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The last year has seen a call to action in how we respond to issues affected by race that are not mindful of equity or inclusion. Beginning with the murder of George Floyd and, more recently, the events surrounding the recruitment of Nikole Hannah-Jones, this has been an especially difficult period. Because of thoughtful leadership awakened to the need for change, the UNC Lineberger Equity Council was formed.

Over the past nine months, this 32-member Lineberger group has gathered the input of the many constituencies and stakeholders of UNC Lineberger including a diverse mix of professional staff, clinicians, patients, patient advocates, researchers, trainees, faculty and leadership. We have evaluated our environment and deliberated about improvements through an equity lens. The result of this work is the creation of a prioritized list of actionable areas for which to implement focused, meaningful and measurable change.

UNC Lineberger Equity Council Phase 1 Actionable Solutions: 1. Dismantle ineffective systems; 2. Conduct research with an equity lens, including clinical trials recruitment; 3. Improve hiring and retention for all positions; 4. Reduce patient care disparities and ensure equitable care; 5. Pursue and uphold an inclusive and equitable culture.

Action 1: Dismantle ineffective systems

1.1. Dismantle ineffective systems that currently block BIPOC advancement and install new systems that promote BIPOC advancement.

Action 2: Conduct research with an equity lens, including clinical trials recruitment
Organizational Capacity:

2.2. Infuse DEI into internal funding mechanisms: Ensure all Cancer Center RFA’s have a detailed scoring section on how the design process and implementation will meet the equity goals.

2.3. Build research capacity: Create capacity, develop procedures and include personnel that ensure research can be conducted with an equity lens.

2.4. Make it easier for researchers to find diverse populations: Create a systematic process to identify underrepresented patients eligible for clinical trials.

2.5. Advocate for reform of NIH review mechanisms to ensure that DEI is considered in funding decisions.

Researcher-Focused:

2.6. Broaden researchers’ DEI lens: All Lineberger researchers should have access to a diverse community advisory board to plan and/or critique the design, process, and implementation of their studies.

Patient-Focused:

2.7. Expand what we can research: Engage and educate diverse populations about biospecimens and the donation process for cancer research.

2.8. Use a patient-centered approach to educate and support patients, their caregivers/ family members and the community to maximize diverse participation in clinical trials.

2.9. Educate, inform and support patients, their caregivers/ family members and the community about the value of and participation in clinical trials to improve DEI.

2.10. Optimize the clinical trial experience and interactions of under-represented patients, care givers and family members.

Action 3: Improve hiring and retention for all positions

3.11. Pipeline: Develop strategies to increase recruitment of individuals from underrepresented groups into cancer-related careers such as an Oncology Mentoring Pipeline.

3.12. Hiring Practices: Improve hiring practices to increase the diversity of the Lineberger workforce for staff, faculty and learners.

3.13. Retention: Recruit and retain clinicians and staff that reflect the population we serve.

Action 4: Reduce patient care disparities and ensure equitable care

4.14. Data: Require race-, age-, and stage-specific information in the EHR system to enable ongoing accountability, efficiency and transparency to improve patient outcomes.

4.15. Enhance communication across the care continuum among patients, families and clinicians, within and beyond the UNC Health system.

Action 5: Pursue and uphold an inclusive and equitable culture

5.16. Create and maintain infrastructure to support and grow a DEI culture that is accountable and transparent.

5.17. Optimize effectiveness of DEI training for new and continuing LCCC constituents. In addition, demonstrate LCCC’s ongoing commitment to improving culture and climate by having a dedicated employee to facilitate these activities.

5.18.  Improve bi-directional LCCC & NCCH communications to foster a more collaborative, inclusive, and transparent environment for all.

5.19. Develop and implement standardized robust DEI training strategies and certification programs for search committees, recruitment and hiring for faculty and staff.

5.20. Create a culture that does not tolerate aggressions among employees or patients.

5.21. Require onboarding and ongoing training and education through a variety of channels, targeting various LCCC constituents, to cultivate, emphasize and reinforce a culture of diversity, equity and inclusion.

5.22. Require evaluation of DEI efforts and activities as part of the annual review process for all LCCC Staff and Faculty.

 

Our Process

Using the framework outline below, our six subcommittees met to establish recommendations for how to incorporate diversity, equity and inclusion principles into UNC Lineberger. On average, subcommittees met twice-weekly to have difficult but necessary conversations to help move our cancer center forward.

Identify the problem

Where are the gaps? 

  • Utilize Listening Session data
  • Conduct a SWOT analysis

Who are the players involved? 

  • Conduct a stakeholder analysis

Develop Measures

Can we measure the problem?

  • Consider practical measures before developing solutions
  • Identify steps required to address the problem and measure every part of it
  • If you can’t measure it, you can’t fix it!

Propose Solutions

Develop actionable solutions

  • Short and long term

How will the proposed solution make a difference?

Identify the policies that need to be created or changed

Develop an Action Plan

Prioritize the proposed solutions

Create a realistic timeline for each

Assign responsibility for each proposed solution

Year In Review: 2020-2021

Beginning with the murder of George Floyd in May 2020, followed by the Black Lives Matter Movement that summer, the UNC Lineberger Equity Council organized to hold trainings and host town hall-style discussions around race and equity.

The first full Equity Council meeting was held in November 2020, followed by 12 listening sessions with faculty and staff of UNC Lineberger and the N.C. Cancer Hospital during February and March 2021.

The Phase 1 Subcommittee drafted the Actionable Solutions list in April 2021, which was approved by the Executive Core in June 2021.

Next Steps

Summer 2021

  • Unveiling: Share LEC Recommendations with LCCC constituents, NCCH, and community & patient advocates​
  • Planning: Use the Recommendations to develop a committee structure & process for implementation and accountability.​
  • Recruitment: Call for nominations to serve on Phase 2 in late August.

Phase 2

  • October Kick-Off: Convene LEC to launch Phase 2. New LEC members will attend REI’s 2-day Phase I training​.
  • November 2021 – June 2022: Convene monthly full Equity Council meetings. Implementation committees will likely meet 2x / month. Some committees will be ongoing; others may be task- and time-limited​.
  • Ongoing: Center-wide listening sessions, education & training.​