A few years ago, while working on a project for Cincinnati Children’s Hospital, I faced one of the more challenging experiences in my professional work — and, even now, reflecting on it gives me goosebumps.
Here’s the context:
BIF had been asked by Cincinnati Children’s to help them explore and design next practices that would reduce infant mortality in the surrounding community — Avondale. Avondale, at the time, was ranked highest in the country for infant mortality, largely stemming from (a) preterm births and (b) a majority population that was at high-risk for preterm births. Sadly, the reason why stems from race — black women experience more preterm births and infant deaths than any other population. I will come back to the role that race (or racism more specifically) plays in preterm births later.
Our team had spent months immersed in so many powerful, wonderful, and often sad stories. We interviewed pregnant teenagers (and non-pregnant teenagers). We interviewed formerly incarcerated women. We interviewed moms and pregnant women, whose abusive husbands had landed them in shelters. We interviewed pregnant moms and their pregnant daughters. We interviewed non-pregnant women. And we interviewed dads.
We synthesized all of the findings from these interviews, landing on a handful of opportunity spaces and brought diverse community stakeholders together into a participatory design studio. And that’s when it happened.
I had just wrapped up a presentation of our findings, including a podcast of women talking about their experiences (note: listening without visual cues is so core to empathizing without judgment), and had opened up the room to observations and questions. One community stakeholder raised her hand and said:
“You’re white. I’m sure it goes without saying. But if you had knocked on my door, my family and I wouldn’t have told you sh*t.”
There are many things that flew through my mind in the nanosecond I had before I needed to respond.
- She just questioned the credibility of our findings, at a moment when I need buy-in in order to move forward
- She’s not wrong; I’m sure there are definitely things we didn’t hear
- What if we didn’t just not hear things, but what if, given our white privilege (and the biases that come with it) we weren’t able to truly witness their experiences?
- Holy crap, are we about to talk about race, for real, in public?
I remember my voice shaking in my response, and (having played this scene over and over again in my head), I know I said something along the lines of:
“Yes, I am white, and as such, I can never fully understand what it means to be a black woman. We’re trained to listen, and we do our best to listen with open hearts. And I’d like to honor these women and their time by considering what they did tell us.”
The conversation continued, but I never forgot that interchange.
Here’s why it matters.
I’ve been working in innovation long enough to see trends cycle through the social sector. Diversity, equity, and inclusion (DEI) has been and might continue to be, one of those trends. It has been on everyone’s radar at one time or another in every decade since, well, before I started working. For example, in 1992, I did my field training in Kenya and required reading was Moving the Centre, a book that invited researchers to consider moving their own race and class privileges out the center of their mental models, in order to explore new ways of working that would leverage diversity. Why do I feel that the invitation didn’t get much traction?
I believe the answer lies in the traditional approach. In BIF speak, institutions approach DEI as a “bolt-on.” This is what we know how to do. We take our existing culture and bolt-on a DEI committee. We take our existing marketing strategy and bolt-on specific activities to reach “underserved communities.” We take our existing products or services and we tweak them to serve “new” audiences.
I think there are perils with this approach:
- People are truly hurt, and injustices are created, when we don’t truly shift our lens, mental models, or our behaviors to address DEI systemically.
- We miss huge opportunities to serve everyone better.
- Bolt-ons aren’t sustainable and will continue to perpetuate trends.
I think the real invitation is to consider how our institutions move from bolt-ons to next practices and new business models. Here’s how.
Shifting our Lens
At the beginning of the Cincinnati research, one phrase kept getting me hung up: Baby Daddy. Women had baby daddies and not husbands. Women had multiple baby daddies. As a white girl from Connecticut, it was hard to say baby daddy comfortably. But here’s the thing that I was comfortable doing:
Asking myself why.
And what surfaces is a bias. Aren’t we supposed to grow up, get married, and have one father for our children? Isn’t nuclear family the right kind of family? The irony, of course, is that I am divorced with two kids. I will never have a nuclear family, and I have learned it takes a village. I host Sunday Dinner — supper with my family, my partner’s family, random teenagers, lonely neighbors, good friends. Why? Because I understand that we don’t get by on a nuclear family. But nuclear family is stuck in my mind — it is part of the whiteness culture that is prevalent in this country – as the universally accepted right way.
Cincinnati Children’s Hospital won a Mayo Transform Award for Neighborhood Feasts, a concept that forged communal relationships between physicians and community women.
Once I acknowledged and moved beyond the notion that there is a right or wrong way, I grew a sense of wonder. Communal families are more expansive; there are more people to play so many roles — regardless of age, gender, or relationship. They are inclusive and accepting. They are more adaptive and responsive; less fragile. There are so many implications for this and how these strengths could be used; it inspired my thinking about how we can re-image support systems; and also, it inspired a key opportunity area:
How might inclusive relationships and communal events change the power structure between patients and doctors (a power structure that often dissuades women from engaging in their care)?
Designing for Diversity, Equity, and Inclusion
The second opportunity is to not just seek inspiration from – but to also design business models for – diversity, equity, and inclusion. In a forthcoming blog, you’ll hear about our friends at Trinity Rep who came to BIF because they were facing an inflection point in their very identity. As a community repertory theatre, it is charged with reflecting the challenges and issues that exist in the community around it. But a racially charged scene on the stage catalyzed a racially charged response from the community; causing them to question what it would mean to not just have a DEI initiative or do DEI programming, but to transform their business model and put DEI at the core? They asked themselves if this could transform their community.
It’s a compelling question and one that is important for all institutions. If public service put DEI at its core, how would communities look different? How would public services look different? For example, the immigrant debate rages so loudly in this country, through a mindset of who stays and who goes; it is a conversation about exclusion. Through this lens, we are failing to recognize the opportunities found through inclusion. This could mean many things, but my mind goes immediately to the power of entrepreneurship. As entrepreneurs, immigrants ground and fuel our small businesses, and through it, our economy. When we design for inclusion and equity, we’re creating institutions that unleash, rather than limit, people’s potential.
The opportunities in education are also enormous. If higher education designed for diversity, it would have a system that was more flexible and affordable. In short, we would have higher education models that are better for everyone. If K-12 education designed for diversity, we would have classrooms that taught us how to collaborate with “unusual suspects” for critical problem solving (hello – major skill requirement of the 21st century), higher graduation rates, and more people actually engaged in developing the skills, competencies, and capabilities that can move this country forward. In our next post in this series, we’ll share findings from our SXL Teachers for Equity project, which points to the fact that racially conscious classrooms forced teachers and students alike to be more authentic and open — the very conditions for learning and evolving.
In healthcare, I have seen first hand (and designed) opportunities for putting DEI at the core of what we do. DEI forced us to question the 9–5 schedule of primary care. It forced us to consider the importance of “connected knowledge,” given how many people are part of raising a child. It forced us to consider the power and importance of first-generation changemakers, for creating and spreading new habits and values related to good health. It forced us to consider how we move from sick care to family well being. And new business models emerged as a result that could better serve everyone.
In short, when we design for DEI, we create more opportunities to be true and worthy market makers.
Sustaining the DEI Shift
The Cincinnati project was one of BIF’s first forays into the use of a community critique. Early on in our research and synthesis, we invited a handful of “experts” in infant/maternal health and community health to hear our findings. I discussed the role that race was playing in women’s experience. One of our critiquers, a white male physician from Brown University, asked me point blank:
“It sounds like you want to address racism.”
The way I heard it, it sounded less like a question, and more like an observation of the preposterous.
“I think we need to,” I said.
I felt small, then. But I’m not feeling small anymore.
Since then, studies have proven conclusively that infant mortality is a direct result of racism in this country. When I say that people are hurt regularly by racism, this is what I mean. We lose babies. And we don’t just lose them as babies, we lose them as children, young adults, adults. We lose the potential they can offer the world. Can you imagine how our communities, cities, country might be different if that creative potential was unleashed and tapped rather than lost? Can you imagine how your institution might be different? More creative? More innovative?
If we fail to create a sustaining shift, if we continue to treat DEI as a bolt-on, we’ll fail to prevent that hurt and injustice. We’ll fail to seize opportunities to make things better. For everyone. We’ll miss opportunities for innovation, and market making.
This is why BIF has taken on a series of DEI efforts — both in the projects that we take on and how we embrace it internally.
This is the first in a series of blog posts focused on how our real-world experience labs are using diversity, equity, and inclusion to design innovative new business models. Coming up next, you’ll see how we’re transforming classrooms and learning by activating teacher leaders in order to design more equitable and diverse experiences. From our Patient Experience Lab, we’ll share how “witnessing our patients,” establishes trust, and fundamentally improves health and well-being. Our Citizen Experience Lab will share how communities become stronger and more resilient through inclusion. Finally, we’ll share the courageous conversations we’re tackling internally, to ensure that our own culture and values are a reflection of sustaining the shift to DEI, knowing that what we design will be better the more diverse our designers are and our culture is.
We invite you to join these conversations, and to explore how putting DEI at the core of your business model exploration can surface opportunities for transformation.
Part 2: Finding Our Equity Why
Part 3: The Equity Opportunity in Healthcare