inclusion and belonging at Dartmouth Health, a healthcare system with more than 1.6 million outpatient visits annually across New Hampshire and Vermont, both of which are still feeling the effects of COVID, Dr. Terri Malcolm continues dedicating her efforts to addressing health disparities in Dartmouth Health’s communities, starting with the recruitment process.
Read on for an edited excerpt of our exclusive interview with Dr. Terri Malcolm, who is also a member of the Senior Executive DEI Think Tank, to learn why Dartmouth Health prioritizes DEIB statements and how it mitigates bias throughout the hiring process. She also shares how safe space conversations have fostered a more inclusive culture.
Senior Executive Media: What does your current hiring process look like and how have you made it more inclusive?
Dr. Terri Malcolm: We’ve changed the language of our job postings and included a DEIB (diversity, equity, inclusion, and belonging) statement in the posts. With our job postings, we use inclusive language that illustrates the necessary requirements for the role … It speaks to a very wide and broad audience. The language isn’t very masculine or feminine … It is inclusive of all gender identities, as well as all ethnic identities. The job posting is also welcoming to people with disabilities and invisible disabilities. It demonstrates a level of flexibility in the position.
In sourcing, where are the job listings being posted? Have we established our relationships with groups that represent individuals who are underrepresented or who have historically been marginalized? What does the screening process look like? When you see a post … and you begin to apply, how user friendly is that process? How accommodating is the process for people who may not speak English as their first language? There are so many aspects where talent acquisition plays a role … and can weed out people before we even get a chance to interview them.
[Sam Verkhovsky, Dartmouth Health’s director of interpreter services, adds: “We provide interpreter and translation services to our Limited English Proficient employees, and we have interpreter services in the form of in-person, video remote, and telephonic interpreter services. We can also send documents for professional translation as needed.”]
I know that talent acquisition is posting on DiversityInc, and I know they’re also targeting Historically Black Colleges and Universities. I’ve been mostly involved in their executive and physician recruitment. When you especially look at executive-level recruitment, it’s very much based on relationships. It’s tapping into your networks and who you know … That has been an area of focus is broadening the net, casting it much wider than it has been before by posting on sites that maybe [we] historically hadn’t thought about.
[Carrie Moore, an executive recruiter, and Patrick Turner, director of talent acquisition, at Dartmouth Health add: “On the provider side, we also recently started posting on Diversitynursing.com for NP (nurse practitioner) positions, National Black Nurses Association, National Association of Hispanic Nurses, and Asian American/Pacific Islander Nurses Association, Inc.
To reach individuals from diverse backgrounds: we post on military sites, such as Recruit Military and Hire Heroes USA, and use social targeting for people separating from the military; disability sites, like AbilityJobs.com and WorkWithoutLimits.org; and HBCUs to promote individual positions and our Nurse Residency Program.”]
Senior Executive Media: Can you share more about the DEIB statement? How has that increased diversity in the talent pipeline?
Dr. Terri Malcolm: We include DEIB statements so that we demonstrate to all of our applicants our commitment to DEIB. For our executive positions, we also require submission of a DEIB statement along with their curriculum vitae, and it carries equal weight to submission of their CV. If an applicant were to not submit a DEIB statement, we would follow up with them to let them know … this is also part of our application process. We are seeking these additional materials during the presentation of candidates to the search committee and the panelists. It’s also a blind process. All of the identifiers of the candidates are blocked; the candidates’ applications essentially are de-identified so that you would not be able to tell one’s gender identity. You would not be able to tell one’s education background in terms of the schools that they attended, but you would know that they met the educational requirements. You probably would not be able to tell what their ethnicity is because their names have been removed; what part of the country they’re from or where they might currently reside … what their ages are because you wouldn’t know the years in which they’ve completed their training or completed their education. All of these [measures] allow for your bias to be mitigated, which allows for your bias to not play a more significant role.
We all have bias, so there’s going to be some bias … but it won’t be based on someone’s gender, ethnicity, age, or what part of the country they live in, or where they attended school. [This creates] a much more equitable and fair selection process.
Senior Executive Media: How do you mitigate inherent biases panelists may hold that can still affect their selections?
Dr. Terri Malcolm: Every member of our search committee is undergoing bias awareness training so that as a participant, they understand what bias is and they recognize what their own personal biases are. They determine in advance what the selection criteria is going to be and essentially have a rubric that they’ll use by which they evaluate each candidate and then the level of weight that the different qualifications will carry.
Debriefing conversations are scheduled very soon after the committee meets with a candidate to ensure the conversations are fresh and the search committee members have an opportunity to discuss openly about their thoughts and not later after side conversations. They’re really coming together and discussing as a group. Everyone is encouraged to share what their thoughts are and so that they try to avoid groupthink — one person having the dominant point of view and everyone just kind of falling into tow. To help facilitate that, the recruiters who have also completed their DEIB training are facilitating those debriefing to help guide some aspects of the conversation and ensure that the conversation is staying as objective as possible.
The standardization of questions … is the other thing. They are determining, as a committee, ‘what are the questions we want to ask?’ and ‘are we consistent in asking the same questions to each candidate?,’ so that it is a fair comparison. It’s not because we try not to compare one person to another person, but there’s a fair evaluation of each candidate based on the set of predetermined questions.
Senior Executive Media: Have you noticed a natural increase in diversity based on this ‘de-identified’ hiring process?
Dr. Terri Malcolm: We’ve really just started kicking off but the early reports are that it’s working. For one of our executive roles, we followed this process … We got a lot more diversity in the candidates to begin with, and candidates specifically shared it was because of our personal statement and the request for candidates to submit a DEIB statement.
Then, as candidates were reviewed, we saw a lot more women being selected and advancing beyond some of the early screening stages. It was just a much more diverse candidate pool. Those were some of the goals that we set: we wanted greater diversity in the candidate pool and in the final slate that would be presented to my colleagues and the senior executives as the final list of individuals to be selected from.
Senior Executive Media: How important is it to cultivate an inclusive culture, especially working in healthcare?
Dr. Terri Malcolm: When patients come to receive care they’re very often in a vulnerable state, especially in the hospital in an acute care setting where you’re sick, you don’t feel well, you could have experienced trauma, you could have been severely injured, you could be extremely sick. You’re not in a position to function at your most optimal level. You’re very dependent on trained individuals to take the best possible care of you. In order for clinicians and the healthcare team to take the best possible care of you, they need to know what’s important to you. They need to know what your behaviors are. They need to know what your practices are. They need to know what your healthcare goals are. They need to understand all of you, so we want our patients to be able to be very honest and to share all parts of themselves, and we want that same aspect for our employees. If our employees are feeling like they have to hold themselves back, it makes it difficult for them to open up, even with a patient or for a patient to feel like they can open up with them.
Senior Executive Media: How have you actively created a culture where people feel comfortable bringing their full selves to work?
One thing we’ve done is we’ve started hosting safe space conversations to address some of the personal impacts that individuals have that we know impact us in the workplace as well. Earlier this year, we hosted a safe space conversation around the murder of Tyre Nichols … Police violence and the inhumane treatment of Black men and how that was affecting our employees. I know it deeply impacted me not just as a Black person but also as a mother of three young Black boys and being fearful of them just living their lives … [Safe space conversations] really gave people a chance to share and share without judgment. To show them that they’re not alone and show them they’re not alone in the thoughts or the feelings that they’re having.
“We got a lot more diversity … and candidates specifically shared it was because of our personal statement and the request for candidates to submit a DEIB statement.”
Then our ERGs have played such a pivotal role in us having heritage celebration months … These are opportunities for our employees who not only identify with these groups, but also who want to be advocates for these groups and who want to show solidarity with these groups to celebrate. The Geisel School of Medicine hosts a ‘Conversations That Matter’ speaker series and they just hosted a discussion about how to care for Muslim patients during Ramadan. Two of our physicians who are practicing Muslims spoke about how to treat and how to talk to your patients about their practice of Ramadan and what that means in terms of fasting. If they choose not to fast, what are some other ways to support their patients? It was such an insightful and enlightening conversation … I walked away a better person because I’m more informed. I’m a more educated individual who understands a practice and a belief that I did not know before, and it was done with such empathy. It allowed for curiosity and allowed us to get to know one another as human beings because the more I know about you as a human being, the more connected I feel with you because we’re here to take care of patients and being able to connect with you on a human level, I can take better care of you.
Senior Executive Media: How long have you been holding safe space conversations? How can other DEI leaders replicate them within their company?
Dr. Terri Malcolm: [Safe space conversations] are during the work day [during our lunch hour], and they just started so we don’t have a regular cadence to them right now. They’re mostly arising, unfortunately, from traumatic events. We just had a conversation about organizing them because we don’t always want them to be a reaction to a horrible, traumatic event. At some level, you do need that, but we also want to provide a consistent place for people to come together and be able to share and talk. There’s so much happening in the world.
Right now, it’s informal and it’s entirely virtual and you’re not required to be on camera. You are not required to speak. You can really just come, join, be present, and listen. You also can come, be present, and share. You can share what’s on your heart and what you might be feeling in the moment. It’s a place of non judgment. It’s a place for storytelling, and it’s a place for community. Because the events tend to be very traumatic in nature, we also have employee assistance services available so that anyone who might really be struggling or who may need some additional support, that’s available. Those individuals are present during the conversations and provide all of their contact information.