EVCP Expresso – March 2020

Dear Colleagues,

COVID-19” is now a part of our daily vocabulary, and I assume you are availing yourself of the regular updates provided at the UCSF coronavirus website. There’s good reason to expect that things may get worse over the coming weeks, so please take seriously the recommendations for preventing the spread of COVID-19. It’s also troubling to hear that, rather than coming together and supporting one another through the uncertainty of the novel coronavirus, certain populations are experiencing discrimination and stigmatization. Under no circumstances is this acceptable.

In the spirit of coming together and being supportive, I am thankful for the community-building events at UCSF like these two:

  • International Women’s Day (IWD) is Sunday, March 8, and UCSF will be celebrating IWD today through this Friday, March 6. Presented by the Office of Diversity and Outreach, Committee on the Status of Women, and the Women of UCSF Health, this week of events and activities is open to everyone, regardless of gender, and includes inspirational talks with UCSF women leaders as well as guest speaker Dilruba Malik (registration), who will share her remarkable story of emerging from poverty in Bangladesh to becoming a leader in Silicon Valley.
  • The 12th Annual LGBTQIA+ Health Forum, the oldest and largest student-run LGBTQIA+ health forum in the country, takes place on Saturday, March 7. With the theme of “2020 Vision: Resistance and Resilience,” this year’s event features Alicia Garza, founder of the Black Futures Lab and co-founder of the Black Lives Matter global network.

And, I continue this theme in this month’s issue. It deals with how we navigate UCSF together, respect and support one another, and make a positive impact on the people of San Francisco:

How do you show respect? Do you feel respected? Please let me know. All comments respectfully considered at [email protected].



Demonstrating Respect: It’s more than just letters

I’ll start with a brief glimpse into writing Expresso. I keep to a fairly informal style, because I’m communicating to you, my colleagues, so I tend not to use formalities, e.g., credentials and honorifics, and typically refer to everyone by first name.

After being quoted in a recent Expresso, one colleague questioned that practice. She called my attention to the experience in particular of women and underrepresented minorities, who frequently don’t get the respect they deserve. Issues of unconscious bias often lead people to assume that someone with a doctoral degree must look a certain way – like in a New Yorker cartoon – rather than recognizing that someone of any gender, race, age, or sexual orientation can possess an impressive intellect and an advanced degree. I’m maintaining my approach for now, but I’d like to hear from you how you navigate this issue.

Denise Davis, faculty in the Department of Medicine, tells a powerful story to first-year medical students. “My favorite aunt, Fanny, went to see a new primary care doctor in her hometown,” Denise says. “He walked into the exam room, greeting her with, ‘Hi, Fanny.’ That was her first and last visit. She is Dr. Fanny Figmont. And she identifies as an African-American woman who was raised in bitter segregation in Texas. To be addressed by a young white man by her first name was offensive.” I’m with Dr. Figmont. Regardless of race or gender, she earned that degree, and thereby deserved the respect it provided rather than an assumed familiarity. And, Dr. Figmont’s experience can cut both ways. Often a young resident may walk into a hospital room and endure comments like “Doogie Howser” or “My grandchild is older than you,” creating an awkward situation.

LaMisha Hill, the director of UCSF’s Multicultural Resource Center, says UCSF worked to address that problem for our clinicians by giving them I.D. badges that distinguish their professional titles and roles. She is always gratified when people introduce her in meetings as “Dr. Hill,” and she does the same for other colleagues, noting that women and people of color often “navigate the world with visible identities where the default assumption is, you’re not in a position of power, so appropriate respect is withheld. That assumption speaks to unconscious bias. Specifically, who we assume to be intelligent, in charge, and worthy of opportunity.”

As we work on overcoming unconscious bias, I’ve witnessed many people make a proactive effort to give honor to other people. Failure to give that honor, that respect, can contribute to an even bigger problem: women receive less recognition through honors, awards, and speaking engagements than men, a point highlighted by Elizabeth Ozer, professor of Pediatrics, director of the UCSF Faculty Equity Program, and chair of the UC Systemwide Committee on the Status of Women.

“There are data that women are less likely to be nominated for awards, to be invited to high-profile speaking engagements, to serve on prestigious committees with access to resources,” Elizabeth says. “It’s important that these things get linked. It may not specifically be about the name or the title, but it’s about women being recognized for who they are and what they contribute.”  And I agree that we need to institutionalize some of these changes to combat unconscious bias. By making sure that committees include women and people of color – instead of just filling slots with the people who come to mind first – we can start achieving a better measure of equity.

Brian Alldredge, vice provost of Academic Affairs, emphasized that he’s come to understand that many, if not most, women can feel slighted and undervalued in meetings and public settings. They’ve seen women provide suggestions that don’t get traction until a man repeats them. They’ve seen men use their professional title, but not use titles when introducing women colleagues.

“After it was mentioned to me,” Brian admitted, “I even noticed myself about to do the same, and probably that I had done it without noticing on some occasions, and I didn’t understand why.” Being aware has helped him be more conscious about interpersonal dynamics and the use of language and titles. And that’s the key, we need to ingrain these practices so we don’t default to old, hurtful mechanisms.

According to Elizabeth, “Most of us are not intentionally doing these things, but we constantly need to refer to that respect checklist.” Because, as Denise adds, “When the cognitive load is high and multiple patients are waiting, and the student, or resident, or faculty member is stressed, unless it’s truly a habit – to address people with respect and ask them how they want to be addressed – it can fall off the radar.”

So, I suggest a few reminders for when to use people’s titles: Don’t assume. Show respect. Ask people how they would like to be addressed. When in doubt, use the title, and let the person invite you to address them more informally if that’s what they prefer.

It’s complicated, because in some group settings using first names for everyone, staff and faculty alike, creates a more egalitarian environment and recognizes that we all contribute to UCSF’s mission and community. As we strive to become a truly inclusive UCSF, I think that it’s most important to remember to question our unconscious biases.

As for Expresso, I honestly don’t know. In my heart of hearts, when Expresso is sent, it’s like you’ve asked me, “Hey Dan, what’s up, how’s everything going?” So for now I think I’ll maintain the informal feel, but I hope you understand this is from a place of enormous respect.

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Setting Anchor: Joining the anchor institution movement

Last July, I told you about UCSF’s intention to join the anchor institution movement, which recognizes that universities and medical centers are anchors within their communities as opposed to corporate headquarters, which can be transient. This movement enables organizations like UCSF to take on a greater role in contributing to the well-being of a great place like San Francisco.

Yes, we already engage with our community, but we can make a greater impact if we consciously participate in three pillars: buying products from local companies, hiring local people, and investing in our local community. I’m pleased to report that the effort at UCSF is well underway, and we’re taking steps toward all three. UCSF is doing this work because we know for a fact that addressing the social determinants of health, such as economic stability, improves health.

I’m particularly keen on the perspective of Jim Hine, our chief procurement officer and associate vice chancellor with oversight of Supply Chain Management, and Andrew Clark, executive director of strategic procurement. Rather than viewing the anchor institution as a mandate, they see it as a tremendous opportunity for their team to engage in the core mission of UCSF – to advance health. That is, if they can help steer more of UCSF’s purchasing dollars toward small and minority-owned businesses in San Francisco, then we increase our ability to have an impact on the overall health of city residents – many who have traditionally been underserved by the health care system.

“Now I get to work on improving health outcomes too,” Andrew says. Buying from local, diverse companies “is totally the right thing to do, especially if it helps them employ folks who are from the area. That will spur job creation, which will improve people’s health and well-being.” Jim and Andrew are compiling lists of local vendors who meet those criteria. While especially large products and projects are subject to state and UC Regents regulations that impose certain purchasing parameters, Jim and Andrew aim to spread the word to our myriad departments that these local businesses can be a resource for catering, office supplies, and other needs – and will keep the money close to home, where it can boost parts of the local economy that have been otherwise left behind.

Similarly, Jeff Chiu, vice president of human resources for UCSF Health, says he’s found a way to use the anchor institution initiative to expand EXCEL, our workforce development program. (I recommend this 2013 story on EXCEL to understand how it has been helping improve people’s lives for years.) Jeff co-chairs the anchor institution subcommittee that’s focused on increasing UCSF’s ability to train, hire, and promote under-resourced populations, toward strengthening our workplace climate – especially around issues of discrimination – building equity and inclusion, collaborating with our community partners, and leveraging our educational pipeline to help fill UCSF positions.

The great thing is that the anchor institution movement calls for work that was already underway. The initiative bolsters HR’s ongoing efforts to make our workplace more diverse, equitable, and inclusive. Jeff would like it to result in additional resources to strengthen and expand EXCEL. “We’ve had 256 participants since 2010,” he says, “and 110 of those are still actively employed at UCSF.” That’s 110 success stories, but considering that UCSF employs more than 27,000 people, there’s a lot more we can do.

The third pillar, investment, may be the most challenging. While UCSF is a $7 billion nonprofit enterprise, that doesn’t mean we have a lot of money to invest in the stock market – or local businesses. Rather, the University of California Office of the President (UCOP) has policies and procedures in place that pool money from throughout the UC system to maximize investment return. Basically, UCSF revenue is sent to UCOP for investment, and then it flows back to us when needed.

UCSF Controller Shannon Turner explains, “This community investment pillar is interesting in that we will see how we can accomplish this within UC policy while also being creative and innovative. We’re considering conducting a pilot project to explore what’s possible outside the norm.”

This intriguing experiment (because that’s what we do at UCSF!) could involve keeping some of that money and choosing strategic local investment opportunities. Shannon describes the big picture like this: “UCSF could take some small amount and direct it to underserved businesses in our community, providing some working capital loans that would otherwise be inaccessible to these underserved populations.”

If the pilot investment project and our other two anchor efforts, i.e., procurement and employment, demonstrate results, then UCSF’s approach could be a model for other UC campuses or the system as a whole. Joining with other health care systems around the country, we have the opportunity to throw the first pebbles into each of these pools and create a resounding ripple effect. Is your interest piqued? Subscribe to get updates about the Anchor Institution Initiative.

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Managers as Advocates: Create a sense of belonging

If you’re a member of the UCSF faculty, what does staff engagement have to do with you? Staff employees are integral to how we as educators, researchers, and clinicians get our work done.

While we advise learners and trainees, serve on qualifying and dissertation committees, and observe and guide in the clinical setting, how do we mentor and advise our staff in similar ways?

Do you thank your lucky stars that you have a fantastic staff member on your team who gets things done and makes your life a lot better? Do you also recognize potential in that person and want to foster their professional growth…but haven’t necessarily followed through with that commitment?

Managing other people is a responsibility not to be taken lightly. UCSF offers many opportunities for training and advancement, and many staff members want to take advantage of those opportunities. When all staff have the chance to grow and progress, they find greater personal and professional fulfillment, and the organization benefits. Not only that, faculty managers who advocate for their employees and encourage professional development will attract more talented people to their teams. We know that employees thrive when their manager is their advocate.

But our Gallup survey results show there’s more work to be done helping UCSF managers become more consistent advocates for all staff and take an inclusive approach. We’ve learned that African-American/Black people, Hispanic/Latinx people, and people with disabilities do not have the same sense of belonging as their colleagues who are white, Asian, and without disabilities. “UCSF leadership wants to change that reality,” says Terri O’Brien, associate chancellor. “Everyone needs to feel that they have opportunities to learn and grow.”

To do just that, we’ve got a major initiative under way, using the A3 methodology developed at Toyota for solving problems that get in the way of helping people learn. A3 is part of Toyota’s famed “Lean” methodology, one of the processes the company used to become more efficient and achieve continuous improvement. “Lean thinking focuses on really understanding the problem before implementing a solution,” says Nancy Duranteau, director of Learning and Organization Development. “People often think they understand a problem without getting to the root cause.”

With this methodology, a problem and its root causes are identified in detail, counter-measures are proposed, and an action plan is developed and implemented. It sounds simple, but to do it right, it takes a huge effort and requires buy-in from a lot of people. UCSF is aspiring to adopt this continuous improvement mechanism regarding staff engagement. We’ve been working hard on digging into the disparity for different groups, and we’re now starting to develop the solutions to help everyone feel more engaged. You’ll be hearing a lot more about this as the year unfolds.

While the Learning and Organization Development unit is focused on creating opportunities for staff, it is also committed to supporting the faculty who manage those staff. “People with high engagement typically have a manager (faculty or otherwise) who supports their career and their development,” Nancy says. “People need help navigating UCSF. It’s a complex organization. Staff often need a roadmap and guidance from more seasoned sources.”

Demonstrate to your staff that you’re their advocate. Have conversations with them about their professional development goals. Create an environment that fosters belonging. Shine a light on the benefits of professional development.

Consider the people who are silently hoping that you, as their manager, are actively thinking how they can grow and develop and find even more fulfillment in their work. Have the conversation.

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Dan’s Tip of the Month

 We have to wash our hands. The upside is that it’s a proven way to prevent the spread of infectious disease, but the downside is that Americans send over six million tons of paper towels to landfills every year. Paper towels are single-use products often made from virgin materials. Once used, they’re not recyclable. They can be composted (as they are here at UCSF), but generally speaking, they’re rarely collected and sorted for composting. So, what if there was a way we could each contribute to reducing paper towel use? Well, there actually is! Spend four minutes watching Joe Smith’s 2012 TED talk and your hand drying and paper towel usage habits may well change forever. It’s a simple act of selflessness – for the trees and our planet!

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