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5-Part Framework for Workplace Equity at Healthcare Organizations

Analysis  |  By Christopher Cheney  
   December 08, 2021

The Institute for Healthcare Improvement has developed five guiding principles to promote workplace equity: assess, build, commit, defend, and evaluate (ABCDE).

As part of its effort to promote joy in work at healthcare organizations, the Institute for Healthcare Improvement has adopted a framework of five guiding principles to foster workplace equity.

"When we are talking about workplace equity, one of the drivers of joy and wellbeing in work is psychological safety," says Marina Renton, MPhil, a research associate at the Institute for Healthcare Improvement. "We see workplace equity as an important component of ensuring psychological safety for staff members. Workplace equity is a vital component of their ability to find joy in the workplace and to feel safe at work. It is foundational to starting to work toward improving staff experience."

1. Assess: The first step for an organization is to assess workplace equity to gain an understanding of the gaps that exist for staff members in the particular settings targeted for improvement.

"Assessment is the first component of the framework because it is fundamental. Collecting and reviewing organizational data allows you to understand where the equity issues are at the organizational level, and that allows you to think about what changes you would like to test. You can find out whether disparities in staff experience exist," Renton says.

Organizations should stratify the data that they collect, she says. "For example, you should stratify data by racial equity in the workplace. If you just ask staff how satisfied they are with their job, and you do not look at that by race, you will get an overall picture, but you may miss disparities."

Assessment should be a collaborative effort between leadership and staff members, Renton says. "In the assessment phase, it is also important to get information on what matters to staff. What is impacting their joy in work? What aspects could be improved? This foundational data collection will allow you to make staff-centered changes that do not involve assumptions."

2. Build: Once the gaps are understood and an aim is identified, the next step is to build—to make structural changes from the top down, with engagement at all levels to prevent equity work from running into barriers.

Leadership must be actively involved in workplace equity efforts, she says. "One of the reasons it is important to make structural changes is you cannot expect staff members to take on this work or for satisfaction to improve without a clear commitment from leadership. For example, achieving equity goals is embedded into executive compensation at Robert Wood Johnson University Hospital."

Planning and allowing time for change to occur are pivotal, Renton says. "You cannot launch into this work without a clear plan and clear supports in place. The building principle includes ensuring that you are guaranteeing adequate time to addressing workplace equity."

3. Commit: Organizations need to make a concrete commitment to equity improvement initiatives through allocating financial and staff resources to the work, rather than expecting staff members to take on the work in addition to their regular responsibilities.

Commitment is a factor in ensuring that initiatives get off the ground and are sustainable, she says. "You have collected the data. You know that you want to make a change. You know you are committed to equity in the workplace. But you need to make the next step. Dedicating financial resources and staffing resources is an important piece of making a commitment to workplace equity. Without a budget, there is risk of the work stalling or being relegated to the periphery. A clear and concrete commitment is crucial."

Robert Wood Johnson University Hospital has business resource groups—affinity groups for employees with shared identities—that have executive sponsors and equity budgets to support equity at the workforce, patient, and community levels.

4. Defend: Equity intersects with principles of physical and psychological safety if there is biased behavior from patients. Organizations can enact systems and workflows to defend and protect staff members quickly and decisively.

The defend principle applies directly to workplace equity during the coronavirus pandemic, Renton says. "Tensions are running high, healthcare decisions are being politicized, and the political climate has been polarizing. So, staff members are at risk of facing instances of bias from patients."

An Annals of Internal Medicine article published last year lists recommendations for medical centers to address patient bias toward healthcare workers, including the following:

  • Creating a policy that explicitly addresses patient bias
  • Establishing trainee-specific procedures because they are at higher risk
  • Making considerations for the role of bedside nurses
  • Creating a mechanism for reporting patient bias toward healthcare workers and supporting staff members to use it
  • Designating a team to support staff and implement policies and procedures
  • Ensuring adequate training for confronting bias-based patient behavior

5. Evaluate: An organization's progress on workplace equity and staff wellbeing should be continuously evaluated and overseen by a board-level committee.

Every project can start with the best of intentions, but you need to make sure that the aim is being achieved, Renton says. "We recommend that this work start at the board level because that is the governing body of the healthcare organization. The charter of whatever committee is devoted to equity should include looking at equity within the workforce. Ongoing evaluation makes sure that your efforts are being directed in the right way and have the intended consequences."

Selecting metrics should be guided by the aims of workplace equity efforts, she says. "What is the organization aiming to achieve? What is the organization aiming to understand? What is the organization aiming to learn about workplace equity? Based on that selection process, an organization can determine what measures might be most meaningful and valuable to both leaders and staff in understanding equity."

For any data collected, there should be a clear plan for how the data will be used, Renton says. "That plan should be clearly communicated to the people being asked to contribute the data. Better yet, that plan should be co-designed with staff."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


Workplace equity is a key factor for healthcare workers to find joy in work and to feel safe at work.

For healthcare organizations seeking to improve workplace equity, the first step is assessing where gaps in staff member experience exist.

Senior leadership must be actively involved in workplace equity efforts.

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