How to Build Equity Accountability Systems in Healthcare Research

Published: 20 Jun 2025

Reading Time: 3 minutes

Diversity, Equity, and Inclusion (DEI) are now central themes across healthcare institutions, research centers, and biopharma companies. Mission statements have evolved. Equity officers have been hired. But as many leaders are discovering, intention without infrastructure leads to inertia.

Equity in research cannot be sustained by statements. It requires systems—clear accountability structures that measure progress, enforce commitments, and align incentives.

As Dr. Marcella Nunez-Smith, former chair of the White House COVID-19 Health Equity Task Force, has said: “You can’t fix what you don’t measure. We need durable systems that make equity actionable and accountable.”¹

Progress in representation, recruitment, and inclusive research design doesn’t happen because of advocacy alone—it happens when institutions build mechanisms that make equity the default, not the exception.

The Implementation Gap

Most healthcare institutions develop multi-year strategic plIn 2022, the Association of American Medical Colleges (AAMC) surveyed over 150 academic medical institutions and found that 94% had public DEI commitments, but fewer than 32% had accountability metrics attached to leadership performance evaluations.²

This implementation gap results in:

Equity efforts being siloed in HR or communications
Token advisory groups with limited influence
Misalignment between stated values and operational decisions

As Harvard professors Frank Dobbin and Alexandra Kalev concluded in their longitudinal study: “Bias training and diversity task forces don’t work unless they’re tied to structures that shift power and policy.”³

What Real Accountability Looks Like

True accountability systems embed equity into decision-making, budgeting, hiring, procurement, and partnerships. They are transparent, enforceable, and driven by both quantitative and qualitative metrics.

Key elements include:

1. Equity Scorecards

These dashboards measure representation, engagement, and outcomes across race, gender, language, and disability status—not only in staffing, but in research design and trial participation.

2. Tied Incentives

Executives and researchers should have DEI goals factored into performance reviews and funding eligibility. The NIH’s UNITE initiative has piloted this model by integrating diversity criteria into grant scoring.⁴

3. Shared Governance

Instead of top-down mandates, equity leadership is distributed. Community advisory boards, ERGs, and frontline staff have defined roles in research governance and policy setting.

4. Transparency and Public Reporting

Organizations like Genentech and BMS now publish annual DEI and health equity reports with recruitment data, supplier diversity metrics, and pipeline demographics.⁵ This practice signals accountability to both internal and external stakeholders.

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A RCase Example: University of Pittsburgh School of Medicine

In 2021, Pitt Med created an Office of Equity, Diversity, and Inclusion that not only advised leadership, but was granted budget authority and oversight over faculty hiring committees.

As part of this initiative:

DEI liaisons were trained and embedded in each department
Search committees were required to use equity rubrics
Annual reporting to the board included recruitment, climate survey results, and promotion data disaggregated by identity

This structure moved DEI from symbolic to structural—redefining how leadership was evaluated and how resources were allocated.⁶

Elevate Impact’s Framework

Based on our work with hospital systems, academic institutions, and government-funded collaboratives, Elevate Impact has developed a four-part accountability framework:

Pillar	Description
Leadership Modeling	Executives and research leaders must consistently champion and embody equity values—not delegate them
Operational Integration	Embed equity checkpoints in budget reviews, trial protocols, policy changes, and partnership agreements
Feedback Loops	Develop anonymous and real-time mechanisms for staff, patients, and partners to share equity concerns and ideas
Data + Narrative	Use both quantitative metrics and qualitative insights to drive iterative improvements and culture change

This approach ensures equity efforts are both visible and verifiable.

Statements about diversity and equity are no longer enough. In the era of heightened scrutiny and community accountability, organizations must move from what we say to how we are structured.

As the late Dr. Paul Farmer reminded us: “The idea that some lives matter less is the root of all that is wrong with the world.”⁷

To change this in healthcare, we must operationalize equity—not just idealize it. Because the real measure of progress is not what we pledge—it’s what we build, and who we empower in the process.

References:

Nunez-Smith, M. (2021). Remarks at the White House COVID-19 Health Equity Task Force Press Briefing.
Association of American Medical Colleges. (2022). Diversity, Equity, and Inclusion Benchmarking Report.
Dobbin, F., & Kalev, A. (2016). “Why Diversity Programs Fail.” Harvard Business Review. https://hbr.org
National Institutes of Health (NIH). (2023). UNITE Initiative Progress Update. https://www.nih.gov
Genentech. (2023). Diversity & Inclusion Annual Report. https://www.gene.com
University of Pittsburgh School of Medicine. (2022). Office of EDI Annual Summary Report.
Farmer, P. (2013). To Repair the World: Paul Farmer Speaks to the Next Generation. University of California Press.

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