We Must Be Empathetic to Be Inclusive

Podcast Transcript

Steph Bayer: Welcome to another episode of Studies and Empathy, a Cleveland Clinic podcast exploring empathy and patient experience. I'm your host, Steph Bayer, senior director of the Office of Patient Experience here at the Cleveland Clinic in Cleveland, Ohio, and I am very pleased to have with me today, Jacqui Robertson. Jacqui, welcome to Studies and Empathy.

Jacqui Robertson: Thank you, Stephanie. Glad to be here.

Steph Bayer: So glad you're here. Jacqui's the Chief of Diversity and Inclusion at the Cleveland Clinic. In her role, she leads efforts to develop an enterprise-wide diversity inclusion or D and I strategy, embrace and leverage diversity across all levels of the organization and integrate D and I approaches into all aspects of work and culture at Cleveland Clinic. Jacqui has nearly 20 years of national, international experience in leading D and I strategies and has served on several boards including I four cp, the Chicago Sinfonietta and the National Conference for Community and Justice. She holds a Bachelor of Arts in behavioral science from the University of Chicago and is a six Sigma executive Green Belt. We're really excited to have you here.

Jacqui Robertson: Today. Thank you, Stephanie. I'm really delighted to be here.

Steph Bayer: Can you tell us a little bit about yourself, your background and how you came to be the chief of diversity inclusion here at the Cleveland Clinic?

Jacqui Robertson: Absolutely, so most of my experience and background has been in financial services. In fact, that's been my entire career. So, I guess you could say I hung up my shingles to make rich people richer to come, to make people well or at least align with that value proposition. Originally from Chicago, as I mentioned and lived abroad for several years in the Netherlands where I raised my two sons, worked for an organization called ING Financial Services, and that's really where I cut my teeth on inclusion. How I came to be here is an interesting story. I got a call from a recruiter asking me if I was interested and I really love financial services. I was not interested, and I remember my husband saying, don't ever turn down a conversation. And so, I don't know, I don't know if it's a me thing, I don't know if it's a female thing. I don't want to make a broad speculation, but there's something to be said about loyalty and I didn't want to leave, but Cleveland Clinic had me at Hello Love. The people that I interviewed absolutely fell in love with the value proposition. Healthcare is a tangible; financial services are not always tangible what we sell as a promise. And in Cleveland Clinic and in healthcare, you can see the difference that you make and the impact you make on people every day.

Steph Bayer: Well, that's amazing and I love that philosophy of never saying no to a conversation, so I'm going to steal that from you as we get into this. I asked you before we started about the diversity and inclusion titling and why we use D and I and there's lots of ways in the industry that we talk about with DEI in other terms, you gave me a great explanation. Can we repeat that on air now and help me understand why D and I isn't maybe as important as other language?

Jacqui Robertson: Yeah, so a few things about diversity and inclusion. Some people look at them as buzzwords in the industry and I guess you could say they could be, but not at Cleveland Clinic. If your values are aligned to inclusion, the expectation is that you live those values each and every day. And so, I guess you could say it's buzzwords, but if you're actually living that out, if you're living out the value of diversity, if you're living out the value of inclusion, I think those are no longer buzzwords. They're actually aligned with our productivity. They're aligned with the impact that we have on patients and our caregivers in our community each and every day. I thought about the title of the role when I came in and the title of the role is Diversity and Inclusion, yet we focus on equity, we focus on belonging. And someone asked, well gee, are you going to change the title? And it's like, we've got too much work to do. Rather than change the title, let's make sure we are focused on equity as part of executing our strategy. Let's make sure we're focused on belonging as part of executing our strategy. And so sometimes I think it's not so much what you call the role, it's what you're doing to create an impact on our patients and our caregivers in our community each and every day.

Steph Bayer: You did mention our value here at the Cleveland Clinic and inclusion is one of our core values. Can you talk about why inclusion is so important and how individual caregivers have an opportunity to embody and integrate inclusion into their own actions?

Jacqui Robertson: Yeah, so having a healthy culture I think is the foundation of everything we do and diversity efforts in any organization are not sustainable unless you have a healthy culture, unless you have a culture based on living out the values of inclusion and diversity. We can implement all the diversity programs in the world, but unless the culture where we live every day where our caregivers feel that they can bring their best every day, they can be themselves every day, they're not going to produce to their full capability. They're not going to give necessarily 110 percent every day unless they feel they belong, unless they feel that their contributions matter. And I think that's why we have such an important role as leaders to make sure that we're creating an environment where people feel they can speak up, they can feel their voices are going to be heard, they can feel that they actually have an impact. They actually see themselves in this strategy of diversity and inclusion.

Steph Bayer: I love how you say make room for people to bring their whole self and to be their whole self so they can do their job well. This isn't as we talked about beforehand and preparing, but it's something you and I worked together on to make it safe for our caregivers and our patients to bring their whole self. We've got to make sure that we can call out behaviors and that we say this is not okay when it doesn't reflect a safe culture. And one of the things that we've done here, and I know there's more going on, but I think that there's really innovative is that in patient experience, we actually do look to say that our patients are not allowed to abuse and to not create a safe space as well, and that we call that out. We make sure that our caregivers feel safe in all ways, and if that behavior happens, we take action and we have consequences for that just as we absolutely protect our patients. But I just wanted to call it out because I think this is a space that we've been looking at where we have some more opportunity and where we can keep doing things, and that's just an example of where patient experience can help you as you're driving towards this atmosphere and this culture.

Jacqui Robertson: Absolutely.

Steph Bayer: What's the relationship between inclusion and empathy?

Jacqui Robertson: I think they are absolutely related. When I think of inclusion, I think of the more holistic approach. When I think of empathy, I think of let's look at empathic versus sympathy. And so, an empathic individual or an empathic leader is going to say, I'm in it with you. I feel it with you. Being sympathetic is more of, I feel for you. I feel sorry for you. There's a difference. And so, when you think about being an empathic leader, that is really cored to being an inclusive leader and leading with that approach. When I think of people who are inclusive, I think of their commitment to develop others. I think of their desire to get people to work at their full potential, to have the courage to give them transparent feedback, constructive feedback when they're not. It's interesting because there are many times in my career where I felt that white males may have been pushed back on their heels because they didn't feel comfortable necessarily giving women feedback.

They didn't necessarily feel comfortable giving women of color feedback. And then I don't think it came from a place of mal intent. I think it came from, and still to some degree comes from not feeling comfortable when you don't know the right words, when you don't know what to say. And I think that's why another aspect of leadership, which is cultural humility comes into place. You don't necessarily have all the right words, but being transparent about the fact that you don't have those and still engaging in a conversation anyway is something that all of our leaders will need if they want to be inclusive. I think it's the intentionality behind it as well. One of the core things is when you think about just being cognizant of the biases we bring as inclusive leaders, we all have biases. Good people have biases. And I think being aware of those helps you understand the intentionality that you need to have to close that gap when you are dealing with difference, when you are managing difference.

And when I say difference, it can mean anything. It can just mean difference in style, difference in background, your willingness and your intentionality and your curiosity about that difference and those differences to be able to engage in a conversation and close the gap. That's why it's so important for people to understand another story, understand their values, understand their beliefs. It's interesting the dynamic that happens when you understand someone, when you understand where they came from, when you understand what's important to them, it allows you to have those conversations, which brings you full circle back to development. You can certainly use a rubric to develop another person, but I think to fully develop someone is going to require trust that mutual trust. And if you don't have that, it's going to be very difficult to get someone to their full potential to give them constructive feedback when they need it so that they're working to their full potential and so that they can speak up.

And so why is that important? I mean, we care for patients each and every day, and we have a team of teams approach, and so I don't even want to imagine what happens if caregivers who are patient facing don't feel like they can share their perspectives, and inclusive leader is going to go out of his or her way to gain those different perspectives. So, empathy, yes, you're feeling it with them, you're listening to those, that inclusive piece, you are pulling all of those perspectives together and you're making sense of them and you're valuing each one of them and you're leveraging that between and among those people who are giving those different perspectives. Some people call that politics, I don't, I call that really being able to read a room. I call that being able to understand the importance and the value and not just what people say, but sometimes what they don't say and being able to pick up on that. So, there's so many things I think that go into inclusion and empathy full circle. I think inclusion is really a holistic approach. Empathy is bringing that approach together in clear behaviors around making sure that you are valuing the different perspectives that people bring and how you do that.

Steph Bayer: That's a great answer. And so much in there to unpack it is meaty. And what I did pick up that I thought, oh, I'm going to steal this again, lots of good notes for me to take home with me is how being curious, even if you don't know the right thing to say next is so important. And empathy can always lead us through that. And you're right to say that if we're not curious and creating space for people that there's no way we're going to get to the inclusion, the holistic approach. I love that advice.

Jacqui Robertson: Yeah, it's interesting. One of the things that I didn't mention in that is the ability to be vulnerable I think goes hand in hand with transparency. It goes hand in hand with empathy. It's okay to not know. It's okay to be vulnerable and say, listen, I know the vision that we're aspiring to get to, but I really need your thinking and your advice and your guidance on how we might get there and really engaging your team and your peers and leaders in order to get there. I think one of my least favorite phrases when I think about transparency is sometimes people will say, "I don't disagree with you. And when I think about that, it's interesting to know what to make of that. And I think that's where courage comes in. You agree, you don't agree, have the courage to start there and then have a dialogue. I was with a consultant once who uses that language all the time. Well, I don't disagree with you. Well, what does that mean? Tell me a little bit more about that. So again, and I know I probably digressed, but that whole willingness to be vulnerable and in cultures where it is so important to be right and to get it right, especially when you're dealing with patients and their safety every day, I think we have to make space for that vulnerability. Clearly our physicians do that. Clearly our leaders do that each and every day they have to. But I wanted to mention it because I think it's just such an important value.

Steph Bayer: It really is. And I know that as I've matured in leadership, vulnerability is something that I can lean into with more confidence, and I can show it to my team a lot easier than I did as a new leader because we think that leaders have to have all the answers and you can't show that vulnerability. And I think you made a great point, and actually that's how we connect and that's how you bring people in with you.

Jacqui Robertson: Absolutely, absolutely.

Steph Bayer: Can you talk a little bit about measures we're taking here at the Cleveland Clinic to strengthen diversity in our workforce?

Jacqui Robertson: Yeah, absolutely. And so first of all, metrics are so important and the ability to be able to track the progress that we are making as we go along this journey is key. And one of the things that we're looking at is when you look at the life cycle of an employee from recruitment to when they come in, onboarding, development, retention, we are putting metrics behind each one of those, but we're also putting processes in place, and it's all part of a larger partnership with diversity and inclusion, with talent acquisition, making sure that every slate that we have is a diverse slate, making sure that we are intentional about onboarding someone and really focused on the experience that they have in the first 90 days here. And why is that important? Because research shows us that for the first 90 days, if people aren't feeling that stickiness to this culture and to this organization, the risk that they might leave is higher.

And so, embedding diversity and inclusion in all of our processes and all of our practices. And so instead of having a specific diversity leadership program, why not embed diversity and inclusion concepts and context into the existing leadership programs that we have already? I don't believe that diversity and inclusion should ever be a standalone strategy. It has to be embedded in everything that we do. And so that's our processes, that's our metrics. One of the things that we are focused on is making sure that we do not just have diverse leadership in the higher levels of the organization. And we know that's important. McKinsey tells us, research tells us the business case for having diversity in leadership. So not only are we focused on doing that, but we're also focused on reducing turnover of diverse talent and leadership. We looked at the data and the data show us that diverse talent leaves more often, more frequently at a faster rate than their counterparts, than their peers.

And so, we really are trying this year to get up under that. We looked at exit interviews, for example, and the exit interviews had some good data, but it made you question whether or not that data is accurate. Think about it, when people leave an organization, are they always going to tell you the real reasons they left or are they more concerned about burning a bridge as they go to that next job opportunity? And I think that's something that we have to take note of. So, one of the things we'd like to do is create an initiative around diverse focus groups to really understand what would compel you to stay, what would compel you to leave? And I think if we can get ahead of that and find out what that reason or those reasons might be before someone leaves, we can put measures in place to ensure that we retain talent.

Stay interviews is an opportunity that I think we should explore more. It only takes a few minutes and instead of waiting until someone exits and asking them why they exit it, let's have managers and leaders more frequently check in with their folks and find out, how are you doing? What can I be doing differently to support you? There was ACEO that I used to work for. He did a stay interview with me in an elevator. I'll never forget, we're on the 36th floor. We went down to the first floor, and it wasn't a long conversation, but it wasn't until I got home that evening that I realized, I'll be doggone, he did a stay interview on me, and it worked, and I ended up staying another five years. So, I think that's going to be important as we move forward trying to get up under wise diverse talent leaving.

And by the way, our data shows us it's not just diverse talent in the leadership levels. It's throughout any and every function role in the organization. Diverse talent leaves faster. I used to be in sales earlier in my career and I was taught very early on that it is cheaper to keep an existing customer than it is to go out and get a new one. And I think of talent in the same way. We invest a lot to source talent to get them in the door and then to not be able to keep that talent and retain that talent, I would say is a disappointment at least. So, when you think about the diverse focus groups that we want to do, when you think about maybe we make some changes to the exit interview process, definitely enhance processes around stay interviews. Those initiatives are born out of what data told us, and that's what I mean by we will never embark on an initiative that is not deeply rooted in data and insights, because otherwise you can't track it, you can't measure it. And at the end of the year, I don't ever want to be asked by my boss or any of my senior leaders, what have you accomplished and help me understand the impact that it's had. I don't ever want to not have an answer to that question.

Steph Bayer: That's a good North star, isn't it? To know where your work makes a difference. And I also love the point of embedding or integrating the work into existing work because that's how you know it sticks and that stickiness is so necessary for all the reasons you just said.

Jacqui Robertson: Absolutely. And you think about that stickiness. Again, it's not so much the initiatives. Yeah, the initiatives are driven from data, but it comes back to culture. And so, one of the things that we've done around belonging last year, we added three questions to the caregiver pulse survey. So, the question that we used to have, which was a consistent question, is I feel like I belong at Cleveland Clinic. Great question. But think about what goes through your head when you're asked that. And I remember thinking to myself, well, in order to answer that question fully, I think about how do I feel about being on this team? How do I feel about whether or not, and to the extent to which my manager makes me feel like I belong, and then from an accountability standpoint, how am I influencing another's sense of belonging? And so, when you think about everything that possibly goes through someone's head when they're trying to answer that question, we decided as a team, let's get more granular.

And so, we added three questions to that survey. And now the four questions are, I feel like I belong to Cleveland Clinic. My manager makes me feel like I belong. I feel like I belong on the team, and I feel like I can contribute to the belonging of others that gets at a level of granularity that helps us to be more granular in the analysis of that survey. And it was very helpful, and our belongings scores were very high. I'm pleased to say that. But you can't just rest on your laurels as they say and think, okay, those are great scores. You have to continue to keep your finger on the pace of this organization's culture. What's going well? What can we do better? What can we do differently? How do we check in with our caregivers to understand how they're feeling, how they're feeling about their ability to speak up and make a difference? So, all of them are, I think, intricately connected.

Steph Bayer: Very much. Jacqui, I hear you're rebranding one of the pillars of cultural competence to cultural humility. Can you talk about what that means and why?

Jacqui Robertson: Sure, absolutely. That's a great question. Cultural competence gives the impression that we are done. We are competent, we are fixed. We know this work is like the back of our hand, and there is nothing more for us to do. Cultural humility denotes that we are still on a journey, and we might not always get it right. We may fail, but we're going to get up and we're going to try again. We might not use the right words in engaging in a conversation with someone whose style is different than our own, but it's okay, we might fail, but we're going to get back up and we're going to try it again. Cultural humility denotes the intentionality to understand someone's story, to understand their values, their experiences, although very different from your own, and use those and the understanding of that story to create a more effective relationship to create a trust in that relationship.

So that's the reason why we're, and it's more than just rebranding it. It's making sure that any training we do is focused on helping us to become more culturally humble than a focus on, okay, we're done, and we don't have any other work to do. And I think one of the things that will help is an inventory that we're using called the IDI, and it's the Intercultural Development Inventory. It's a baseline. It's a very simple test that you take to understand where you are on that continuum, if you will, of cultural humility. Because how can you begin to develop someone else if you don't really know how others are perceiving you? And there are other psychological tests like the Hogan, or you can do the 360. And that is certainly going to give you, both of those will give you tremendous insight into yourself. But one of the things we want to do is add a baseline for culture and around culture and where you are on that continuum, because that's going to give your insight to really focus on not just getting to know someone else, but knowing yourself and knowing what you need to bring to the equation to close that gap between someone whose style or background might be different than your own. So that's the reason for a focus on cultural humility versus cultural competence.

Steph Bayer: That's great. And it goes back to speaking to what we talked about earlier about vulnerability. It makes room for that vulnerability and that curiosity.

Jacqui Robertson: Absolutely. Absolutely.

Steph Bayer: This is a patient experience podcast. And let's switch a little bit and talk about how diversity in a caregiver workforce can impact our patients.

Jacqui Robertson: Yeah, absolutely. So, let's start by saying that when you think about diversity in the workforce, think about the bias that exists for all of us that we tend to be people who are like us, we tend to gravitate towards people who are like us, people who think like us. That's a similarity bias. It exists and it's real. And if you don't believe me, look at your LinkedIn profile, 85 percent of the folks on your profile in your network probably look like you. So, think about that for a minute. As a backdrop, if we like people who are ourselves who think like us, there's probably going to be an element of trust there. Now, think about the relationship between a patient and a patient facing caregiver. You cannot avoid that bias of wanting to trust the person who is giving you that care. And more often than not, we feel a deeper connection to people who we feel are like us, and somehow, we feel like they have our best interest at heart.

Now, not in all cases, but just recognize that there is a bias there. And so, I can imagine that patients want to look up and see people who are themselves because it does engender a certain level of trust. And so, when I think about that in terms of the patient's experience, I think about do we have enough diversity in our physicians, in our nurses in the staff? And I think that's something that we absolutely need to be intentional about as we do succession planning, as we look to create a pipeline for diverse talent coming into healthcare and learning the healthcare business, if you will, so that they can have that impact on patients. So, I only mentioned the similarity bias as a backdrop because it's real. And it's not to say that you don't trust someone or a doctor or a nurse who's does not like you. Absolutely. I'm not saying that, but I think there is something to say for that similarity bias and looking for and trusting people who we feel look like us, think like us, believe like us. If that wasn't the case, then America would not be as divided as it is today.

Steph Bayer: But that's an interesting point too, because I think there's, especially in some traditionally underserved communities, there's been some good reasons why people don't trust healthcare when we think historically.

Jacqui Robertson: Absolutely. Absolutely. I mean, you think about Henrietta lack story, you think about the Tuskegee experiments I just read not too long ago that some of the instruments that are used in surgery are still named after a surgeon, and I refuse to call his name, but named after a surgeon who experimented on black women without any anesthesia, without anything to help them with the pain of those particular experiments. So, you can absolutely understand why trust is not there, but it's certainly something that we are trying to rebuild with the community. I think we've made great strides there. And when you look at the efforts that we've made around infant mortality and maternal health and LED abatement, and that continues, and that's one of the things I love about Cleveland Clinic. It's not just about giving money to things. It's about fully investing in the research that we're doing and making sure that these efforts have an impact.

It's making sure that people's homes are free of lead, so you don't have to worry about the negative impacts that it has on the people who inhabit those homes. Maternal health is real. You look at what has happened in many instances with women and especially women of color who feel that they are not listened to when they go to a physician. Serena Williams is one of those individuals who was very clear about some of the medical issues that she had. She tried to get her doctors to listen, and even someone of her socioeconomic background was not successful in getting her doctors to listen. And that's scary if you think about it, because some people might look at this as a problem of, well, it is not so much diversity in terms of race and ethnicity, it's diversity in terms of socioeconomic background. Well, the research shows us that socioeconomic background still doesn't have as much to do with this issue as maybe we previously thought. And the facts are, the facts are definitely there.

Steph Bayer: Your work matters and for patients and for us, I'm glad you're in the seat you're in. One of the things we've talked about data and how important data is to drive where the direction of the work is. I also know, especially with patient experience, patient stories are also a motivator that you can then back up with that data to create that burning platform from a diversity inclusion perspective. Do you have a story or a moment you can share with us from your own experiences that exemplifies either the need for inclusion or shows how inclusion can be done really well?

Jacqui Robertson: Yeah, absolutely. When I first joined Cleveland Clinic, I remember being told when caregivers join us, they're like family. They are our family. And I was not here for six months When I really experienced the full impact of that, my brother-in-Law was admitted to the hospital in Canton, Ohio and really had some preexisting issues and needed to have care and resources that are part of our main campus. And when I asked one of the physicians who is also a colleague, what should I do? She really just jumped into motion around, okay, let me know what you need. If we need to get your brother-in-Law transferred here, we will do that. And just the swiftness with which she really leapt to my side and aligned with the situation, and not just what I was feeling, but what my brother-in-Law might've been feeling. And literally, he came here, he had the surgery on the main campus, and they literally saved his life.

And people can say your family, but it's when you truly experience the behaviors that show you that make you feel, yeah, you know what family would do. It wasn't a clinical discussion, by the way, when I asked for help, it came from a true feeling of I care about you. I care about you as if you are my family, and we will do everything we can in our power at Cleveland Clinic to make sure that your loved one is okay. I will always remember that my brother-in-Law still talks about it to this day, and I think that's what matters most. The fact that he had an exceptional patient experience here at Cleveland Clinic, and he's doing well. I saw him not too long ago. I saw him about a month ago, and he looks great. He's doing well. And yeah, it matters. And it really brings to life that statement of we treat our caregivers like family.

I can certainly say that I experienced that. I think my hope and my vision is that all of our caregivers feel that way and that all of our patients feel that way. That's the vision. The vision for diversity, equity and inclusion is Cleveland Clinic is a place for a person like me. And I'm hoping that that vision will resonate with caregivers throughout the organization, regardless of their level, regardless of whether they're entry level, regardless of whether or not they're in the highest levels of leadership. We want our caregivers to feel that Cleveland Clinic is a place for a person like them.

Steph Bayer: That's a great story. I do love that our CEO even sees access and getting people in as a moral imperative. We need to see more people and make room for people like me. Is there anything I didn't ask you or anything you want to make sure that we hit on before we close today?

Jacqui Robertson: One of the things I'm very proud of is our direct council. Direct is an acronym, diversity Inclusion Racial Equity Council, and it's a council whose members were handpicked by Dr. Kelly Hancock and Dr. Barry Ridgeway. And we expanded the council to include global representation this past year. So, we have representation now from London, from Abu Dhabi and from Canada, and they are working on health equity initiatives that matter and everything from how we're serving our community to making sure that we have in my language communications, in my language signage throughout the enterprise. So, I'm really proud of the work that they are doing, and I would be remiss if I didn't point it out. I'm also very proud of the business employee resource groups. We have nine of those and the work that they're doing, and one of the things we want to do more of is align them more to the business and more to the strategy of diversity, equity, and inclusion.

And why do I say that? Because they're doing great work. And research shows you that people who are part of employee resource groups are 10 percent more engaged than people who are not. And so, I am really looking forward to the partnership with our business employee resource groups to elevate them in a way that matters and shows the impact that they are actually having on this organization. The other thing that we are working on is standing up regional diversity councils where they don't exist and enhancing and supporting the ones that do exist. And why is that important? When you think about the diversity, equity, and inclusion strategy, it's enterprise wide, but it's locally relevant, and people I believe are more engaged when they can work on issues that are locally relevant to them. And so how those initiatives might be carried out in Florida will be different from those and how they're carried out in Ohio or Ohio versus London, and that's okay.

But we're working to help support those regional diversity councils, align them with our strategy, make sure that they're the arms in the legs of the direct council that I mentioned earlier, and also to make sure that they're aligned around the four core pillars of the diversity, equity, and inclusion strategy, which are health, equity, cultural competence, which we are now rebranding to cultural humility and recruitment and retention and community engagement. So, I'd be remiss if I didn't speak of the work, the great work that those entities are doing. I'm very proud of them and just really proud to be their partner on this journey.

Steph Bayer: And what a great example of how you're including voices or caregivers into the work directly. So even the leader of our inclusion strategy has shown some examples of how we can include others. That's a great way to end. Hey, thank you for joining, not just today, but thanks for joining the Cleveland Clinic. I'm so glad you're here.

Jacqui Robertson: Thank you, Stephanie. I'm grateful to be here.

Steph Bayer: This concludes the Studies and Empathy podcast. You can find additional podcast episodes on our website, myclevelandclinic.org/podcast. Subscribe to the Studies and Empathy Podcast on iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcast. Thank you for listening. Join us again soon.