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In early 2021, Avera — along with other Catholic health systems throughout the country — joined CHA's We Are Called initiative. ¹ As Avera's service region in five states continues to reflect greater cultural and religious diversity, ongoing education and formation around diversity, equity and inclusion (DEI) is essential to faithfully live our identity, demonstrating Christ's healing compassion in the world. Knowing that good intentions are not sufficient to ensure positive outcomes, Avera's boards and employees need up-to-date information to guide decision-making and effective action.

In light of this, Avera's fiscal year 2023 formation curriculum — including board formation — focuses on DEI. As explained by Bob Sutton, Avera's president and CEO, "By becoming more aware and culturally competent through DEI formation, we honor the legacy of our sponsors who extended Christ's healing compassion and served all without distinction."

The curriculum was designed to support and instill a culture of diversity, equity and inclusion as the ministry continues to work toward overcoming "all forms of racism, of intolerance and of the instrumentalization of the human person."²

IMPORTANCE OF BOARD FORMATION
Because culture starts at the top, board formation has occurred since Avera's inception in 2000. Prior to 2015, formation of board members happened at board orientation and during Avera's semiannual leadership conference. In 2015, Avera began integrating quarterly board formation throughout the year both at the regional and system levels. Mission leaders now facilitate 10- to 30-minute formation discussions at the beginning of their respective board meetings every three months to help set the context for deliberations. The quarterly cadence allows for real-time discussions about current issues impacting the ministry and the communities where board members live and work.

A curriculum committee of mission leaders develops the formation materials and questions used in these discussions from a variety of sources, including CHA's Health Progress articles and its Framework for Ministry Formation,³ Vatican documents, USCCB content and other relevant sources. Formation materials are distributed to board members so they have an opportunity to engage with the content prior to a meeting. Questions are structured in a way that allows board members to meaningfully participate in formation discussions even if they have not had a chance to read the materials in advance of the gathering.

This year's DEI-related board formation curriculum has stimulated thought-provoking and fruitful discussion among Avera board members, both personally and professionally. Board members are invited to share from their own experiences, including where they'd like to see more growth, as well as thinking from an organization, business or community perspective. Topics explored include DEI terminology; culture, power and privilege; bias; equity, equality and justice; and the ways Catholic health care is called to respond. These issues are complex, yet feedback from board members has been very positive. Avera Sacred Heart Hospital Board Chair Brian Steward said the DEI formation carries "great weight as it has a direct impact on the health of our patients and the welfare of our employees."

FORMATION OF PHYSICIANS, LEADERS AND FRONTLINE EMPLOYEES
In addition to board formation, Avera's clinical and administrative leaders, as well as frontline employees, participate in ongoing formation. Quarterly clinical service line meetings operate much like board meetings, so formation is similar in that mission leaders facilitate discussions of the curriculum, which is more clinically focused than that of board formation. All other Avera leaders participate yearly in an eight-month formation series through the Mission Leadership Development program and resource guide. These peer-facilitated sessions are offered both in-person and virtually to accommodate leaders' schedules and work locations. After the monthly sessions, leaders then cascade the learnings to their teams through the program's takeaways designed for staff huddles, department meetings and as opening reflections for meetings.

SETTING THE STANDARD FOR DEI FORMATION
During a recent Joint Commission survey at Avera St. Luke's Hospital in Aberdeen, South Dakota, the board chair and executive team spoke about this formation curriculum in response to surveyors' questions regarding DEI education and health equity initiatives. The surveyors asked for a copy of the curriculum to share with their colleagues and other health systems as a practice supporting the Centers for Medicare & Medicaid Services' new health equity strategic pillar⁴ and The Joint Commission's health equity standards. Similarly, the DEI formation curriculum has been provided to granting and regulatory agencies, which now require evidence of health systems' commitment to DEI.

At the conclusion of fiscal year 2023, Avera's board members and employees will be surveyed about the impact of DEI formation on their personal and professional experiences. In the meantime, unsolicited feedback about the curriculum has been positive. Many shared that although the conversations were sometimes uncomfortable, the curriculum has increased their awareness around diversity and inclusion and provided practical tools for becoming more culturally competent. For example, one clinician shared that they began to recognize their own biases, resulting in a change of practice to better meet the unique social and cultural needs of their patients.

UNCONDITIONAL ACCEPTANCE AND LOVE
During his life Jesus taught, befriended and ministered to persons from every sector of society, then commissioned us to, "Go and do likewise." Catholic health care is a response to that challenge. Providing Avera's board members and employees with relevant and timely DEI formation helps to ensure that our positive intentions will yield positive outcomes and expresses our love for God — the author of diversity — and each other.

For more information and/or to obtain supporting materials on Avera's DEI formation curriculum, please contact Faith Minnich Kjesbo at [email protected].

FAITH MINNICH KJESBO is manager of formation and cultural competence for Avera in Sioux Falls, South Dakota. MARY L. HILL, BSN, MA, JD, and KARA PAYER, MBA, MS, are contributors to this article. Mary L. Hill is chief mission officer for Avera in Sioux Falls, South Dakota. Kara Payer is vice president of mission for Avera Sacred Heart Hospital in Yankton, South Dakota.

NOTES

1. "We Are Called," Catholic Health Association, https://www.chausa.org/we-are-called.
2. Pope Francis' tweet: "We must overcome all forms of racism, of intolerance and of the instrumentalization of the human person" (@Pontifex, July 18, 2017).
3. Framework for Ministry Formation (St. Louis: Catholic Health Association, 2020), https://www.chausa.org/store/products/product?id=4363.
4. "Pillar: Health Equity," Centers for Medicare & Medicaid Services, https://www.cms.gov/files/document/health-equity-fact-sheet.pdf.