Dignity and Respect

Candi Castleberry Singleton, chief inclusion and diversity officer at the University of Pittsburgh Medical Center, has found ways for employees to respect patients’ various cultural practices — and to expedite healing, or at least provide dignity at death’s door.

Conversation about dignity and respect is particularly important in hospitals. Case in point: Muslim female patients need to have their husbands in the room when male doctors explain treatments; women won’t follow a doctor’s orders without the husband’s consent. And, husbands want to be there when male technicians draw blood, to make sure only their wives’ arms are uncovered.

“If you go to buy a car or an item in a department store and you don’t like the experience, you can just choose to buy from a competitor,” Singleton said. “But in health care, you may not be able to walk away as easily, particularly if you are sick. You can’t as easily change doctors or hospitals as you can switch phone service.”

At the Core

Singleton has spearheaded a number of initiatives focused on dignity, respect and cultural competency in health care delivery since joining UPMC in 2008. Her efforts have led to UPMC’s board designating dignity and respect as two of the center’s core values incorporated in employee onboarding programs, performance reviews and now the foundation for any new department initiative — whether it be nursing practices, housekeeping chores or even corporate marketing campaigns.

Singleton is taking these concepts outside UPMC and into the greater Pittsburgh community and even nationally, working with competitors, nonprofits and corporations to spread the message about the “Platinum Rule” — treat others how they want to be treated if you want to be more successful in your endeavors. Her endeavors include launching a dignity and respect national campaign, with its own website and networking events. Singleton calls this “her second job,” participating on the board, speaking at conferences on behalf of the campaign and bringing on new partners.

UPMC also designated January as Dignity and Respect month, holding a celebratory breakfast to recognize community businesses and nonprofits that have championed concepts within their organizations. And Singleton works with local school districts to teach anti-bullying by emphasizing dignity and respect; works to motivate the community to become partners in their health care as a leader in the local Healthy Community Healthy You program; and is co-chairman of the Regional Health Literacy Coalition, formed to improve patient and provider communications.

If these initiatives don’t sound like typical duties for a diversity executive, it’s because Singleton has made a career out of coming up with creative ways to infuse diversity and inclusion into business. At Sun Microsystems Inc. she developed a trademarked Integrated Inclusion Model, which puts the onus to achieve an inclusive culture into the hands of each department leader and his or her reports, rather than the traditional compliance-driven processes led by human resources.

That creativity or freedom to employ nontraditional methods to promote diversity and inclusion is still in effect at UPMC. Cultural competence is a particular focus area, which Tami Minnier, UPMC’s chief quality officer, said should permeate health care models in general as part of the industry’s overall efforts to improve delivery.

“You could provide the best medical procedures and medicines in the world, but if you don’t understand where they are coming from, you won’t be successful,” Minnier said.

Take the example of having Muslim husbands participate in their wives’ treatment discussions. “If a woman has been assaulted and is now ashamed to have her husband in the room, the doctor has to make it safe for that woman to talk,” Minnier said. “It’s very important to listen to patients, learn who they are and what they may want.”

The Pieces in Play

Cultural competence is important in health care, but putting it into practice can be more complex, said Geri-Ann Galanti, faculty member of the David Geffen School of Medicine at the University of California at Los Angeles and author of the book, “Caring for Patients From Different Cultures.”

For example, Catholic hospitals might have to take down crosses in rooms for non-Christian patients, or let them display their own religious symbols. These kinds of small gestures can make hospital stays more comfortable, Galanti said. Hospital staff also can ask families to donate books and magazines in their language, and serve ethnically appropriate foods and utensils.

“Cultural competence should be made part of the job description, and thus part of the yearly evaluation,” Galanti said. “If someone is specifically mentioned by a patient in the cultural competence category of patient satisfaction surveys, he or she could receive a small reward.”

Engagement is also an issue. In 2008, Singleton and her team created the UPMC Center for Engagement and Inclusion, a framework to integrate diversity and inclusion into everything the medical center does on a daily basis — for employees, patients, families and the community.

The first initiative Singleton and her team launched was the Dignity & Respect Campaign, based on a list of 30 tips to treat UPMC employees how they want to be treated. Tips include seeking understanding, communicating respectfully and remembering that we all make mistakes.

The 30 tips were presented to employees at each facility and incorporated into an online video with brochures for new hire onboarding. Singleton and her team then took feedback from employee focus groups and developed a cultural competency initiative to help employees address the diverse needs of patients and their families.

For instance, they developed UPMC’s Interfaith Pocket Brochure in 2009 to outline cultural traditions related to sickness and death for 15 common faiths. The brochure is available on UPMC’s website and in print in nurses’ stations and physician offices, and upon request by community organizations.

In 2012, Singleton and her team got cultural competency, dignity and respect incorporated into UPMC’s learning and development programs for new hires and managers. In 2013 the UPMC board added dignity and respect as a core organizational value, solidifying the concepts into everyday practices throughout the center’s facilities.

“Candi reframed the diversity conversation around the words ‘dignity’ and ‘respect,’ and those words have become one of our core values, from the top of the organization on down,” Minnier said. “It’s become what we talk about — I hear those words 10 times a day coming from senior-level managers and front-line staff, and that’s an understatement.”

Singleton said the importance of dignity and respect became particularly poignant when she and her husband first moved to Pittsburgh and were not allowed to view an apartment for rent until the real estate agent learned she was a new executive for UPMC, one of the largest employers in the region.

“At that moment, nothing that I have tried to accomplish in my career mattered — in that interaction, that person was not treating me and my husband with dignity,” she said. “It doesn’t matter what your socioeconomic status, age or race is, when you feel an absence of respect, it still makes you feel angry.”

Past Informs Present

While these types of initiatives centered around care work for a health care provider, Singleton was able to find creative ways to foster inclusive cultures for previous employers as well.

For example, as Sun’ Microsystems’ chief diversity officer from 2003 to 2006 — before the technology company was acquired by Oracle Corp. in 2010 —

Singleton said she knew she had to develop a more data-driven cultural competency model that would better resonate with its engineers.

Singleton came to Sun Microsystems in 2000 as an operations manager. While there, she received a Stanford University business certificate in 2004 from its Human Resources Executive Program, and in 2006, an MBA from Pepperdine University.

In 2004 she created a global leadership model survey, asking managers what was important for global leaders to know to be competent in their job. Each business competency was then multiplied by a fraction representing the amount of cultural competency required for each business skill. The equations were developed by Singleton and her team with the aid of University of Illinois researchers.

For example, if a global leader was rated a 10 on his ability to conduct business across multiple regions, but a zero on cultural competency when performing that skill, then that executive’s global leadership rating for that competency would be lowered to zero. Singleton fine-tuned the competency framework to form the Integrated Inclusion Model, which she included in a chapter she wrote for the 2009 book, “Crossing the Divide: Intergroup Leadership in a World of Difference.”

The model can be used in many industries, she said, or have an impact when developing a new commercial product or marketing plan, or figuring out how to treat patients in hospitals. Workers need inclusion training that shows them how to operate. “We, as HR leaders, can’t fish in all of those areas, so we need to teach workers how to be aware of these issues themselves, or else they’ll never get better at it,” she said.

In 2006, Singleton moved to Motorola Corp. to serve as vice president of global inclusion and diversity for two years. From 2003 to 2008, she also served as a workshop leader for the Corporate Card Game. She joined UPMC in 2008, and it is there that Singleton said she has done her best work.

“They’ve given me space to be creative, and many of our leaders have embraced these concepts by putting them as core values of the organization and how we develop cultural competency in our work,” she said. “I love this type of work, and there’s always so much change and so much more work to do.”

Katie Kuehner-Hebert is a California-based freelance journalist. She can be reached at editor@diversity-executive.com.