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Count me in! – Detailed case studies

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Mount Saini Hospital 

Founded in 1923, Mount Sinai Hospital (MSH) is a large patient care, teaching and research hospital affiliated with the University of Toronto. Since 2007, Media Corp Inc. has named MSH one of Greater Toronto’s Top Employers.

MSH’s vision is to deliver and model world-class proactive health care. The hospital also seeks to be a national leader in all of its diversity and human rights programs, and to have a staff team that reflects the diverse patients they serve. In November 2006, MSH approached an external consultant to help them learn more about their staff in terms of characteristics like race, ethnicity, disability, sexual orientation, age, gender, education, languages and place of residence. MSH was the first health care institution in Ontario to do such a broad workforce census.

Why consider collecting data?

Some factors that led MSH to do this census included:

  • A desire to provide equitable access to care that took into account a range of culture and language needs given that MSH belongs to the most socially diverse urban Local Health Integration Network (LHIN) in Toronto[1]
  • Concerns that some groups were underrepresented in upper management jobs
  • A desire to understand the makeup and needs of its workforce, measure the success of its diversity efforts, and apply this understanding in future plans
  • A history of serving members of society who faced discrimination and exclusion
  • A belief, strongly supported by the President and CEO, that this was the right thing to do.

Goals of the workforce census

The key goals of the workforce census were to help MSH:

  • Be a great place to work, teach, research and volunteer, where patients could get the best care and staff could reach their potential in an environment that was inclusive and free of discrimination
  • Understand the make-up of the MSH workforce and compare it to the external population and patient base
  • Understand the needs of the MSH workforce
  • Address the needs of the patient population and broader community by developing the MSH workforce through recruiting new employees and succession planning
  • Deliver and model world-class proactive health care
  • Be a national leader in all of its diversity and human rights programs.

Challenges and planning

MSH had to consider a number of challenges when planning how best to collect the data:

  • The need to get support from many different stakeholders across the organization
  • The strong sensitivity to the information being asked, its use and confidentiality 
  • The desire for anonymity by healthcare workers because of strong concerns about privacy and fear of discrimination, especially based on sexual orientation or psychiatric disability 
  • The logistical issues of surveying 5000 staff, including many who worked shifts and did not regularly use a computer
  • The resource constraints of trying to reach 5,000 staff members and make sure that the highest number complete the survey in the time given.

Preparing for the workforce census

To address the above challenges, MSH took the following steps before launching the workforce census:

For the past seven years, MSH’s Diversity and Human Rights Office (DHR), under the leadership of the Hospital’s Diversity and Human Rights Committee and Marylin Kanee, MSH’s Diversity and Human Rights Advisor, had done extensive work to advance human rights issues and foster an organizational culture of inclusiveness and equity, which earned the trust and support of senior leaders, particularly the President and CEO. This trust and support was a key element as MSH prepared for the survey. Activities before the survey was launched included:

  • Training, resolving complaints, developing policies, and reviewing systems and procedures[2]
  • Involving all departments in creating the census, including DHR, Human Resources, Occupational Health and Safety, Organizational Development and Volunteer Services
  • Working with a steering committee at all stages
  • Making the census voluntary, anonymous and confidential
  • Getting buy-in from union representatives and physician leaders early in the process
  • Working with managers and recognized role models in the hospital as key communicators
  • Inviting representatives of other organizations that had conducted workplace surveys and audits to speak about the benefits achieved
  • Involving the communication team in all meetings and vetting of communications materials
  • Identifying a two-week time period during which the majority of staff were typically available as the appropriate time to complete the census
  • Designing an extensive communications strategy that included posters, pay stub inserts, newsletter ads, staff letters from the CEO and other Hospital leaders, and frequently asked question handouts.

Administering the workforce census

  • The MSH workforce census was launched from May 14, 2007 to May 27, 2007, with an extra week added for staff to complete the census
  • The census consisted of 50 survey questions and took, on average, 7-20 minutes to complete, depending on English language fluency and other factors
  • Staff could fill out a paper copy, or use laptop computers that were made available at key locations throughout the hospital
  • DHR staff and committee members were in the lobbies every day with laptops and paper copies of the survey for staff to complete manually or on-line. They also were available to answer any questions or concerns, and to assure people that the census was confidential and anonymous. Each unit and department in the hospital was similarly approached with laptops, hard copies and refreshments in hand
  • Staff who filled out the census were eligible to win prizes if they filled out a ballot and dropped it off in a drum in the main lobby
  • An external consulting company administered the census, collected and stored the data, and reported the overall results to MSH. No one at MSH saw the individual responses.

Some key results

  • The return and response rate was 55%;[3]  the sample size was 2475 employees;[4] 70% of employees completed the census on-line
  • General census statistics for the Toronto Census Metropolitan Area were used as a baseline against which internal MSH results were compared against the external population[5]
  • Overall, the MSH workforce fairly reflected the community it serves.

For example:

  • staff represent more than 100 culture and ethnicity categories[6]
  • 57% can speak a language other than English
  • 38% are members of racialized groups[7]
  • 6% identified as having a disability[8]
  • 5%[9] identified as gay, lesbian, bisexual, questioning[10] or Two-spirited[11] and 1.1% of persons identified as “transgendered” (GLBTTQ)

As well, one-third of foreign-trained immigrants were less likely to be using their credentials in their jobs (21%) than people educated or born here (34%). And while there is much diversity in the lower and supervisory staff levels, diverse groups (especially racialized persons) were underrepresented in upper management positions.

Acting on results of the workforce census

  • MSH widely reported the results of the workforce census to staff in many formats including: in its internal newsletter Inside Sinai; on MSH’s intranet; through informational employee forums in the hospital; and via workshops conducted with managers and senior leadership
  • MSH is using the data to find where there are gaps between the make-up of its existing workforce and that of the City of Toronto
  • Targeted programs, policies and initiatives aimed at supporting diversity throughout the organization are being developed to identify and address barriers.

Some examples are:

  • A new Fair Employment Opportunity Policy on how to conduct fair recruitment and hiring. MSH is integrating human rights and diversity competencies into hiring, performance appraisals and succession planning.
  • For employees facing barriers in having their credentials and qualifications recognized, MSH is looking at ways staff and volunteers can have them acknowledged. MSH has partnered with the Toronto Region Immigrant Employment Council (TRIEC) to provide mentors to internationally-trained professionals and is building relations with organizations that find employment for people with disabilities and recent immigrants
  • To improve access for people with disabilities, MSH has conducted focus groups with patients to better understand their experiences, and is implementing Accessibility for Ontarians with Disabilities Act (AODA) Customer Service Training
  • To promote respectful treatment of “GLBTTQ” members of the hospital community, the hospital developed an anti-homophobia/transphobia communication campaign and posters and brochures promoting “equity is good for your health.”
  • The next MSH workforce census is planned for 2011.

Best practices

  • Having strong leadership that promotes a culture of respect, inclusion and equity
  • Having the support and testimonials of recognized role models in key constituencies across the organization
  • Making people and resources available to develop and run an effective communications strategy
  • Making the census as easy and accessible to complete as possible. For example, offer accessible print and on-line format options in easy to reach places throughout the organization
  • Offering creative incentives for taking part (such as refreshments and prizes)
  • Giving people a chance to speak about their questions and concerns
  • Following-up and communicating the census results to staff
  • Regardless of the participation rate, use the census as a valuable education process to learn about the organization and raise awareness.

Lessons learned

  • Making sure that the census has a manageable number of clear questions[12]
  • Anonymity of respondents limited the ability to identify gaps and track progress in units and branches[13]
  • Having some understanding of employment equity terminology and processes is helpful
  • Organizations lacking the internal capacity or ability to review the raw data results should consider investing in a respected external consultant to do the analysis.

[1] MSH belongs to the Toronto Central LHIN. This LHIN serves some of Ontario’s lowest-income neighbourhoods and many of Ontario’s high-income, high-education neighbourhoods. Residents come from over 200 countries and speak over 160 languages and dialects. There is a high concentration of people who are homeless and living with serious mental illness. There are also high rates of lone-parent families, people living with HIV/AIDS, unemployed youth, and seniors living alone. See Mount Sinai Hospital, A Framework for Creating Health Equity In the Toronto Central LHIN (2005) at 1 online: [Health Equity Report].
[2] DHR had been conducting internal focus groups to assess the experience of various groups within the MSH work environment, and a community consultation with 10 distinct cultural communities that have traditionally experienced barriers to healthcare. MSH also offered targeted policies and programs for underserved or underrepresented populations, including a summer mentorship program for Black and Aboriginal students, a clinic for HIV-related concerns, and a study of cancer screening for women with mobility disabilities. Marylin Kanee in telephone interview with Commission staff on March 23, 2009 [MSH Telephone Interview].
[3] This rate decreases to 52% if persons on leave are factored in.
[4] The MSH sample size on which the analysis was based includes MSH staff, staff physicians, principal investigators, volunteers and Lunenfeld employees. Health Equity Report, supra note 1 at Appendix B.
[5] Statistics Canada compiles a range of statistical tables by Metropolitan Area across Canada, including Toronto, based on immigrant population, income, language and other indices. A Metropolitan Area is defined as a large urban area with a population of 100,000 or more, based on the previous census. Statistics Canada, Tables by Metropolitan Area online:
[6]“Most notably with Chinese (10 per cent), Jewish (9 per cent), Filipino (6 per cent), West Indian (6 per cent) and English (6 per cent). Health Equity Report, supra note 1 at Appendix B.
[7] In Appendix B of its Health Equity Report, MSH describes “racialized” as “…a term that expresses race as a social construct rather than perceived physical traits.” Ibid.
[8] Of those employees who identified as having a disability, 90% said they had a disability that was not visible, and 53% had a chronic illness. Ibid.
[9]  “This percentage reflects the response in a study conducted by the Canadian government but does not reflect the GLBQ2 population of Toronto, which is expected to be at least 10 per cent. Under-reporting is possibly the result of privacy concerns and fear of discrimination.”  Ibid.
[10] Questioning was defined in the Census as “unsure of one’s sexual orientation.”
[11] Two-Spirited was defined as “Aboriginal people who identify as gay, lesbian, bisexual, transgendered, transsexual or intersex.”
[12]  “Next time I would like to shorten the number of questions to 20 and focus on demographic questions relating to race, ethnicity, sexual orientation, etc...The responses to other questions, such as staff activities, were interesting but not as necessary. I would also like to simplify some questions to avoid any possible confusion that may result. MSH Telephone Interview, supra note 2.
[13] Conducting the workforce census for the first time gave employees the opportunity to become comfortable with the concept and develop trust around the organization’s use and handling of the census data. I hope that the next time we do the census, employees may be more open to providing their employee numbers.” Ibid.


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