Elevating Equity: A Conversation with James Williams, Jr. Executive Director, Diversity, Inclusion and Equity at University of Chicago Medicine

by Tiara Muse, Vice President/Senior Associate at Koya Partners/Diversified Search Group and James Williams, Jr., Executive Director, Diversity, Inclusion and Equity at University of Chicago Medicine

Diversity, equity, and inclusion (DEI) has been at the center of people management and organizational development for several decades now, but most would agree that 2020 has been a pivotal moment for prioritizing paths forward. Seasoned healthcare DEI leaders like James Williams, Jr. of University of Chicago Medicine have higher expectations for sustainable change for staff and patients alike.

Muse: James, thank you for agreeing to share your thoughts and expertise with CHEF. Please describe your career at University of Chicago Medicine and how your role has evolved over the years.

Williams: I began my career at UChicago Medicine in Finance with leadership roles in accounts receivables and admission services where we were able to exceed our annual financial targets and redesign our admitting processes to be more patient centric.   After Finance, I was tapped to join Supply Chain where I was given the opportunity to launch and manage our Business Diversity Office focused on expanding the utilization of minority- and women-owned firms through inclusive business practices.  In 2013, I was asked to expand my scope of work and impact by launching our Diversity, Inclusion and Equity Department to design and implement an enterprise-wide equity strategy.

Muse: I can see how your leadership experience in finance and supplier diversity would be valuable in building a DEI strategy for the organization. How do you define diversity, inclusion, and equity?

Williams: Diversity is simply the presence of differences that make each person unique.  We see these as important human characteristics that impact an individual’s values, beliefs, and perceptions of self and others.

Inclusion is the act of creating an environment where any individual or group feels welcomed, safe, supported, respected, and valued.  An inclusive and welcoming culture embraces differences and offers respect in words and actions to all people.  It is important to note that although an inclusive group is by definition diverse, a diverse group is not always inclusive. Increasingly, recognition of implicit bias helps organizations to be constructive about addressing issues of inclusion.

Equity is the fair treatment, access, and opportunity that leads to the advancement of all peoples.  Equity is about striving to identify and remove barriers that have prevented the full participation of some groups. Improving equity means increasing justice and fairness within the processes of institutions or systems, as well as communication and sharing of resources. Addressing issues of equity require a deep understanding of the sources of disparity in our society.

Muse: Yes, I often say that when it comes to healthcare, DEI and health equity are on a spectrum. What health disparities exist among the patient population that you serve and how are you/UChicago Medicine addressing them?

Williams: At UChicago Medicine we take a holistic approach to advancing health equity by linking equity to our organizational strategy. Through our Urban Health Initiative, we partner with our community and other members of the Southside health care ecosystem to strategically address the priority health needs through our Strategic Implementation Plan.  Simultaneously, we create a Culture of Equity within the walls of the organization focused on building an infrastructure to identify inequities and take responsibility for addressing them.  After assessing our organization against the National Standards for Culturally and Linguistically Appropriate Services, we designed and implemented an enterprise-wide Equity Strategy aligned with the evidence-based Roadmap to Reduce Disparities.

In 2020, we built upon our strong foundation and intensified our equity focus to address the racial and ethnic disparities in our workforce, climate, healthcare delivery services and community engagement.

To support organizational equity efforts, I, along with Equity Strategist, Scott C Cook, Co-Director National Program Office for Advancing Health Equity funded by Robert Wood Johnson Foundation, were added to the organizational Quality Committee. Today, we can stratify 82 quality measures by race, ethnicity, ZIP code, gender, language, and financial class.  Priority measure owners are now expected to examine their measure(s) using the equity lens and report on them in the Quality Committee meetings.

As a result of linking Quality to Equity, we identified a 12% disparity in Hypertension Control between our Black (62%) and White (74%) patients.  To diagnose the disparity, we engaged a multidisciplinary group which notably included patients to conduct a Root Cause Analysis with an Equity Lens incorporating the patient voice.  Presently, we are reviewing this data to identify and prioritize root causes with patient feedback before we design interventions. Our aim with this renewed focus on equity is to identify causes that contribute to the disparity and support our efforts to simultaneously reduce the disparity while improving quality.

Muse: That is outstanding – you have created organizational accountability through establishing measurements and regular reporting. Accountability is key.Tell us how University of Chicago Medicine is addressing DEI needs (internally) among the leadership team, staff, or management levels?

Williams: Our focus on equity is based on what we believe is the smart and right thing to do.  The evidence is that diverse teams outperform homogenous teams on complex problems, producing what Scott E. Page calls The Diversity Bonus.  Additionally, McKinsey & Company’s Diversity wins: How inclusion matters report indicates that companies in the top quartile for gender diversity and ethnic diversity financially outperform companies in the bottom quartile.  Thus our equity integration work is inextricably linked to excellence across our teaching, research and clinical missions.

We operationalize equity by applying an equity lens to our processes, leveraging data and engaging a diverse set of stakeholders in ongoing equitable transformation and accountability.  Recognizing that race is one of our leadership representation opportunities, our Human Resources team developed a Workforce Diversity Plan with an initial focus to identify, recruit, train, and promote racially diverse team members into leadership. Given that we value all persons and understand that all dimensions of diversity are important, we will continue to monitor our data and expand employee demographic data capture to understand our disparities and take action to address them.

In the spirit of continuous equitable improvement and transparency, Human Resources leadership updates organizational leadership and is finalizing metrics and analytical tools for leaders to gauge progress and drive execution.

Muse: Can you share examples of three different metrics organizations can track to measure progress toward equitable practices among staff and patients?

Williams: Given the complexity, varied contexts, and multiple factors contributing to equity, it is difficult to pick just three metrics to track and measure progress.  Our approach to equitizing the organization is to systematically apply an “equity for excellence lens” to all organizational key metrics and functions.  This includes organizational governance, strategic planning, execution and role in the communities where we practice.  Additionally, I would advocate for four domains of metrics across patient, employee, workforce and community data. Finally, if I had to choose just three metrics, I would choose:

• Priority Quality Measures stratified by patient demographics and provider(s)
• Employee Engagement scores stratified by employee demographics and role/level
• Workforce Diversity stratified by employee demographics and role/level

Muse: Those are great metrics to examine. Leaders will greatly appreciate your insight on key items to measure. What advice would you give an early careerist considering a role in DEI?

Williams: I would advise an early careerist considering DEI work to build skills in inclusive leadership, organizational change, group relations, strategy development and execution.  I would also advise them to study the history of white supremacy, the social construct of race, and the roots of capitalist industry in the United States.  Additionally, I would encourage them to study the work of Scott E. Page, Mazarin Benaji, Martin Davidson, the late Katherine Phillips and other scholars who provide insight into moving beyond negative notions of diversity to a space of leveraging difference as a competitive advantage.

Coupled with this knowledge and skill set, I would advise them to study the industry, firm and people of any particular company through the organizational culture and leadership lens as espoused by Edgar Schein, a world-renowned expert on organizational culture credited with founding the field.

Essentially, equity leaders are first leaders who catalyze and drive equitable organizational culture change for excellence, irrespective of the industry and firm.

James S. Williams, Jr. is the Executive Director of Diversity, Inclusion and Equity in the Urban Health Initiative at the University of Chicago Medicine.  He is responsible for executing the enterprise-wide diversity, inclusion and equity strategy focused on building a diverse, culturally competent, health literate organization that supports the delivery of high quality, equitable patient outcomes.  James facilitates the innovative E4 Leadership Integration work to improve organizational performance in collaboration with operational excellence, quality performance improvement, strategic planning, patient experience and engagement, marketing and communications, and human resources.  He partners with staff, leaders, faculty and implementation science experts to evaluate and advance best practices in creating fair, inclusive equitable organizations that innovate and deliver superior results.