The ongoing development of the ACS Diversity, Equity, and Inclusion (DEI) Toolkit supports the College’s commitment to uphold the highest standards of inclusion and equity and—when completed—will feature 40+ chapters written by 87 surgeons from 25 aligned committees, workgroups, and stakeholder organizations (see table).
“ACS Executive Director and CEO Patricia L. Turner, MD, MBA, FACS, emphasized that all of these aligned organizations be included in this project,” said Bonnie Simpson Mason, MD, Medical Director of the ACS Office of DEI. “We understand that because of the challenging nature of the content for those who are working in the DEI space, it is important to align messaging and leverage the collective experiences in presenting best practices, such that through shared work, peer mentoring, and collaboration, the House of Surgery could benefit.”
Formally titled the ACS DEI Resource and Implementation Toolkit, this resource is offered in a digital, interactive format with chapters covering key DEI-related topics, including the role of surgical societies in promoting inclusivity, diversifying committee membership, strategies for implementation, and a Lexicon of language and terms that are relevant to DEI topics in the surgical sphere.1
The ACS DEI Toolkit, beta launched in June 2023, features a case-based approach with real-world scenarios that are intended to clarify nuanced aspects of DEI work, with content that is applicable to the individual provider, private practice surgeon, institution, or healthcare system.
The ACS Office of DEI—led by Dr. Mason and Administrative Director Cie Armstead, DBA—partnered with the ACS Board of Governors Diversity Pillar to develop this expanded version of the Toolkit. It will be available to all ACS members, and exploration is underway to offer continuing medical education credits in 2024 to physicians who use Toolkit elements.
“The Toolkit is intended to be a comprehensive resource for our learners, including students and residents in surgery, and for Fellows of the College, particularly for leaders in surgery, such as vice-chairs of DEI and other faculty or community surgeons that are primarily responsible for making the decisions to move any equity strategy forward,” explained Dr. Mason.
According to Susan Pories, MD, FACS, and Valentine Nfonsam, MD, FACS, two of the lead editors of the Toolkit, and the authors of its introduction, this resource is intended to “serve as a collection of authoritative and adaptable resources for surgeons to not only learn about DEI, but also to identify practical approaches for addressing issues that arise locally, regionally, and nationally.”1
The Toolkit and Lexicon were also developed for use by ACS staff members. “These resources were designed as part of a larger strategy to enhance ACS culture through the work of the ACS DEI Racial Equality, Diversity, and Inclusion program,” said Armstead. “These tools will be used in multiple ways to support all staff in exemplifying ACS values in the workplace.”
A primary aim of this content is to help align staff commitment to the principles of DEI with that of the College’s membership, ultimately fulfilling the ACS’s mission “To Heal All with Skill and Trust.”
The core content of each chapter is organized into four sections: Why (describing the rationale for including a topic); What (outlining research and perspectives); How (identifying strategies and tools for improvement); and Next Steps (determining future action items toward implementation). Most chapters also feature a list of references or a bibliography of cited sources.
Lexicon
The ACS Office of DEI started the process of developing the Lexicon by first reviewing associated terminology and usage in healthcare, specifically in surgical settings, but also within association management and other relevant domains.2
“We, along with the numerous surgeon volunteers, took an extended amount of time collecting, developing, and reviewing the Lexicon,” Dr. Mason said. “We see the Lexicon as the first step to building a knowledge base and a DEI skillset that will help create safe and equitable clinical, surgical, and learning environments for our surgeons and staff.”
The Lexicon is available to everyone, including surgeon members, staff, and members of the general public, and is intended to help individuals communicate in a manner that recognizes and respects diversity in all of its forms.
“If you think about any given profession, there’s a lexicon of terms that are commonly used that serve as connectors for anyone who’s engaging in that space,” said Armstead. “And when you consider the work of DEI, it’s even more important to have an agreed upon terminology and an understanding of what those words mean.”
The Lexicon’s composition is intended to facilitate efficient use of its content. Related terms are grouped together; for example, the term “bias” includes references to “implicit bias” and “unconscious bias.” According to the Lexicon’s introduction, this resource is “not designed as an exhaustive encyclopedia of all DEI-related terms. Only terms that are the most germane to DEI in the College and the House of Surgery are included.”2
Historical, social, or cultural context for select terms is provided to offer insights that extend beyond the standard definition and to enhance appropriate use of words or phrases.
Both Dr. Mason and Armstead described the Lexicon as a dynamic resource that will be updated as needed, and they encourage participants to avoid using it as a definitive guide for determining correct (or incorrect) wording.
“It is critically important, for those of us in the DEI space, both on the staff side and member side, to have an understanding of how the College is using certain terms and phrases,” explained Armstead. “Because, quite honestly, in society right now, there’s a lot of misinformation and conflicting interpretation regarding DEI terminology. Hopefully, the Lexicon provides a level of clarification that provides a common ground for us to move this work forward.”
The College’s Role in Supporting DEI
The ACS has a long-established commitment to the principles of DEI, particularly in the past couple of decades. In 2001, the ACS Board of Regents published its first Statement on Diversity, which was updated in 2018.3
On June 9, 2020, the ACS Committee on Ethics and the Board of Regents issued a call to action describing racism as a “public health crisis resulting in healthcare inequities” and requesting that “all members of the organization to treat all patients, regardless of race, ethnicity, religion, or sexual preference with compassion, skill, and fidelity.”4
Later that same year, the ACS Board of Regents appointed a Task Force on Racial Issues, which issued its recommendations in November 2020—including the formation of the Office of Diversity, Equity, and Inclusion, which was launched in August 2021.
In June 2021, the idea to develop what would eventually become the ACS DEI Resource and Implementation Toolkit was conceived as a result of the Promoting DEI and Antiracism: Professional Surgical Society Retreat. Members from 54 organizations, 13 ACS Advisory Council Chairs, and 17 surgical board leaders, Regents, Officers, and ACS executive leadership participated in the virtual meeting.5
Today, the College’s role in supporting DEI initiatives continues with the ongoing development of the ACS Toolkit, and with the establishment of the innovative grant program, which awarded $325,000 in grants in December 2021, and $50,000 in sustainability grants in 2023. Additionally, the new ACS Equity in Quality Initiative will work in tandem with the ACS Office of DEI and the Division of Research and Optimal Patient Care to determine how equity can be integrated into the ACS Quality Programs.
“We are building all of our DEI-related efforts on a foundation of education and evidence such that our surgeons can more confidently communicate their efforts in DEI for the benefit of all surgery patients,” Dr. Mason said.
