Good afternoon, everyone. Welcome to today's educational event titled Implementation of Institutional DEI, sponsored by the American Academy of Sleep Medicine and co-sponsored by DEI Committee. Today, we have Dr. David J. Brown, who is the Associate Vice President and Associate Dean of Health Equity and Inclusion and Associate Professor of Pediatric Otolaryngology at Michigan Medicine, joining us to discuss this timely topic. Before I introduce Dr. Brown, I'd like to remind you that your audio is muted and your video is turned off. We encourage you to include any questions on this topic or for the speaker in the Q&A of the Zoom platform. Please refrain from using your cell phone and or pager while you're on this webinar. Now, allow me to introduce our speaker today. Dr. Brown is the Associate Vice President and Associate Dean for Health Equity and Inclusion and Associate Professor of Pediatric Otolaryngology at Michigan Medicine. Dr. Brown leads the Office of Health Equity and Inclusion at Michigan Medicine and implements the University of Michigan Diversity, Equity and Inclusion Strategic Plan, provides training to advance diversity and inclusion and provides numerous healthcare pipeline and mentorship programs. He has successfully recruited many medical students, house officers and faculty to University of Michigan Medical School. As a leader at Michigan Medicine, Dr. Brown is an executive sponsor of the Anti-Racism Oversight Committee, AROC, initiated in June, 2020. He was also recently honored with the Harvard Medical School 2020 Distinguished Alumni Service Award for co-creating an alumni mentorship program for medical students underrepresented in medicine. Thank you, Dr. Brown, for taking time from your busy schedule, which I know is very packed and joining us for this webinar. Thank you very much, Dr. Hassan, for that kind introduction and for inviting me to share with you all some things that we're doing here at Michigan Medicine on an institutional level to implement diversity, equity and inclusion. For me, diversity, equity and inclusion is a journey for all of us. Although I work in diversity, equity and inclusion, I'm constantly learning and must recognize that people are at different stages and I'm happy that this is on your agenda today. For me, a willingness to learn and grow will help us all navigate towards a more inclusive culture. Throughout this journey, just like with these roads, there will be twists and turns, potholes and hazards, dead ends and non-ending roads. Throughout all of this, we must be persistent in our goals to arrive at a place where there are diverse individuals and perspectives, equitable opportunities for all and inclusion for all voices. So what is the value of diversity, equity and inclusion? Healthcare systems, and many of you work in healthcare systems, can improve their performances by tapping into the power of differences in how people think. Workforce diversity is more than simply just the right thing to do in order to make society more integrated or just. And diversity can improve the bottom line of healthcare systems facing complex challenges. Scott Page, who is another professor at the University of Michigan, presents overwhelming evidence that teams that include different kinds of thinkers outperform homogenous teams on complex tasks, producing what he calls the diversity bonus. These bonuses include improved problem solving, increased innovation and more accurate predictions, all of which lead to better performance and results. Differences in how people perceive and code, analyze and organize the same information experiences are linked to better outcomes. So how will diversity and inclusion improve your department or your institution? There are many reasons, and we hate to call it a business case, but it actually does make things better for your business. There are better patient satisfaction results, outcomes and healthcare equity. Improved employee engagement. In fact, we know from our data that those departments and units that are more engaged with diversity and inclusion have increased employee engagement scores, and there's a direct correlation. Funding and accrediting organizations are transitioning from asking you what your plans are about diversity and inclusion to what your actions are. And especially if you're renewing, they're asking what have you done since your last renewal? And so you really need to show some actions in addition to plans. And for those health systems that are participating in high reliability organizations, the DI principles overlap greatly. So in the United States, our population is becoming more and more diverse. And by 2055, these are US Census Bureau data. Our country will be a majority minority country, whereas non-white individuals will be more than 50% of the population. This is the future of our learners, faculty, staff, and patients. So we need to learn how to value diversity so that all of these individuals can thrive. So getting to our strategic plan, this was the result of a collective vision created through a university-wide grassroots process. We had a planning year actually in 2016 in which we engaged thousands of constituents before initiating our plan. DI plans were created for 50 units at the University of Michigan, of which Michigan Medicine was one large unit. And we defined diversity in the broadest sense of terms and do not restrict ourselves to just racial, ethnic, or gender diversity because we strive to have all people feel they're a part of the DI plan. We had three primary strategies. One is climate enhancement so all individuals could thrive. Two is diversifying the community. And three, scholarship and teaching for ourselves and for others to learn from our experiences. We built this off of foundational programs that already existed within our institution. We had an existing and developing infrastructure, and we also had and developed more metrics and reporting. At the same time, we also had a chief diversity officer at the University of Michigan named Dr. Rob Sellers. The university also invested millions of dollars into this over the next five-year period. So how did we go about doing this at the beginning? To engage people during our start and even before we started, and then throughout the process, we used techniques described as liberating structures. You can look up liberating structures online. These are free tools that help you engage individuals in visioning and developing plans for complex priorities of which DI is one. We asked many of these questions on the screen using various liberating structures to hear as many voices as possible. We felt that diversity, equity, and inclusion plan should not only be for the people, but by the people and develop based on their concerns, needs, and opportunities. These are pictures from a session about increasing mentorship and sponsorship to promote academic success for women. We did numerous sessions like this and collected thousands of suggestions and themes to help direct our efforts. Midway through the five-year strategic plan, the president of the university asked us to go back again and engage with the constituents to hear them, to see how we were doing, and adjust our plans accordingly. And this is from one of those mid-plan sessions. This is something that you can do in your own unit, or department, or institution, and you can also do them via Zoom or in a hybrid format because those are ways that many of us are functioning these days. This gets more complex when you need to devise a diversity, equity, and inclusion strategic plan for an academic medical center the size of Michigan Medicine, which is about half the size of the whole university. And we had one strategic plan for the entire academic medical center. What we had to do is to break that down into smaller plans for each of our business units. We had a total of 227 business units. And since we feel that the work needs to be carried out locally, we devised 227 diversity, equity, and inclusion plans for all of the units within Michigan Medicine that rolled up into our one large plan for our academic medical center. Each plan needed to address the planning domain set out by the university, as well as address each constituent group, and we had the addition of adding patients. There was a standard template, but units could address each planning domain in ways that best supported their needs and their journey. We realized that there are many groups at our academic medical center that shared many of the values and aspirations of the diversity, equity, and inclusion strategic plan. And we included them in our community of positive culture because this culture change is what we all desire. We all work together now to weave all of our overlapping principles together. This is our will of positive culture, and I encourage you to bring together groups from your institution who are overlapping in priorities to synergize your work. We realized that there were many great ideas throughout our academic medical center, and many of them said, you know, we have great ideas, but we just don't have the funding to do this or the time to do it. Since they came to us with that and stated that they don't have the resources to put together these innovations, we were able to secure funds from the dean to have diversity, equity, and inclusion mini grants of up to $5,000. These are awarded on a competitive basis, and they submit applications with a budget, and some of them get $5,000, but some of them only need $1,200, for example. They're awarded twice a year, and anyone at the academic medical center can apply. It can be a faculty member, a learner, a staff member, someone who works in environmental services, someone who works for food services. Anyone can apply for these. The most successful grants were ones that could be scaled up for the entire academic medical center and thus ultimately useful for the majority of the institution. And you can see some of the great grants that we did here. One was about transgender care videos, which I'll show you a slide of later. One was to help students learn Spanish for our free-run clinic. Numerous of them are for pipeline programs. We've had quite a few about managing microaggressions, and some from our gifts of art wanted more diverse books for our children's hospital. Around the same time that our Diverse Health Inclusion Strategic Plan was being initiated, I had the honor to begin leading the Office for Health Equity and Inclusion, also called OHEI. This is a picture of us in our virtual times. We started before the virtual times, but this is how we meet these days. One of the first things that I did when starting this office was to develop our vision and mission. And our vision is to create a world where every person feels valued and can thrive. And our mission is to honor the well-being, dignity, and individuality of all who work, learn, and heal at Michigan Medicine to champion diversity and inclusion for our patients, community, and society, and to diversify the next generation of physicians, nurses, health professionals, and scientists. Creating a diverse health inclusion vision and mission, or incorporating diverse health inclusion principles and priorities into your department or institution's vision and mission statements are important to help guide you in your work. We also put a lot of information on our website because most people Google things when they're interested in activities. And we wanted to create a central resource for all our diversity and inclusion work. We keep our news, events, toolkits, opportunities for training, our anti-racism work, and our resource groups on here. Community conversations are drop-in sessions that anyone can attend that often have discussions about current issues locally, nationally, and internationally. These community conversations start at twice a month and are now once a month, and have included many topics, including anti-Asian and Pacific Islander hate, healthcare inequities, anti-Black racism, intersectionality, veterans issues, disability issues, and wellness, to name a few. We have forums twice a year to celebrate the accomplishments of those doing the DI work and to share best practices, rejuvenate workers with inspirational speakers, and provide tools and professional development, much like what you're doing with your conference today. We feel this is important to kind of recenter us and refocus us, and to remind us, and to bring us together as a community. Also during these symposiums, which happen twice a year, are when we give out our diversity, equity, and inclusion mini-grants. It also gives us an opportunity to provide each other tools and provide best practices learned from each other. To help diversify the clinical pipeline, we have dedicated faculty members for each segment of the pipeline, from pre-meds, to medical students, to house officers, to faculty. And I must say that in many institutions that I go around and visit, house officers is a group that's not often catered to because they're transient. However, they are potentially our future faculty. At Michigan Medicine, 70% of our faculty come from our house officers, our residents, and fellows. And I imagine it's a large percentage of most academic medical center. And the faculty are also not attended to as much. However, we learned from talking to our faculty that if we want them to participate and them to mentor students and residents and pre-med students, that we also need to take care of their needs as well. So as is common, as you go up the national pipeline for diversity, the majority of the diversity goes down. So we're looking to increase the pipeline throughout. Each of the faculty who leads a segment in the pipeline has five domains to create action plans for diversity, equity, and inclusion success. And these are one, recruitment and retention, two, mentorship, sponsorship, and coaching, three, community building and networking, four, leadership and professional development, and five, wellness. We were thinking about the wellness even before the pandemic and the burnout because we feel that for our communities of color and marginalized communities and people have multiple intersecting identities, that wellness can be a big issue. Since we knew that our pipeline was dependent on fortifying the house officers and faculty because the numbers go down as you go up, we wanted to be innovative in programming to help us recruit to those areas. We looked to our strengths and one of our strengths was teaching. We learned that from our house officers that one of the things that brought them to Michigan was the quality of the education here. And we also realized that a lot of our faculty of color and residents of color also love to teach. So we married those two things together and developed something called SimFest or Simulation Festival at the Student National Medical Association meeting. This is a meeting that has the largest absolute number of underrepresented students attending annually. We bring over 50 faculty, staff, and learners who each bring their own simulation equipment depending on their specialties. And we engage with over 350 students. The experience is positive for both the learners because they get to learn about different specialties that Michigan values, diversity, and inclusion that they may want to apply to Michigan for future parts of their career. And you can see some of the data from our pre and post survey assessment of them. And also our Michigan Medicine faculty and staff learned that there was a lot of diversity out there that they were missing out on and a lot of talented individuals that they had no idea existed until they came to this meeting. So it was a beneficial situation for all. In this particular picture, you can see one of our breast radiologists teaching a medical student how to do a breast ultrasound on her simulation. Additionally, we started a new visiting clerkship to bring anyone interested in health equity, a large percentage of them were underrepresented, but not necessarily. We give them all stipends to offset expenses very similar to other visiting clerkships. We are also more intentional than some places and have the students come before the rotation starts on the Saturday or Sunday to, excuse me, bring them to a brunch where we intentionally build community with other underrepresented students and residents. We build a sense of belonging. We help them with teaching them how to navigate our culture and we break down the hidden curriculum, which is so important for them to feel comfortable. It's very distressing when you go to another academic medical center to do a visiting rotation and don't even know how to use the medical records or how to get around. So we try to build a community and help them navigate the system even before they stepped foot on campus. They also have mentorship within our office for health equity and inclusion, as well as within each department. So they're meeting with us at multiple times. And they also have to do a scholarly project on health equity. We feel that these activities help set these students apart from other students doing visiting clerkships and that it also sets Michigan Medicine apart where it's a place that values their advancement because of our intentional activities. We've been successful in matching many of them and over 22% of them have matched with us since we started the program about five years ago. And in 2020, which was the last time that we ran this program in person because of COVID, we matched a third of them, six out of the 18 who did the program matched with us. And this is Dr. Terrence Pleasant, and this is an old picture of him from when he was an intern, who was part of the first cohort of this visiting clerkship. He and two others have stayed on as fellows and ultimately will be faculty here at Michigan Medicine. So, so far, just from doing this program for five years, we've already gained three additional underrepresented faculty who would have never considered Michigan as a place to do residency or to live and work. Every year, we also have a health equity leadership weekend and we invite 50 prospective residents, you know, IE fourth year medical students to attend. We're very intentional about using these as recruitment ideas as well, because once you kind of show what you value, what your priorities are, like-minded people come to your programs and want to be a part of your institution. With this, we have a national speakers for our health equity leadership weekend. And our first, during our first weekend, we had Dr. Kamara Jones, who many of you may know is a national leader in the impacts of racism on health equity and other forms of health inequities. Since the pandemic, we've continued this program virtually with over 400 participants. When we had the weekend, it was over a day and a half. These days, we have it over four hours virtually. Hopefully, we'll go back to in the future. Hopefully, we'll go back in the future to being in person. All of these intentional efforts have more than doubled the percentage of underrepresented residents at Michigan Medicine in the past five years. We started at a very low number. However, we're one of the largest, if not the largest GME program in the country with 1,300 residents. We're now sitting at approximately 9.3% of the residents being underrepresented in medicine. And our goal is to keep on going until we're equal to the national average for this as well. We also developed things to help out with our faculty recruitment. So we developed and also revised already our faculty recruitment toolkit, which can be accessed online, which includes many resources and do's and don'ts for attracting diverse talent. It includes ways to write inclusive job search descriptions and building diverse search teams. It also has different videos and checklists that each team has to fill out. I get a report of these when they are filled out, and this is not a requirement for all levels down through chairs. We haven't yet gotten it down to the level below chairs for searches, but we hope to institute that soon. We also provide resources for advertising to attract diverse talent. This is one of the objectives in our faculty search toolkit. And we showcase things that we purchase as an institution, some that are free nationally, and some that we have been honored to receive from receiving certain national awards and some that they have to pay for. So these all give them an opportunity to reach a broader audience. And we give them a toolkit of how to access these and navigate the system, or they can contact us for help as well. As with many institutions, we've done unconscious bias training and we've trained probably close to 20,000 people here at Michigan Medicine. The trainings have been for various purposes, and we have one for search committees, and we're now developing unconscious bias trainings for healthcare equity and inequities, because this will be a requirement for all healthcare providers in the state of Michigan beginning in June of 2022. Since unconscious bias training is an awareness tool, we also teach bias mitigation tools, and ask that the participants commit to bias mitigating strategies. We follow up in four to six months with an automated email to check on their progress. We find that people who do the unconscious bias courses together as a team that works together have a shared language and experience and are more likely to hold each other accountable despite any power differentials. Keep in mind that doing an unconscious bias course does not resolve any one of biases. In fact, myself, after doing numerous courses, have the same biases, but we must always remind ourselves of how these biases impact our minds when important decisions are being made and slow down the process to make sure that we control for those biases. We also recommend doing short touch-ups periodically, and that's actually built into the Michigan, the state of Michigan requirement, because with renewal of every license, you need an hour of unconscious bias training for every year since your last renewal. Transitioning to healthcare equity, we developed a curriculum for house officers to understand healthcare disparities and allow house officers to study healthcare disparities within their own department through research projects, working with our quality improvement office. This was a collaboration between the Office for Health Equity and Inclusion, Graduate Medical Education, the Office for Patient Experience, and Quality Improvement. We were part of nine different GME programs to participate and the ACGME Pursuing Excellence Quality and Healthcare Disparities Collaborative. And we're really happy to have developed a curriculum where we teach about social determinants of health, cultural humility, and how racism and bias impact healthcare. We also had them, again, work with our quality department to examine outcomes within their own specialty by race, ethnicity, primary language, LGBTQ status, and other metrics. We did our pilot last year, and we're now in our second year, and we even have faculty auditing it as well. It's a great course, and you learn a lot every year. I tried to listen to as many lectures and I learned a lot myself. They have monthly lectures that talk about disparities in vulnerable populations. And many of these lessons learned are useful for how we engage with other faculty, staff, and learners in addition to patients. For example, there's a lecture about LGBTQ plus disparities and includes inclusive language and importance of preferred pronouns and preferred names. And it goes over a lot of the definitions and what to use and what to avoid. And with each vulnerable population that we talk about, we give them data on the specifics of the disparities. They also have to do a reflective writing after each session rooted in their cultural humility. The writing is less than a page long, so it's not too onerous because we know they're busy as learners and residents. Structural racism is a big component of the curriculum, and they all read Medical Apartheid, which is a really great book that unpacks how structural racism impacts the care of Black and other patients of color. This is a dense book and you can also get it on audio. There's also a study guide with questions about the book available online that's free that you can use to guide your discussions. And we use that study guide as well. I'll show you that in a second. Although we do these trainings for RGME residents and we do this as an institution, you can also scale this to your department or unit or institution, and there are numerous free resources online. For example, the National Collaborative for Improving the Clinical Learning Environment has an entire booklet online for doing quality improvement work for healthcare disparities. Also, the National Library of Medicine has PowerPoint slides, facilitator guides, and pre and post questions for health literacy, cultural humility, LGBTQ plus affirming care, social determinants of health, and other work. Dr. Kamara Jones, as I mentioned, is an international expert on healthcare disparities and the impact of structural racism. Many of her lectures are available online and they're available through YouTube and they're for free. And there are also numerous DI offerings available online. SPINT also has a free poverty simulator that is very informative on how low resource individuals fare in society and also what their healthcare needs. And Academic Life in Emergency Medicine has a great book discussion section with synopses, podcasts, and discussion questions to guide you in many of the diversity readings that you might have. Included is the study guide for medical apartheid as you see here. Transitioning to engagement and belonging, the inclusive part of diversity, equity, and inclusion, we started an opt-in email list for faculty to be a part of our faculty inclusion network. An email is sent twice a year for faculty asking them if they want to join. Over 25% of our faculty are members of the FIN, as we call it, and they receive all our emails and all of our opportunities because we know that we need to contact not just faculty of color or marginalized faculty, but also allies are so important. The faculty love working with students, so we use the faculty inclusion network as a mentorship opportunity to connect our Michigan Medicine faculty with our medical students for diversity, equity, and inclusion in a program we call MFANS. We have a program that we did for faculty pre-COVID that was, hopefully we'll resume it in the future, that's been very successful to hear the voices and help understand the obstacles to advancement for faculty. It's called MDINE, so it's called Michigan Diversity, Inclusion, Networking, Equity. And the reason why it's called MDINE is for Michigan Dine, because we're dining and we're actually having these discussions. And these are structured and unstructured dinners at a leader's house. This is at my house. It builds strong networks that would not happen through the everyday work environment because we're all running from one place to another. Allows for more open and frank conversations because of the intimate setting and not being in the hospital. And also we provide adult beverages and great food and that helps bring people along. Again, anyone can come to this. It's not just marginalized or underrepresented faculty. And again, we need allies to help hear the voices and help us also advance the work. It's important that once we diversify our faculty that we support them and help with their advancement. And so one of the things that we've committed to is providing funding for minority faculty development through two different programs through the AAMC, both the Minority Faculty Development Leadership Seminar and the Mid-Career Faculty Leadership Seminar. And these are for different levels of faculty. We sponsor up to three faculty to participate in each of them each year. Those faculty who have participated in this get mentorship and development and coaching from national leaders and get to be a part of a cohort of other faculty around the country at a similar level. And they all have stated that this development series was transformative for them and their development as faculty leaders. Here are three other belonging or inclusion for community building programs that we do that can be scaled to any number of people. We first started with the story of my name, which is a way that people can get together over lunch or in a formal setting or formal setting to talk about how their name came about. It could be from their first name, their last name, a name that was inherited, their nickname. And a lot of times people start to talk about their culture, their identity and the significance of their name where their family comes from. And another one is the story of my holiday. And this allows people to express the diversity of holidays that they celebrate. And even if they celebrate the same holiday, how they might celebrate them differently. I like these because they allow all people to participate, not just underrepresented or marginalized people. This helps bring us all together in an authentic way. It helps bring people and teams closer together because of each other's genuine curiosity and authentic sharing. Also, we started a program called Honest Conversations so that we can have panelists and webinars about different conversations that we feel that everyone needs to hear. This particular conversation was about code switching to increase the awareness that this happens on a day-to-day basis for marginalized individuals. And this was extremely well-received. There are also trainings to increase belonging and inclusion. And that includes one of our newest trainings on LGBTQIA plus inclusive language. And also, as I mentioned earlier, one of the winners of our first cohort of the RISC-Hack Inclusion Mini Grants was a video series that's available now as an optional training for everyone to teach caregivers, faculty, staff, and learners at Michigan Medicine about how to best take care of transgender patients. It also tells them how to update their preferred names and pronouns in our medical record system and how to address them and how to ask them about their pronouns and preferred names. These videos are not mandatory, but they've been highly well-received and appreciated because it really helps some people navigate some difficult conversations and engagements with transgender patients and makes it a lot easier. One action-oriented training is Stepping in for Respect, which is a two-hour bystander intervention training, which was developed at the University of Virginia. We are licensed to train, do the training for this. And this training helps promote and build respectful and professional relationships and helps individuals practice speaking up in instances of bias. So this is a form of bystander or ally training. And one of the most important things is to practice your responses to microaggressions or racism that you might see or other inequities you might see. There are multiple modules. There are a few modules in there for gender harassment, racial discrimination, and responding to biased patients. These are very well aligned with healthcare delivery and are not just your standard bystander intervention. And so we've had great success with rolling them out. To hear the voices of many groups, we instituted our resource groups. Many institutions have employee resource groups. Those went away at our institution decades ago. And as stated, employee resource groups were largely for employees. When we brought them back a few years ago, our resource groups are for everyone at Michigan Medicine, our faculty, staff, and learners, because we all are part of this working group. The purpose of these resource groups is to help bring people together as a community, to help identify some of the challenges and opportunities, and to give them an opportunity to bring these concerns and opportunities forward to our leadership so that we can create action plans on institutional level for more diverse and equitable and inclusive climate. We have, it looks like, eight resource groups right now, and they're listed there. There's a process for developing other resource groups. Our AAPI, or Asian American Pacific Islander resource group is our newest one. We can have other ones in the future, and there's an opportunity for them to come together as leaders of these resource groups to present to the health system leadership annually. In order to be successful in our DI work, we need metrics so that we can analyze how we're moving along and see if we're being successful. We created a dashboard to help us out with this. And the dashboard for our diversity and inclusion work has four components. One, demographics and trends of our workforce so you can evaluate how your workforce is doing compared to other departments at Michigan Medicine, compared to Ann Arbor, the state of Michigan and the country. Our second component is hiring and retention of our workforce by race, ethnicity, gender and age. You can see who's interviewing, who's being hired. Also, you can see who's leaving. You can also do some workforce planning as you can look by age and see who is likely to be retiring. The third component is the culture and climate assessment of each unit where we extract a lot of the data from our employee engagement, faculty engagement, and medical student as well as patient satisfaction surveys and we extract all the diversity questions and able to lay them out and compare them over time and also with other units. And then fourth is our perception of how the diversity and inclusion plan is working in each unit using a net promoter score similar to what you might get from a hotel or an airline asking you your satisfaction with your service there. This is our dashboard on culture and each unit can look at the data we extracted here from our employee engagement and faculty engagement surveys around diversity as in the left column in the middle column is respect and in the right hand side column is teamwork. You can see your trends over time. You can look at it by gender, by race, by multiple identities, and you can also compare it with other parts of the institution with the mean of the institution which is between the white part and the gray part and with other departments you can compare this. This is a tool that people can and units can track their team's success or their journey over time. As part of our anti-racism work and after the killings of George Floyd and the conversations of racism reached a peak in our country, we developed an anti-racism oversight committee. The way we started this was by engaging again our entire academic medical center. We sent out a survey to everyone at Michigan Medicine which is over 30,000 people asking them one single question. What actions can we do to be a more anti-racist academic medical center? We received thousands of responses and then coded them and these are the six priority areas that we got. Speak up and show solidarity, opportunities for conversation and a safe space to discuss issues, work with the communities we serve, education and training, diversify the workforce, advocacy and professional development. These six priority areas had subcommittees and they all developed action plans. We have developed those and now they are being linked to operational partners and beginning to do the work. You can do a similar type of survey in your department or your institution or your unit for any type of thing that you want to work with for DEI, you just have to have an expert who is good with coding. When we started our diversity and inclusion work, initially we had a lot of people volunteering to do the work and still we have some volunteers doing the DEI work and this became problematic because this was added work to most of our diversity, equity and inclusion leads. They weren't getting paid or time to do it, so this was contributing to the diversity tax and we know that women and people of color do a lot of the work in diversity, so we wanted to figure out how do we make this more equitable? Right before COVID started, I can't remember how long ago that was, we developed diversity, equity and inclusion associate chairs. Since diversity inclusion was a stated priority of the institution, one of the first things that I did after creating this group was to get them equal titles, pay, resources and a voice at their leadership tables for their departments to truly impact change. We were meeting twice a month initially, but now we meet once a month and we share best practices, we decrease silos, we keep drop boxes, a drop box of multiple resources that they all share because they're all doing amazing work individually and we work closely with the chairs and deans to advocate for DEI work. We completed our five-year diversity, equity and inclusion strategic plan this past October, just a month ago, which we are now calling DEI 1.0 and we are in the process of evaluating the work we've done, assessing the impact and re-engaging the constituents for opportunities moving forward in order to develop a plan for launching DEI 2.0 in one year. Now that we have a foundation, a common vocabulary, a better defined value of diversity and inclusion, we have the opportunity to build on DEI 1.0 to create DEI 2.0. Again, the DEI process is iterative, so we are continuously assessing and adjusting. For that, I'll close out and see if there are any questions and I'll stop sharing my screen. Thank you, Dr. Brown, that was very informative. I didn't realize the length and breadth of everything in Michigan Medicine and I just wanted to tell you, I think we've incorporated some of the faculty DEI questions in our faculty hiring as well. Happy if I have any questions. I realize that this is on an institutional level and, however, there are opportunities to do this at other institutions and many of these things can be broken down to your own departments or units. University of Michigan actually gave millions of dollars for this and we realized that not every institution might have those resources, but if you kind of think of it again as the business case of it, if we are able to put in resources for this, hopefully that will be multiplied in the future. I do see a question. Yes. Was there any resistance to the DEI efforts at first? There might have been resistance at first, but we didn't sense it. I imagine that when we were doing our focus groups, it was primarily people who were part of the choir. However, there are always some people who question, why is this for a certain person or is it for certain groups or advancing others and not me, and that was a great way to kind of talk to them and engage with them and let them know that this is for everyone. So some of the first questions that we asked were, what does the risk inclusion mean to you and what success look like to you and what would failure look like to you? After we've gone through the process and we've done different faculty engagement surveys and employee engagement surveys, we can see the resistance, or I don't know if it's resistance, but the people who are aligned with it and people who state that we might be doing too much in this area. So as many people who might be underrepresented or marginalized in our system who are saying we need to do more, there were majority people who were stating we need to do less or that they weren't being, they didn't see themselves in diversity, equity and inclusion. And so one of the things that we did notice is that there were sometimes straight white males who were Christians and, you know, no one talks about our issues. And so we use that information to develop our spirituality and religious research group to make sure that we're covering people of all backgrounds. And there wasn't necessarily resistance, but there are people who are like saying, I don't see myself in this because I'm a white male or white female or whatever. And so this is an opportunity for us in our DI 2.0 to be more intentional about incorporating them. In fact, the president said at the very beginning of our diversity, equity and inclusion work that we need to figure out how to engage the silent majority. I think I have another question, Dr. Brown. You mentioned you have required bias training. Is that for all staff or just people in leadership positions? So the bias training is only right now required for high level search committees. And that's anyone who's on the search committees. Starting in June of 2022, it's going to be required from the state, not just for Michigan Medicine, for anyone who's licensed by the state. So that would be nurses, physical therapists, social workers, physicians. And then there's also coming down the road, there is going to be a requirement for everyone in the clinical environment to have required bias training. And then there's a plan for also bystander training. Now I have a question from Dr. Shervin. Any thoughts for the sleep medicine field in particular? We have a pipeline challenge overall, and perhaps in particular with regard to DEI, in that we rely on people coming out of residency programs to come to sleep fellowships. The challenge is exacerbated for research-oriented sleep trainees. Do we work at early stages of training, hoping they will eventually choose sleep? Yeah, this is a great question, Dr. Shervin, and nice to see you or to see your writing. Yeah, we need to get people excited about this early. One of the things we learned at our simulation fest at the Student National Medical Center is that a lot of these diverse students had no idea that these career options existed. You know, one of the students who I met said that he suffered from sleep apnea as a child, this is African American male, and decided to go into otolaryngology, for example, because he suffered from sleep apnea and needed surgery. And so when you meet people early in their development, you get them excited about mentoring them and having them be a part of your research work. It's an opportunity to engage them for the long haul. When we're thinking about diversifying our workforce, we can't be thinking just about tomorrow or next year or the next five years, but we really need to be developing the pipeline for the next generation of sleep medicine doctors and fellows and research-oriented people. What people, a lot of times, underrepresented and people of color, they choose fields based on people who engage them, that got them excited about the work, and were mentors to them and sponsors. And, you know, I have a great sponsor who's a pediatric otolaryngologist, and without him, I would not be where I am today. Absolutely true. I think I had one question while I wait for other people to type. There's one in the chat, too, from, I don't know, by the way, Sameh Marcos, or Marcos, I'm sorry if I mispronounce Marcos, the name. Sorry if I mispronounce it. So the University of Michigan has a, the question is, what is the definition of diversity in Michigan? And so we define diversity very broadly. And so one of the things with the state of Michigan is that we have this Proposition 2 law that doesn't allow us to target any groups. So we don't define diversity as gender and race alone. So we define diversity as kind of the unique attributes and experiences and qualities of all individuals. And they are inclusive of race, gender, ability, you know, religion, perspective, thought, political party, and belief. So it really should include everyone at the university and not just people who are historically marginalized. And yet the challenge still exists of how to incorporate people in all their experiences and having them seem like they're a part of this. I think that we do a fairly good job, but we can still do better. I think there's one more question in the chat. How do you promote the collection of DEI data? Are they required questions? So I'm not sure, and maybe they can help direct me again. So there's DEI data collected from our faculty satisfaction survey, our staff satisfaction, employee engagement data, and also our medical student data. And we actually are able to put questions into the staff and the faculty one that are specific to diversity, equity, and inclusion. Some of them already exist if you are with certain companies like Press Ganey. Many of them have diversity questions there, but we like to have certain questions that we track over time. And then when they fill out those questions, we can evaluate the data by different demographics. And so to completely fill out the surveys, they are required questions. I'm not sure if that's what this person was getting at, but if there's a follow-up, I would appreciate them putting it in the Q&A again. Sorry, my dog wants to be a part of the conversation too. I know, you have to love Zoom nowadays. I'm trying to see if there's a follow-up in there. Don't see it as yet. I think the other question that sometimes people ask is why nowadays we treat medicine sometimes as a business model. And there's a lot of questions about like what is the return on investment? And what is your answer to those people? Like why is D&I so important to the business model? Or what is the return on investment to this? Mm-hmm. Yeah, it's a great question. And so there are many different returns on investment. One, we have data even from like one of the psychiatrists at Michigan did a great study on interns throughout the country with depression and suicidal ideation and all those things, and compared that by if they were the diversity of their residency programs. And there was a protective effect if there was more diversity and inclusion there. Also, we know from our data at Michigan Medicine that the more diverse each unit is and the more involved in their diversity efforts they are, the higher the employee engagement. You have more engaged employees, they're working harder. They're more excited to come to work. We also know that if you have more knowledge about diversity and inclusion, you're better able to take care of diverse patients, which is increasing health equity, which is decreasing patients returning to the emergency department or to clinic earlier because they don't understand or having complications or misunderstandings about their care because, for example, maybe it wasn't stated at a level they understand. Maybe a translator wasn't used. Maybe they didn't understand the risk. If we understand their social determinants of health, can we address their food insecurity if they have difficulty accessing meds? That actually saves us a lot or actually helps our academic medical center increase the amount of money that it keeps instead of that being given for other health care needs. Additionally, as we are trying to think about ways of navigating certain systems and attracting faculty, staff, and learners to our institution, having a culture of diversity and inclusion helps out with that. Nationally, we're at a staff crisis right now. Since COVID, there's a staff crisis all over the country. Younger individuals especially are looking for purpose-driven work that aligns with their values. Many of them appreciate diversity and inclusion, and this is more normal for them. As you're thinking about future generations of work, this is where they already are. We need to catch up to them. With that, I would like to wrap up today's session. Thank you so much, Dr. Brown, and thanks to everyone who participated today. Stay tuned for other upcoming webinars offered by the ASM on Sleep Medicine. Thank you for taking time from your busy schedule, and everyone have a great day. Thank you, Hassan. Enjoy your conference. Thank you. Bye-bye.

DEI initiatives

Michigan Medicine

academic medical center

diversity

equity

inclusion

healthcare systems

problem-solving

innovation