NASHVILLE, Tenn.—Diversity, equity and inclusion (DEI) programs have come under fire since President Donald Trump took office in January.
Trump released a slew of executive orders that rolled back DEI programs in the federal government. Trump’s department of health has turned away from the health equity goals set by the Biden administration.
Myriad private and public sector organizations responded by rolling back DEI initiatives this year for fear of losing grant funds or government contracts or simply to curry favor with the administration.
Two healthcare organizations, Lyra Health and Texas Health Action, have maintained DEI practices in their organizations. While company leaders see more apprehension and scrutiny about the direction of DEI strategies, even internally, they have continued prioritizing diverse perspectives in hiring, distributing DEI-related content and supporting employees with DEI programs.
They believe doing so not only improves the culture of their organizations, but it also helps build trust with patients and improve patient outcomes, executives told Senior Writer Anastassia Gliadkovskaya during a panel at the Fierce Health Payer Summit earlier this month.
Lyra Health is a comprehensive mental health benefit for health plans, employers and other payers. Andrea Holman, Ph.D., is the senior manager for DEI and belonging for workforce transformation at Lyra.
Lyra aims to break down barriers to mental health treatment for all groups of people, Holman explained on the panel. Research has demonstrated ongoing disparities in access to healthcare among racial and economic groups.
Lyra employs a diverse set of healthcare providers so that patients can see themselves represented by their providers. Doing so builds trust in the treatment process and helps folks stay in treatment longer, she noted.
“Culturally responsive care, then, is a very foundational part of mental health benefits … that's going to help bridge that trust gap, because trust is the biggest predictor of treatment outcome,” Holman said.
Christopher Hamilton is the CEO of Texas Health Action, which is dedicated to culturally affirming care for LGBTQIA+ individuals and people impacted by HIV.
Hamilton explained a similar experience for LGBTQIA+ individuals in Texas who can face stigma for their sexual orientations and gender identities—the stigma compounds when those individuals seek testing and treatment for sexually transmitted diseases like HIV.
“Part of our mission includes, very explicitly, creating a safe and supportive environment for our patients, because so many of whom we are taking care of are from marginalized communities, and if we don't create that space and safety, they're not going to come back,” Hamilton said. “They're not going to engage with us.”
Hamilton stressed the importance of disaggregating data in order to understand the situations of small communities and specific individuals. For example, Hamilton said that Texas Health Action has a 95% rate of viral suppression of HIV. He said it's important to look closely at the 5% to determine if there is a group who is not being served well.
“We have been able to make a staff that is very reflective of our patient population,” Hamilton said. “I think that has led to trust. What we do can be very unnerving for people. Even just a simple STI test, something that can be treated with an antibiotic, there's a lot of shame, there's a lot of stigma that goes into that, let alone people being worried about HIV or a diagnosis of HIV.”
Lyra and Texas Health Action also engage in DEI practices for the benefit of their own workforce. Holman explained instances of her providers feeling unsafe because of their identities.
“When you peel back those letters and those acronyms, it boils down to safety, to me, and difference,” Holman said. “So not all humans have the same life and life experiences and histories and dangers. I believe that people should feel safe, psychologically, physically at work. You shouldn't come there and leave worse than when you came. And I think that intentional efforts towards inclusion and belonging help to that.”
Holman said that the politicization of the acronym obscures the benefits of diversity, which are richness and efficiency. During the Biden era, Holman had more leeway to create DEI-related content for the organization. Now, she faces some hesitancy.
“I had a bit of a carte blanche to make the content that I wanted to make about the populations that I wanted to make,” Holman said. “I had to pretty much do things without really thinking … as long as it was research-backed and followed the science and those types of things. And I think this year, I have experienced more questions and, like, apprehension and fear from different people.”
Gliadkovskaya noted that healthcare organizations have started to consolidate DEI departments or phase out Chief DEI Officers post-COVID. She asked the panelists if having a dedicated leadership position for diversity was important.
Holman said that the title matters less than the actions of the organization. She discussed how executives are often “afraid of the misstep,” or doing the wrong thing in the name of DEI, and so choose not to take action when adverse events involving race or sexuality arise. She argued against this approach, saying that a genuine attempt to engage with the subject and employees shouldn’t result in backlash for the executive.
Hamilton said he ultimately made the decision to not hire a chief diversity officer after the death of George Floyd in 2020, even though some of his staff were calling on him to do so.
“I very seriously thought about that … I've been at a large Catholic hospital system where we had a chief diversity officer, but I don't know that I could have ever identified an initiative that went and did something differently to address disproportionate health impacts actually taking place … And so I went back to some of our staff and said, 'I'm not doing that, because I've seen how this works in a lot of places'.”
Instead, Texas Health Action took steps such as reforming its hiring practices to reach out to disadvantaged communities. Hamilton said they reviewed their job listings and removed the college degree requirement for roles that could be performed with a lower level of education, such as a community health advocate. They also began to think about where they were advertising the job postings and redirected them to engage more communities.