A CEO's Perspective on Creating a Culture of Equity

Rebecca Gallo recently sat down with Diane Gould, President and CEO of Advocates, one of the region’s largest human services agency, to talk about their internal work to create a more equitable workplace. Focusing on equity internally mirrors the organization’s commitment to equitable access to care and positive health outcomes for those they serve.

RG: What drives Advocates’ commitment to equity?

DG: Advocates serves many people who have very low incomes; have disabilities; are Deaf; are struggling with addiction and mental health challenges; and who are affected by autism spectrum disorders.  Many speak Spanish and Portuguese as their first language. They face a number of barriers to accessing healthcare, including finding providers willing to accept MassHealth, trained to meet their specific needs and able to provide culturally competent care. Too often individuals with mental health conditions are dismissed when seeking help for physical health issues. This can mean being turned away from emergency rooms or physicians’ offices, by providers who mistakenly assess physical complaints as psychiatric in nature. These inequities in access to services lead to disparities in health outcomes.

The principle that everyone has the right to good health and access to quality healthcare is a core value at Advocates. Embedded in this core value is the idea that there is equity in terms of who is making decisions about services and who is providing those services. This means that those most affected by health disparities have a voice at every table. At Advocates, this includes the leadership team, which is not only racially diverse but also includes people with lived experience with issues similar to those facing consumers. This is also true of the Board of Directors, where lived experience is valued just as much as experience in other areas, such as finance and law. The commitment to equity is evident throughout the agency.

RG: As the leader of the organization, what have you done to promote a culture of equity within Advocates?

DG: My personal commitment to exploring and understanding privilege and unconscious bias guides how I lead in this area, and I ask the same of our senior leadership team. For example, the entire leadership team recently attended a two-day intensive training on Healing Racism.

Advocates has also instituted rules around hiring leadership staff. An offer is not made to a candidate unless a diverse pool of candidates has been interviewed for the position. Only then do we choose the best person for the job. This policy has resulted in a more diverse leadership staff, which has strengthened conversations about equity issues. For instance, it can be easy to get caught up in the tremendous amount of work that needs to be done daily and to push off addressing issues of equity. Often people of color sitting around those tables will remind the group that they do not have that option. They live with the effects of structural racism every day, so addressing it needs to be a priority. Another result of having people of color in leadership roles is that those who aspire to grow in the organization can see a path for themselves. The agency tracks the number of people of color who apply for, are interviewed for, and receive internal promotions. We also have a partnership with William James College, funded by the Foundation, to enroll staff of color who want to further their education so they can move to new positions. Our Emerging Leaders program is another opportunity to encourage professional development. These initiatives have led to more people of color applying for promotions.

RG: What are some challenges you face in creating and maintaining a culture of equity?

DG: There are inherent power dynamics that are sometimes hard to manage. For instance, many front-line workers are people of color, particularly African immigrants, often serving white consumers. There have been incidents of racism reported by staff. Our practice is to address these issues immediately. Our Chief Diversity Officer staffs our Diversity Advisory Council and oversees a Response Team that addresses any staff reports of racism or inappropriate interactions. We want a culture in which staff feel safe reporting incidents and feel like action will be taken, if necessary.

The 2016 election also brought some unique challenges. Members of our community felt anxious about their own safety and security. One Board member stated, “I am afraid of what people will now feel they have the right to do to me and my family”. We were careful to frame our discussions about these issues as non-partisan, acknowledging the differing political views among staff, and focused instead on Advocates values.   We held open forums for staff and people we support to talk about their fears and to offer support.  We took stands against attacks on the Affordable Care Act and new immigration policies that go directly against our values of access to equitable healthcare and opportunities.

Senior leadership also solicits feedback from staff in regular “listening circles”, including how we can better promote an equitable workplace culture. The common thread is that while they appreciate what the agency has done, there is still more work to do. It can be hard to stay the course when many other pressing issues are pulling attention in different directions. But, having support within the leadership team and on the Board of Directors is extremely helpful. It means that there are many in the organization committed to the hard work of making the workplace more equitable.

RG: What advice do you have for leaders of organizations beginning to think about issues of equity internally?

DG: It is important to have a mix of accountability and support. Accountability can come from ensuring equity is part of the organization’s mission as well as an integral part of the strategic plan. It helps that outside groups are beginning to stress equity as well. For example, equity is showing up in accreditation standards and more and more funders are asking for a commitment to equity as part of grant applications and reporting. Accountability also means having the structures and people in place to support keeping equity at the top of the agenda even when there are many pressing issues. In most nonprofit organizations, there is more work to do than staff time to get it done, making it easy to let the hard work around equity get left behind. This is where support is essential. I get regular consultation and feedback from our Chief Diversity Officer and Senior VP, both women of color, and from colleagues in other agencies who are engaged in this work. This has been invaluable in maintaining commitment and focus.

The leadership from our Diversity Advisory Council provides support to all staff. They have also helped to keep equity and diversity issues on the agenda. They help facilitate difficult conversations, recommend policy changes, normalize discussions about racism and injustice, and also host diversity celebrations and events. A diverse leadership team also provides support and can change conversations at the highest level.

Finally, it is important to devote resources to equity work. This can include hiring a Diversity Officer, paying for intensive training for staff, hiring a consultant to help shape strategy, and creating safe spaces for peers to connect with each other around issues of equity. It is these kinds of investments that have helped to ensure that equity is a part of Advocates’ commitment to access to good care for all in the community.

Give your thoughts and ideas on how we can work together to eliminate health disparities by emailing [email protected].