Working in leadership at a hospital can be complicated—there are a range of education and job functions, all while everyone is ultimately responsible for patient care. Being a DEI leader in a hospital system in a border city, HR Brew recently sat down with Nancy Maldonado, chief diversity officer at Rady Children’s Hospital in San Diego to discuss launching the organization’s DEI team, how she measures success, and unique challenges of her job.
Pathway to diversity officer. Maldonado didn’t plan on a career in DEI, and began in health and wellness with a master’s degree in exercise physiology, then developed her own consulting business for corporate wellness programs.
She was working on her PhD in public health when an opportunity arose with the American Heart Association. “I started working [for a] nonprofit, and then just fell in love with this idea of, ‘I can make a living by doing really great work,’” Maldonado said, and worked as a community health director before moving onto the Chicano Federation, a social services organization.
The nonprofit work taught Maldonado about equity work, and advocating for communities of color, so she felt prepared when Rady Children’s Hospital created the chief diversity and inclusion officer role in 2022.
“I understand when you’re making decisions how to have that big picture view,” she said. “Sometimes where folks in my position or my role get maybe burnt out is that they’re not able to see that bigger picture, and not have that global understanding.” But Maldonado had the skills to develop a good relationship with the CEO and ensure DEI had proper visibility and buy-in.
Targeted DEI approach. While Rady Children’s Hospital had worked with diversity consultants, the organization really needed Maldonado to develop a new program. “Part of it was that the workforce was so hungry for it [DEI], so I didn’t come into a completely blank slate…but I didn’t have a team,” she said. “It was exciting and frustrating and fulfilling.”
Maldonado said her biggest challenge was moving fast enough for the organization and individuals, from patients to families, when she was a one-woman show. “It’s a big system, so keeping that in perspective and that I needed to move at the speed of the system,” she explained. “I always felt like there was just more that we could be doing.”
She takes a wide-view approach to DEI, even including job roles and tenure in her planning. “If somebody’s not at the table, and we’re really intentional about saying what voice are we missing? Who needs to be here to give us that different perspective, or to fill a gap?”
While Maldonado spends a lot of time in high-level meetings, she also focuses on individual coaching for employees for various work challenges. “We don’t have a canned or set [DEI training] curriculum,” she said. While not all DEI training is effective, Maldonado believes that workers still need development opportunities, and that involves training.
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“We’ll go in and meet individually with people, and that’s where some of the coaching is happening,” she said. “Then we can create customized curriculum, and that can look like anything. It rarely looks like one session.” To her, the impact happens thanks to her customized approach and every day coaching.
The DEI program also leans on employee resource groups and a DEI council that’s now in its fifth year. “The intent is for them to be representatives of the workforce so they are sharing what they’re hearing,” Maldonado said, noting that the council shows her where there are opportunities for change.
The DEI program’s success is, in part, measured by employee engagement and patient care scores. Maldonado examines psychological safety and belonging to understand how employees are doing because engaged employees “are going to deliver better service to our patients and families, and they are going to get better care.”
Still, Maldonado recognizes the unique stressors that employees are experiencing right now and tries to mitigate the effects of the outside world. “It shows up in the way that people interact with each other at work. It shows up in the way that teams communicate or don’t, and then it shows up in patient-to-provider interactions as well,” she said, noting that safe open spaces are especially important for employees right now. Rady Children’s Hospital hosts monthly dialogue sessions, where employees have guided personal conversations.
“Being in a border town right now is really hard,” she said. “Not just for our patients and families, but this is impacting our people on a very personal level, with their families, with them, so it’s been a really tough time.”
On board with DEI. Maldonado understands that it’s also an uneasy time for DEI practitioners, but she’s been able to keep employees engaged in their work by focusing on employees who may have more “neutral” views about DEI.
Maldonado estimates that 20% of workers are all-in on DEI and 20% hate it. “I’m really focused on [the other] 60% because that’s where we can have the biggest impact. And it’s folks that maybe don’t understand it,” she said, so she shows employees why the work is good for patients. “I’m not there to change anybody’s beliefs. I’m not there to change anybody’s mind. I’m there to help people deliver better care.”
“The more that we’re able to connect with people, the more that they see themselves reflected in the folks who are providing their care, and that’s in culture, language, identity all of the above, the better experience they’re going to have, which impacts their care outcome. And at the end of the day, that is why every single one of us should be there, and if it’s not, then that’s a different conversation.”