An Effective Way to Assess DEI at Children’s Hospitals

An Effective Way to Assess DEI at Children’s Hospitals

How one children’s hospital uses its safety reporting system to track respect and dignity incidents.

It’s a common challenge for workplaces trying to navigate the complex issue of diversity, equity and inclusion (DEI): “In trying to get an actionable strategic plan for DEI, it's very hard if you don't know what's happening in your environment,” says Elaine Cox, M.D., CPE, chief physician executive at Riley Children’s Health in Indianapolis.

To solve for this, Cox established employee councils to work toward enacting DEI initiatives. But the council participants reported that little progress was coming from these efforts. That sparked inspiration.

“I took that as a challenge—we had to do something different,” Cox says. “It made me think about everything we learned from safety reporting systems around patient harm and how that was a keystone of understanding what was happening in our own building.”

Adapting the safety reporting system to assess DEI incidents

The benefits of a healthy reporting culture are well-documented within Patient Safety Organizations, and Riley Children’s own reporting system has supported safety improvements across the organization. So, it made sense to try carrying those results over to the reporting of respect and dignity events. And it found added benefits in leveraging its existing reporting system vendor, including:

  • Familiarity. Since the health system’s employees are already well versed in using the online reporting platform for safety purposes, it’s a seamless transition to using the system to report DEI incidents. “It's familiar to our team members—that was one of our main initial goals,” says Katherine Du Fresne, RN, M.S.N., CPHRM, executive director of clinical risk management at Riley Children’s Health.
  • Output. Riley Children's Health hired a senior equity consultant to manage the system and incorporate its findings into the system’s overall DEI strategy; knowledge of the legacy system makes that process easier.
  • Speed. In not having to build an entirely new reporting platform, Cox and her team were able to move from planning to execution in a matter of months.

Of course, Cox and her team needed to overcome challenges in retrofitting a safety incident reporting system to accommodate the unique needs of a respect and dignity event reporting platform—among them, determining the proper verbiage to be used within the user interface.

“I had an issue of labelling these as ‘grievances’, because it feels like somebody's just complaining as opposed to using this as a learning and an understanding tool,” Cox says. “We ended up settling on ‘impacted party’ and ‘acting party’—it was a hard, tedious process.”

Because Riley Children’s Health is following a familiar path in building this DEI-based reporting system, it understands how to deal with some of the challenges it’s facing.

“When we began doing safety event notifications, it was the same thing; people didn't want to say that they harmed somebody or almost harmed somebody,” Cox says. “But once they got used to the fact that it's not a witch hunt, they're not going to get in trouble and that we're just trying to learn, it became a very healthy reporting culture.”

Fine-tuning the safety reporting taxonomy to assess DEI incidents

Riley Children’s Health’s current respect and dignity event reporting system involves the equity consultant processing incidents to a multi-disciplinary committee for adjudication. In many cases, the incidents—which Cox says often comprise language barrier issues, cultural misunderstandings or pronoun usage—are used to inform the health system’s broader DEI education.

Ultimately, Cox and her team plan to continue refining the process to include a more focused selection of incident categories and a dashboard to provide transparency of the committee’s findings across the organization.

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