Whitman-Walker’s DEI focus helps weave a ‘tapestry of humanity’

By Julia Elligers, principal, Deloitte Consulting, LLP

Whitman-Walker has been rooted in the Washington D.C. community for more than 50 years. It describes itself as an affirming and safe place for the area’s gay, lesbian, bisexual, transgender, and gender-expansive community as well as for those affected by HIV. The Whitman-Walker Clinic (now Whitman-Walker Health) opened its doors in the 1980s in response to the emerging HIV/AIDS crisis. The care it provided to patients, along with education and prevention programs, played a critical role in reducing the impact of HIV/AIDS in the community, according to the organization. Whitman-Walker has since grown into a comprehensive health care organization that provides a wide range of medical, dental, behavioral health, and social services. The organization says its commitment to inclusivity, advocacy, and community engagement has made it a vital resource for lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) individuals seeking affirming health care. In addition to its clinical services, Whitman-Walker says it is working to create a more equitable and compassionate health care landscape through public health initiatives, educational outreach, community research, and policy advocacy.

The Deloitte Health Equity Institute's social impact arm provides funding and pro bono support to help strengthen place-based change for organizations such as Whitman-Walker, the Trevor Project (see The Trevor Project helps young LGBTQIA+ feel safe, accepted), and New Profit (see Can BIPOC entrepreneurs make mental health more equitable?), which are working to improve mental and behavioral health in the LGBTQIA+ community.

I recently had the opportunity to talk with Naseema Shafi, CEO of Whitman-Walker Health, about health equity, the importance of diversity, equity, and inclusion (DEI) in a clinical workforce, and some of the potential challenges in creating and maintaining a culture of inclusion and belonging. Here is an excerpt from that conversation:

Julia: What do you think makes Whitman-Walker unique as a community health care organization?

Naseema: Whitman-Walker truly stands out as being a very, very special place. We arose out of social justice movements and civil rights movements of the 1960s with a primary focus on the lesbian, gay, bisexual community. At the time, this community did not recognize the transgender and gender-expansive members of the community. What makes Whitman-Walker so unique is that intersectional understanding that some identities are layered. A bisexual Latinx individual, for example, is going to be different and have different needs than someone else [with other identities]. The layers are important to who we are. There is a tapestry of humanity that shows up here every day. I think that sets us apart from other organizations.

Julia: Why do you think a focus on DEI can be important for a community health organization like Whitman-Walker?

Naseema: As a federally qualified health center (FQHC), DEI is essential. We know workforce diversity and DEI training improves both patient care quality and financial results.¹ We try to recruit and retain members of the community who look like and have similar lived experiences to our patients because patients are more likely to engage with someone who acknowledges and understands their challenges.^2,3 It is important that [our staff] reflect the patients and the community we serve to deliver culturally responsive and affirming care. They need to be able to relate to our patients and to the community, especially when we consider how social determinants of health can impact someone’s ability to access care.⁴

Julia: How does having a DEI workforce strategy help you attract and retain employees? How does it impact patient care?

Naseema: Being able to recruit and retain great employees is a business strategy for every industry. But our workforce also needs to be incredibly diverse. We care for people of color. We care for members of the LGBTQIA+ community. We care for immigrants and people with international backgrounds. When we think about hiring, we want to try to hire people who are reflective of those populations. We also know that we need to retain those employees. We offer great benefits and a competitive salary, but we also have an environment where employees feel affirmed…where they feel welcomed and feel that they belong. We recently held an in-person staff gathering, and you could see that our employees really care about each other. That environment is cultivated with closeness and team-based care. We have a program where you can reward a colleague for doing something great or recognize people through our HR portal. This helps to reinforce a culture where people feel welcome and valued. We think that culture has an impact in the exam room and in health outcomes. Recent research shows that having a provider who understands your cultural needs can improve patient engagement.^5,6 Patients also seem to be more willing to share details about their lives with providers who understand their background and where they are coming from. That helps us assess them and provide the best care.

Julia: What sorts of organizational challenges have you experienced in creating an inclusive culture among staff?

Naseema: We are proud to have a diverse workforce that is reflective of the communities we serve. But it can be difficult for us to compete with other employers on salary alone. We have different expectations in terms of volume of visits, and that can make it harder for us to afford salaries that might be offered by other organizations. We want our employees to thrive and have long careers here, and that takes an investment from us, which we don’t always have. We are a busy organization, and we are constantly innovating so that we can do incredible things for our community. Part of the challenge is having the discipline to slow down. We need to be sure our people have training opportunities and growth opportunities and still have time to stay connected to each other.

Julia: How have you been able to get leaders, board members, and staff aligned with the same vision and mission regarding DEI?

Naseema: The leadership team has to be aware of its own biases and understand how those biases can play out in decision-making. It is easy to feel conflicted knowing you have biases. We try to have a constant and consistent message that we all have work to do, but we are all committed to social justice, gender justice, and racial justice. We have to be able to step back from a situation and have the emotional intelligence and awareness to be present for what the team needs. We are repetitive and diligent about the importance of this effort. But we are never done. It helps to stay humble and honest about the work we do and the quality we seek.

Julia: What might larger health care systems learn from Whitman-Walker and other organizations that are focused on equity and social justice?

Naseema: Broader health systems can learn, and should learn, a lot from the federally qualified health center model. FQHCs provide primary care to nearly 30 million Americans every year.⁷ It's a huge part of the health care infrastructure in the United States. A lot of those organizations provide care to Medicaid beneficiaries and Medicare enrollees. People who don't have employer-based health insurance make up a large part of the population. FQHCs grew out of a need in local communities. And because they are community based, they tend to understand the social needs of that population. I have a friend who runs a health center in Hawaii. The native Hawaiian community it serves is affected by poverty and dietary factors that often leads to high levels of obesity, diabetes, and cardiovascular disease. But the diet is part of the culture. A patient might say, “I eat this way, because this is how my community eats.” Teaching people how to make healthy food choices is important, but it should be done in the context of culture. Community health centers tend to be great at that kind of work. Equity does not mean everyone gets the same. Everyone has different needs and will therefore need different resources.

Julia: Staff burnout, employee satisfaction, and retention seem to be challenging a lot of health care organizations. What is your strategy in dealing with these issues?

Naseema: Diversity, equity, inclusion, and a sense of belonging, is a retention strategy that improves employee satisfaction and reduces staff burnout. Staff understands that they are our most valuable resource, and they matter just as much as patients. They bring an incredible amount of value with every patient interaction. Investing in our people, recognizing their contributions, and celebrating their diverse and intersectional identities truly makes a difference. It does really help retain people.

Julia: What do you think health care organizations can do to remove biases and ensure equitable care for everyone?

Naseema: Curiosity, humility, patience are skills that everyone in the health care field should possess. Humility comes into play when a staff member introduces themselves to a patient and offers their pronouns. That gives the patient an opportunity to share their pronouns. The way this translates into health care is significant. There are so many health disparities, and outcomes can vary based on the patient’s identity. Since COVID-19, the country seems to be in a different place of awareness. There is a broader understanding of health inequities and the disproportionate impact on the LGBTQIA+ community and communities of color.

Conclusion

Organizations should consider actions that promote diversity, equity, and belonging as foundational components to advancing health equity. This can help to drive a greater impact on population health. Creating equitable opportunities for employees so they can advance and thrive can directly contribute to health equity and population health. Good business and good health go hand in hand.

Acknowledgement: Shari Boyce

Latest news from @DeloitteHealth

Endnotes:

¹Diversity improves performance and outcomes, National Medical Association, August 11, 2019

²Cultural competence in the care of LGBTQ patients, StatPearls Publishing, October 3, 2022

³Association of affirming care with chronic disease and preventive care outcomes among LGBTQ older adults, National Library of Medicine, November 29, 2022

⁴A population health impact pyramid for health care, The Milbank Quarterly, April 25, 2023

⁵Black representation in the primary care physician workforce and Its association with population life expectancy and mortality rates, JAMA, April 14, 2023

⁶Do Black patients fare better with Black doctors?, Association of American Medical Colleges, June 6, 2023
⁷Health Center Program: Impact and growth, Health Resources & Services Administration

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