Organizational Behavior Management has the potential to help organizations drive racial equity and inclusion

In order for the field of Organizational Behavior Management to help lead on racial equity change, it must first prioritize becoming more racially inclusive and equitable itself.

Introduction

With the growing prominence of the Black Lives Matter Movement, many organizations, no matter the type, have increased their commitments to racial equity in the last several years. As a result, racial equity efforts have proliferated across all sectoral institutions in the US—ranging from public to private, corporate to governmental, and policy to grassroots. While these efforts have developed more extensively, the field of organizational behavior management (OBM) is positioned to be a prime actor in understanding their impact to promote racial equity. However, OBM, as a field, has not historically focused on racial equity nor held a significant lens of systemic oppression. Akpapuna et al. argue that OBM has and continues to be a white-dominated field with a critical need to respond to the discipline’s intersections with racism, and growing calls for addressing systemic racism in the US.

They report that across literature in OBM over 43 years on racial equity, multiculturalism, and diversity there is consensus on what needs to be achieved, yet ambiguity on strategies for how to achieve it. As a result of their review, the authors maintain that the field of OBM must become more racially inclusive and equitable before it can provide technical assistance and learning for US actors seeking to undertake  racial equity institutional change. Ultimately, the authors provide recommendations for ways in which the OBM field can become more racially inclusive, equitable and just internally, as well as its outward facing scholarship for the field

Merrilyn Akpapuna, Eunju Choi, PhD, Douglas A. Johnson, PhD and Juan A. Lopez were with the Department of Psychology at Western Michigan University at the time of publication. Akpapuna and Choi are part of the Instructional Design and Management Lab, headed by Dr. Johnson, who is also a Learning Leader for Eastman Chemical Company. Dr. Choi is also an Assistant Professor at St. Cloud University. Lopez is a Behavioral Sciences and Software Development Consultant and Instructor of Western Michigan University’s undergraduate Organizational Psychology course.

Methods and Findings

Utilizing a racial equity lens, the authors explore issues related to training, financial support, recruitment, retention, measurement of progress, support of emerging diverse voices, and self-reflection in the field of OBM. Akpapuna et al. reviewed 40 volumes of the Journal of Organizational Behavior Management throughout 43 years of literature to identify the number of articles in which the words multiculturalism, diversity, racism, or prejudice appeared in the title. The authors found only one. Additionally, to illustrate the urgency for a racial equity focus, and provide more personal background for their findings, the authors shared both personal and peer stories in the article. In sharing these intimate anecdotes they sought to elucidate the needs of Black, Indigenous and people of color (BIPOC) professionals in the OBM field. 

The authors identified the following findings, which also consistently matched theirs or their colleagues’ experiences:

• White colleagues dictate the rules (written and unwritten) of the field, 
• BIPOC professionals’ failure to comply with these rules leads to disciplinary action, which can result in job loss,  
• White colleagues receive preferential treatment within organizations while BIPOC colleagues are scrutinized more than their white counterparts  for the same behavior,
• BIPOC professionals witness or bear racially insensitive jokes by colleagues and are often told they are overreacting when concerns are expressed; 
• BIPOC professionals are tokenized; and 
• There is a clear need for student recruitment efforts aimed at BIPOC individuals at higher education institutions, especially in OBM programs, and there is a major lack of funding to make OBM education accessible.

Conclusively, the authors argue that the OBM field does not tackle social injustice in an effective manner.  Based on their personal accounts and a review of the literature, the authors offer several recommendations for the field of OBM:

• OBM professionals should actively participate in cultural-competency training as part of broader change initiatives
• Ensure that voices of underrepresented groups are included and elevated in OBM training by investing in mentorship, recruitment, promotion, and/or patronage. 
• Organizations should provide financial assistance for participation in OBM training, particularly for BIPOC and international students, and focus on intentional recruitment and retention of BIPOC individuals.
• Partner with Historically Black Colleges and Universities (HBCUs), Hispanic-Serving Institutions (HSIs) and Tribal Colleges and Universities (TCUs) for recruitment and retention efforts.
• Engage appropriate stakeholders to identify equitable outcomes, processes, and performance measures.
• Establish performance standards that are well-defined and measurable. 
• Develop and measure  outcome metrics that have an equity focus; revisit those outcome results on an ongoing basis.
• OBM professionals must regularly reflect personally and professionally about their own prejudices, privileges, biases, and blind spots and acknowledge how the status quo fails to support marginalized communities, and instead often creates harm. 
• The OBM field should interrogate the patterns, outcomes, systems, policies, and procedures that have led it to a state where racial equity is not a focus of the field.

Conclusions

The authors argue, “deciding to increase diversity, equity, and inclusion in an organization is not the end; it is the beginning.” While the framework and recommendations they offer are not meant to be a comprehensive solution, they hope they will galvanize the field of OBM to be more racially representative and inclusive. 

Yet, there remains a lack of research at the intersection of racial equity and organizational behavioral change, and the authors encourage continued scholarship in this nascent field. They call on the field of OBM to dedicate all of its tools toward dismantling racist systems and repairing scholarly work  within their own field and practices within the organizations they study and work with.

Six Steps Organizations Can Take to Help Reduce Health Disparities

Organizations can do more than report health disparities by integrating interventions to reduce disparities into their quality improvement processes.

Introduction

In this special symposium, the authors report findings from Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation. This project investigated and evaluated interventions to reduce racial and ethnic disparities in care, performed systematic reviews of disparity-reduction interventions in healthcare, and provided technical assistance to other healthcare organizations. 

The authors report findings from the systematic reviews on disparity-reduction interventions in healthcare and provide a roadmap for organizations to follow to reduce health disparities. The authors encourage healthcare organizations to go beyond simply reporting health disparities; these organizations should hold themselves responsible for reducing disparities. The authors highlight a predominant disparity-reducing intervention focus on collecting and reporting race-specific data and then creating an intervention based on that data. However, many interventions often dismiss essential steps to ensure interventions are sustainable long-term. This article provides a roadmap that offers six steps for healthcare organizations to implement and ensure balance across the design of their interventions. The roadmap’s findings are applicable to a variety of healthcare settings ranging from public, nonprofit, and private providers who manage care organizations and payors to health departments and academic medical centers. 

Marshall H. Chin, MD, MPH is the Richard Parrillo Family Distinguished Service Professor of Medicine at the University of Chicago School of Medicine. Amanda R. Clarke, MPH, is Director of Programs at California Health Care Safety Net Institute. Robert S. Nocon, MHS is an Assistant Professor in Health Systems Science at the Kaiser Permanente Bernard J. Tyson School of Medicine. Alicia A. Casey, MPH is a Research Associate at the Georgia Health Policy Center. Scott C. Cook, PhD is a Co-Director at Advancing Health Equity: Leading Care, Payment, and Systems Transformation at the University of Chicago. Anna P. Goddy, MSc and Nicole M. Keeseecker, MA, as well as all of the authors, were part of the Robert Wood Johnson Foundation Finding Answers: Disparities Research for Change National Program Office and the Center for Health and the Social Sciences at the University of Chicago.

Methods and Findings

The authors conducted a systematic review of disparity reduction interventions in five healthcare areas: asthma, HIV, colorectal cancer, prostate cancer, and cervical cancer. 

• From the asthma review, they found that educational interventions were most common.
• From HIV, they found that interactive, skills-based instruction was more likely to be effective than didactic educational approaches for changing sexual health behavior. 
• The colorectal cancer review highlighted key gaps as the review identified no articles that described interventions to reduce disparities in post-screening, follow-up treatment, survivorship, or end of life care. 
• The cervical cancer review identified how navigation can improve screening. 
• Lastly, prostate cancer review also focused on the importance of educational strategies to target screening as well as how cognitive behavioral strategies can impact quality of life. 

The authors point out that promising interventions frequently were:

•  Multifactorial and targeted multiple leverage points along a patient’s pathway of care.
•  Culturally tailored and employed a multi-disciplinary team of care providers.
•  Interactive and provided skills training rather than didactic approaches (especially for educational interventions). 

The authors also point to the potential of interventions reducing health disparities when the interventions focus on patient navigation, family participation, and community involvement. 

Ultimately, within the review, the authors found that a majority of interventions focused on  changing the knowledge and behavior of patients through  some form of education. Yet, there continues to be a lack of data and research on the efficacy of interventions targeting providers, microsystems, organizations, communities, and policies.

Conclusions

Based on the findings, the authors provide a six-step roadmap for organizations to consider reducing health disparities. These include:

1. Recognize disparities and commit to reducing them – to do so, it is key to stratify performance data by race, ethnicity, and language (REL) and provide training on specific populations and disparities for staff.
2.  Implement a basic quality improvement structure and process – create a culture of quality with a quality improvement team, processes, goals, and metrics. Utilize champions to help lead disparity reduction work and cultivate leadership support.
3. Make equity an integral component of quality improvement efforts – by recognizing equity as a cross-cutting dimension of quality and not marginalizing efforts to address disparities.
4. Design the interventions by first focusing on root causes of the disparities– consider the six levels of influence (patient, provider, microsystem, organization, community, and policy), learn from the literature and peers, use evidence-based strategies, and identify specific, tailored interventions. 
5. Implement, evaluate, and adjust the interventions – use implementation models, best practices, and evaluation strategies that lead to adjustments and improvements. 
6. Sustain the interventions – institutionalize the intervention and create financially sustainable models. These models can include providing incentives and reimbursements for team-based care, implementation of pay-per-performance programs for reducing racial and ethnic disparities or creating linkages between community and health care systems. 

Beyond reporting disparities, the authors concluded that organizations must design, implement, and sustain interventions that are focused and tailored to their specific populations, communities and environments. More importantly, however, they caution against paralysis from undertaking these efforts due to the need to be specific in these objectives. It is important that they begin by identifying actionable steps to address the disparities they identify and prioritize.

Structural racism and health inequities cannot be disentangled

Introduction

The Black Lives Matter movement has put the spotlight on the costly impact of racism on Black lives and led to a growing recognition that racism has a structural basis and is embedded in long-standing social policy. Racism is not ahistorical and neither are U.S. health care and public health institutions and practices. Drs. Bailey, Feldman and Bassett argue that structural racism is a legacy of African enslavement and affects both population and individual health. They offer three examples of structural domains that continue to lead to poorer health outcomes for Black Americans: (1) redlining and racialized residential segregation, (2) police violence and the carceral state, and (3) unequal health care

Dr. Zinzi D. Bailey, ScD, MSPH, is a social epidemiologist, an Assistant Professor at the University of Miami, and Managing Director at Health Equity Research Solutions, LLC. Dr. Justin M. Feldman, ScD is a Research Associate and former Health and Human Rights Fellow at the François-Xavier Bagnoud (FXB) Center for Health & Human Rights at Harvard University. Dr. Mary T. Bassett, MD, MPH is the Director of the FXB Center, the FXB Professor of the Practice of Health and Human Rights at the Harvard T.H. Chan School of Public Health, the Health Commissioner for the State of New York, and a former Health Commissioner for New York City.

Methods and Findings

The authors point out how structural racism functions to harm health in ways that can be “described, measured, and dismantled.” They provide examples of how these functions can be described and measured by providing historical context and tying the history of three specific domains with current health outcomes. 

Redlining and racialized residential segregation 

• Historically, health inequities can be traced back to the policy of redlining, the federally-sanctioned practice of drawing red lines around communities with large Black populations, denying home ownership loans and limiting financial investments. This financial disinvestment led to residential segregation and poorer health outcomes in Black neighborhoods. 
• Presently, racial segregation in housing remains a powerful predictor of Black disadvantage in health, documented with poorer outcomes in preterm birth, cancer, tuberculosis, maternal depression, and other mental health issues. 

Police violence and the carceral state 

• The history of modern US policing is rooted in slave patrols first established in the 18^th century. Since then, policing has continued to disproportionately affect Black Americans negatively, particularly through the “War on Crime” and “War on Drugs” era. Policing and incarceration have profound adverse consequences for the health of Black people. 
• From police violence towards Black Americans to the mental health impacts of policing and incarceration on Black individuals and communities, health disparities associated with incarceration and reentry into the community persist. For example formerly incarcerated individuals, who are disproportionately Black, bear a disproportionate burden of sexually transmitted infections, infectious diseases, and the mental health impacts of the threat of violence and surveillance. Incarcerated people also face a high risk of death after release and have been disproportionately impacted by the spread of COVID-19, for example. 

Unequal health care

• Modern health care has evolved from historically racist practices and policies. The healthcare system has long pathologized blackness to justify inhumane practices like whippings and experimentation on Black bodies. White superiority was the basis for falsely perceived differences in skull size between races, sterilization, scientific racism, and the eugenics movement. 
• Unequal treatment in health care remains a contemporary and persistent reality. For example, research has shown that white medical students inappropriately assess or ignore pain  among Black patients compared to white patients. These individual and institutional practices cannot be disentangled from racial segregation policies which lead to disparities in access to high quality medical care and continued experimentation on Black bodies, evidenced by the disproportionate share of medical training programs that provide services in Black communities.

Conclusions

The dismantling of structural racism must involve the whole of society, including health care and public health practitioners, to whom they offer four recommendations. The first (1) is the need to document racism, which includes recommendations to funders, editors, and reviewers to acknowledge that racism and inequities in social determinants of health more generally are valid research topics. Second (2) is the need to improve both the availability of data that include race and ethnicity and the tools to measure structural racism. 

Third (3), they suggest that the medical and public health organizations must turn a lens on themselves, both as individuals and as institutions to reflect and recognize the harms associated with using racial categories uncritically and connecting the history of racism with the healthcare field. Faculty and students need a more complete view of the ways in which medicine and public health have participated and continue to participate in racist practices throughout United States’ history. Finally, (4) the authors conclude that mass social movements are a necessary tool to dismantling racism in health care delivery and public health. Health inequities cannot be separated from the broader, antiracism movement. 

Despite the disjointed creation of the fields of diversity training and diversity education, taking the best of each would advance both goals.

Introduction

Over the last two decades, the fields of diversity training and diversity education have become critical components of organizations and academic settings. Just as organizations develop antiracism policies and employee training, management programs have also expanded their diversity management educational offerings. Diversity training refers to the specialized field devoted to ad hoc training in organizations and companies that address tailored diversity needs and practices. Diversity education refers to the formalized educational field, often in business and management programs, that focuses on the broader need for diversity practices. 

In some cases, the academic and popular literature treats the concepts of diversity training and education as interchangeable. This study seeks to correct that conflation by highlighting how these two fields have developed independently of each other and identifying the nuances between the two distinct fields. The authors find that the content of diversity management courses does not seem to match practical and organizational needs, and diversity training often lacks the standardization and accountability embedded in diversity education. By combining the strengths of both fields, diversity training and education overall can be improved and may steer future research. 

The authors include Dr. Eden B. King, Lynette S. Autrey, Professor of Psychology at Rice University, Dr. Lisa M.V. Gulick, human capital and leadership consultant with Deloitte-Australia, and Dr. Derek R. Avery, C. T. Bauer Chair of Inclusive Leadership in the Bauer College of Business at the University of Houston.

Methods and Findings

The authors looked to the existing literature to assess diversity training and education’s content, delivery modes, and benefits. They also reviewed core differences between education and training fields and applied those findings to the subject matter of diversity. 

Benefits of diversity training include:

Emphasis on organizational needs:  Trainings tend to be more informed by prerequisite assessments of the organization’s and individual employees’ needs and current level of understanding on a given topic.

Contextual specificity: Diversity training can provide an opportunity for various levels of management and staff to design and demonstrate commitment to diversity best practices tailored to the organization. 

Competency-building: Diversity trainings move participants beyond awareness alone toward the activities and skills necessary for behavioral change.

Benefits of diversity education include:

Active learning and formal settings – Courses in diversity education benefit from having constant communication and feedback between expert instructors and pupils, including grades and assessments, to maintain engagement. 

Higher participant commitment – The opt-in nature of many elective diversity courses means that the underlying commitment of those enrolled may be higher than in mandated training. 

Knowledge-building – Diversity education tends to center reflection on and awareness of the cognitive functions and biases that underlie our beliefs, which is more likely to change attitudes than behavior.

Conclusions

The authors conclude that by distinguishing between the fields of diversity training and education, the distinct benefits of each can inform the other. Diversity education, for example, would benefit from increasing needs analysis, contextual awareness, and practical focus. Diversity training, on the other hand, could better incorporate knowledge building and reflection and increase emphasis on measuring performance and creating accountability for sustained behavior change. 

As more organizations incorporate diversity training in line with their antiracist statements and more diversity classes are taught, the bridge between these divides becomes increasingly important. Diversity training or education alone is not enough to sustain antiracist efforts; practitioners in both fields can learn from one another to better implement equity, diversity, and inclusion practices. Finding, elevating, and integrating best practices from both fields can potentially improve desired outcomes, direct research, and enhance organizational work around their diversity efforts.