R.T. Ramirez1,2, M.L. Hunt2, J.E. Sanchez1,2, C.J. Smith3, D. Amortegui2, N.I. Mackiewicz2, B.S. Mason6, C. Glass5, C.N. Clarke4, J. Holl2, J.K. Johnson1, K.Y. Bilimoria2, Y. Hu1,2 1Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES), Department Of Surgery, Chicago, IL, USA 2Surgical Outcomes and Quality Improvement Center (SOQIC), Department Of Surgery, Indianapolis, IN, USA 3University of Illinois, Chicago, Department Of Surgery, Chicago, IL, USA 4Medical College Of Wisconsin, Department Of Surgery, Milwaukee, WI, USA 5Wake Forest School of Medicine, Department Of Surgery, Winston-Salem, NC, USA 6American College of Surgeons, Diversity, Equity and Inclusion, Department Of Surgery, Chicago, IL, USA
Introduction:
Departments are establishing positions for Vice Chairs of Diversity, Equity, and Inclusion (VC-DEI) to address healthcare disparities. The structure and function of these new roles have not been described. We sought to qualitatively explore the experiences of VC-DEI, understand their job demands, and elucidate how to set them up for success.
Methods:
We conducted virtual semi-structured interviews and/or focus groups with 19 VC-DEI, of whom 15 were female and 13 racially/ethnically minoritized, all first in their roles. A codebook was developed inductively. Pairs independently coded transcripts using the constant comparative approach with differences reconciled by consensus.
Results:
Most VC-DEI lacked clear job descriptions or departmental goals. Some felt that the creation of the job was performative: “There are times where it feels like they just want us to submit projects to… check a box as opposed to make meaningful change.” They often wrote their own job descriptions, then negotiated revisions with their chair. This process delayed goal setting and achievement. Many described responsibilities outside of the job, commonly acting as the point-person for departmental conflict: “It's a lot in the middle of your workday, and you've got 22 people like, ‘Hey, can you talk about this?’ or ‘I heard that…’” There was wide variability in allocated resources. Budgets ranged from 0 to “6 figures.” Those with financial support expressed it allowed for autonomy, efficiency, and effectiveness in implementing DEI initiatives, demonstrating departmental investment: “This cannot be done without money. You have to have a budget. And that speaks to your commitment to this whole process.” Protected time for DEI work ranged from 0-20%, but some VC-DEI described an inability to decrease their other responsibilities in line with this allocation. DEI committees and administrative staff could mitigate time poverty by sharing the task load. Finally, VC-DEI described visible, active leadership support as critical for the uptake and effectiveness of DEI initiatives. The minority tax of the role was universally acknowledged. Some accepted the burden, feeling they had achieved enough in their careers to sacrifice other opportunities. Others, particularly those more junior, expressed concerns about being pigeonholed, detracting from their other talents. All continued to be driven by a steadfast belief in the importance and impact of DEI work
Conclusion:
To ensure credibility and success, VC-DEI should have clear job descriptions, adequate dedicated time and finances, administrative support, and visible advocacy from leadership.