Strengthened through Diversity: A Blueprint for Organizational Change

Abstract

R ecently, health care and medicine have broadly sharpened their focus on inequity, unconscious bias, and systemic racism. Accordingly, the field of neurology has identified serious challenges in our culture, academic structures, training, and, most importantly, disparities in access to and receipt of quality care for neurological disease. For the past decade, the American Neurological Association (ANA) has been changing its structure to welcome a broader and more diverse membership within the clinical, educational, and scientific domains of academic neurology. These acts arise from the ANA's aspirations to develop a more inclusive and equitable internal culture and serve as a resource to academic neurology departments seeking to promote equity of opportunity for neurologists and neuroscientists in research, education, and clinical care. The ultimate goal of these actions is to achieve equity in neurological research, health, and care.According to the principle of inclusive excellence, "Diversity is a key component of a comprehensive strategy for achieving institutional excellence." 1 The success of an academic community or institution depends on how well it values, engages, promotes, and includes a richly diverse constituency of students, staff, faculty, administrators, and alumni. Not only is this a moral imperative, but there is empirical evidence that diverse scientific or corporate teams are more productive and more creative. Teams that include different kinds of thinkers or diverse perspectives outperform homogenous groups on complex tasks, producing what has been called "diversity bonuses." 2 Thus, diversity, equity, and inclusion (DEI) efforts are as critical to an academic institution's success as human and animal research protections, fiscal responsibility, and scientific integrity. Given that clinical neuroscience is evolving rapidly and the diversity among medical school applicants, matriculants, and graduates is growing, embracing and achieving diversity in the ANA and academic neurology are critical to our success. In this commentary, we outline some of the areas that need urgent attention and then the actionable steps that have been implemented.Recent events have underscored these imperatives. The COVID-19 pandemic has generated a global health crisis. Current infection rates are on track to exceed those TABLE 2. Respondent Characteristics-Self-Reported Experience with Discrimination in Home Academic Neurological Department and in the 2020 ANA Survey Response Considered Leaving My Home Institution Due to Discrimination Considered Leaving the ANA Due to Discrimination n % n % Yes 39 14.0 6 2.1 No 227 81.6 264 95.0 Declined to answer 12 4.3 8 2.9

Kenton Award Lecture—Stroke Disparities Research: Learning From the Past, Planning for the Future

“…The American Neurological Association's blueprint on organizational diversity recommends the collection of data on social determinants of health and other key variables at both the individual and neighborhood level, the incorporation of behavioral and social science methodologies to identify and address the underlying causes of inequities, and the use of cross-institutional studies to facilitate recruitment and improve generalizability. 85…”

“…43,44 Professional societies, funders, and journals can correct practices that perpetuate inequities and institute policies that diversify grant review panels, guideline panels, and editorial boards, and many have committed to do so. 17,45–48,85,86…”

Black Patients Matter in Neurology

“…Recent years have seen substantive changes along these lines by organizations such as the AAN and ANA, which augers further future positive developments. 42…”

“…Recent years have seen substantive changes along these lines by organizations such as the AAN and ANA, which augers further future positive developments. 42 Finally, professional organizations, institutions, and individual neurologists must all advocate for policy changes to combat racism and eliminate neurodisparities. Examples of important advocacy work include the expansion of funding for disparities and antiracism-related research and lobbying for reimbursement practice changes (e.g., increasing Medicaid reimbursement for outpatient and preventative care, reimbursing telephone visits, and encouraging more equitable allocation of specialists to underserved areas) to encourage better access to care and outcomes for marginalized populations.…”