Diversity, Equity, Inclusion, and Belonging (DEIB) Principles for Palliative Care Leaders

Drawing from the insights of experienced leaders in the field and CAPC’s DEIB journey, this tool provides foundational guidance for people leading in this changing landscape. It underscores the importance of DEIB within health care organizations, particularly in palliative care, where empathy and understanding are crucial. In these settings, the strength of a leader is inherently tied to the well-being of their team and the quality of patient care. Therefore, integrating DEIB principles is not only beneficial but vital for fostering a supportive, effective, and compassionate health care environment.

DEIB stands for Diversity, Equity, Inclusion, and Belonging. It is a framework often used by organizations to ensure a comprehensive approach to creating a diverse and inclusive workplace.

• Diversity refers to the presence of differences within a given setting. In the context of a workplace, diversity can include differences in race, ethnicity, gender, sexual orientation, socioeconomic status, age, physical abilities, religious beliefs, political beliefs, or other ideologies.
• Equity is about ensuring fair treatment, access, opportunity, and advancement for all people, while striving to identify and eliminate barriers that have prevented the full participation of some groups. The concept of equity acknowledges that advantages and barriers exist and that, as a result, we don't all start from the same place.
• Inclusion is the act of creating environments in which any individual or group can feel welcomed, respected, supported, and valued to fully participate. An inclusive climate embraces differences and offers respect in words and actions for all people.
• Belonging is a newer addition to the DEI model. It refers to the feeling of security and support when there is a sense of acceptance, inclusion, and identity for a member of a certain group or place. It's the outcome of ensuring diversity, equity, and inclusion.

In palliative care, embracing DEIB can lead to a more supportive, effective work environment, fostering a range of perspectives and ideas vital for innovative and compassionate care.

Implementing DEIB in the workplace, particularly in health care, offers several key advantages:

• Improved Patient Care: A diverse health care workforce can provide more culturally competent care to a diverse patient population, which can lead to better patient communication, higher satisfaction, and improved health outcomes and a reduction in health disparities.
• Enhanced Innovation and Problem-Solving: Diversity in the workplace brings different perspectives and ideas, fostering creativity and innovation. In health care, this can lead to the development of new treatments, approaches to patient care, and health care delivery models.
• Increased Employee Satisfaction and Retention: Inclusive environments where employees feel a sense of belonging and are treated equitably are more likely to retain staff. This reduces turnover, which is particularly important in health care where there is often a shortage of skilled professionals.
• Expanded Talent Pool: By embracing DEIB, health care organizations can attract a broader range of job candidates. This is especially important in filling roles that require specialized skills and in areas where there is a competitive job market. For younger candidates, DEIB is a requirement.

Implementing DEIB in health care creates a more positive and equitable workplace, more effective health care delivery, and overall organizational success.

While there is no one size fits all approach for embedding DEIB into your organizational DNA, here are opportunities to begin:

• Acknowledge areas where your team needs improvement. Naming problems is the first step.
• Prioritize DEIB goals and set feasible targets that align with your organization's overall mission and vision.
• If you are hiring new staff, this is your opportunity to create a more diverse team. Examine your hiring processes with an eye toward DEIB. Is there bias in your position descriptions, interview process, or candidate selection process? Your organization’s Diversity Office may have resources to help you integrate DEIB best practices for hiring
• Understand the complexity of DEIB issues and get comfortable being uncomfortable. Seek out compassionate leaders to provide support for overcoming any discomfort and apprehension about getting it "right,” understanding that we all make mistakes and must be open to feedback.

A brave space is a team culture in which team members feel psychologically secure to express their thoughts, especially in discussions that delve into personal aspects of DEIB. Sustainable change stems from a personal commitment to DEIB, making it essential for leaders to cultivate an environment that encourages and is welcoming of dialogue, and that can tolerate uncomfortable conversations. The focus should be on fostering sustainable, purposeful changes that contribute to long-term cultural transformation.

1. Encourage and Model Inclusive Conversations. Recognize the importance of addressing challenging topics openly and in a timely manner. Encourage open dialogue to create an atmosphere where difficult conversations are not avoided but embraced as opportunities for growth. To foster a culture of trust and collaboration, set an expectation that you and your team members assume positive intent from one another, while considering how your words and actions will impact your colleagues.
2. Avoid Quick Solutions. Avoid trying for a ‘quick fix’, and prioritize sustainable, intentional culture change. Acknowledge that lasting change takes time and commitment.
3. Involve the Whole Team. Encourage and create space for everyone to give voice to their values in DEIB conversations. Start by making sure that you are not reinforcing the traditional medical hierarchy in your team discussions.

Remember that by fostering a brave space, as the leader, you lay the groundwork for meaningful DEIB discussions.

Your team members are likely at different starting points when it comes to DEIB, so it is important to establish common language and baseline understanding of important DEIB concepts. Here are some strategies to get started:

1. Start from Scratch – and Then Repeat. Initiate DEIB education at foundational levels to accommodate varying knowledge levels within the team. Ensure that everyone, regardless of their DEIB expertise, can actively participate in the journey. Reinforce DEIB principles and practices through repeated conversations over time.
2. Utilize Practical Tools. Apply the concepts of DEIB to your team’s lived experiences at work, for example, by integrating DEIB concepts into the design of a quality improvement project. Provide resources and tools that encourage staff to engage with DEIB concepts in a practical and applicable manner. For example, to empower the team to discuss issues in which identity comes into play at work, your team may benefit from a standard framework for giving and receiving feedback. One example is the SBI (Situation, Background, Impact) model.

As a leader, you don't need to have all the answers. Sometimes, the most impactful response is to actively listen and to model the art of receiving feedback gracefully and gratefully. Your job is to amplify the diverse voices on your team, facilitate psychological safety, and explicitly prioritize DEIB. If your organization has DEIB experts, invite them to speak with your team. Seek out external leaders in this space who may be willing to share their wisdom with you and your team. Take proactive steps to invite others to hold you accountable, maintaining an ongoing dialogue about your DEIB journey.

The journey ahead is about embedding DEIB principles into your leadership practices, empowering you and your team to co-create an inclusive and high-performing culture.

1. AAHPM Diversity, Equity, and Inclusion Resources
2. Approaching Diversity, Equity, and Inclusion | Executive and Continuing Professional Education | Harvard T.H. Chan School of Public Health
3. Developing an authentic DEI program for healthcare organizations (chghealthcare.com)
4. How DEI Training in Health Care Can Improve Patient Outcomes | Regis (regiscollege.edu)
5. The Importance of Diversity and Inclusion in the Healthcare Workforce - PMC (nih.gov)