The Diversity Science Program in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery studies, implements and disseminates solutions to emerging and complex inequity issues within Mayo Clinic and beyond.
This dedicated focus expands center's ability to provide evidence-based solutions that advance inclusive, equitable norms for organizational wellness and practice transformation. Mayo Clinic approaches diversity science as an interdisciplinary field that integrates various principles, approaches, conceptual models and theories into practical and effective tools and strategies with sustainable impact and measurable outcomes.
Diversity science is the scientific discipline aimed at analyzing and eliminating racism, inequity, exclusion and health disparities. Diversity science is a multidisciplinary field that takes a wholistic approach to considering fields and systems including:
The goal is to understand key drivers of behavior and causes of inequity and create opportunities to advance positive, normative cultural change and belonging.
The Diversity Science Program has both an inward and outward focus on equity, inclusion and diversity through a four-prong approach to impact the following areas:
- Patient care.
In their work to eliminate discrimination and address health inequities, center experts employ qualitative, quantitative and mixed methods including:
- Validated assessments and instruments.
- Emotional response strategies, also called sentiment analysis.
- Advanced analytics and trends.
- Strategic solution generation and evaluation.
- Community engagement and partnerships.
- Advanced implementation approaches.
The program's goal in studying and advancing equity, inclusion, belonging and diversity is to effect change in the workforce and community and for patients. Its effort is conducted in collaboration with numerous Mayo Clinic entities, such as:
Current infrastructure projects include:
Get Real, Mayo Clinic platform
No place in the world is free of racism, bias, microaggression or inequity, a fact acknowledged by Mayo Clinic leadership. As part of a broader response to increasing social unrest and recognizable strain within the organization, the "Get Real, Mayo Clinic" platform was launched in mid-2020.
It started with the development of an anonymous storytelling platform, using an internal crowdsourcing approach to document experiences of African American and Black employees at Mayo Clinic. After a pilot phase, it was expanded to collect stories from other employees, describing their experiences of discrimination or racism in Mayo Clinic and its surrounding communities. Stories can be submitted and reviewed by anyone at Mayo Clinic. For some readers, these stories provide their first recognition that racism and discrimination is everywhere.
Narrative data analysis led to development of an actionable scorecard to inform anti-racism and pro-equity initiatives and strategies to benefit Mayo Clinic staff, patients and communities. The next step is to better understand the current state of Mayo Clinic's racial diversity, equity and inclusion climate through robust scientific methodology. A series of baseline assessments will identify and target opportunities for improvement and for sustainable progress. Program experts, in collaboration with other community and Mayo Clinic entities, will work to develop and implement evidence-based techniques to influence culture change.
Diversity science interactive dashboard
The development of a data and analytics platform focused on diversity, equity and inclusion allows the Diversity Science Program to provide real-time guidance to the institution based on robust analysis and evaluation. The interactive dashboard is updated on a daily basis. It provides insights on recruitment, retention, career progression and pay equity.
To understand the current state of diversity, equity and inclusion at Mayo Clinic, the dashboard provides performance measures in the following areas:
Quantitative data — workforce metrics
- Overall gender, racial and ethnic diversity at Mayo Clinic with capability to track by site and department.
- Benchmarking for all sites using county census data.
- Recruitment data by race and ethnicity for both internal and external applicants.
- Race and gender distribution of employees by department and job role.
- Leadership distribution by race, ethnicity and gender.
- Hourly pay distribution by race, ethnicity and gender.
- Voluntary and involuntary termination rates by race and ethnicity.
- Career progression.
- Qualitative metrics including culture of inclusion survey data.
- Projects and initiatives repository.
- Crowd-sourcing data.
- Externally administered all-staff survey.
- Other ad hoc surveys.
Current research projects include:
Race, gender, weight and other biases in health care
In any situation where two or more people come together — including doctors, nurses, patients, family members and others — prejudices may emerge, or unconscious biases may be triggered. In health care, this can lead to thoughts and actions that make it less likely that patients will receive optimal care with the best possible outcomes.
The Diversity Science Program seeks to identify and address the source of bias. The program also tries to find ways to help people understand and cope with the effects of bias and microaggressions.
Research topics span experiences and wellness concerns of both patients and clinicians. One current effort is a scientific assessment of implicit racial and gender bias in patient satisfaction reports in the outpatient pediatric practice. This work will lead to a better understanding of the factors that can contribute to inappropriate variation in satisfaction scores. It also will shed light on how these scores affect physicians' wellness, burnout and perception of inclusiveness in their work environment.
Other recent research findings are discussed in these publications:
- Dyrbye LN, West CP, Herrin J, Dovidio J, Cunningham B, Yeazel M, Lam V, Onyeador IN, Wittlin NM, Burke SE, Hayes SN, Phelan SM, van Ryn M. A longitudinal study exploring learning environment culture and subsequent risk of burnout among resident physicians overall and by gender. Mayo Clinic Proceedings. 2021; doi:10.1016/j.mayocp.2020.12.036.
- Lichen IM, Bellamkonda VR, Campbell RL, Phelan SM, Anderson JR, Mullan AF, Knier K, Sadosty AT. Association between patients' body mass index and emergency department wait times: A multicenter observational cohort investigation by the reducing disparities increasing equity in emergency medicine (REDEEM) study group. The American Journal of Emergency Medicine. 2021; doi:10.1016/j.ajem.2021.06.007.
- Porter SB, Lovely J, Phelan S. Consideration of religion as a source of unconscious bias affecting surgical outcomes. International Journal of Surgery. 2021; doi:10.1016/j.ijsu.2021.105953.
- Onyeador IN, Wittlin NM, Burke SE, Dovidio JF, Perry SP, Hardeman RR, Dyrbye LN, Herrin J, Phelan SM, van Ryn M. The value of interracial contact for reducing anti-Black bias among non-Black physicians: A cognitive habits and growth evaluation (CHANGE) study report. Psychological Science. 2020; doi:10.1177/0956797619879139.
- Ceppa DP, Dolejs SC, Boden N, Phelan S, Yost KJ, Edwards M, Donington J, Naunheim KS, Blackmon S. Gender bias and its negative impact on cardiothoracic surgery. The Annals of Thoracic Surgery. 2020; doi:10.1016/j.athoracsur.2019.06.083.
- Wittlin NM, Dovidio JF, Burke SE, Przedworski JM, Herrin J, Dyrbye L, Onyeador IN, Phelan SM, van Ryn M. Contact and role modeling predict bias against lesbian and gay individuals among early-career physicians: A longitudinal study. Social Science & Med. 2019; doi:10.1016/j.socscimed.2019.112422.
Engaging with patients and community to improve outcomes for the most vulnerable
Where someone lives and works is integral to that person's ability to achieve equitable health outcomes. In addition, other contextual and behavioral elements must be considered when developing a framework for best practice in health care delivery. Finally, for people to achieve their goals — personal or professional — and live their best lives, they need to be involved in the process.
Many Diversity Science Program projects are developed and conducted in a collaborative, participatory way. One such collaboration involves the Mayo Clinic Health System in Southwest Minnesota and the Rochester Health Community Partnership. Ongoing work includes developing and evaluating a community-engaged research framework. This project is centered on issues arising from the COVID-19 pandemic. The investigators hope to identify best practices in outreach and education around the themes of prevention and containment; testing; and vaccine awareness, access, acceptance and distribution.
- Wieland ML, Asiedu GB, Njeru JW, Weis JA, Lantz K, Abbenyi A, Molina L, Ahmed Y, Osman A, Goodson M, Torres-Herbeck G, Nur O, Porraz Capetillo G, Mohamed AA, Sia IG. Community-engaged bidirectional crisis and emergency risk communication with immigrant and refugee populations during the COVID-19 pandemic. Public Health Reports. 2022; doi:10.1177/00333549211065514.
- Wieland ML, Asiedu GB, Lantz K, Abbenyi A, Njeru JW, Osman A, Goodson M, Ahmed Y, Molina LE, Doubeni CA, Sia IG; Rochester Healthy Community Partnership COVID-19 Task Force. Leveraging community engaged research partnerships for crisis and emergency risk communication to vulnerable populations in the COVID-19 pandemic. Journal of Clinical and Translational Science. 2020; doi:10.1017/cts.2020.47.
Another project involves using a visual method approach to recruit and treat minority patients in therapeutic cancer clinical trials at Mayo Clinic. Specific tactics are being developed and analyzed in collaboration with Mayo Clinic Cancer Center and other groups.
Racial and ethnic health care disparities in intraoperative anesthetic management in general surgery
Studies examining pain management in the emergency department and outpatient settings suggest that African American and Hispanic patients are less likely to receive analgesia for acute pain. Other studies have found that African American patients are less likely to be screened for pain and that medical students and providers hold false beliefs regarding biological differences by race or ethnicity leading to racial biases in the treatment recommendations for pain.
This project examines differences in intraoperative anesthetic management of patients by race, ethnicity and socioeconomic status. It focuses on intraoperative pain management and prevention of nausea and vomiting. This research is the first step in examining differences in anesthetic management at Mayo Clinic.
Opportunities for communication and intervention in telemedicine
With the expansion of telemedicine, and its added complexity, it is important to ensure that clinicians are providing the best care and communication to all patients and not increasing health care disparities. Additionally, it is possible that some clinicians are less effective practicing telemedicine, which may have the unintended consequence of a more negative impact on patients who are already underserved or higher risk.
This study examines the feasibility of using telemedicine cardiology clinical encounters to better understand how patients and clinicians perceive the communication between them. Such encounters also could be used to study patient-clinician communication based on the characteristics of each group.