Why diversity must be a ‘culture change strategy’

When Tanya Blackmon talks about Novant Health’s efforts to improve diversity and inclusion, she said it’s important to realize that it’s not a program.

Tanya Blackmon

Blackmon is the executive vice president and chief diversity, inclusion and equity officers at Novant Health, based in Winston-Salem, N.C. She has been leading diversity and inclusion efforts since 2015.

If diversity is simply a program, Blackmon said that suggests it could just be a temporary initiative.

“We’ve really approached diversity, inclusion and equity as a culture change strategy, not about a program,” said Blackmon. “I really believe that when you have a program, you kind of pull it up one day and say, ‘Here’s our program,’ and when you can’t fund it or are tired of it, you put the program in the drawer.”

“Diversity, inclusion and equity is a core value of ours,” Blackmon said. “And so when something is your core value, you’re saying this is who we are.”

Novant Health includes 15 medical centers, hundreds of outpatient facilities and 35,000 employees. She said it takes commitment from leadership across the organization to make progress, along with a willingness to engage employees and understand their concerns.

In an interview with Chief Healthcare Executive, she talked about how Novant has built support for diversity and inclusion, why resistance isn’t something to fear, improving health equity and ways to ensure lasting change.

(Tanya Blackmon offered her thoughts on building diversity programs in this video. The story continues below the video.)

Getting started

Blackmon said the commitment of leadership from Novant Health has been crucial in addressing diversity.

“Our whole executive team really bought into that this was our core value and that we needed to operationalize it, as well as our board of trustees,” Blackmon said.

When she first took the role as chief diversity officer, Blackmon began a listening tour and engaged with leaders and employees throughout Novant Health. She drew on her training as a social worker, when she had to understand the challenges of her clients.

“I wanted to understand and hear the voices of the people about what diversity and inclusion meant to them, what were their hopes, what were their fears, what would it look like in 3 to 5 years if we really were on this journey for embedding diversity, inclusion and equity,” Blackmon said.

“I did it with the board of trustees, I did it with the executive team,” Blackmon said. “I did it on all shifts. I did it on weekends in healthcare, because I truly wanted to hear everybody’s voice.”

Blackmon talked about the value of engaging employees and giving them space to air their views after the murder of George Floyd. They had staff conversations and also put out a position statement affirming Black lives matter, Blackmon said.

Novant also held conversations for staff after the killing of eight Asian women in the Atlanta area in March 2021, an event that chilled Asian Americans across the nation.

Dealing with resistance

Blackmon has worked with Novant Health for three decades and has held leadership roles throughout the system, which she said helped her when she became chief diversity officer.

“I did understand and had worked with so many people across our system, I do believe I brought credibility to the role,” Blackmon said.

Even so, she admitted there were setbacks along the way.

“Change is change, whether it's a great change or people don’t perceive it as a great change, it’s still a change,” Blackmon said. “That means that people have to do something. I think in the beginning we felt some resistance. But one of the things that you learn in this work is resistance is good. It’s really about a fear of something,” she said.

“Our goal and our work has been to lean into what that resistance was, so that we could figure out, what was the resistance? What were the issues?”

Blackmon said Novant provided workers a broader definition of diversity, inclusion and health equity. “If you don’t have aligned definitions, you go somewhere in your head that really isn’t what you’re trying to accomplish,” she said.

“A lot of times when people hear the word diversity, they think about race, and only black and white, and sometimes gender,” Blackmon said.

Blackmon and other leaders stressed diversity has many different facets and can include, age, sexual orientation, economic background, gender identity, disabilities, or status as a veteran.

“We have lots of dimensions of diversity listed,” she said. “When people see that and you’re aligned, then you can really start having dialogue.”

Novant has been measuring different aspects of its diversity strategy. Employees told Novant the organization had to be accountable to making progress.

The system surveys employees and asks if they feel Novant values having members from diverse groups. Novant initially hoped to see 90% of employees saying diversity was valued within three years. After three years, Novant reached 95%, Blackmon said.

Linking to health equity

Novant's efforts to improve diversity have been linked to closing disparities in health outcomes among patients belonging to minority groups.

Blackmon pointed out that Novant looked at why Asian women and Latina women weren’t getting mammograms as often as white and Black women. The system learned that Novant wasn’t offering enough information on mammograms in languages other than English. And she said they learned that they needed to do more outreach and go to those communities to help them understand the importance of breast cancer screenings.

Novant saw an uptick in screenings among Asians and Latinas, along with women in all racial groups. Blackmon cited that as evidence that efforts on health equity lead to improving care for all patients.

“Our mission is to improve the health of communities, one person at a time,” she said. “All of this work has been able to do that.”

Plus, Blackmon said taking better care of workers will help them to take better care of patients.

It’s also important to have knowledge and understanding of the backgrounds of different patients. Clinicians lacking knowledge of a culture or differences in gender orientation, she said, aren’t going to provide the safest care.

She said those efforts over the years proved worthwhile with the emergence of the COVID-19 pandemic, which renewed attention to the stark disparities in outcomes among minority groups. The Centers for Medicare & Medicaid Services awarded Novant one of its first Health Equity Awards in 2018.

The pandemic also drove Novant to look at what else could be done to support staff members. Some endured serious financial hardships if spouses or other family members lost jobs. Novant put $13 million into a disaster relief fund that helped 13,000 employees with basic living needs, Blackmon said.

“We didn’t realize how much people would be struggling,” she said.

Showing clear intentions

Healthcare organizations need to make diversity and inclusion part of their strategic business imperatives in order for those efforts to be effective and sustainable, Blackmon said.

She also stressed the importance of commitment from the top leaders so everyone in the organization understands the goals.

“You have to be clear about your intentions. Be clear about what you want to accomplish as an organization,” she said.

Blackmon also stressed that setbacks should be expected. She also suggested leaders should summon more patience than they thought possible.

“You don’t have to be perfect. We’ve not been perfect along the journey. But It’s important to continue to make progress,” Blackmon said.

“When you feel resistance, lean into the resistance. You don’t have to go backwards, but you have to lean in and understand it so you can keep moving forward on the journey.”

She also suggested leaders should think about diversity and inclusion as “a long-term intentional journey.”

“I don’t think it’s an endgame,” Blackmon said. “I don’t think it’s a destination. I think it’s a journey.”

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