Cleveland, Ohio’s Cuyahoga County became significantly more diverse in the decade preceding the 2020 US Census. The multiracial population nearly tripled, the Hispanic population more than tripled, and Asian residents increased by a third.
This bears significant importance in the administration of public health, a fact not lost on Margarita Diaz—who spent the majority of the decade preceding that census working for the MetroHealth System in Cleveland. Now the director of inclusion, diversity, and health equity, she has spent nearly twenty years working with the sprawling safety-net healthcare provider, which employs eight thousand people in four hospitals and across forty “touch points” in the communities they serve.
Hers is an important and powerful position, and it’s hard to imagine anyone better suited for it. Not only did she spend most of her two decades with MetroHealth in direct caregiving, but she also is the daughter of immigrants, raised in a community heavily populated by Puerto Ricans like her own family.
“I like to say I grew up at MetroHealth, where I volunteered my summers as a high school student ‘candy striper,’” says Diaz. She was then hired as an administrative assistant and moved up to medical assistant, spending nearly a decade with MetroHealth.
After earning her first nursing degree she spent a few years working for other providers, but returned to MetroHealth a decade ago as a clinical coordinator and nurse manager for ambulatory surgical services. Diaz holds both nursing bachelor’s and master’s of science degrees, in addition to certifications and specialty training in multiple subjects. While she now works in management, she continues to wear her nurse credentials badge.
“Being here at MetroHealth feels like home,” she says. “Plus, my core values align with our mission and values. I love serving the MetroHealth community.”
The hospital has a 184-year history and is now building the Glick Center, a billion-dollar facility, on its main campus. Within its patient population more than half (54 percent) are from marginalized groups, and two-thirds are either uninsured or on Medicaid or Medicare. The system’s mission includes the promotion of community health and wellbeing with affordable housing, a cleaner environment, economic opportunity, access to fresh food, convenient transportation, and legal help.
The Glick Center is being built in an EcoDistrict—the first in the US to be anchored by a hospital. EcoDistricts take a comprehensive approach to community planning that emphasizes health equity, resilience, and sustainability. Diaz values the fact that landscaping around the new facility is intentionally designed for optimal patient outcomes, a best practice in modern hospital design.
MetroHealth’s DEI (diversity, equity, and inclusion) programming intentionally mirrors national best practices. “Health systems have to reflect the communities that they serve,” says Diaz, elaborating that the organization adheres to National CLAS Standards: a framework of fifteen action steps that are culturally and linguistically appropriate and respectful of the beliefs, preferences, and communications needs of patient populations. Some of these standards are federally mandated for hospitals receiving federal funds (including Medicaid and Medicare), while others are voluntary or required by individual states.
But Diaz’s work goes far beyond simply meeting requirements. She’s extremely engaged in her job, occupying leadership positions with a number of initiatives and organizations that address equity concerns in very specific ways. She also speaks of certain events of 2020—the COVID-19 pandemic and the Black Lives Matter movement response to the murder of George Floyd in Minneapolis—as pivotal events with broad implications.
“In the wake of Mr. George Floyd, we as a system established nine equity goals to include racial equity,” says Diaz. “In those goals is a commitment to increase the diversity of staff and clinical providers.”
To ensure that those goals are more than pipe dreams, her department is developing hiring and retention tools that address this particular challenge. “While we do have representation from African-American and Hispanic providers, we have to increase and enhance those numbers,” she says. “That includes a hyper-focus on medical colleges and organizations that have large minority representation.”
On the education and retention side, bias awareness courses (“Unconscious Bias: We All Do It” is one example) are mandatory for all system employees. Racial equity training began with the system’s leaders, including senior executives and trustees. This education has cascaded to at least four hundred others in managerial roles. Diaz says that data shows that bias and stereotypes impede care—and that building awareness in this area achieves better outcomes for patients and the hospital overall.
Diaz approaches certain equity issues by leading problem-specific programs. She is cochair of an action team for First Year Cleveland, a comprehensive program that addresses high infant mortality rates among African American families in the county. She’s also the local chapter president of the National Association of Hispanic Nurses, and mentors prospective healthcare workers through this and other organizations.
With eleven employee resource groups, including a Pride Alliance for LGBTQ employees, the DEI function was recently elevated to C-level status—outside the human resources umbrella, with a chief equity officer and health equity medical director.
“That is a huge system shift,” Diaz says. “As a team we will work with all departments and initiatives throughout the system to eliminate disparities and make equity a central organizing principle of everything MetroHealth does.”