During this segment, we will discuss creating a culture of quality in the GI unit. Dr. Day will start us off with a talk on diversity, equity, and inclusion in GI. This is a new talk for this course, and we are very, very excited about its introduction. Luke, audience is yours. Welcome back from your break. Again, I hope all of you have been enjoying today's course and have been gaining helpful information to take back to and apply within your endoscopy units. The focus of the next presentation is to talk about diversity, equity, and inclusion in GI and in health care. This is a broad topic, and my goal today is to focus on several key aspects of it. I hope that you leave today's session with some strategies about how you can improve diversity, equity, and inclusion within your endoscopy units. Also, this is a topic that is very personal to me and is an area that I'm quite passionate about. There are four key objectives I want to accomplish by the end of today's presentation. First, I'll start by providing some definitions of diversity, equity, and inclusion. Second, I'll give an overview of where we are in GI in terms of diversity. Third, I'll highlight and discuss the importance and benefits of diversity, equity, and inclusion in health care. And I'll conclude by going into some detail about effective improvement strategies for improving and sustaining diversity, equity, and inclusion within GI and the health care workforce. Let's start with our first objective, and that is, how do we define diversity? There are many definitions of diversity, but there are two I want to highlight as I believe these definitions capture the essence of diversity. One definition is that diversity encompasses acceptance and respect. It is the understanding that everyone is unique and it recognizes our individual differences. An equally strong definition is that diversity is the goal to create a culture where individual differences are respected and all employees are treated equally and receive the same opportunities for growth and advancement. Both these definitions highlight key areas of diversity, appreciating our differences, offering respect, and ensuring equality and equity for everyone. Now, how do we define equity? To understand equity, it is important to distinguish it from equality. Equality implies that each individual or unit should receive the same. In health care, this would translate to all individuals paying the same amount for the same health care service or receiving the same amount of information. For example, in the picture on the left, everyone has a box in which they can stand to watch the baseball game, making it equal that everyone has received a box and opportunity to view the game. However, this doesn't necessarily level the playing field as some people may be shorter and some people may not be able to stand on the box. On the other hand, equity focuses on eliminating differences between groups when those differences can be addressed. In health care, this would translate to sliding payment scales for the same health service or differing amounts of information based on prior knowledge and access to information. Moving to the right side of the picture, equity ensures that everyone can view the baseball game at the same level, but this may have to be accomplished through various methods. It is important to recognize that as its definition states, diversity, understanding everyone is unique in recognizing our differences. We know that there are many facets of diversity. They include race and ethnicity, gender, socioeconomic status, national origin, sexual orientation, gender identity, geographic location, physical ability and religion. My next objective is to provide an overview of diversity within the field of gastroenterology. Now, before examining diversity in GI, I want to take a step back and look at health care and the patients for whom we are caring. Our patient population, United States population, is constantly changing. Perhaps the greatest change we will ever see will be in the next 30 years. These two bar graphs reflect this change of our population based on race and ethnicity. Specifically, by the year 2050, over half of the entire United States population will be non-Caucasian. The reason I show this slide is that the landscape of the U.S. population is quickly changing and that as a result, this has major impacts on health care. And it also reflects that we need to have a workforce that mirrors the population for whom we care. Turning our attention back to gastroenterology, I want to outline the diversity pipeline for the health care field and specifically look at gastroenterology and focus on race and ethnicity. At the beginning of the pipeline, in the current U.S. population, individuals who are underrepresented in medicine represent about 35 percent of the population, with this number increasing to over 50 percent by 2050. As we move down the pipeline, especially as we move to medical school, individuals who are underrepresented in medicine represent only 11 percent of graduating students. Within internal medicine residency programs, this number drops to 9 percent. And within GI fellowship programs, only 10 percent of GI classes have fellows who are from an underrepresented background. And when we look at the end of the pipeline, in terms of practicing gastroenterologists, we see that only 9 percent of practicing gastroenterologists in the United States are from an underrepresented background. We see several things from this leaky diversity pipeline. One, there is a significant bottleneck between the population and entrance into medical school with regards to diversity. Two, by having such a small number of individuals who are underrepresented in medicine graduating from medical school, this has downstream effects for all specialties in medicine, including GI. And three, the health care field and GI does not reflect the population for whom it cares for, and much more work needs to be done to improve diversity within our field. I want to highlight two areas in GI that illustrate a lack of diversity within our field. That is race and ethnicity and gender. On the last slide, I discussed how racial and ethnic diversity is lacking among GI providers. And this graph here on the left illustrates this point, highlighting that nearly two-thirds of GI providers within the United States are Caucasian. The graph on the right shows that there is a lack of gender diversity within GI, with again, nearly two-thirds of gastroenterologists being male. And unfortunately, these numbers, both with regards to race, ethnicity, and gender, have remained unchanged for the last three decades. Together, all of this data highlights that more work is needed to improve diversity, not only in health care, but within our own field of gastroenterology. Why is it important to have a diverse health care workforce? There are a number of reasons for having a more diverse health care workforce. The first is individuals from diverse backgrounds are more likely to work in underserved communities. Second, having a diverse health care workforce helps to exchange cultural customs, values, and behaviors, which help in patient communication, compliance, and adherence to provider recommendations. Third, diverse teams bring different points of view to the workplace and scholarly activities, which helps to lead to more innovation and productivity in organizations. Fourth, individuals from diverse backgrounds are more likely to perform research that addresses health care disparities. And finally, we see a diverse workforce can serve as mentors to younger physicians and students. Overall, diversity is key to a thriving, flourishing, and successful organization in terms of innovation, productivity, and profitability for the institution. Moving on to our final objective. How can your organization and your endoscopy community improve diversity, equity, and inclusion? There are many approaches and frameworks one can take for this important journey. To be successful, I recommend that you follow a proven and systematic approach and framework. Here, I highlight the cultural change model, which provides a step-wise approach on how an organization can begin to take with respect to improving diversity in their organization. There are six critical steps to this model that start with addressing your leadership team, learning from your leadership team, and building a strong team. These steps start with addressing your leadership team, leveraging data on your organization, building and acting upon a plan and interventions, and sustaining and adapting these interventions over time. Note that this framework is a continuum for organizations, with organizations moving between each step, but at times they may have to move back and examine earlier steps, very much emphasizing that this is a continuous journey for organizations. It's important for organizations to understand that improving diversity, equity, and inclusion is a continuous journey for them. I highlight an outline here to help organizations navigate this journey, recognizing that we each may be at different starting points. At the beginning, there is the building phase, which involves identifying areas where the organization and individuals need to recognize that they must improve. Most organizations are at this starting phase, and many may never move past it. The next phase is immersion. Here, organizations and individuals take what you've learned about the organization or themselves and make concerted efforts and implement interventions to improve. The final and most difficult phase is accelerating. In this phase, one takes their learning and experiences and then begins to build and sustain their diversity efforts. Building on this framework, what are some specific strategies that one can use to improve diversity, equity, and inclusion in their organization? I illustrate some key areas to consider when thinking about improving diversity within your institution. Note that these strategies are in a circular pattern. This is how you should approach this work. Again, it's a continuous stepwise process. Key strategies for improving diversity, equity, and inclusion are eliminating bias in the hiring and advancement process, having mentorship programs in place, providing education and training to staff, changing the institutional culture, and lastly, celebrating diversity within the institution. Let's explore some of these strategies a little bit more. One of the first strategies in improving diversity in the workforce is to ensure that you have a system for both hiring and advancing diversity at every level in your organization. The pictures here highlight how barriers can exist for individuals applying for jobs within an organization. There is a large body of research that shows that the hiring process is unfair and full of bias. For example, a candidate's name alone has been shown to immediately cause bias for people who are reviewing them, or even when someone showing up for an audition in an orchestra or a symphony can also be filled with bias. Organizations have to strive to eliminate these biases in the hiring and promotion process and examine ways to remove these barriers. For this, I encourage groups to consider rewriting job descriptions so they are gender neutral, create a blind system of reviewing resumes so that people don't see demographic characteristics of applying candidates, and also it's essential to set diversity goals as an organization, which will help you track your progress over time. As part of this strategy, institutions must strive to uncover and remove unconscious bias. We know that our attitudes or stereotypes affect our understanding, actions, and decisions in an unconscious manner. Also, there is a direct causal link between unconscious bias and an organization's culture and success. And also, we see that decision-making capacity can be riddled with unconscious bias. Consequently, it is crucial to have strategies to address unconscious bias in the workplace, which include being aware and understanding that it's present, assessing and asking how it impacts the workplace, and finally, leveraging tools for counteracting such bias. Part of the building phase that I discussed earlier is to begin to use data to drive cultural change within your institution. There are several modalities by which this can be accomplished and include conducting disparities assessment, stratifying data within employee engagement surveys, conducting staff focus groups, having a newsletter or town halls, and empowering either an equity champion or an equity council within your organization. Critical to having a diverse organization is to critically evaluate your executive and leadership teams. Our leadership teams must be diverse, and leaders need to take explicit and public accountability. Finally, we must create space where microaggressions are addressed. Employees must feel respected and valued. During the emerging phase, we need to foster a company culture where every voice is welcomed, heard, and respected. There are several interventions that can help in this area. One is to utilize evidence-based research. This is a tool that can be used to better understand the work that is being done. One is to utilize employee orientation, staff meetings, and leadership retreats. Next is to use or offer diversity training. This can help the organization raise awareness of concepts related to diversity and inclusion, creates a space for diverse perspectives, and promotes workplace sensitivity. And it does so by increasing awareness about diversity, reducing biases and stereotypes, and changing behaviors. Organizations can consider using simulation and clinical case studies. Importantly, panel discussions with community members to discuss their experiences in healthcare can be incredibly powerful. And finally, establishing partnerships with agencies that serve your community can also help in improving diversity and inclusion. As part of accelerating your organization on their diversity journey, or really sustaining the work, it's essential that you have mentorship and programs in place to help recruit new team members, as well as grow, develop, and support current team members. There are several successful components of a thriving mentorship program, and include being able to work with a diverse team. Encouraging mentors to actively seek out and learn the background of their mentees and vice versa. It's essential to protect mentorship time. And lastly, we need to track and measure the program results. In particular, we should gauge the program by measuring promotions, retention rates, and advancement statistics. Finally, it's important that we celebrate diversity at work. There are many ways this can be done. You can develop a multicultural calendar, or dedicate a bulletin board or an entire wall to promoting cultural diversity in the workplace. Employees can share pictures or information on this board that may be useful to them. And finally, it's important that we celebrate diversity at work. You can develop a bulletin board or an entire wall to promoting cultural diversity in the workplace. Employees can share pictures or information on this board that promote their culture, background, or lifestyle. They can also post information about an upcoming holiday, including its background and what it means to them. We also want to make sure we encourage educational opportunities, such as diversity and cultural sensitivity training. We must invest in employee diversity training, and we must support advancement opportunities for our staff. In summary, we covered a number of critically important topics on diversity, equity, and inclusion. Diversity is a range of human differences, and is about empowering people by respecting and appreciating what makes them different. We saw that the demographics of the United States are rapidly changing. However, the healthcare workforce, and specifically GI, does not mirror or reflect this change. We also see that there are a number of important benefits to patients, providers, medical teams, healthcare systems, and future providers for having a diverse healthcare workforce. Also, we note that improving diversity within an organization and workforce requires the entire team and is a continuous journey. Key to this journey is doing an assessment and gathering data on your organization, evaluating your leadership teams, changing the institutional culture to focus on listening, appreciation, and celebration, and supporting mentorship programs. There are a variety of strategies I outlined that can improve diversity, equity, and inclusion within GI and your organization. And finally, organizations should not look at diversity as just a point in time for the organization, but rather as an evolving process of learning, adjusting, reflecting, and leading.

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