Sparking the Conversation on Building a Diverse and Representative Workforce in Primary Care and Behavioral Health

Shifts in Human Resource (HR) processes, such as hiring, are essential to recruiting people with lived experience and creating a more inclusive company culture. Panelists discussed the importance of hiring people with lived experience, and described how shifts in hiring and other HR practices are essential to recruiting and hiring a diverse workforce. These changes include how the interview process is conducted, the qualifications required for a position, how people are supervised, and other organizational processes. By changing some of the hiring practices at his organization, Alfonso was able to hire individuals with lived experiences that Community Medical Centers might not have reached through traditional recruiting and HR processes. 

Strategies to support the advancement and retention of Black, Indigenous, and People of Color include mentorship programs, management trainings, pathways for career development, and funding opportunities for higher education. Eleanor highlighted the importance of having an accountability partner who can help with growth into leadership opportunities. She also discussed how intersectionality plays a role in leadership and development, and how challenges that marginalized groups may face make it more difficult to be in a leadership position. For example, women of color who are experiencing motherhood might not have the same time and capacity to dedicate to advancing their career, compared to others. Such elements should be considered when developing leadership opportunities in order to support the success of people of color in leadership positions. 

The Covid-19 pandemic has exacerbated staff burnout at many safety-net organizations, as staff have had to handle their standard workload and additional Covid-related responsibilities. Addressing burnout and supporting staff well-being is an essential strategy for retaining staff, and an ongoing challenge for many organizations. Nira shared how her team has been supported through listening circles, mindfulness, and wellness initiatives backed by their self-care assessments. They have also provided mental health resources for frontline workers, opportunities for civil engagement and advocacy, an Employee Assistance Program (EAP), and resources for addressing vicarious trauma. All panelists agreed that burnout is an issue that needs to be continually addressed, and they are still working to find the best ways to support staff wellbeing.

Understanding and dismantling power dynamics is essential to successfully integrating staff with lived experience into the workforce. The first step in addressing power dynamics in a healthcare setting is to acknowledge that power differentials exist. This opens the conversation, allows for trust building, and creates a more welcoming environment, particularly for staff with lived experience. By returning to the team’s shared goals and values of caring for patients, staff of all levels can begin to break down hierarchies. Additional support and capacity building for staff may also be needed to combat misconceptions and address power dynamics. For example, at Community Medical Centers, many staff members had not previously worked with people who had been recently incarcerated. Staff had to be trained on how to work with patients and staff with justice system involvement in order to best support them in the workplace.

The hybrid remote/in-person workforce that developed as a result of the pandemic presents unique challenges to providing integrated care. Having a hybrid delivery of services can present challenges for staff schedules, impact the patient experience, and affect how services are delivered. For example, behavioral health teams often have more flexibility to provide virtual services compared to primary care providers. Concurrently, there has been an increased demand for mental health services during the pandemic. Providing services via telehealth has offset the challenge of serving more clients, but also comes with its own set of challenges, such as inequities in service delivery for people who do not have access to the technology necessary to take part in virtual care. Additionally, with primary care and behavioral health services offered in different modalities, it can be difficult to build an integrated team when part of the care team is remote and others are in person. The workforce continues to adapt to meet the needs of providers and the community while operating in a hybrid environment.