AANS Neurosurgeon | Volume 27, Number 3, 2018

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Building Cultural Competence in the Workplace

The University of Michigan has openly and widely embraced diversity, equity and inclusion (DEI) for many years, with the central goal of making Michigan Medicine a place where every person feels valued and can thrive. Achievement of this goal relies on having a set of guiding principles to work from in your workplace’s pursuit of cultural competence. Michigan Medicine strategizes around the principles for the creation of an equitable and inclusive climate; how to recruit, retain and develop a diverse community as well as support of innovative and inclusive teaching and scholarship. These are principles that are discussed and communicated on a regular basis and for which all individuals, leaders and departments are held accountable. To create the culture that you desire, it is always important to find individuals who agree with those principles and who are capable of espousing them on a daily basis. We are fortunate to work in an institution that has always admired diversity. For example, Michigan is among the first institutions to grant a medical degree to a woman. As is always the case, culture triumphs over any mandates within larger institutions.

Within our own neurosurgery department, we found that the development of the principles regarding inclusion and seeking cultural competence requires effort, not only at the institutional level, but also at the local level. To that end, plans were undertaken to help reinforce the culture that we wish to achieve, including:

  • Unconscious bias training
  • Communication skills enhancement, including a culture coach
  • Mini-grants to support programming
  • Innovative approaches to hiring
  • Ongoing self-assessment

Understanding our own biases was an important first step. Available training in unconscious bias was established within the department. All department members, including faculty, residents and staff, have undergone a series of formal unconscious bias training sessions, working with trained DEI coaches from the University of Michigan. As a byproduct of this, we found a greater awareness of the importance of diversity within our individual unit and certainly how it could be important to us as we hire new individuals. The process of selecting new members of the department requires not only assessment of their skill set with respect to a particular job, but also their skill set with respect to the cultural principles of the larger community. Thus, an important tradition has been established.

The ability to communicate becomes particularly important when developing a positive workplace culture. The University of Michigan promotes a yearly confidential employee engagement survey for staff throughout the organization. To further increase participation, a culture coach designee for the department was introduced for the purpose of communicating the survey’s purpose, promoting participation and monitoring survey results. The Culture Coach’s role in its simplest form is connecting people and purpose. Our Culture Coach works to champion the overall employee experience within our department. When selecting our Culture Coach, we select an employee (non-supervisor or manager) with no active discipline, who demonstrates a positive work ethic and supportive attitude toward the department’s vision and strategy. The role is voluntary and provides an excellent leadership development opportunity for the designee to grow. Innovation does not always come from the top leaders; it often comes from the “frontlines.” By designating a Department Culture Coach, we are empowering employees to help shape our department as they want it to be. Ultimately, our Culture Coach emphasizes our mission and values from the frontlines to our leadership, reinforcing our employee culture and our sense of shared purpose. We, as a department, took the role to another level and developed an employee engagement workgroup, led by the Culture Coach. This workgroup is tasked with creating programs and opportunities that foster collaboration and employee engagement, while showing respect for inclusiveness and diversity on every level.

A volunteer DEI Unit Lead and workgroup were established to develop programs that reflect and address diversity within the department. These programs include applications for mini-grants, hosting “brown bag” lunches that allow for a short presentation and discussion centered around DEI topics and educating faculty and staff on multi-cultural holidays throughout the year. Through these efforts, the DEI lead and workgroup have been able to promote DEI skill building and training, advise on our culture climate and develop a departmental DEI strategic plan. Diversity and culture constantly evolve, so the DEI strategic plan is reviewed, improved and implemented on a tri-annual basis always concordant and compliant with the University of Michigan’s mission of acceptance, diversity and accountability.

We further enhanced these communication efforts by launching a monthly electronic intra-department newsletter that communicates upcoming events, important awards and recognitions, individual staff and patient stories, research updates and introductions of new members, all with the goal to fortify the culture of the department.

One of the guiding principles of our department has always been our mantra, “We are about our patients, past, present and future.” We recognize that by focusing on our patients, as well as ourselves, we provide the best opportunity for a common dialogue theme among specialists. Our goal is always, to the best of our ability, identify what is important to our patients, recognize cultural differences and identify what is important to us. As such, it allows us to understand why we work so hard to take excellent care of our patients. As part of our mantra that we are always about our patients, there is also the necessary call of, “What about the team?” How do we create a sense of equality amongst team members? We recognize that in taking care of our patients, we must also take care of ourselves. Among the new realizations was that care of each other within the framework of our busy lives is important. As such, we have developed a plan that provides advice and training for wellness at all levels of the department. It suggests that we take care of each other first and foremost, because in so doing it gives us the sub-strength to take care of others. This mantra has proven to be powerful in that by taking care of each other extremely well we find that the cultural environment improves regularly.

Culture stems from a collective of individuals, and although it establishes a sense of community, that community must be actively engaged in taking care of itself. Among the undertakings that have helped bring this into focus was the designation of an employee as our Community Outreach Coordinator to help organize and facilitate events that benefit the local community. Across all levels of the department — faculty, residents and staff — we strive to create a culture of community involvement through opportunities to come together and accomplish shared goals such as:

  • Meal preparation at the Ronald McDonald House and local homeless shelter;
  • Volunteering at the community food bank; and
  • Collecting school supplies and personal items for homeless youth.

These opportunities are unique, because they take place within the community and outside of the workplace and they boost a sense of teamwork, meaningfulness and contentment. Reaching out has helped to define who we are internally. It intrinsically feels good to be part of these events and recognize the common values we share, such as empathy, generosity, service and teamwork. We take pride in celebrating this commitment to volunteering and giving back to the community. It stems from an understanding that community along with diversity, equity and inclusion all require intentional handiwork. It does not come from mandate and cannot be created without communal goals and aspirations.

One area where cultural competence has changed our business practices is the recruitment of new employees. In selecting a new employee, particularly a new faculty member, a good fit with the existing and desired culture is important. To that end, there is a discussion about the culture and what is expected at the very onset of the interview process. It is reinforced during the negotiation phase and monitored in the early days of employment. Respect and civility are important to achieve a cohesiveness that allows a department to not only take excellent care of its members, but also provide outstanding care to patients even under the most desperate of circumstances. Culture guarantees that the norms of the group and the boundaries of behavior are internalized and demonstrated daily. Culture will always trump rules.

Cultural competency requires an ongoing effort of self-reflection and understanding of how the world is perceived differently by others. Such ongoing effort is rewarded with the knowledge of cultural differences to build a more inclusive and collegial work environment. One can understand that, as an institution, we must value not only our patients, but each other and strive to make the work environment the best that it can possibly be. It is exciting to work in an environment in which individuals know that respectful discussions and civil disagreements are an avenue to learning and discovery for the betterment of our culture.

Co-authors

Stephen Napolitan, MHA, Chief Department Administrator, Department of Neurosurgery, University of Michigan

Melissa Matthews, Administrative Assistant, Community Outreach Coordinator, Department of Neurosurgery, University of Michigan

Kaitlin McMurray, Brain Tumor Program Coordinator, DEI Unit Lead, Department of Neurosurgery, University of Michigan

Becky Sigler, Executive Assistant, Department Culture Coach, Department of Neurosurgery, University of Michigan

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