In 2019, Seattle Children’s leaders committed to becoming an anti-racist organization. They strived to go beyond traditional diversity, equity and inclusion (DEI) initiatives by adopting strategies to identify and challenge values, structures and behaviors that perpetuate systemic racism.
The hospital set out to address gaps that lead to inequities or disparities in employee recruitment and retention, access to care or patient outcomes. The work prompted leaders to examine organizational policies and procedures through an anti-racist lens.
“We have been very deliberate to ensure this is not just a training initiative and that we are actually moving the needle on our health equity and anti-racism work,” says Myra Gregorian, M.A., senior vice president and chief people officer. “We are after real change, and we are at a place where transparency with our workforce is not just a nice-to-have but a must-have.”
Phase one of the hospital’s three-phase Health Equity and Anti-Racism Action Plan wrapped in the spring and showed quantifiable results. For example, the hospital saw improvements in racial/ethnic representation across its workforce:
- Overall employee diversity rose from 36% to 42%.
- Diversity among managers grew from 22% to 25%.
- Executive leadership diversity jumped from 46% to 55%.
- The hospital board’s diversity increased from 30% to 38%.
To address disparities across the organization, hospital leaders examined a broad cross-section of policies and procedures and have published progress updates along the way.
Quality and safety
As part of the effort, Seattle Children’s Center for Quality and Patient Safety has worked to understand and address inequities in patient care and outcomes. Central line infections sit at the core of this work. The hospital stratifies central line infection data across race, ethnicity and language to identify potential disparities. Then, unit managers deploy resources to bring patient groups experiencing higher infection rates in line with the rest of the patient population.
The approach has proven successful. For nearly two years, the hospital has been free of disparities in central line infections for Black patients and those who speak a language other than English.
“We've sustained the elimination of the disparity because we integrated interventions that reach families differently,” says Alicia Tieder, MSW, LICSW, senior director of Health Equity, Diversity and Inclusion at Seattle Children’s. “The interventions are offered to all but built with the understanding that they would be more accessible for certain families.”
No-show rates were much higher among some ethnic groups at Seattle Children’s Odessa Brown Children’s Clinic. That led to an effort to make appointment reminders more accessible to all, including translations into more languages.
Additionally, if a patient has not arrived within 10 minutes of their appointment, care coordinators contact their caregivers to reschedule. If appropriate, patients may be offered an immediate telehealth visit. These interventions led to an 11% decline in no-show rates within the first nine months of implementation.
Traditional human resources complaints typically involve an investigation and minimal follow-up with the original complainant. The practice can potentially harm interpersonal relationships or others affected by the transgression but didn’t lodge a complaint.
Gregorian says a new framework ensures anyone affected by an offensive or racist incident receives follow-up support. Additionally, the hospital has added fields in its complaint-reporting system to capture racially or ethnically insensitive details.
“Because traditional HR is confidential, you don’t disclose anything and everybody goes back to their corner,” Gregorian says. “It makes for a difficult dynamic if the restorative work isn’t done.”
An anti-racism focus must ensure diversity on both sides of the interview table. That’s why the hospital asks staff from outside the hiring departments to participate in the interview process. These “external” viewpoints often illuminate candidates’ behaviors or attitudes that are inconsistent with the organization’s core values. The extra feedback also helps ensure candidates aren’t eliminated simply because they might not be a “good fit”—language the HR team is working to remove from the hiring process altogether.
“When you say someone’s ‘not a good fit,’ that has often been a way to prevent people who have different perspectives or experiences from entering an environment, and it protects a milieu that doesn’t have a history of supporting diversity and inclusion,” Tieder says. “We try to lead with, ‘Tell me why, tell me more about what those challenges and barriers are.’”
Additionally, Seattle Children’s keeps manager-level and above job openings active until the pool includes 30% racially and ethnically diverse candidates. Team members also reviewed job descriptions and removed arbitrary degree requirements that don’t affect a candidate’s readiness, allowing the hospital to cast a wider net.
Inadvertently discriminatory policies
Seattle Children’s audited legacy policies and procedures to ensure the rules served their intended purposes while fitting within an anti-racist framework. For example, the hospital stopped requiring “room-in” nights for specific patients' parents or guardians. “The intention behind it was to help parents feel empowered, safe and secure to go home, but in practice, it ends up being kind of a punitive measure that belittles certain families,” Tieder says.
The hospital also amended policies to align with the community’s cultural, spiritual and religious needs. Changes to visitation policies ensure the hospital respects rituals specific to patient deaths. For employees, the hospital has revised its dress code to be sensitive to staff needs, such as wearing hijabs while on duty.
Accountability and transparency
Seattle Children's maintains a dashboard available to everyone in the organization to track its progress toward becoming an anti-racist organization. It displays outcome and process measures, including executive commitment to diversity, workplace culture indices and overall employee diversity.
Seattle Children’s staff members have taken notice of the organization’s anti-racist efforts. In a 2022 workforce survey, employees rated the hospital a 4.0 (out of 5.0) for how well it values team members from different backgrounds—outpacing its benchmark goal by 5%.