Mo: Hello, hello, hello and welcome to this week’s everyday inclusion and belonging where we talk about everything from diversity, inclusion, equity, and belonging under the sun, and this week I’ve been trying to get these two guys on for a while here. I have a Lor and Andre from Mayo Clinic and I am, as you know guys, I never do, and I’m using the word guys, which I don’t, usually, you know.
I’m going with my gender-neutral pronouns. It’s one that’s interesting is something that we as a team, talk about a lot. And we’re catching each other more and more, so just busted myself. Introduce yourselves, and then we’re going to dig in and talk about such a broad range of things that you all are doing at the Mayo Clinic.
Lor Lee: Andre, go ahead.
Andre Koen: Alright, so my name is Andre Koen and I am the program director for the office of equity, inclusion and diversity at Mayo Clinic. Love it, it’s something to marvel at working at such a value centered organization that’s actually doing just profound work. And so really excited to be a part of not only this discussion, but a part of that great organization so Lor.
Lor: Thank you so Lor Lee, I get the opportunity, privilege and my honor to work with Andre and the team at Office of Equity Inclusion and Diversity and Mayo and advancing the work. I’ve been at Mayo for about 3 ½ years I want to say feels much longer, but 3 1/2 years, been doing the work of diversity, inclusion and equity, though for nearly 20.
Started my career in K12 Education where you know you got into the working directly with the students in in addressing the needs that other students, but also working with your teachers and your curriculum, directors and your superintendents in building out multicultural curriculum and then move into healthcare space about eight years after that. And really embrace the healthcare space because I believe that when we talk about it all starts with health, right?
If we can ensure that people have healthy lives and can access all those when we talk about social determinants, all those things that we call social determinants and remove those barriers that people will have the highest possibility to achieve their highest outcomes possible.
Mo: Well, I was thinking about this like often, we’ll say in this work oh, it’s not life or death. It is, right?
Diversity and Inclusion in Healthcare
Lor: It is in healthcare, it is. It can be, yeah.
Mo: Yeah, and I mean we’re seeing right now in real time unfolding the disparities that have existed. And what I appreciate again, is the really thoughtful broad approach that y’all are taking and doing some really innovative things as well.
In this really, really important space and I have to say because you to know this, but my grandmother worked at Mayo Clinic for about 40 years and my mom grew up in Rochester. So not only are you near and dear to my heart because of the work that you’re doing, but also the personal connection for me and you know all the stories over the years and my grandmother having doctors stay at her house from you know various countries as they were coming in.
So again, I think this year has taught us so many lessons and when we’re really looking at Healthcare in particular. Yeah, folks that didn’t understand before now, are again seeing real time this play out.
And so, I think what’s interesting about what you all are doing is you’re both taking the internal right. What are the tools, the resources, the things that you can do to create an inclusive culture. But then what can you do externally facing to make sure that people coming to Mayo Clinic are experiencing the greatest health outcomes that they can have. Because you understand that diversity that equity creating inclusion and belonging in systems of care.
Lor: Mo I would even say that it sometimes it’s not even about when people arrive here. Some people that we reach will never come to Mayo Clinic, right? But we are reaching them because we know that there are especially with Covid there are impacts on those particular communities that are above and beyond, and they may be getting their information from sources that may not be very credible. So, we are working with communities and community organizations without even having the intention that they will come to us right.
And so, when we talk about and I know that our health, our role really isn’t quote on quote, Public Health but I believe that we do have a role to play when it comes to prevention.
Andre: And it’s also interesting, you know some of the partnerships Covid has actually launched us into some spaces that I don’t think that we would have really thought about. Or maybe they were on the docket and outside of my pay grade.
But really, thinking about like our partnerships and how do we educate restaurants or partnerships with airlines. How do we? How do we help airlines do their job better because it helps us do our job better, right? And so, when we think about particularly the way Covid has really reframed and reshaped how the science and the data and how we apply that.
We now recognize and it may be we recognize it before, but it’s much more profound to apply our science and our data in the things we know about health and disparities. To, you know, fast food chains, right? Who would have thought that would have ever been a connection, that health care organization in a fast food chain could have some things in common?
Or an airline and so I think those things are really important to it in terms of recognizing how much we’re interconnected and how that those health disparities manifest themselves in lots of ways, and how we can intervene to reduce those health disparities in nontraditional kinds of ways. Because we’re in a nontraditional situation, right so?
Mo: Yeah, hopefully this doesn’t become tradition. And I think you bring up such an important point about the interconnectedness that we’re seeing now that has always existed. But maybe we weren’t seeing played out in such a profound way.
Let’s just talk broad, overarching approach. Philosophy, sort of the framework that you all use for DEI Mayo Clinic.
Lor: So before or after Covid?
Mo: Right isn’t that interesting? We talked about this with the team a lot. It’s like, well, here was the plan before, and here’s the plan now and then. And then we actually created six-week sprints because we didn’t know what was coming at us.
Andre: I was just going to say you know a lot of it, though kind of stems from 2 pieces. And then you know, you know we can talk more about the pragmatism of these things, right? So first we recognize that the needs of the patient come first, so that’s like our overarching drive. And so, the question then becomes, do we have to address race and racism? And the answer is yes, because those are blockages to making sure that the needs of the patient come first right.
The second is, you know really then focusing on our rich tie’s values. And so, I won’t go into our values and all that kind of stuff but here’s the essential question. Do our values support sexism? Do our values support racism? Islamophobia, xenophobia, heterosexism, lack of access for people with disabilities and the answer unequivocally, is no!
And so, when we start to talk about you know, how to be pragmatic, once we’ve once we’ve settled on those primary objectives. We’ve got a team of folks who are excited to start moving, even if we don’t know exactly what to do. We recognize that we’re moving in a direction that is going to be a power, is going to have some powerful results.
Mo: You know I have to say and Lor, before you jump in, I want to make this comment.
I got to meet with y’all, I met a couple of you in person back in March when it was, I think the last time we all traveled. And then I got to demo the app for the team, and that was probably back in in April and I immediately got off that demo an I sent Lor an email that just said, what an amazing team.
That energy that you were just talking about Andre I saw, and I was like y’all are walking the talk. Like the way you interacted riffed everything about it was this just overwhelming feeling of belonging, joy and energy about the work?
I think you know, as you were saying, that I just wanted to amplify the fact that that’s real. Y’all are living it in a way that I don’t see many teams, I mean it was coming through every interaction that you had during those meetings and I’ve seen that, I’ve seen that since.
The Three Shields
Lor: Well thank you. Often when you’re on the inside you don’t often see that for yourself and so it’s good to hear that what we’re trying to practice is actually being notice outside. So, the only thing I was going to add to Andre, is saying is that kind of the more infrastructure perspective. The office that Andre and I support and run is really looking at across the enterprise, what are some of those large big bucket item needs. We’ve got three shields of practice education, practice, and research.
And within each of those shields they also have some offices that are also focused on, particularly the work within those shields. So, in practice, for example, and we have an office that’s focused on the actual disparities in equity work for tracking of disparities within our house.
Being able to disaggregate that data, collect that data, all that fun stuff in education. So, because we have both the undergrad and graduate school programs here, we have offices that are focused on both recruitment and retention of diverse learners and building out curriculum. So, we just rolled out Andre, I believe curriculum for year one and year two students focused on anti-racism.
And then the third shield is researching. Actually, you know when you think about traditional research, we have an office that works on traditional research with your principal investigators and teams of investigators that look at certain particular outcomes in particular groups or communities and identify what those gaps may be, what interventions we can be doing to close those gaps, right?
So, there is that. And then there’s the research office that’s looking at the workforce within themselves because, well, one of the things that that office found was when we looked at industry supported research dollars, most of that those dollars were actually going to men.
Mo: Right, it’s mostly white men, yeah?
Lor: Yeah, and what can we do to address that gap from that perspective?
Mo: Yeah, and think about that approach right, breaking it out and then being really thoughtful and you know, having those shields. Then the measurement against that and the resources against that and understanding what might be different.
What might work in education could be very different in practice. Really dialing in each area and being specific to each area’s needs. Although it’s interesting, right, you think about some things like Covid research right now?
You know, with some of the data that was coming out in terms of who were actually a part of the trials, right? And we were about to replicate some really bad examples.
Let’s test all this on white people. So, I think now I’m really glad that there’s this lens that is getting caught right in it. That’s getting like stop distracting and we have to stop and that’s not going work anymore, right? Because we’ve seen what those outcomes look like and they’re not good.
Lor: Yeah, and that that has been, uh, not just a Covid-19 trend, right? Yeah, it’s been when it comes to research and specifically trial research, it’s been part of the flaws of art that has been part of the history where research has been conducted on such a minute group of people or specific group of people and then applied to others, right?
And Andre does a wonderful job of talking about his own personal experience in this space. But like research that was mostly practiced or done with white men does not apply to Black men and Asian men, right? Or could apply, but could apply differently.
Or at different stages in our lives versus white men. And so, I think Covid to your point about disparities research has amplified it. But in what we’ve talked about in our own conversations is all those have always been there. All those issues we know about health disparities have always been there, right? We’ve known about disparities since the 1990s, but we’re still doing the same stuff because we haven’t done anything to address those systemic issues that are causing the outcomes that we see today.
Future Change in Research
And so, I think it is time for us to start to look at, truly look at, what are those systemic barriers that we need to start to undo. And I think that’s what part of, and Anre can speak a little bit more about this, one of the things that we’re trying to build inside a male clinic is helping people better understand and give them the tools and resources to address the systemic pieces. Even using your own individual power, yeah?
Andre: And we recognize, you know, a large part of why some of those trials well, in some of that research hasn’t been done. It is primarily due to the lack of relationships with communities, right? So, you know if we look back at you know, and I think these aren’t typical, but they are. They have been consistent throughout history, right where things have been done too people, as opposed to with people right?
Which is done on a group of people as opposed to with a group of people where that knowledge is shared with the learning you know. You know there are communities that feel very resistant to this idea of being part of a clinical trial. You’re not going to use me as a Guinea pig.
Right, right, one of the things we’ve been really trying to work on is how do we build authentic relationships with communities so that we’re building this body of knowledge together. And I think that’s a really tricky thing to kind of do, particularly given you know some of our historic pieces.
You know we have hospital, we have arms in in communities like Owatonna in Mankato, and so there’s a history there that one must understand if one wants to be effective in in those areas and their relationships that have to be constantly built and maintained and fostered and nurtured.
Because of historical harms and you know one of the things we’ve been really trying to work on is, how do we use our power to restore history to its rightful place with the proper perspective as we move forward in building things together or collaboratively so.
Mo: So right, it’s like acknowledge, understand, learn from that history. You said something I think that was really important, you said many things are really important.
You said its ongoing right, you don’t get to say, yeah, we were fixed it, band aid, done, boom move on. That so true of this work overall, we’re not done it’s constant.
Let’s talk about some of the things that you’re doing internally.
I’m going to make some assumptions here, might not be the same in Arizona as it is in Minnesota, right? Some of the programming, some of the approach.
Lor: So, as we were going into Covid and being asked to work remotely our office launcher, what we called everybody in conversations back early April. I want to say late March early April and every Friday we bring in participants from across the enterprise and have conversations on topics of diversity, equity, inclusion.
And then the George Floyd killing happened. And quickly we pivoted and focused on our conversations on race and racism and specifically and within healthcare. And at that time we turned then into helping build tools and resources and helping our people have these conversations, whether it’s internally or externally. And so, we have everybody in conversations we have on every Friday at 12 noon Central time.
We have over 500 people in attendance every Friday and we thought originally in our discussion we thought that you know, by the end of the year, that the participation might peter off and we may have to reevaluate how we move forward in 2021. They’ve actually gone up. So, when we first started we had 300 something maybe 400, and now we’re looking at 500 plus some calls. We have 580 on the call and then so that everybody in conversations we have that we have what Andres and the team has worked really hard on is launching what we call that everybody in challenge. It’s a four-week intensive dive into four particular topics. Andre, you want to talk about those.
Break Your Own Bias
Andre: Yeah, so we talk about breaking your own bias. We talk about systemic racism and oppression. We talk about recognizing your own privilege and then finally your own power. So those are the kind of four pillars of the challenge. And so, what that provides people is an opportunity to not see yourself as a victim, but to see yourself as an actor right?
And so, what we recognize is either you are, I mean, you know maybe I’m an absolutist or purist, but you’re either working too undo the harms that racism has caused, or you’re passively active in it. And so, what this challenge does is it really encourages people to get the skills. One of our theoretical underpinnings is that people are doing the best they can with what they have an it, and it will always be inadequate.
All right, so we, we’ve decided to really give people tools to make them adequate for the challenges that they’re facing today. Recognizing that there will be challenges tomorrow that we don’t know about. But if you take these principles, you can apply those and be successful in in addressing those things as well. And so, we all recognize at the end of the day, no matter what has happened, what we’ve been taught or not taught we will be held accountable for our own actions. And so, we want to give people skills and tools that will allow them to act in accordance to our organizational values. But more importantly to act in the world in accordance to their own values and so we spend a lot of time around skill building.
Diversity and Inclusion Goals
Less about ideology, less about how you should necessarily think about these things. But really, focusing on the skills that are necessary to help us accomplish goals, one of the things that we were really focused on at Mayo Clinic is being goal focused, right? So if it’s not meeting the goal then it can be questioned if it’s not helping us to reach our outcomes, then that’s where critical thought needs to be applied to that particular ideology, behavior, what not so.
Mo: So say more about that because it’s interesting to me and if we could just unpack that a bit, because there are organizations that are like no, no, we can’t have goals around this, we can’t measure around this.
And I understand like in some organizational cultures they’ll do anything to hit a goal, even if it’s bad, right? Right? Like it’s like you gave us this number. You gave us this percentage, or you gave us this thing. We’re just going drive to get that, even if it’s not sustainable, right? It’s sort of like short-term profits in the stock market, right? Might not be great for the long term of an organization.
I’d love to hear sort of how you all measure, what are goals, what does that look like in a way that actually creates the positive behavior change that you’re looking for?
Lor: So let’s be clear, there are differences between quotas and goals, right? Yes, so we’re not talking about quotas here. We’re not talking about quotas. We’re talking about goals based on a baseline, right? So, one of the things that we are measuring, and this goes all the way up to doctor John Rico Farrugia, who’s our CEO and president, and Jeff Bolton, who’s our chief administrative officer.
So, this particular measure around top 200 leadership roles and the goal was to expand that to the diversity, both gender and racial ethnic diversity among the top 200 leadership roles, right? And so, I can certainly go into some numbers here, but because of their commitment, and they report out these numbers and successes and progress to the Board of Governors and trustees on a regular basis. Right? So, it’s not us going now to report it it’s the top two gentlemen of the house.
Mo: So, it started there, and he looked at the top 200 rolls, right? So he said OK, we were going to diversify there and yeah, we’re going to constantly talk about it.
Looked at both the physician leadership as well as the allied, we called allied health so non physician leaders an what’s the current representation in 2018? And by as we think about jobs that are coming open and potential rotations that may be coming around for our physician leaders, what are opportunities, maybe and then we set out goals right?
Goals, No Quotas
So again, it’s not a quota its goals and then between there what we do is we put in programs to help build leaders and our succession pool to make sure that we have the most opportunities to meet that particular goal. Yeah, right? So, there’s a difference between quotas and goals.
Mo: Yeah, that’s perfect and I don’t have any tattoos, but like I want to get the quotas and goals (pointing at her arm).
So that’s where we run into trouble. That’s when people start to say, well, are we going to lower the bar right? Like that horrible yeah conversation exactly. We do have to have right? We have to have that. Let’s talk about why it’s not lowering the bar, but let’s absolutely throw out, burn that word to the ground and never have it be used again. Let’s get rid of quota.
Andre: And Mo, I mean the thing that’s really interesting about just having that that thought is around lowering the bar or whatever. What oftentimes we don’t do is we don’t ask what is the necessity of the bar? And so just asking that question will actually lead you to a more equitable outcome in your organization, because too often we just walk into this bar. And we’re like we keep bumping our heads and all you got to get low but what function does that serve?
And so, if you can answer that with goals and objectives and data, an even quantitative analysis, you can actually augment that bar when necessary. We all we need standards, right? So, I want to be crystal clear about that we do not believe in reducing standards, but we do believe in asking questions about the bars that we’ve set. And are they actually helping us or are they hindering us from, goal accomplishment?
I think those are some you know, maybe there’s a little bit of wordsmithing or splitting hairs, but I think it is absolutely crucial in this work to be able to identify that, as opposed to talking about where we’re lowering bars. What purpose does that bar serve, you know?
Mo: Right, and are the folks that are already in those roles would they have met that bar? Right, when we talk about positive bias. So, I think there’s I think that whole conversation, although sometimes painful to have, is really critical, right? Like let’s talk about the bar. Is it the right bar? Should it be monkey bars?
And always making sure that you’ve got talent ready. There’s so much talent, so much unidentified talent.
Lor: Well at Mayo Clinic you got almost 70,000 people that work here. You talk about unidentified talent, right? And if you if we put into place bars to hundreds point bars that restrict people in saying things like you have to have worked at Mayo Clinic for a certain number of years, you have to have been in certain leadership roles. Then we start to put into place bars that only serve our purposes and doesn’t get us to these diversity, equity, and inclusion goals. It’s actually creating inequities.
Mo: Right and old paradigms, right? Old paradigms of what things look like, and I think that’s a thing too. It’s like tear those down and take a look and explore everything and what you really need, right?
What’s really core to this? There’s an organization out of Texas or a tech company, and they looked and said, what do we really need, and they broke it down actually, into some beliefs and behaviors, right? Like curiosity and they just about tossed out any you know college degree and they got really, really good at training different elements of jobs. They’re this wildly diverse organization.
Let’s flip to the other side because we’ve talked about some of the systems things right, the diversity, and equity. That happens at leadership at the system level, let’s talk about inclusion and belonging which happens right between every single employee and every single interaction.
What are you all doing when it comes to that? I think I think your Friday series is certainly a part of that. What are some other things?
Lor: Go ahead, Andre.
Andre: Yeah, so I was nervous about this and then Lor said it.
Mo: Because I’m so hardcore!
Andre: We started on a journey to have and I don’t even know if we officially have a title yet Lor, do we? But like a whiteness academy.
And so, I’m nervous because we’re in this political environment. So how do you talk about whiteness? Why is it important to talk about whiteness? How do we not alienate our white colleagues? And so, we’ve been working with doctor Mary R. Ferguson out of Saint Louis, who has really been walking us through this absolutely brilliant and beautiful dialogue. I thought it was going to, you know, divide us. It actually has brought us closer together, not only just in what she has.
What she has given us as a tool is radical compassion, and the recognition that wherever whatever we came from is not our fault but where we are is our responsibility and so really helping us to use this radical compassion to dispel some of these things that I refer to as obstacle illusions.
Mo: Love that, I love that.
Andre: Years between human relationships, right? And so really trying to dispel those and so we had a series on being black in America right now. We’re kind of in this is white in America kind of thing in recognizing that there are more people it’s not just a black and white thing, but there are folks in there, but that’s the dominant dichotomy that we oftentimes find ourselves in.
And so, we’ve been doing that we’ve been, here’s the thing that’s really interesting, and I’ll stop talking Lor so you can get in, but I think Lor, I think the number is over 300 people that we that we use as outreach, I think that’s about the number. But we’ve been teaching people how to have these same conversations, so it’s not just our team now it’s in the body of Mayo Clinic and it’s becoming a practice that people are doing in their smaller groups and under their shields and in their sites and in their regions.
And so, I think that’s important, the notion of you know, kind of radical compassion, but also recognizing with great power, comes great responsibility. I think that’s from Ben Parker from Spiderman, but by those things it certainly becomes easier to have these tough and difficult conversations. And when you support that with data in science and statistics, that that really helps us to fuel that.
Lor: I would add that our leaders really jumped in, and even in the beginning. So, George Floyd killing happened our leader came back, leaders, not just one leader across the organization said we’ve got to do something about this right? And so, what we gave them was here’s a tool where you can go and do your host your own listening sessions, right? We coached them through it, we took them through it we sat down and advised.
In certain instances, and for example, in the health system, we had doctor Mary Jo Gusto, who leads all of our health system. So southern Minnesota, western Wisconsin, the community hospitals, community health clinics and what not. And they have about, by themselves about 6000 employees roughly, she went out and hosted a virtual zoom conversation and had over 650 of her colleagues join.
To talk about the impact of the social unrest and racism in the community, what makes it hard for us to have these conversations at Mayo Clinic? And what can we do about it to move forward collectively, together, right? So, they are hearing in that instance, hearing it directly from their top of their house leader that this is an important issue to me.
So, what she’s done after that is tasked all her region leaders to go and host two to three other conversations deeper into the organization, right? So, we see this happening across the organization that leaders are taking it up. We’re just providing them the tools to have these conversations. I have the one on one or the group or the staff level.
The tools Andre certainly talked about with the everybody, any challenge, the whiteness, the being black in America, all those tools. Also, you know we often talk about that this work isn’t just, it doesn’t end when you clock out right? This is about who we are as people even outside of the quote on quote work world. And so, these two are the skills are always can be applied to anywhere you walk.
Ideologies are Limiting
Andre: Again, Lor hit on something that I think is important skills and tools, not ideologies. Correct because ideologies limit our ability to be affective. They certainly fuel our emotions or maybe or even our intellect but at the end of the day I need folks to be able to be affective with tools and resources.
Those are things I can teach tools in and I can provide resources, but when we start talking about ideologies and all those things, those become really subjective and really hard to manage in organization, so that’s why we’ve been really focusing on tools, technology, focused on goals, let’s do those things.
Mo: Well, right we always talk about practical, actionable, right? Give me something that I can actually do and change behavior and something to like hang my hat on so that then I can practice and get better, right? And stay in motion with it. Ideology I can do a lot of talking.
Lor: And let’s be honest, ideologies are what got us in trouble in this space.
Mo: I know we could talk forever, and I know that that you have busy days and I am so, so appreciate this. I want to pack unpack like a million other things. I knew it was going go like this, leave me with one last truth bomb.
Lor: Oh, I don’t know. Andre, you got anything off the top of your head?
Andre: Well, the only thing I would say is and this is one of our themes of our conversations is to give people space, to make mistakes and give them grace when they do. Because it’s easier for you to do the same thing for yourself, when you do it for other people.
Lor, you want to follow that up?
Lor: No, I don’t think that it needs to follow up.
So that’s what we do in our everyday. Any conversation is if Andre closes it well, I’m not, I’m going to shut up and do it.
Mo: I love it. Well, I really appreciate we covered so much ground and your sharing will help some other folks move forward and stay in motion.
Um and out there doing the everyday inclusion and belonging work that needs to be done. So, we’ll see you all next week, and thanks Lor and Andre.
Lor: Thanks for having us.
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