Monday, October 24, 2011

Identity-Based ERGs

A couple weeks ago on a list serve/linkedin group, there was a debate about Employee Resource Groups. My personal sentiments at times differ from the standard practice of the majority of corporations and their diversity teams. Other times, it may be me simply being difficult. In this instance, my thinking about ERGs that identify by an exclusive group (i.e. African-American, Latino, LGBT, particular religion, etc.) is that representation of those identities in and of themselves in organizations are important, but less and less lead to believe that most ERGs (a.k.a. affinity groups) focused on a single identity are helpful in the long run for organizations or for those engaged.

My responses to the inquiries and reactions are in italics.


In response to a member asking about starting an LGBT ERG.


It is not a secret how I personally feel about identity-based ERGs. By their nature, I think they are exclusive and have spotty effectiveness in the strategic sense. People will naturally gravitate towards that which is like them at some point or another. Reinforcing this actually can set people up for challenges (i.e. Asians (particularly Chinese) being promoted proportionately to upper management/leadership in technical organizations where they well-represented overall). Of course, marketing segmentation, product differentiation, etc. make sense to me. At the same time I always wonder about the ability of a particular group ERG to engage outside of their group beyond situational engagement that is, in a way, artificially constructed. The key ingredient to whether decisions get made based on particular input--trust--is missing in the equation. It is missing primarily because the out-group (e.g. non-LGBT and perhaps A, in this case) is rarely intimately embedded in the foundational conversations of group establishment. Consciously or unconsciously in-group bias on both sides is reinforced. Further, we get these ERG leaders focused on themselves more than the strategic direction of the company, again setting them up for missing opportunities in the long-term as they don't see the bigger possibilities and responsibilities that their role as a member of an ERG entails (or at least could/should/potentially might entail).

So, the intention is good. On the other hand, where long-term impact is concerned (so-called measurement or data supported justification or not) I am not convinced that in the times we are in now that newly established identity-specific ERGs can have the impact that a broader concept (i.e. inter-generational groups) can.


The responses ranged from people defending the position of ERGs in general to letting me know that, for all intents and purposes, "You are wrong." A summary statement that I thought spoke for most respondents was the following: "Creating these identity based groups creates a sense of place in the company for people who fit a particular affinity. It allows them to have a safe place in a company where most do not look like them and don’t understand their experience. It is a message from the company that they are “present” and that the company understands the uniqueness of their experience. This is very affirming for employees who are not part of the majority. This I can stomach and they in fact could be right." Again, point taken.

Thing is, when we look at the stats and articles such as this:
Is there a bamboo ceiling at American companies? what do we conclude?

One is left wondering how affective these ethnic and other identity-focused ERG really are? Answer is, we really only know by anecdote. And in many instances the ERG has not made much of a dent in dynamics such as these. They either are not tasked to or have not made it a priority. People are more comfortable around other folks like them and very little changes. Perhaps when people are too comfortable, very little changes for individuals or the organizations they serve?

The conversation ended with the potential of an academic study of ERGs. Great outcome!

My conclusion was the following:

Know that there is little in the world that I am flat out opposed to. LGBTA ERGs and ERGs in general included. ERGs make sense, we should have them, we also should be tasked to take the idea of them deeper, this is my intention.

One thing I am allergic to is doing the same things over and over and even when evidence of effectiveness is limited, justifying that which we are attached to for lack of a viable alternative.

This is the situation with ERGs in many cases. There are some great identity-focused ERGs in companies. Some contribute a lot to all of the areas that were shared from 'engagement to safe spaces'. I am less sure of their collective, long-term, impact across the board. . .This is not something "I know" but intuitively and experientially I sense and have seen limited impact other than the generic anecdotal statements that "ERGs are good, they help underrepresented people" and perhaps some ROI anecdotes on a limited basis; yet, have not seen anyone challenge the notion that this is "true" beyond anecdote alone. Are we capable of assessing broad impact beyond a few isolated cases? "Its like a jungle sometimes it makes me wonder. . ."

So, ERGs get a thumbs up in theory! Our collective willingness to question that which we are convinced of or explore alternatives to, gets a "so-so (with the hand vs. a thumbs up)" in practice.


Hopefully, the result of this conversation is another avenue to test hypothesis about this work we call diversity and inclusion. The urgency of our politico-economic situation requires us to go deeper. No time to waste.

Make it a great day!

Tuesday, September 27, 2011

NIH Uncovers Racial Disparity in Grant Awards

It has been a while, but I am back and hopefully consistently so. Thanks to all of you who have encouraged engagement during my hiatus.

Let's explore the impact of disparate funding for black scientists. While studies like this can always be questioned as to method and reliability with over larger sample populations, the fact that the study was published in a reputable journal says that this issue is bigger than one of one race vs. another. This is an American problem. Disparity exists just like diversity does.

The questions are numerous: How well do we understand the impact of these disparities on our ability to compete globally? What is the impact of disparities such as those described in the study to our healthcare system overall?

As we examine the future of health, how science gets done and who does science is critical to our success in the U.S. and in a way globally given the historic impact of U.S. scientists. The conversation has to start even as far back as elementary education. This is significant, let's treat it as much bigger than we can see at present.


Biomedical Research Funding
NIH Uncovers Racial Disparity in Grant Awards

by Jocelyn Kaiser

It takes no more than a visit to a few labs or a glance at the crowd at a scientific meeting to know that African-American scientists are rare in biomedical research. But an in-depth analysis of grant data from the U.S. National Institutes of Health (NIH) on page 1015 in this issue of Science finds that the problem goes much deeper than impressions. Black Ph.D. scientists—and not other minorities—were far less likely to receive NIH funding for a research idea than a white scientist from a similar institution with the same research record. The gap was large: A black scientist's chance of winning NIH funding was 10 percentage points lower than that of a white scientist.

For whole article Click Here:

Saturday, February 26, 2011

Medical News: Pro-Bowl Player's Suicide Renews Head Trauma Debate - in Orthopedics, Sports Medicine from MedPage Today

Very interesting article. What stood out was the statement that people responded to Dr. Omalu in a way that immediately tried to discredit him based on his ethnicity: "The National Football League reacted with outrage, demanding a retraction of the paper. "They said I was Nigerian -- what I was doing wasn't science, I was practicing voodoo medicine," he recalled." This is not uncommon and speaks to the lack of consciousness that we exhibit when emotional threats (attachment to the sport of American football) or financial threats (NFL, vendors, broadcasters) are perceived. Dr. Omalu's emotional connection to the sport is likely to be less than mine or if you are a fan, yours. Scientifically, his seemingly extreme statements have to be put into context and examined as the problem is a clear one. Given the escalating dialogue about it over the past few years, it is probably bigger than we think and starts when simple aspirations of a professional sports career germinate.

Medical News: Pro-Bowl Player's Suicide Renews Head Trauma Debate - in Orthopedics, Sports Medicine from MedPage Today

Friday, May 7, 2010

The Risk of Cultural Illiteracy

I went to a networking breakfast this morning at the Boston Center for Community and Justice on Diversity: Institutionalizing Diversity as a Business Strategy.

A very well done event with a number of business leaders committed to the integration of this thing we call diversity in a manner that connects like "traditional" business staples like lead generation, fulfillment, accounting, etc.

It is easy in meetings like this for the default to go straight to workforce representation conversations. Some commented on how some of their companies have gotten executives to fulfill diversity goals and it has increased representation. Others shared that the goals of representation are also tied development. That resonates with me, but it also falls short to me in a way, in that what development means and is are often much different than what those responsible for developing their people do.

There was one hospital COO there. She mentioned the ideas of health disparities (quality disparities) and cultural competence. I appreciated her commitment and candor about how far they have come and how far they have to go. Where I wished she could have taken the conversation was into an area that most organizations face on a regular basis: risk.

Now, while the idea of risk is one that most leaders have to face, they don't generally think about risks in terms of people not being able to relate to others in a manner that is in alignment with their needs. In healthcare the risks here are obvious. Just speak to any clinician who has had diagnoses compromised due to not having the ability to discern cultural cues. Cues that may have provided additional data for a diagnosis that could have prevented or at least mitigated further suffering on behalf of the patient.

In other industries, I hold that the risk of cultural incompetence and what I call "cultural illiteracy" (extrapolated from health literacy) is just as profound. In a global playing field of business, the stakes of cultural navigation matter more than ever before.

For many Americans, the lens of the world is narrow and generally has an insular focus. The risk here is that if we are not able to consider the globe as the business environment that we live within; and recognize that the norms of business are as diverse as the world is big, our ability to be competitive in this global economy is mitigated. This is not just true for people from the U.S., this is true for everyone.

Consider that we are all culturally illiterate in a way. Now, think about the risk of being illiterate in any other sense of the word.

Make it a great day!

Sunday, April 11, 2010

Talking Electronic Health Records and Clinical Trials

Two of my colleagues, Chris Thorman from Medical Software Advice and Avis Williams from Solar BioMedical have written some great articles on the connections between clinical trials and electronic health records. The opinions expressed are their own and not necessarily reflective of the views of Diversity HealthWorks or Amri Johnson.

With the changes in health reform, this may be a topic of increasing interest. Thanks to both Chris and Avis for their contribution. Enjoy!

Make it a great day!
Amri


Electronic Health Records and Clinical Trials: An Incentive to Innovate

by Chris Thorman

As we wait for the federal government to finalize important sections of the Health Information Technology for Economic and Clinical Health Act (HITECH), there is a lot of talk about the financial incentives for implementing electronic health records (EHR). And understandably so. Practices that implement an EHR under the federal government’s guidelines stand to gain nearly $50,000 in incentives over the next five years. (More)

Electronic Health Records and Clinical Research: A CRA's Perspective
by Avis D. Williams, MSPH, CCRA

A CRA is the term for anyone involved in monitoring clinical trials. One of the main roles of a CRA is to help ensure timely generation and collection of quality research data. With the advent and popularity of electronic clinical trials (eClinical Trials), CRA’s are seeing a gradual increase in the number of clinical research sites (research hospitals, educational institutions, and private medical practices) opting to use electronic medical records as source documents for their clinical trial data. This article describes some of the benefits and drawbacks encountered by CRAs when monitoring sites that use electronic medical records as source documents for their clinical trials.

Benefits
During a typical monitoring visit at a site that does not utilize electronic medical records, a CRA can expect to be provided with at least two or three thick medical charts that often take up needed space on the small desk provided by the site to work. A paper medical chart may or may not be organized, legible, or complete. Sometimes, the paper medical chart is not available to the CRA during the monitoring visit because the patient is scheduled to have an office visit on the same day as the monitoring visit. All of these factors can potentially hinder the timely collection of important data, or compromise the quality of the data collected by the CRA. Each day’s delay in getting data collected and analyzed for drug approval can cost more than a million dollars to the pharmaceutical or biotechcompany sponsoring the clinical trial. Therefore, timeliness in collecting quality clinical trial data is very important.

However, when a site uses electronic medical records, the CRA experiences a very different scenario. There are no thick medical records to clutter his/her work area. All the medical data are on the computer provided by the site. The electronic medical records tend to be very organized and consistent with the same layout, making it easier to maneuver through the chart and locate the data needed within the chart. The doctor’s progress notes are typed instead of hand written, making the progress notes legible to read. Because the medical records are electronic, more than one person can have access to the record at the same time. The CRA no longer has to wonder if a chart will be available to review during the visit if the patient’s visit happens to be on the same day as the monitoring visit. All of these factors help ensure the timely collection of data, reduce the risk of poor data quality and data analysis delays.

Perhaps one of the more important benefits of having electronic medical records from a CRAs view point is the salvation of data during natural disasters caused by hurricanes, tornadoes, tropical storms, fires, earthquakes, etc. The database that stores the information in the medical record prevents the information from being destroyed during these events. Most southeastern and coastal states in the U.S. are prone to these types of disasters. Clinical research associates can often expect delays in collecting data at these sites during the seasonal weather patterns, but the threat of never collecting the data is eliminated due to the use of electronic databases to store the medical records.

Challenges
Though the benefits of having electronic medical records are substantial, a few important challenges exist at many sites when monitoring clinical data sourced from electronic medical records is required. These challenges include: 1) non-compliance with 21CFR(code of federal regulations) Part 11; 2) defining the difference between research chart and medical chart; 3) Typos and transcription errors; 4) data entry delays.

Compliance with 21 CFR Part 11 is very important when sites decide to use electronic medical records as source documents for their clinical trials. This federal regulation requires all electronic records to be electronically signed off with a unique user ID and password that is only known by the person creating the document. The regulation further requires each person who has access to a patient’s medical record to be provided with a unique User ID and password as well, including monitors and auditors. CRAs often find that sites and hospitals are using electronic medical records, but they are not 21 CFR compliant, and therefore cannot be deemed as a true electronic medical records facility for clinical trials. In these cases, the CRA is often unable to view the electronic medical record because the site’s computer network is not secure enough to provide the confidentiality needed for other patients’ medical records who are not participating on the clinical trials. The site is still expected to provide printouts of the unsecured information in a paper medical chart along with a statement confirming that all of the printed medical records are complete, and that not documents are knowingly withheld.

A second challenge observed by CRAs is the site’s difficulty in determining the difference between a research chart and a medical chart. Many electronic medical record sites tend to still provide the CRA with a separate paper research chart even though they have electronic medical records. This is often explained by stating that some records are not a part of the medical record, but were obtained from documents developed for the clinical trial, not for the medical record. Therefore, the extra documents were filed in a separate folder outside of the electronic medical record. The challenge encountered here is that a true electronic medical record should contain all documents pertaining to any treatments or clinic visits by that patient. Therefore, the ideal electronic medical system should have the capacity to accept scanned documents from outside sources as well as contain all dictated notes from internal clinic and hospital visits. The purpose for utilizing an electronic system in clinical trials is so that all source data is available and accessible in one working system.

A third challenge experienced at sites with electronic medical records is the increased risk of typos and transcription errors of dates, patient identity and treatment information, cutting and pasting. These errors can compromise data quality, and delay timely data collection if not promptly corrected.

A final challenge experienced by many CRAs working with electronic medical record sites is the have lag time in which patient visits are posted for viewing in the medical record. Many sites have lag times of 48 to 72 hours before the most recent visit can be available for review. Therefore, if a patient’s most recent visit was completed one or two days before the CRA’s visit, then the CRA will be unable to review the data for that patient’s visit because of the lag time required before the patient’s most recent visit is posted, making it difficult to collect the most current data (serious adverse events, adverse events, conmeds, treatment, etc.) for the patient.

Conclusion
Though the above challenges of non-compliance with 21CFR Part 11, defining the difference between research chart and medical chart, typos and transcription errors, and data entry delays are significant, they are fixable and will only enhance the benefits of utilizing electronic records once resolved. Sites that are dedicated to providing stellar electronic medical records are already implementing checks and balances in their system to resolve these challenges. Many of the benefits of easy access, less clutter, data storage during adverse weather patterns, legible progress notes, and consistent chart organization discussed in this article are key drivers of productive monitoring visits that will increase data collection and data quality at the site.

Saturday, March 27, 2010

Truth Serum

"The truth as an offense, but not a sin."
Bob Marley

Last week (March 23, 2010), President Barack Obama signed into law Healthcare (insurance) reform after it successfully passed in the United States Congress on Sunday, March 21st.

What it means as you have probably read in the paper is that a lot more people will eventually be able to have healthcare coverage and health plans will have a few new restrictions that will aid in them being somewhat more balanced as far as covering people's needs is concerned. Health plans will not suffer, business will not suffer, if you are reading this blog and you make over $200,000 per year (at most about 5% of Americans) you will be required to contribute a little more of your income in taxes. I think this article from MSNBC is one of many that gives a pretty good explanation of what is to come on the surface.

With that out of the way, I wanted to see if now that we have something to work with, will those who we have elected to govern choose to govern or will they choose to hide behind one excuse after another so that they can continue to resist their leader. Or should I say the elected leader that some consider theirs?

I wrote several months ago that this idea of healthcare reform is a microcosm for American society. My intention was to begin a dialogue about what the realities of this debate really were and until today actually are.

So, now that we have a health reform bill signed into law, what is the truth? If we had a truth serum to get into the minds of those who are still living with what is in many ways a violent, and certainly visceral response to this legislation what would they say?

Believe me when I say that I get political leanings. It is clear that tilting the balance of power towards the political party that one represents is generally in the goals of a politician. And despite obvious drawbacks of governing on leanings versus principle, I don't expect for that to change.

And while I fundamentally believe that the interests of most politicians are consistently biased towards how they can negotiate in a particular direction; I don't believe their intentions are such that they are opposed to things that have the potential to do a great deal of good for a majority of the people that elected them to office.

In the case of healthcare insurance reform, I am not so sure that this is about party, position, or the American people.

When one hears the rhetoric and refrain of healthcare reform opponents via social media or the news media, I have not heard the whole truth. It is almost like listening to code language.

We hear:

"It's too expensive, it will break us."

"This is a [still] a government take-over of healthcare."

"He said he was going to be bipartisan, what happened to that."

"We want healthcare reform, but we feel like we simply need to start over, why rush this?"

"This bill is not good for the American people."

Then of course:

"Obamacare is socialized medicine!"

and recently from Newt Gingrich:

“They will have destroyed their party much as Lyndon Johnson shattered the Democratic Party for 40 years [by passing civil rights legislation]."

You have to appreciate Newt's honesty. He spoke as if he had taken truth serum. In fact, he summed up what the unspoken sentiment of many Americans is and has been manipulated to be where reform is concerned: opposition to the idea of President Barack Obama.

They are not opposed to the Office of the President, they are not really even opposed to Democrats, or healthcare reform for that matter. I would argue that most Americans don't know enough about the inner workings of health reform or economics to an extent that they even really understand why they feel how they do. In this case of resistance to reform, they are primarily opposed the physical identity of one man.

The code language that has been used by resistant politicians and pundits is incrementally becoming more explicit, but in general they have restrained themselves. They have done so because deep down they know that their sentiments are contrary to what they believe is "the right thing". Their anger and resistance is a reaction, in my opinion, to a compromised conscience.

When the integrity of one's conscience is compromised, guilt often turns to guile. To mitigate the guilt, many make the object or idea of their guilt to be wrong. They demonize and attack them as a salve to mitigate such a compromise. When the salve doesn't serve its intended purpose, they intensify it.

I am still concerned with unilateral thinking and total lack of compromise for anything other than personal benefit. I still feel it could be the downfall of country's integrity and I am hoping that I am wrong.

For now, I am pleased that President Obama did something. With the bill's flaws (there are in my humble opinion several unknowns that could be problematic), challenges to the idea of reform, and vehement resistance towards his character, he persisted. I don't care too much about party, but I do care about principle.

What principles will we carry forward in the transition to a new America or for that matter a new world?

I think that is one vital question of the future. With all of the unknowns facing us in the future of healthcare and our general prosperity as a country, we can only rise or fall on principles.

Make it a great day!

Sunday, March 14, 2010

The Idea of Mentoring

If there is an idea of mentoring in your mind that is about how one person with expertise and another more "junior" person sit by the fireside while the knowledge seeps in from the "expert". . .think differently.

I had the opportunity to hear Dr. Audrey Murrell, Associate Professor at the University of Pittsburgh, speak today. Her approach, depth, and breadth of reach where the idea of mentoring is concerned was phenomenal.

She started the conversation getting us clear on the distinctions between mentoring myths and the realities of what mentors are and can be. From there she moved into clearly describing the roles of mentors and how within the role is always a symbiotic relationship. She shared that it is not a paternalistic/maternal parent-child dynamic with a superior-subordinate, helper-helped interaction.

This fact that the nature of mentoring is two-way and that both parties should be benefiting from the cultivation of the relationship is, for many, a profoundly different way of viewing mentoring. And even though there are people who have experienced the benefits of having a mentee and have communicated about these inherent benefits, there is still the idea by some that it is a time-sucking, obligatory distraction from "my work".

What excited me the most was the clarity she brought to the idea that mentoring is a separate responsibility of the leader/manager vs. an integral responsibility that benefits individuals and organizations in the short and long-term. She said this supported by data and great personal experiences.

Dr. Murrell's explanation of the benefits of mentoring led me to reflect on the views that people often have about diversity and inclusion. Inclusion goes naturally hand in hand with development. Being truly inclusive as a leader fosters the manifestation and cultivation of diversity in its myriad dimensions. Developing people is not optional just like cultivating diversity is not optional, especially in certain disciplines and industries. And given the nature of the especially complex problems we are asked to solve in our businesses these days we cannot afford to discount it in any sense.

Diverse perspectives are not only valuable, but to be competitive they are essential. All dimensions of diversity from identity to outlook must be considered if innovation and continuous improvement/maintenance of quality are desired.

I suggest you pick up Dr. Murrell's book Intelligent Mentoring. Her perspective and insight is a great contribution to any organization or professional who would like to develop this vital leadership competency.