Working Towards Equal Health Outcomes
Wellcome, headquartered in London, is one of the world’s largest (non-governmental) funders of medical research, second only to the Gates Foundation. With a workforce of around 800 people, it carries the profound public purpose of improving health for all. In the extraordinary year of 2020, Wellcome’s expertise and medical contributions have never been more important.
In recent years, Wellcome has started the journey of embedding inclusion into research and research culture, both internally and externally. This will ultimately reduce inequalities in treatments and improve global health outcomes in the longer term.
Externally, Wellcome’s Covid-19 response is to apply an international, inclusive and culture-led approach to tackling the pandemic, as well as a technical one. This reflects a significant development in the handling of epidemics, demonstrating that inclusive thinking is now central to its work.
Internally, inclusion metrics have improved over time within Wellcome. Inclusion is high on the agenda at all board meetings and actively encouraged in the performance reviews of all colleagues at Wellcome as of 2020/21.
Sir Jeremy Farrar has been the Director of Wellcome since 2015. Upon assuming the role, he quickly identified D&I as critical areas for improvement both in Wellcome, and the broader field of medical research. This would, he told us recently, “allow ideas to thrive”. Ideas, a er all, are the lifeblood of science.
If ideas thrive, health outcomes will ultimately improve and become more equal. In the wider medical world, this includes tackling inequalities that, for example, see women suffer disproportionate morbidity rates in cardiology. Or that has tragically seen marginalised ethnic minority groups suffer more from the impact of Covid-19, both in the UK and globally. For Sir Jeremy and Wellcome, inclusion is therefore an imperative.
Included and Wellcome partnered in 2016. We embarked on a series of interventions to help Wellcome paint a current-state picture of their D&I practice, and ultimately to embed inclusive thinking more tightly within the organisation. In 2016 we supported the co-creation of a five year D&I strategic plan. This was formed under the leadership of Wellcome’s Head of Diversity and Inclusion Lauren Couch and Kalaiyashni Puvanendran and was eventually approved with an overall investment of £12.5m. The fact that it was positioned alongside Vaccines and Drug Resistant Infections, as one of only a few key focus areas, revealed the importance Wellcome attributes to D&I.
We first undertook an Inclusion Diagnostic (ID) in 2017 to gather insights and to quantitatively determine the behaviours that were contributing to, or detracting from, greater inclusivity. This helped us identify key areas of need on psychological safety, flexible work for disabled staff and macro aggressions experienced by Black and minority ethnic staff. Senior leaders at Wellcome were largely male, largely white, and experts in their medical fields. On D&I, they increasingly ‘got it’ intellectually, rationally and commercially. However, often through no fault of their own, they had little or no lived experience (or even understanding) of what life might be like inside or outside of the organisation as, for instance, a Black and minority ethnic professional.
We facilitated an away day for the Executive Leadership Team (ELT) in 2017. We helped the ELT to position inclusion as a lens through which they could analyse the entirety of their work. We also conducted a multi-month Inclusive Leadership Programme (ILP) in 2018 for Sir Jeremy and the team. The aim was to support their understanding of the lived experiences of minority groups. Through our work together, we were able to build on the base already created and to create advanced levels of understanding, empathy and leadership. After inclusion measurement work and the ILP, and with the team having identified improvement areas for Black colleagues in particular, we helped Wellcome design a Reverse Mentoring Programme with Black and minority ethnic colleagues. This had initially been inspired by a 2017 meeting of the Equality, Diversity and Inclusion in Science Group (EDIS), co-led by Wellcome. The Reverse Mentoring Programme encouraged and supported the workplace journey in normalising conversations about race and ethnicity at senior levels.
We co-developed and ran the ID again in 2018, and results from the second ID revealed measurable progress. Scores for macroaggressions – overt and explicit derogatory comments and behaviours directed towards those with certain characteristics – saw a 20% improvement for Black and minority ethnic staff. In the first year disabled staff gave inclusion scores 26% lower than non-disabled staff, in part due to the fact that they felt they couldn’t use flexible working arrangements. Changing the policy as a targeted intervention meant that by the time of the second ID in 2018 there was no significant difference on flexible working between disabled and non-disabled employees.
Also, in the first year, there was a statistically significant difference showing team members scored 12% lower on psychological safety compared to Executive or Leadership members. By the second year, there was no statistically significant difference – likely thanks to the wider D&I programming in the organisation including inclusive leadership interventions and mentoring programmes. Internally, Wellcome is working towards ensuring that inclusion is an assessment factor on each colleague’s performance review. D&I are truly embedded and are discussed, Sir Jeremy says, at every board and executive leadership team meeting.
Externally, a critical measure of the wider inclusion work done within Wellcome can be seen in its response to Covid-19. Sir Jeremy has become a familiar figure in the UK during the pandemic, as a key member of the Scientific Advisory Group for Emergencies (SAGE). He told us that a lot of the Covid-19 work undertaken by Wellcome in 2020 has not been focused on the UK. They have taken a wider-lens approach, recognising early that some of the greatest negative impacts would be on lower middle income countries, for example in Central and South America.
Sir Jeremy also told us how the difference in approach between SARS in the early 21st century and Covid-19 now is incomparable. SARS was seen as a technical issue that needed a technical, medical fix. But Ebola and SARS2 are more complex. There are technical solutions to Ebola, and SARS2, but unless they’re part of a broader approach – trust, communication, culture, and inclusion – we won’t be able to address them adequately. In this way, inclusive thinking has taken its place at the heart of Wellcome’s Covid-19 work.
Other recent examples show Wellcome’s investment in inclusion and improvements in representation and participation. One of these is the Research Enrichment Fund, which enables Wellcome grant holders to identify and tackle barriers to D&I in their work. Another is the 2017 launch of the Equality, Diversity and Inclusion in Science Group (EDIS), in conjunction with the Francis Crick Institute and GlaxoSmithKline, which works collaboratively to create equal and be er health outcomes. Of the work that Included and Wellcome did together, Sir Jeremy told us that it was “absolutely integral to moving the team and the whole organisation forward during a time of very exciting but also profound change.”
The work undertaken on D&I has undoubtedly helped prepare Wellcome for 2020. They have built a strong technical foundation of inclusion infrastructure. Next on the agenda is further embedding inclusion into research culture and Wellcome’s strategy. This will give the organisation the strongest chance of fulfilling the medical impact it wishes to create – and which will be so critical to us all as we reflect on changed global realities.
Allow ideas to thrive
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