Medical University of South Carolina Transforms its Culture Through Accountability

One of the oldest continually operating schools of medicine in the U.S., and the oldest in the Deep South, the Medical University of South Carolina (MUSC) in Charleston is a shining example of what can be achieved by acknowledging the link between diversity and success. In an area known for its segregated past, this academic medical center has transformed its legacy into one of inclusion by focusing on all aspects of its culture and constituency.

[Above: Students, faculty, and staff at MUSC participate in a Black History Month luncheon forum.]

“It is really important as an institution to embrace diversity and inclusion. The reasons for this are manyfold, but in a practical sense, we cannot function at our best if we don’t have a diverse culture, a diverse background, a diverse perspective that’s inclusive,” says President of MUSC Health David J. Cole, MD. “… We have to be committed to actually having an impact.”

With 13,000 employees and 3,000 students across six colleges and the hospital — which serves millions of patients each year — MUSC has had its work cut out for it. To ensure it has the most impact, the institution has not only taken an overarching approach to diversity and inclusion work, but an individualized one as well.

Willette Burnham-Williams

In year two of a five-year diversity and inclusion strategic plan, the institution set goals based on national health professions standards and has been working to meet them. Beyond a focus on improving the recruitment and retention of diverse and underrepresented faculty, staff, students, and healthcare providers, MUSC works to ensure the cultural competence of its students and workforce. University Chief Diversity Officer Willette Burnham-Williams, PhD, oversees these efforts in the university, with the help of her colleague Anton Gunn, chief diversity officer and executive director of community health innovation at MUSC Health.

MUSC Chief Diversity Officer Anton Gunn (right) presents a plaque to Mary Moultrie during the hospital’s inaugural Patient Safety Day in honor of her and other protestors’ activism during the 1969 Hospital Workers Strike.
MUSC Chief Diversity Officer Anton Gunn (right) presents a plaque to the family of Mary Moultrie during the hospital’s inaugural Patient Safety Day in honor of her and other protestors’ activism during the 1969 Hospital Workers Strike.

Understanding the complexity of this work — and the unique challenges faced by the different health professions — the university also assigned a faculty diversity officer to each individual college and regularly engages them in these efforts. Each unit was tasked with creating its own diversity and inclusion plan and objectives using national metrics specific to its healthcare field. As part of this effort, the colleges have to address five key domains: recruitment, retention, and pipeline; education and training; engagement and inclusion; communications and community outreach; and metrics and outcomes.

Once a month, Burnham-Williams meets with the faculty diversity officers to share best practices and resources, talk about challenges, and offer her and Gunn’s assistance wherever needed. And ultimately, leaders are held accountable for meeting their diversity goals.

Cole believes this synergy is key to improving diversity and inclusion enterprise-wide.

“I think most academic medical centers are somewhat siloed in their approach, so getting together to …  help the left hand help the right hand, to me is one of the purposes of having an overarching strategy,” Cole says. “If they’re doing a great job in the college of medicine, for instance, how can that reflect into the college of pharmacy? What are the best practices? How do we help each other? Everybody wants the boat to rise.”

Student Recruitment

MUSC medical students John Robinson and Lance Braye
MUSC medical students John Robinson and Lance Braye

Some colleges at MUSC — which include medicine, nursing, pharmacy, dental medicine, health professions, and graduate studies — naturally attract a more diverse candidate pool, Cole says, citing nursing as an example. The College of Medicine has also experienced success in terms of recruiting and graduating students from underrepresented groups.

Burnham-Williams attributes the College of Medicine’s success to several key areas. “From 2006 forward,” she says, “they have seen incremental, steady, and now significant results because they made a commitment early, they aligned it with the Association of American Medical College’s national goals at the time, they put human and fiscal resources behind it, and they literally held people accountable for the work.”

However, some colleges struggle more than others when it comes to recruiting diverse students and have developed pipeline programs to help address this issue. For example, the Post-baccalaureate Research Education Program (PREP) in MUSC’s College of Graduate Studies, funded by the National Institutes of Health, is designed to recruit diverse students to graduate programs in biomedical sciences to better address and reduce health disparities.

PREP provides individuals interested in pursuing a PhD or an MD in this field a one-year intensive research and professional development experience. Those accepted into the program become full-time employees of the university, during which time they receive a salary and benefits. They also receive hands-on research experience, attend workshops and conferences, prepare for the GRE and the graduate school application process, complete graduate-level coursework, and network with students and professionals. While completion of the program doesn’t mean an individual will automatically be admitted to MUSC’s College of Graduate Studies, PREP provides critical support to help prepare for graduate school and a career.

According to Burnham-Williams, the college was able to admit and matriculate three underrepresented minority students through the program this year. “Three doesn’t sound like a lot,” she says, “but when you think about the field of bioengineering and the sciences for underrepresented minorities, to get three in one cohort is amazing.”

The Summer Institute, another pipeline program at MUSC, focuses on providing assistance to students interested in medical school who may need some extra help. It targets those who, except for standardized test scores, would likely be admitted to the university; this group often includes people who have previously applied and been denied admission to MUSC. The program lasts six weeks and involves intense instruction and study, as well as educational advising and networking opportunities with clinicians.

“We might find a highly qualified and desirable student who doesn’t quite have an MCAT score that meets our threshold,” says Burnham-Williams. “We work with those students to get them better prepared for competition [in medical school admissions], and we allow them to apply and be reconsidered.”

In addition to these and other pipeline initiatives, MUSC has several scholarship programs to assist disadvantaged students. Currently, the institution is working to raise $20 million for its Opening Doors Medical Scholarship Campaign to help remove tuition as a barrier to a career in medicine.

Faculty and Physician Recruitment
When Gunn arrived at MUSC Health nearly two years ago, he immediately noticed the lack of African American nurses. At around 7 percent, this population was four percentage points less than the number of black nurses in South Carolina and 21 percentage points less than the hospital’s black patient population.

To improve the representation of nurses of color, Gunn worked with human resources staff to change where they were recruiting to better reach African American nurses and recent graduates — in areas such as Atlanta, for example. And already, the hospital is beginning to see results.

“I’m proud to say that in less than two full years, we’ve increased the percentage of African American nurses working at MUSC Health from 7 percent to 11.2 percent today,” Gunn says.

At the university, each college has developed strategic methods of allocating resources to recruit and retain the best and brightest underrepresented faculty members. Mentoring programs for junior faculty are now a staple at the university in an effort to help them remain engaged and focused. In addition, MUSC uses software to monitor the demographics of its faculty to identify areas where certain groups are underrepresented, Burnham-Williams says; when there’s a vacancy, search committees will then be more aware.

While MUSC is making some progress toward diversifying its constituent groups, Burnham-Williams says that “as you go higher up the leadership hierarchy, it becomes whiter and whiter, and more male.”

“We want our leaders to reflect national and state standards, so we set quantifiable goals based upon the state, the region, and their demographics,” she says. “So if 15 percent of the demographic in the tri-county region of Charleston is underrepresented minorities, then we want, as a minimum, 15 percent of our leadership to look like that across the board.”

Training and Education

MUSC faculty leaders and members of Girls Loving OurSelves Successfully (GLOSS), a program aimed at empowering middle school girls in Charleston
MUSC faculty leaders and members of Girls Loving OurSelves Successfully (GLOSS), a program aimed at empowering middle school girls in Charleston

For an institution that values diversity as MUSC does, having buy-in from all groups across all units is crucial to ensuring an inclusive environment for everyone — from students, faculty, and staff to clinicians and patients. To engage all constituents in this commitment, MUSC instituted an enterprise-wide, four-hour diversity training requirement for students, administrators, and other faculty and hospital leaders.

First-year students in all six colleges participate in a face-to-face classroom seminar during the first several weeks of the fall semester to satisfy this requirement. Institutional leaders, on the other hand, have the option of participating in online training to accommodate their busy schedules. Each department sets its own goals around training.

“Diversity to many people is just a word, but the question is, ‘What does it look like, what does it actually mean, and what are the competencies necessary for you as a leader to be a mentor in diversity?’” says Gunn. “So part of the training [involves] helping our leaders understand why this is important to us, how [it] helps us achieve all of our other goals around growth, finance, service, and everything else.”

Students support MUSC’s Alliance for Equality, an on-campus organization that provides support and advocacy for individuals of all sexual orientations and gender identities.
Students support MUSC’s Alliance for Equality, an on-campus organization that provides support and advocacy for individuals of all sexual orientations and gender identities.

While the training is not mandatory, MUSC greatly encourages leaders to participate and holds those who don’t accountable. According to Burnham-Williams, colleges and departments vary in how they approach these situations, with some taking a person’s lack of participation into consideration in performance reviews — which could affect salary increases and promotions — and others tying it to departmental funding.

“What we want to encourage is the kind of environment where if you do what is required, then we want to champion you as a leader, a leader who we want to promote and have play a leadership role in the organization. And if you’re not committed to these goals, then you are demonstrating that you don’t have the same values as the organization,” Gunn says. “Some of this will be about letting people see which one of their colleagues is committed versus which ones are not. We are hoping that peer pressure will be just as impactful, if not more impactful, than any kind of punitive punishment for [those] who don’t achieve the goal.”

According to Gunn, participation hasn’t been much of a problem. All of the nearly 400 leaders in the hospital have completed four or more hours of diversity training. Since accomplishing this goal in June, the hospital has since set a new one: for all new hires to participate in diversity training as part of their orientation. As of now, Gunn says, they have a 99.3 percent completion rate.

Furthermore, the hospital has created several different types of training opportunities this year that leaders can choose to engage in — either to fulfill a requirement or otherwise.

“We can’t hold leaders accountable for hiring a diverse workforce if they don’t know how to recruit and select for diverse talent. We also can’t hold leaders accountable for retention of diverse talent if they don’t know how to manage a diverse workforce. [And] we can’t set metrics around health disparities … if people don’t know what disparities exist in our state and in our patient population,” says Gunn. “So we’re going to do some training around [those].”

The entire institution has also instituted cultural competence training; the requirement applies to new-hire physicians in the hospital and to students in the university. Students, as well as faculty search committee members, are also required to participate in unconscious bias training and workshops.

Planning and Prioritizing
MUSC’s efforts to improve diversity and inclusion institution-wide also include working to improve how it collects patient data — such as information on demographics and language proficiency — to better serve them, as well as increasing supplier diversity. The hospital recently signed contracts with 16 new businesses, nine of which are African American-owned, four that are Hispanic-owned, and five that are owned by women.

Beyond the human capital behind this work, MUSC has successfully allocated fiscal resources to these efforts as well. This task, Cole says, was made easier by designating diversity and inclusion as priorities via the strategic plan. By reviewing and eliminating programmatic redundancies, he was able to strategically repurpose and earmark funds for this work.

Yet, despite the positive impact the diversity and inclusion strategic plan seems to be having on MUSC, Cole dreams of a day he’ll never have to draft another one.

“I would like to get to the point where a diversity and inclusion strategy, a strategic plan, is totally unnecessary, is irrelevant. Why? Because it is who we are,” he says. “To make a diversity and inclusion plan obsolete [is] the long-term goal.”●

Alexandra Vollman is the editor of INSIGHT Into Diversity.