Voices From Diversity, Equity, and Inclusion Leaders in Emergency Medicine, Understanding Their Experiences

While EM departments have designated new leadership roles to focus on diversity, equity, and inclusion (DEI) in recent years, the experiences of DEI leaders have not been thoroughly investigated. The purpose of this study was to describe the factors that impact the effectiveness of DEI leaders within EM.

We conducted a national qualitative study of DEI leaders in EM. Participants participated in a 60-min semi-structured interview. An interview guide was pilot-tested and iteratively refined. The interview audio was recorded and professionally transcribed. Two team members developed a codebook, independently coded transcripts, and generated categories using content analysis. We analyzed the interview transcripts using inductive and deductive content analysis. Inductive analysis allowed us to identify emerging categories, while deductive analysis allowed us to overlay Camara Jones' Allegory of the Levels of Racism to our data.

We completed 24 interviews, representing 21 unique institutions in 14 states. In our adapted allegory, the DEI leader is represented centrally within the ecosystem. The effectiveness of the DEI leader is influenced by institutionally mediated, personally mediated, and internally mediated factors. Institutionally mediated factors included the macroenvironment, administrative positioning, and promotion pathways. Personally mediated factors included communication skills, ongoing leadership development, change management prowess, and seeking colleagues' support. Internally mediated factors included personal commitment to DEI work, as well as feelings of workplace inclusion, imposter syndrome, and tokenism.

This qualitative analysis of EM DEI leaders highlights how factors at various levels influence their experience. Jones's allegory helps conceptualize how a DEI leader functions in a dynamic, continually evolving environment that is sometimes beyond the leader's control. Our research identifies opportunities at the personal, departmental, and institutional levels, such as maintaining a personal commitment to the work, supporting leadership development, and improving administrative positioning that can assist DEI leaders' effectiveness.