MODERN HEALTHCARE: Hello, Kou. How are you doing?

KOU THAO: Good. Glad to be here.

MODERN HEALTHCARE: Thank you so much for making the time, and thank you for being willing to share your insight on this topic. Before we get started with our discussion, I just want to share a couple of data points.

Between May 25th — the day George Floyd was murdered — and July 31, 2020, 90 of the year’s Fortune 100 companies made a public anti-racism statement, or a social media post, or did a press release. The second point is that, according to an analysis from Color Lines — a new site that is published by Race Forward, only 66% of those statements actually included the word “racism.” And few mentioned their own shortcomings or contributions to inequity. And then lastly, when it comes to follow through, according to the consulting firm Creative Investment Research, of the estimated $50 billion that U.S. companies pledged towards racial equity, only $250 million has been assigned to or spent on a specific program.

Raising our voices for racial justice and health equity

To battle racism, experts say make health equity a central principle

So, we’re talking about how healthcare organizations can make good on the diversity, equity, and inclusion goals that they set last year or the year before, and what should be the results that leaders in this space are looking for.

Let’s talk about you first, because I feel like you’re a good example of the people stepping into this space and figuring out what path they want to pursue. This past year, you accepted a position as the Director of the American Medical Association’s Embedding Equity initiatives. What do you see to be the top responsibilities of diversity, equity, and inclusion leaders right now?

KOU THAO: I’ll first just speak to what you shared and reflect on that, and tie that into this question. I am based in the Twin Cities, Minnesota, and so that is my backyard, that is my community. When we talk about George Floyd and his murder, and the uprising that resulted from that — and at the time, I was at the Minnesota Department of Health and I was Director of the Center for Health Equity there. The impact of that in the midst of the pandemic and trying to protect and slow the spread of COVID, protect our communities, it’s definitely impactful for me in terms of the resulting impact that that had on our communities and the way we do this work.

And so, as we talk about diversity, equity, and inclusion I think it’s so critical to name that. In the context of what’s happening in America — with the pandemic, with the racial uprisings — that this is so much more than these 3 words of diversity, equity, and inclusion. This touches all of us, regardless of our race or ethnicity. And this is tied to the legacy of our history as a country. Diversity, equity, and inclusion work — it really is centered in community and centered in a trauma-informed lens as we approach this work.

And in terms of your question about the responsibilities or the role of diversity, equity, and inclusion leaders, I think it’s important to distinguish and differentiate the various components of diversity, equity, and inclusion. In many industries, the diversity and inclusion components are often held by HR. The model that I came from — from the Department of Health in Minnesota and many government institutions across the country — we’ve seen the creation of these centers for health equity across the country. And the AMA recently formed our Center for Health Equity. We view this as really a true partnership between centers for health equity and our HR partners.

And our Center for Health Equity is really responsible for equity within systems change, within our internal processes and procedures across the enterprise — and is external facing. Which just differentiates that scope a little bit from what an HR DEI office may specifically focus on. In that sense, you’re talking about employee lifecycle, employee experience, and HR-specific policies, ADA compliance and such. So, I just want to name these distinctions because I think, institution to institution or sector by sector, it varies on how they’re structuring this. But in our configuration of the Center for Health equity and then our HR office of Diversity, Equity and Inclusion, it’s really vital to have these partners because there’s so much work to be done. And to be able to sculpt that out and have specific components led by different offices is very helpful.

MODERN HEALTHCARE: So, if you’re thinking about top responsibilities, it seems like this role in HR context is pretty well defined, right? They’re focused on recruitment, retention, employee lifecycle. For some of these leaders that are very new to this space — I feel like every time I’m on Linkedin, a company has hired or created a new position around diversity, equity, and inclusion, and a new person has been hired. What should their goals be?

KOU THAO: I think the first step is identifying what resources or supports you have available to you. Do you have a team? Do you have a budget? Was there prior work done around health or racial equity? Depending on the configuration that I talked about, are you situated in HR? Has there been an equity-specific office? Do you have an HR counterpart that you can work with? The first step is identifying the resources and supports. If you are in an institution where you are the one sole person responsible for DE&I across the institution, that could easily become a way that you’re set up for failure — if it’s just you and there’s no budget and no team.

MODERN HEALTHCARE: OK. Truth and reconciliation — I know that the AMA is very heavily focused on that. A lot of healthcare organizations have declared wanting to be more transparent about how they may have contributed to inequities, especially in access to healthcare. How much should healthcare organizations disclose about their contributions to health inequity and their contributions to health disparities? And how do you do that in a way that you don’t upset people who are already very uncomfortable with this?

KOU THAO: I think the first step is an institution needs to review and acknowledge their history and their track record regarding commitments to health equity or ways that they may have perpetuated inequities. And once you’ve done that review and analysis, from there it’s about identifying how your institution wants to address that. You may want to start with internal conversations and planning and identifying how and what you want to communicate out with stakeholders in the community. And the way that AMA is doing this is demonstrated through our recent release earlier this year of our strategic plan to address racial equity and health equity. And it’s a very detailed plan, it’s about 80 pages long.

MODERN HEALTHCARE: Yes.

KOU THAO: It’s a very powerful document in naming our commitment to a trauma-informed lens, in our commitment to truth and reconciliation. And in that, we do outline the many times in AMA’s history where maybe a decision was made and years or decades later, we came to the realization that that was a misstep. And that there needed to be a way to reconcile that and to be transparent about that, to own that — but also to identify the ways we’re going to make things right.

MODERN HEALTHCARE: That’s so key to just own it, do the research to understand how you may have contributed. And then like you said, most importantly is — what are the solutions, then?

So, let’s say a health system has gone through that process. If they’re really dedicated to addressing health disparities, what types of initiatives should they be focused on?

KOU THAO: The way that I think about this work — how AMA has been thinking about this work — is we draw from a framework created by the Government Alliance for Racial Equity, or GARE, which is a part of Race Forward that you mentioned earlier. And what they say is that in order to visualize health equity within your institution, you need to be able to normalize it, organize around it, and then operationalize it. And those three components of normalizing, organizing, and operationalizing it break down well the ways that you can begin thinking about the initiatives that you should focus on.

The GARE website has a ton of resources on there that are available. You know, it’s the Government Alliance for Racial Equity, so the bulk of the work has been within government institutions, but the lessons and the approaches can be applied to any organization. And as I think about that, a key part of the work is to have both an inside and outside approach. And what I mean by that is you really cannot commit to doing external work outside of your organization on health disparities without getting your house in order.

MODERN HEALTHCARE: That’s right.

KOU THAO: Part of that is also thinking about, is equity a core value to your institution? And if so, how are you living out your values? And I would say lastly, ensuring that the community or your stakeholders are engaged in this process to identify where there may be gaps internally or externally.

MODERN HEALTHCARE: So, you’re newish in your role, I would say. What should new DE&I leaders focus on during their first year? Should it be just doing this review and performance tracking, and listening and discovery? Or should they be doing something else? What should that first year look like?

KOU THAO: The first year, it’s really critical to have an assessment of the landscape within your institution, and within the community and the field. And so the first year is critical for learning, for observation and for gathering input or data to know the baseline of where you currently are. And then from there, you can work towards the creation of equity work plans or action plans. But a lot of this work is about building trust and building a relationship. And so the first year would be meeting with the key stakeholders within the institution, meeting with leadership — different directors or or VPs — and meeting with staff at all levels to get a full 360 view of what’s currently happening and what the challenges have been.

MODERN HEALTHCARE: You mentioned earlier that if you have been given this role to focus on diversity, equity, and inclusion — but you’ve not been given a staff, a budget, an office, business cards — it’s really just a title, which we have seen before. How should you plan to structure a strong team? For example, we know what a strong marketing team looks like. But what does a healthy, effective diversity, equity, and inclusion team look like?

KOU THAO: I refer back to the GARE framework — the normalize, organize, and operationalize approach. And that’s actually how I’ve used — I’ve used this framework to build out my team and the programmatic areas that we’re focused on. And so under normalize, this is really about normalizing the conversation, normalizing terminology. For most people, the terms that we use in the field and in DE&I work are unfamiliar, and so this requires strong facilitation skills — either training skills for your staff or the ability to bring in external consultants to provide training.

But oftentimes, what I do and what my team does is we hold space for staff. Because as you open up this conversation and this work within your institutions, the communities who have been most oppressed and impacted by inequities that are within your institution have been experiencing that every single day. And it’s critical to hold space for those staff to be able to come and share and learn about what you’re doing because in many instances as well, organizations have tried to do this before, or it’s started and then stopped. And many staff feel really jaded by prior attempts and are really hesitant to believe that true transformation can occur because they haven’t experienced that. So, that first piece around having the staff and the skills to be able to help normalize this within the institution is critical.

For that second component of organizing, it’s helpful to have staff with the skills or the experience from organizing work, whether that’s community organizing or public policy and advocacy work. But if you have the skills and the knowledge for how to do systems change — how to navigate power or influence, how to identify the power levers within your institution or the key influencers, or to understand decision-making processes — is critical, so that then you can embed equity within each of these spheres, if they’re not already there.

And then the third piece around operationalizing equity is really the need to have a strong evaluation plan, to have assessment tools, and also to be creative and flexible about how you approach this. And the measurement — the evaluation is critical to be able to show progress, not just externally but to your teams within the institution. And often, this requires a mentality of being willing to fail forward, and what I mean by that is being willing to take informed risks. And learn from them collectively to share that learning out, and to practice these tools and the language and the assessments. I often say that it’s like working out, so if you go to the gym every day for a month and then you stop, you know what happens, right?

MODERN HEALTHCARE: Right.

KOU THAO: And so, we often view ourselves as coaches. Internally, we’re coaching staff, we’re helping them to practice their equity muscles, because we have to continually practice — use those muscles.

MODERN HEALTHCARE: I love that analogy of thinking of DE&I leaders as coaches for the rest of the organization. That is absolutely spot on.

That seems like the work of getting your own house in order: Making sure you have a strong team, making sure you’re normalizing this conversation internally. But once it’s time to reach out — and like you mentioned, building partnerships and talking about community — how should DE&I efforts look then when they want to include the communities that they serve?

KOU THAO: Yes. I think this piece is critical. And in our institutions as we engage in this work, we must center communities who have been most impacted. And we have to ensure that there are feedback loops, so it’s not a transactional engagement — but it’s really relational, and it’s building trust and community across institutions, across communities. And it’s also about accountability. And so it’s helpful to think about, what are our two-way mechanisms for feedback, two-way communication? So that as we’re identifying what we’re trying to do internally — as we’re engaging community for feedback — that it’s not patronizing, that we’re not tokenizing, and that we’re not over promising or committing to things that we cannot do. And it’s helpful to be transparent with internal processes — if there are delays in equity plans that we’ve put together, challenges that we may have — to be able to share that with the community. And also, if you’re engaging communities in your assessment processes or feedback processes, you need to provide compensation to communities.

MODERN HEALTHCARE: Don’t ask for free insight. You wouldn’t do that for other folks, right?

KOU THAO: Exactly.

MODERN HEALTHCARE: Let’s talk about results, because you mentioned evaluation, you mentioned assessing and tracking performance. What results are realistic for DE&I leaders to expect to achieve in their first year, third year, and then maybe five years into the job? Do you have any tips on how they can outline these results, and then how they can actually get there?

KOU THAO: Yes. And as I think about this question, I think it’s important to note that when we think about culture change within institutions, really we’re talking about change that will take at least five to 10 years. So, this is a marathon and it’s not a sprint, although many of us feel immense pressure — given what’s happening in society today — to solve problems tomorrow. It’s never going to happen that quickly, and so we have to think about the long game and also about how we’re resourcing ourselves.

If you are the leader of DEI work within your institution, particularly if you are the only one, then positioning yourself or resourcing yourself so that you’re not set up to fail. And you’re not burning yourself out or sacrificing yourself in these efforts to get this work moving forward. So, I think that’s about being optimistic, but also being realistic. You know, as I think about these timelines of you know one, three, or five years, for sure as I mentioned earlier, the first year should be about assessment, learning, observation, gathering input and data. Building relationships with your colleagues and key stakeholders within the institution. And that should provide you with the foundation to be able to work towards the creation of an equity work plan or an equity action plan, which should outline what you’ve observed. Where the gaps are, what processes or systems need to be further assessed or reevaluated or adjusted, to be more equitable. And then, you could work towards the creation of a three- to five-year work plan.

And in that, you’re setting out your benchmarks for measurement and progress, and how you’re going to communicate that out. And then, the five-year mark, it’s really dependent on the goals that your organization has set within the equity plan. But I would say it’s critical to continue having evaluation, communication, and transparency, so that you’re building a relationship and trust as you go.

MODERN HEALTHCARE: Yeah. I think you’re absolutely right: Be realistic, do the assessment piece first, so at least you know what kind of mud you’re stepping in.

KOU THAO: Right.

MODERN HEALTHCARE: Absolutely. Thank you so much for your time. Thank you so much for this insight.

KOU THAO: Yes. Happy to be here and thank you so much for having me.

OUTRO COMMENTS: Thank you, Kou Thao, for joining me on the podcast to share your insights on what Diversity, Equity, and Inclusion leaders should be focusing on in the next year.

Again, I’m your host, Kadesha Smith, CEO of CareContent. We help health systems reach their target audiences through digital marketing that focuses on the right content.

Look for more episodes of Next Up at modernhealthcare.com/podcasts, or subscribe at Apple Podcasts, Google Podcasts, or your preferred podcatcher. If you’ve been enjoying Next Up, please go ahead and leave us a review on your preferred podcatcher as well. Thank you again for listening.