6

Inclusive Excellence and Leadership

To set the context for the next session, planning committee co-chair André Churchwell, M.D. (Vanderbilt University) shared a definition of inclusive excellence developed by the Office of Diversity and Inclusion at the College of William and Mary:

Dr. Churchwell elaborated that inclusive excellence creates a shared narrative across the organization, from top to bottom, as part of the ethos of a school. Moreover, because academic medical centers are engines of the economy, they can have an effect on inclusive excellence in their communities. According to data from the Association of American Medical Colleges, he noted, medical schools that are members of the Association of American Medical Colleges supported more than 7.1 direct and indirect jobs in the United States and contribute $728 billion annually to the gross domestic product (AAMC, 2022). The average school provides $148 million in community benefit. Inclusive leaders show what can be done with that power. However, he also noted the paucity of diverse leadership among these institutions. Of the top 20 hospitals rated by U.S. News & World Report, men lead 88 percent of them, and whites lead a similar percentage.

He noted that the four Black leaders of major medical institutions who participated in the workshop panel incorporate inclusive leadership in what they do every day. He asked each to share which key events in their lives shaped them for leadership, what they have done inside their institutions to promote inclusive excellence, and how they have used their institution’s resources to invest in and build community-based programs to enhance the success of Black male and female students. The presenters were Robert S. D. Higgins, M.D. (Brigham and Women’s Hospital), Talmadge E. King, Jr., M.D. (University of California, San Francisco

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¹ See https://www.wm.edu/offices/diversity/inclusive-excellence/index.php.

[UCSF]), Deborah Deas, M.D., M.P.H. (University of California, Riverside), and Keith Churchwell, M.D. (Yale New Haven Hospital).

LEADERS’ JOURNEYS

Robert Higgins, M.D., M.H.S.A.

Dr. Higgins shared his journey to leadership. His father was a doctor who, after medical school at Meharry Medical College and service in the U.S. Army Reserve in California, opened a practice in Charleston, South Carolina. He was killed in a car accident, leaving his widow to raise three young sons. The family moved to upstate New York to live with grandparents. The journey was difficult, he acknowledged, but the foundation of support from extended family launched him and his brothers to Ivy League institutions and careers in medicine, business, and law.

Dr. Higgins specialized in cardiovascular and cardiothoracic surgery at the University of Pittsburgh, Yale, and other institutions. His experience in building successful programs and collaborative teams led to his current position at Brigham and Women’s. He expanded his horizons and learned new skills, including to earn a master’s degree in health administration focused on management, finance, and operations. As associate dean for diversity, equity, and inclusion (DEI) and faculty development at Johns Hopkins University School of Medicine, he felt he had a great opportunity to change the landscape, he said. He helped develop the Johns Hopkins School of Medicine Diversity and Inclusion Mission Statement: “to recruit, promote, retain, and engage those underrepresented in medicine, science, nursing, and healthcare administration so that we can achieve health equity for the most vulnerable populations.”² Mentorship and sponsorship are critical to that mission, he stressed. Pipeline programs that start in elementary school provide basic reading and writing skills that are otherwise hard in an underresourced public school system.

As president of Brigham and Women’s Hospital, he is involved in clinical training and research. “We also have a strong community mission in Boston communities that need support,” he continued. The goal is to promote a vibrant, diverse, and inclusive professional community where every person thrives. He stressed the need to do more than just say these words but instead to put money behind them. A 5-year mentored career develop-

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² See https://www.hopkinsmedicine.org/diversity.

ment program, the Minority Faculty Career Development Award, has been expanded from two awardees to five annually. First awarded in 1996, the award has a 65 percent retention rate. He noted that the recipients, who are diverse professionals with exceptional education and skills, are ripe for recruitment from other places, so it is important to retain them or at least understand why they leave. He concluded:

Talmadge E. King, Jr., M.D.

Dr. King grew up in Darien, Georgia, as the oldest of five children, all of whom graduated from college. His father was an electronics repairman and policeman, and his mother was a teacher. His path went from a small town to undergraduate school in Minnesota, Harvard Medical School, and a residency at Emory University Affiliated Hospitals. He went to medical school on the advice of a mentor in college; as he said, “an encouraging word at the right time” can change one’s direction. He had specialty training at the University of Colorado and stayed there as a physician-scientist. Becoming the chief of medicine at San Francisco General Hospital was taking a chance on something new, he related. Since 2015, he has been dean at UCSF.

When he began as dean, he developed a comprehensive 5-year program to make USCF the most diverse, equitable, and inclusive academic medical system in the country. Six work groups, led by faculty and staff, were formed: (1) diversity in leadership; (2) recruitment, retention, and climate; (3) pipeline and outreach; (4) clinical health equity; (5) research action group for equity; and (6) learning environment.

A few results of the robust program from 2015 to 2020 are that half of the department chairs were turned over and 42 percent of the positions were filled by women or underrepresented in medicine (UiM) appointees. Across all of these positions, 29 percent are women or UiM. The appointment process was changed to become more equitable because women and UiM candidates were rarely considered for chair positions. Now all committees

must be composed of at least 50 percent women or UiM. Also, each department had to conduct an open search process for its leadership roles. After changing the composition of endowed chair appointment committees, the number of females named to endowed chairs also rose dramatically.

Dr. King reported that this effort laid important groundwork and the school is now working on “2.0.” Faculty training is conducted around DEI and allyship. Student and resident recruitment processes are also being examined, with increased scholarships and holistic reviews. A diversity “second look” program was instituted to invite accepted students to visit campus. The campaign led to more acceptances by all students, including UiM. Dr. King added that 38 percent of residents are now UiM.

UCSF has made many investments in the community, Dr. King said, such as the John A. Watson Faculty Scholars Program. Eight scholars receive financial support and mentorship, and they develop a sense of community with support to get their career launched.

Deborah Deas, M.D., M.P.H.

Dr. Deas echoed previous speakers that her family shaped her path as a leader. She was born and raised on a farm in rural South Carolina. Her parents were not able to continue education beyond eighth grade but became change agents in the community and reinforced to their children to “lift as we climb.” She attended the College of Charleston as an undergraduate and earned a master’s degree in public health from the University of South Carolina before attending medical school. She was 28 and a parent when she entered medical school and went on to complete a residency in psychiatry, with a specialty in child and adolescent psychiatry and addiction psychiatry.

When Dr. Deas recognized she needed formal leadership training, she participated in Executive Leadership in Academic Medicine, a program that trains women in medicine and other health careers to excel. She said she benefited from mentors and sponsors who have opened doors for her and recommended her for “spaces that aligned with my values.” She has “always valued the collective wisdom of different voices,” and noticed how many voices are missing. “I knew it was important that the missing voices be heard,” she said, recalling that she was 2 of 165 students of color during her training. Yet, “I had the audacity to think beyond the status quo.”

After her residency program and fellowship, Dr. Deas worked at the Medical University of South Carolina, where she launched research and

leadership programs. She was interim dean and was then recruited by the University of California, Riverside.

Dr. Deas described three ways that she is promoting inclusive excellence as an institutional leader. First, DEI is being integrated into the fabric of the institution in a strategic and intentional way. DEI goals serve as overarching goals for all departments and units, and they are evaluated on an ongoing basis, which she termed “DEI continuous quality improvement.” An Office of Strategic Initiatives assists the departments, for example, to assess, evaluate, and enhance hiring. About 70 percent of the staff comes from underrepresented backgrounds, and the leadership team is becoming more diverse. The Values in Action Award rewards individuals and departments. Second, DEI is embedded into the academic mission of the school and pathway programs, from elementary school through residency training. Health equity, social justice, and antiracism, or HESJAR, is threaded throughout the curriculum. Dr. Deas also called attention to HABLAMoS, the Hispanic and Bilingual Ambulatory Medical Studies program, which provides medical students with skills to communicate with Spanish-speaking patients and families in clinical settings, and the Programs in Medical Education Leadership Education to Advance Diversity—African, Black and Caribbean (PRIME LEAD-ABC). Six students in PRIME LEAD-ABC have their tuition and fees paid, and they pursue an additional track to work in the community and learn about higher education. Third, community impact and clinical care are emphasized. Dr. Deas noted that California’s Inland Empire, where Riverside is located, is projected to be one of the country’s 10 most populous areas in the next 10 years with a significant number of underserved populations. In addition to filling gaps in clinical care, the institution has established the Center for Healthy Communities and Health Disparities Research.

As the number of Black students has grown, it is important to ensure retention and create the environment where students can thrive, Dr. Deas said. Recruitment of diverse faculty and staff has been strengthened, and students are being integrated into the community at large. Investments have been made in leadership training, mentoring activities, and affinity groups. Student support includes the Office of Student Support and Wellness, wraparound services, scholarships, funded research opportunities, and emergency funds. Graduation rates are 98 percent, and students have been successful in highly sought-after residency programs. Dr. Deas said about 60 percent of UC Riverside students are from the Inland Empire, and many are not only from underrepresented minorities but also from low socio-

economic backgrounds. “They have experiences that may not be typical of medical students. We are right there to support them so as not to interfere with their academics.”

Keith Churchwell, M.D.

Dr. Churchwell noted that he is on the same plane as previous speakers in what he is trying to accomplish as president of a hospital (Yale New Haven) working in concert with a medical school (Yale School of Medicine) in a day-to-day relationship. He echoed the influence of family on his leadership journey. He and his twin brother (Dr. Kevin Churchwell, see Chapter 3), as well as older brother Dr. André Churchwell (workshop co-chair) grew up in a family of five children. Their father, the first African American reporter for a major metropolitan newspaper in the South, and mother, a teacher, instilled the desire to excel, work toward goals, and play an important role in wherever they find themselves. He attended public school in Nashville, Tennessee, then went to Harvard University where part of the experience was to think about leadership inside and outside the classroom. He said a significant step as a leader was as the chief resident in medicine at Grady Memorial Hospital in Atlanta, Georgia. He learned about dealing with people as they undertook their residencies and about his own leadership style. When he moved to Page-Campbell Cardiology Group in Nashville, he had a tremendous amount of freedom to take on meaningful projects with enhanced care for patients. The cardiology group developed a relationship with Vanderbilt University, offering new opportunities in leading the integration of a private practice and academic institution. This culminated in being asked to become the executive vice president, executive director, and chief medical officer for the Vanderbilt Heart and Vascular Institute. In 2015, he moved to Yale New Haven, where he has held several positions. In 2020, he was named president of the hospital and executive vice president of Yale New Haven Health. All these experiences, he shared, helped him understand his leadership style and learn how to bring people forward and improve medicine.

A key development at Yale New Haven was placing DEI into every initiative. A more diverse senior leadership, along with the pandemic and the events of May 2020, accelerated the acknowledgment that DEI can enhance the overall capabilities of the organization and make it a top-tier healthcare institution. He said it was evident that the hospital had to make a greater investment in diversity and understand why residency and fellow-

ship groups were not as diverse as needed. A multitude of factors were revealed, including the impression that the New Haven area provides limited opportunities for growth and advancement. Dr. Churchwell advocated for aggressively reaching out to show that the institution is a great place to start a career. Second Look Weekend, begun 6 years ago, has increased exposure and, subsequently, has increased diversity. When the program had to move to Zoom because of COVID-19, the number who participated grew, as did the number of faculty who invested time and embraced the idea of a more diverse program. The most recent class was the most diverse class of residents in race and gender, he said. House staff also took on the initiative to do virtual fairs with Historically Black Colleges and Universities to get the word out and to engage with individuals.

Dr. Churchwell observed that when he first joined Yale New Haven, he saw diversity work at the senior level and lower level, but little investment in diversity at the mid-career level. He asked his leadership team to each suggest at least three people with talent potential who could grow into leadership within the system. About 24 people are on the pathway for leadership development, mentoring, and a plan to consider their 2 to 3 years of career growth. The medical school has made an aggressive investment in faculty retention, supported by the dean and departments. Young faculty can chart a pathway for academic and clinical careers, supported by the medical school and health system. The house staff developed the Minority Housestaff Organization, which is very engaged internally and in the community. Project Access was designed for immigrants and others who have significant health, administrative, and financial needs to navigate the system. A new facility at 150 Sargent Drive in New Haven was built to enhance continuity of care in the greater New Haven community.

FUTURE DIRECTIONS AND FINAL THOUGHTS

Dr. André Churchwell commented that the four presenters all discussed the need for investments in the workforce, including house staff, residents, and administrative leaders, as well as in the health of the community. He asked each to briefly describe new directions they are planning.

Dr. Higgins stressed the need for Brigham and Women’s to send the message to the community that “we are here to serve” and that a diverse and inclusive workforce will help achieve that goal. He said messaging within the institution and to the community needs to be strengthened to lead to recruitment and retention of diverse faculty and staff.

Dr. King highlighted UCSF’s multipronged Differences Matter, which has a goal to make the school more diverse and inclusive. “I am pushing hard on getting clear data and better systems to make sure we have the follow-through on programs already started,” he said. “If we do not ask leaders to document what they are doing year over year and give them support, things will not get done.”

Dr. Deas said that to better engage the community, UC Riverside has asked community members about their needs and priorities. Focus groups revealed the need for more investment in mental health and wellness for children. They expressed concern about the increase in the number of children being diagnosed with diabetes and other adult-like illnesses.

Dr. Keith Churchwell called for better coordination among multiple initiatives. Recognizing the existing investments, he said it is necessary to look at how to construct investments to “answer the right questions, support the right people, and live up to the promise of what the health system can achieve.”

Dr. Shirley Malcom (American Association for the Advancement of Science) picked up on the idea of moving toward systemic change. At a certain point, she asserted, efforts that are found to work should replace those that have not worked but have “always been there.” Thanking the presenters for their leadership, she concluded, “Without the inclusion and values you are bringing to your work, I am not sure it is possible to be excellent.”

REFERENCE

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