Several radiology departments have begun to create diversity, equity, and inclusion (DEI) committees to systematically address DEI issues in radiology. However, there are few articles that provide departments with guidance on how to create DEI committees to comprehensively address DEI issues in radiology. The purpose of this review is to provide readers with a framework and practical tips for creating a comprehensive, institutionally aligned radiology DEI committee. The authors describe key components of the strategic planning process and lessons learned in the creation of a radiology DEI committee, on the basis of the experience of an integrated, academic northeastern radiology department. This review provides academic radiology departments with a blueprint to create a comprehensive, institutionally aligned radiology DEI committee.
Coronavirus disease 2019 and the publicly documented deaths of countless Black individuals have highlighted the need to confront systemic racism, address racial/ethnic disparities, and improve diversity and inclusion in radiology. Several radiology departments have begun to create diversity, equity, and inclusion (DEI) committees to systematically address DEI issues in radiology. However, there are few articles that provide departments with guidance on how to create DEI committees to comprehensively address DEI issues in radiology. The purpose of this review is to provide readers with a framework and practical tips for creating a comprehensive, institutionally aligned radiology DEI committee.
The authors describe key components of the strategic planning process and lessons learned in the creation of a radiology DEI committee, on the basis of the experience of an integrated, academic northeastern radiology department.
A hospital-based strategic planning process defining the DEI vision, mission, goals, and strategies was used to inform the formation of the radiology department DEI committee. The radiology department performed gap analyses by conducting internal and external research. Strengths, weaknesses, opportunities, and threats analyses were performed on the basis of consultations with institutional and other departmental DEI leaders as well as DEI leaders from other academic medical centers. This framework served as the basis for the creation of the radiology departmental DEI committee, including a steering committee and four task forces (education, research, patient experience, and workforce development), each charged with addressing specific institutional goals and strategies.
This review provides academic radiology departments with a blueprint to create a comprehensive, institutionally aligned radiology DEI committee.
The US population is diversifying, with rapidly increasing proportions of Hispanic, Asian, and Black individuals. Racial/ethnic minority patients who receive care from racial/ethnic minority physicians are more likely to experience improved communication, increased patient satisfaction, improved adherence with medical recommendations, and improved health care outcomes.1,2 Race/ethnicity is the strongest predictor of whether physicians will care for vulnerable or underserved patient populations.3,4 Given historic mistrust between racial/ethnic minorities and health care systems, a diverse health care workforce will be vital to take care of an increasingly diverse US population.
Diverse health care organizations have benefits beyond patient care. Maximizing the benefits of diversity and inclusion means incorporating a broad definition of diversity encompassing not only race/ethnicity and gender but also sexual orientation, age, socioeconomic status, veteran status, disability, and language. Diverse organizations have higher profits, reduced employee turnover, higher employee engagement, increased innovation, and improved decision making.5
Radiology departments consist of a wide variety of role groups, including physicians, technologists, nurses, and administrative staff members. Although there are limited data about the nonphysician radiology workforce, our physician workforce in radiology currently does not reflect the increasing diversity of the US population.6 In comparison with the US population and medical school graduates, women and several racial/ethnic groups are underrepresented both as trainees and as practicing radiologists. A recent ACR workforce survey in 2018 revealed that only 23% of practicing radiologists were women, a proportion that has not substantially changed over the past decade.7 Although many other specialties have improved their pipelines of female and underrepresented minority trainees, the proportion of female residents in radiology has remained stable or slightly decreased over the past decade8, and several racial/ethnic groups remain underrepresented as diagnostic radiology trainees and practitioners.6 The lack of racial/ethnic and gender diversity in the radiology physician workforce limits the ability of radiology departments to provide high-quality care for an increasingly diverse US population.
Coronavirus disease 2019 and the publicly documented deaths of countless Black individuals have highlighted the need to confront systemic racism, address racial/ethnic disparities, and improve the diversity and inclusiveness of radiology departments. Radiology departments have recognized the heightened urgency of diversity, equity, and inclusion (DEI) initiatives not only for patient care but also for the long-term health and growth of a radiology department. Departments can foster DEI goals by creating DEI committees composed of dedicated individuals across role groups. However, there are few published guidelines to help radiology departments create institutionally aligned DEI committees that comprehensively address DEI topics in radiology. The purpose of this article is to provide readers with a blueprint for creating a comprehensive, institutionally aligned radiology DEI committee, on the basis of the experience of an integrated, academic northeastern radiology department.
In 2014, the chair of the Radiology Department was asked by the president of the hospital to co-chair the diversity committee of the general executive committee for the hospital. The Radiology Department chair and program director of radiology administration played central roles in formulating the DEI vision and mission for the hospital as part of the strategic planning process (see Figure 1) on the basis of several strategic retreats. The overall process of defining the vision and mission of a DEI committee provides an opportunity to harness positive energy among staff members toward common DEI goals.9 The vision represents the ultimate purpose of the DEI committee, states the committee's aspirations, and helps guide committee members toward current and future actions. An effective mission statement defines the goals an organization aims to accomplish using specific, actionable language. The hospital vision statement captured the aspirational goals of the institution for DEI. On the basis of this vision, the hospital developed a mission statement to help define DEI goals for the organization (Table 1). The vision and mission formed the basis for specific DEI goals, mapped to core elements of the vision and mission statement (see Figure 2). These goals then served as the basis for the development of specific strategies to comprehensively address these specific goals (Table 2).
Note: D&I = diversity and inclusion.
Internally, many academic medical centers and universities have resources available to inform best practices, leverage existing programming, and provide organizational support for DEI initiatives. In 2015 and 2016, the Radiology Department conducted internal research by connecting with institutional and departmental DEI leaders within the hospital and the medical school who have created committees and initiatives. Internal research also included detailed review of the hospital-wide DEI strategy and hospital-based internal and external research findings to inform the development of the Radiology Department strategy. Externally, the Radiology Department contacted DEI leaders from other radiology departments10- 20 and regional and national societies21 that have created initiatives and committees charged with addressing DEI issues to provide additional perspectives on the basis of experience.
These internal and external efforts were subsequently used to perform informal gap and SWOT (strengths, weaknesses, opportunities, and threats) analyses and served as the basis for the initial proposal for the radiology DEI committee structure. To summarize information from internal and external research, radiology leaders conducted SWOT analyses derived from the vision and mission statements. Strengths represent the initiatives and ongoing DEI programming for which a department or institution already performs well with reference to peer institutions. Weaknesses represent the areas for improvement, derived from candid, internal reflection. Opportunities integrate the strengths and weaknesses of a department to identify potential initiatives. Threats represent external challenges a department may need to confront to ensure the viability of DEI initiatives. Examples and practical tips on how to perform a SWOT analysis are available in Sharpe et al.9
The Radiology Department then internally evaluated its own status by conducting gap analyses. Gap analyses for departmental DEI efforts include examining the current status of DEI efforts within the department and the departmental vision for an ideal DEI environment and then considering the steps required to bridge the gap. Our Radiology Department then used strategic program assessment principles to prioritize initiatives derived from SWOT analyses on the basis of program attractiveness, competitive positioning, and alternative coverage.22 For a given initiative, program attractiveness refers to the extent to which a given initiative aligns with the institutional and departmental DEI vision and mission. Competitive positioning refers to the ability of a department to successfully execute and support the initiative. Finally, alternative coverage refers to an assessment of the extent to which other internal or external organizations may provide similar services or initiatives to similar constituents.
Internal and external research efforts served as the basis for the initial proposal for the Radiology Department DEI committee structure. This initial proposal was refined on the basis of feedback from division chiefs and senior departmental leaders, leading to the establishment of the radiology DEI committee.
The vision, mission statement, and DEI goals developed for the hospital served as the framework for the establishment of the radiology DEI committee, informed by internal and external research conducted by the department. The radiology DEI committee was led by a committee chair and guided by a steering committee composed of the department chair and senior clinical, technical, and administrative leadership (see Figure 3). The committee chair worked with the steering committee to create four task forces (education, research, patient experience, and workforce development) designed to address radiology-specific tactics derived from the hospital-wide strategy (Table 3).23 To ensure diversity in roles across the task forces, each task force was co-chaired by one physician and one member of another role group (nurse, technologist, administrator, etc).
Note: D&I = diversity and inclusion; DEI = diversity, equity, and inclusion.
The steering committee of our DEI committee was charged with guiding and implementing the overall DEI strategy across the task forces and the entire department, in conjunction with institutional DEI leaders. Composed of senior departmental leadership, one of the most important functions of the steering committee is to embed DEI principles into every aspect of routine departmental clinical, administrative, educational, and research operations. Additionally, the steering committee and committee chair were tasked with the creation of a centralized infrastructure, led by a chief diversity officer, to guide and manage the implementation of the diversity and inclusion strategy. Finally, the steering committee was charged with fostering a culture of safety and trust among our patients and families, colleagues, and communities.
The patient care task force was charged with developing and advocating for programs that provide high-quality, equitable care to diverse patient populations and increase the number of patients from underrepresented backgrounds. Additionally, they were charged with creating spaces that recognize and celebrate the diversity of our patient populations and health care providers in the physical and virtual environment of the department. On the basis of initial gap analyses and conversations with stakeholders, DEI committee leaders identified potential tactics and areas of focus for the patient care task force (Table 4).
Note: DEI = diversity, equity, and inclusion; URiM = underrepresented minority in medicine.
The workforce development task force addresses workforce issues for faculty members, trainees, technologists, nurses, administrative staff members, and researchers in the Radiology Department. The workforce development task force was charged with creating a comprehensive talent management model focused across the continuum of pipeline development (recruitment, retention, development, advancement) with specific focus on increasing workforce diversity. Additionally, the workforce task force was charged with proactively seeking input from employees on issues of DEI and responding to issues in a timely and effective manner. Finally, the workforce task force was charged with coordinating and expanding diversity and inclusion educational opportunities in the Radiology Department. On the basis of initial gap analyses and conversations with stakeholders, DEI committee leaders identified potential tactics and areas of focus for the workforce development task force (Table 4).
The research development task force was charged with increasing the percentage of the research portfolio focused on health disparities and topics of DEI. Additionally, the task force was charged with partnering with institutional and department-based research study recruitment teams to increase the number of study participants from racial and ethnic minority populations. On the basis of initial gap analyses and conversations with stakeholders, DEI committee leaders identified potential tactics for the research development task force (Table 4).
The education task force was charged with coordinating and expanding diversity and inclusion education and training opportunities with a focus on making it easy for individuals and departments to participate in a routine and ongoing manner. Additionally, the education task force was charged with helping create a comprehensive talent management model focused on pipeline development for trainees. On the basis of initial gap analyses and conversations with stakeholders, DEI committee leaders identified potential tactics for the education task force (Table 4).
Providing structure and organization to the DEI committee can sustain initial momentum. Regular (monthly or quarterly) meetings with defined agendas can help the committee and task forces stay on task. During meetings, facilitators can provide focus to the meetings and maximize engagement by providing the group with specific questions that committee leaders would like the group to provide input on. Meeting facilitators should set a tone of action focused on answering questions, delegating tasks, setting deadlines, and establishing timely follow-up. During the course of the meeting, meeting facilitators should be consciously aware of various phenomena that limit the voices and perspectives of women, underrepresented minorities, and less powerful individuals present in the meeting.24,25 Finally, in addition to regular meetings, committees should set annual goals with interim opportunities to evaluate progress, successes, and failures.
With the formation of the committee, steering committee, and four task forces, the radiology DEI committee developed and implemented specific programming and initiatives to address DEI strategic goals over the past 4 years. In this section, we highlight a few representative examples of specific programs developed by our education, research, workforce, and patient experience task forces. Additional programming with details and recordings of some of our prior events are available on our website.23 Our education task force has evaluated the proportion of female and underrepresented minority trainees in comparison with institutional and national benchmarks, instituted processes to systematically evaluate residency and fellowship recruitment efforts, and worked in conjunction with institutional diversity programs to support the recruitment and retention of underrepresented minority in medicine (URiM) trainees. These efforts have led to increased numbers of female and URiM trainees. Additionally, the task force created accessible, routine, and ongoing educational opportunities for the Radiology Department, including our annual diversity week and hospital-wide sessions to address Islamophobia and xenophobia. These events have educated and engaged hundreds of attendees within the department, across the hospital, and in radiology departments across the country. Finally, the education task force has collaborated with schools and educational equity initiatives to encourage low-income and URiM middle school, high school, first-generation college, URiM, and female medical students to pursue careers in radiology in conjunction with our research task force. As many of these educational institutions lack mentors in health professions, these sessions connected dozens of URiM and first-generation students with physician mentors in small groups (in person and virtually). Our research task force has developed and successfully applied for a T32 training grant focused on training underrepresented minorities to pursue neuroimaging research. Additionally, DEI committee members have conducted and published numerous diversity and health equity research projects (representative examples [26-29]).26- 29 Our patient care task force has translated radiology examination instructions into Spanish, audited our department's accessibility for patients with disabilities, and collaborated with our technology incubator to develop artificial intelligence–based translation applications (apps) to provide real-time imaging instructions in multiple languages during coronavirus disease 2019.30 Artificial intelligence translation apps have been successfully integrated into imaging workflows, resulting in more reliable average examination times for patients with limited English proficiency. Our workforce task force has analyzed faculty salaries to assess gender equity in physician compensation. These data enabled Radiology Department leadership, working with departmental finance teams, to eliminate gender-based salary disparities among our research faculty members, adjusted for rank, grant funding, and duration of employment. Finally, we have held interactive, educational sessions to help address micro- and macroaggressions directed against staff members.
Aligning DEI initiatives with existing departmental and institutional initiatives is essential for the success and growth of a departmental DEI committee. Within a department, several DEI initiatives may overlap with existing departmental initiatives (eg, outreach, education, quality metrics, workforce development). Our DEI committee has been able to successfully disseminate DEI programming throughout the department by collaborating with individuals in the department to integrate DEI principles and outreach into existing roles for which there is potential overlap with DEI initiatives. Commitment from the department chair and departmental leaders has been crucial in providing support to help integrate DEI principles within these roles. Additionally, departmental DEI committees should align themselves with institutional DEI efforts to support the growth and development of DEI programming. Hospital-wide, radiology DEI leadership actively contributes to the institutional equity and community health task force, a forum in which departmental and hospital-wide initiatives and best practices are shared. This forum provides opportunities for collaboration and avoids duplicated efforts when multiple DEI entities are working toward the same goals. To this end, the radiology DEI committee at our institution implemented a number of educational programs that were eventually made available at the institutional level for a broader population to benefit. Similarly, many institutional offerings were made available to the department, where applicable. DEI committees can support the success of departmental DEI initiatives through close collaborations and alignment with existing departmental and institutional initiatives.
One of the central factors associated with the success of our DEI committee was the extent to which our efforts were supported by both institutional and departmental leadership. The hospital committee had already established a DEI framework through the creation of a strong central hospital-based DEI program. Our department chair was co-chair of the hospital committee and was committed to having a strong departmental DEI committee. At our institution, other departments already created active committees and were eager to help us initiate our program. Our DEI committee was embraced by both departmental leadership and the majority of our employees. As a result, we were fortunate to have experienced few obstacles toward the initiation and implementation of our DEI committee.
One of the other essential factors for the success of a DEI committee is the extent to which DEI initiatives actively incorporate different role groups. Because many DEI issues have disproportionate effects on different role groups within a radiology department, it is crucial to incorporate the perspectives and experience of these role groups in the planning, implementation, and monitoring of DEI initiatives. For example, although there are low proportions of URiM physicians in radiology, there may be considerably higher proportions of URiM employees working as technologists and/or administrative staff members in a given radiology department. In this scenario, a given department may need to focus more of its energy on the retention, promotion, and advancement of URiM staff members in these roles. Similarly, our technologists and front-desk workers interact with our patients on a daily basis; hence any DEI efforts to improve the inclusivity of our environments for the diverse patient populations we serve must integrate the perspectives of these role groups. Overall, there are limited data about the nonphysician radiology workforce, suggesting ample opportunities for investigators to evaluate the extent to which our nonphysician radiology workforce reflects the diversity of the US population, evaluate barriers for the advancement of our nonphysician workforce, and identify opportunities for our nonphysician workforce to improve the inclusivity of our environments to care of the increasingly diverse patient populations we serve.
Current events have highlighted the need to confront racial/ethnic disparities and improve the diversity and inclusiveness of radiology departments. Committees represent important tools for radiology departments to comprehensively address DEI issues in radiology. This article provides academic radiology departments with a blueprint to create a comprehensive, institutionally aligned radiology DEI committee on the basis of the experience of an integrated, academic northeastern radiology department. Although our experience reflects our unique local environment, the strategic planning process we used and described in this article involves generalizable principles that can be applied to any academic practice environment that seeks to advance DEI goals.
To confront systemic racism, address racial/ethnic disparities, and improve the diversity and inclusiveness of radiology departments, radiology departments should convene stakeholders across multiple role groups to appoint DEI leaders and committees.
Strong support from institutional and departmental leaders in conjunction with broad-based engagement from departmental staff members is crucial for the successful creation and implementation of a DEI committee.
Strategic planning processes can be used successfully to create a radiology department DEI committee and advance DEI goals.
Aligning DEI initiatives with existing departmental and institutional initiatives is essential for the success and growth of a departmental DEI committee.
Because many DEI issues have disproportionate effects on different role groups in radiology departments, it is crucial to incorporate the perspectives and experiences of these role groups in the planning, implementation, and monitoring of DEI initiatives.
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Disclosure Statement: Dr Brink has received personal fees from Accumen, outside the submitted work. All other authors state that they have no conflict of interest related to the material discussed in this article. Drs Narayan, Schaefer, Daye, Chonde, Flores, McLoud, Brink and Ms Alvarez are employees.
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