Profession & Career

ESCMID Panorama

B. Making a Diagnosis

This section provides a guidance on how to detect possible inequality issues in one’s own working environment.

B1 – The first topic is that of why a diagnosis of inequality is important and who could do it.

B2 – The next one is how to define the scope of the diagnosis. A single CM department or CM laboratory? A larger organizational unit? The hospital or the university as a whole? It is not always easy to decide. Some tips are provided.

B3 – Then, it is necessary to decide which kinds of inequality will be observed. Some possible paths and approaches are briefly discussed.

B4 – Another topic is to identify the inequality dimensions, i.e. the domains of the professional life where inequality may emerge and be addressed and...

B5 – ... the procedures to follow in order to collect relevant data and information for each dimension.

B6 – Finally, the last decision to take is which data, information or even indicators may be collected in order to make a diagnosis. Some suggestions and examples are provided in this regard.

The first step is making an evidence-based diagnosis of possible inequality profiles in the working environment.

B1. Why doing a diagnosis of inequality and who could do it

Obviously, a diagnosis is necessary to understand size and depth of inequality and to decide what actions to take to address it.

But a diagnosis is also necessary to pursue other important aims, such as:

  • Making equality issues visible within the working environment so as to start an internal debate
  • Showing to leaders and managers that inequality exists and could be a problem to be coped with at institutional level
  • Showing the risks and lost opportunities associated with inequality for both employees and the institution
  • Attracting people potentially interested in getting involved with anti-inequality initiatives.

Another important question is who is meant to make the diagnosis. There is not a single answer, since this depends upon the many possible institutional situations (see Box 4).


Box 4

Who makes the inequality diagnosis? Identify your case....

There are many different possible cases defining who makes the inequality diagnosis. Some examples are given below. Identify yours...

Leadership-led diagnosis. In the majority of cases, the diagnosis is directly promoted and led by the leaderships of the institution, using their own funds and resources. Often the diagnosis is made by the Human Resources Department, by the unit in charge of gender and diversity issues or a team specifically established to do it.

External team with internal funds. Some methods (see B3) establish that the inequality assessment must be made by an external expert group, acting as a consultancy team and paid by the institution. It is up to it to collect data, making interviews, interacting with leaders and drafting the reports in coordination with managers and employees of the institution.

Internal team with external funds. The diagnosis exercise is sometimes carried out by an internal team and funded through sources external to the institution (granted by national bodies, the European Union or, more rarely, international funding agencies).

Bottom-up process. In some cases, the diagnosis is promoted by internal players, such as an association, a women's network or trade unions. Leaderships are usually involved in order to get institutional support and access to official data. Activities are mainly conducted on a voluntary basis.

Limited-scope diagnosis. The assessment exercise may also be promoted and carried out at the level of a single organizational unit of a given institute (be it a hospital, a university or a research centre), initiated by, e.g., a head of department or a head of division. In these cases, it may be of a more informal nature since it involves a limited number of professionals who usually know each other. However, support from the management of the institution or some of its offices (typically the Human Resources Department) could be still necessary to get relevant information. The process may be largely conducted on a voluntary basis.

Externally induced diagnosis. Another case is that of inequality assessments induced by external factors. They may include, e.g., evaluation criteria adopted by research funding agencies, national anti-inequality programs (such as, in the UK, the Athena SWAN awards for gender equality in science) incentivizing research organizations or health service providers to activate equality-oriented initiatives, or national anti-inequality laws and policies.

Mixed cases. Needless to say, mixed cases are also possible such as, for example, individual professionals or a professionals' network promoting the assessment and pushing the management to activate the process or single departments starting the diagnosis and gradually involving other departments.

B2. Defining the scope of the diagnosis

To begin with, it is necessary to understand which is the scope of the diagnosis, i.e., which is the working environment to refer to.

This resource tool is addressed to clinical microbiologists and infectious diseases professionals. The assessment scope should therefore be infectious diseases departments, divisions or hospitals, or departments of internal medicine where infectious diseases specialists work as well as hospital-based microbiology laboratories. Moreover, clinical microbiologists and infectious diseases professionals may also work in Academia. Therefore, their working environment may also be university faculties or research laboratories. In many cases, clinical microbiologists and infectious diseases professionals work both in Academia and in hospitals.

However, many data and information about inequality are only available at the organization level and not at the level of individual unit. They can be get only interacting with, e.g., the Human Resources Department or the direction of the hospital. This is only to say that, in making a diagnosis, defining the scope of analysis is necessary. There are no specific procedures or rules to follow. Nevertheless, some tips can be given (see Box 5).


Box 5

Defining the scope of the diagnosis: some tips

Defining the scope of the analysis means here defining the organizational context to take into consideration: department, laboratory, division, faculty, university, hospital as whole, etc. Some aspects should be taken into consideration.

  • It is better to start with the smallest relevant organizational unit. For example, in a hospital, the smallest unit may be the infectious diseases department and the microbiology laboratory; in a university, the department of infectious diseases or the faculty of medicine; if the hospital is fully specialized on infectious diseases, all the hospital should be taken into account.
  • Mapping the available information before to start. All universities and hospitals, usually through the Human Resources Department, produce data on their staff and, in some cases, on inequality-related issues, in the form of, e.g., publications, reports or web-pages. Such data are not always systematically disseminated. Understanding which data are already available may be a starting point for defining the scope of the diagnosis.
  • Tailoring the scope on the available resources. Even though making an assessment does not necessarily require significant funds, some funds are anyway needed. The scope (and also the methods; see B3) of the assessment should take into account the existing economic and financial constraints so as to avoid to start an assessment process which cannot be completed.
  • Collecting additional information for comparative reason. Even when the focus is a single department, division or faculty, some basic information out of the scope may still be useful. Indeed, it allows to compare data and information collected on the selected unit with those at institution, national or European level. 
  • Some types of data may imply the involvement of a higher unit to be collected. For example, data pertaining to the staff (e.g., uptake of parental leaves by women and men) can only be obtained through the involvement of the Human Resource Department or the direction of the institute.
  • Some equality-oriented activities can hardly be developed at the level of the smallest unit. For example, problems like the pay gap between women and men or between expatriates and nationals, those related to parental leaves, and generally also those pertaining to the access of disadvantaged groups to leadership positions, can be appropriately addressed at the level of the institution as a whole (hospital, university, research centre, etc.). Others, instead (those pertaining to, e.g., a fair distribution of tasks, the prevention of sexist, racists or homophobic behaviors or a fair recognition of skills and competence) can be more appropriately dealt with in smaller units. This is important to take into consideration in defining the scope of analysis.

B3. Inequality based on what?

Another question to cope with is that of identifying which inequality grounds are to be primarily taken into consideration. Actually, inequality can be grounded on different kinds of features and qualities of people (for finding some definitions, see here) and some of them may be more visible and felt than others, while still others may be not existent at all.

Nothing, of course, prevents the promoter(s) of the assessment from focusing it exclusively on specific kinds of inequality on the basis on their own perception of the situation or the funds available. For example, many institutions (universities, hospitals, etc.) systematically collect data on gender inequality, but not on inequality grounded on, e.g., disability, sexual orientation or national origin.


Otherwise, it is also possible to keep the survey as inclusive as possible at least at the beginning, so as to consider any kind of discrimination. A possible approach could be that of starting the assessment with an opinion pool or a simple collection of information using a self-administered questionnaire, sent to the staff or made available online, to collect opinions and feelings about discrimination problems within the organization or the selected unit. If such an approach proves to be too costly or difficult to organize, other tools may be used to get information about which kinds of discrimination are felt the most in the working environment.

B4. Identifying the inequality dimensions

Another key step is that of identifying the inequality dimensions, i.e., i.e. the domains of the professional life where inequality may emerge and be addressed. They may include, for example, the access to leadership positions, the selection and recruitment process, income and salaries, labor conditions, work-life balance, equality-related policies or sexual harassment.

Identifying relevant inequality dimensions is important for three main reasons.

  • It allows not to forget something important in the assessment process or to consciously decide not to consider some of them.
  • It helps keep a holistic approach to inequality, avoiding to focus on just one factor or another (for instance, identifying the problem of gender inequality with work/life balance issues alone, overlooking the effects of other factors, such as gender stereotyping or unequal access to research funds). 
  • It helps prioritize the dimensions where there are the main problems to address.

Some examples of models identifying inequality dimensions are given here.

B5. Methods for making a diagnosis

Whatever the decision is taken about the types of inequality and the dimensions to be considered, there is anyhow the need to identify a procedure to collect relevant data and information.

Different methods are available to asses inequality in a given working environment. In the majority of cases, these methods are based on the mixed use of desk work (e.g., analysis of relevant documents, relevant legislation, etc.), quantitative tools (e.g., collection of statistical data, quantitative surveys, etc.) and qualitative tools (e.g., in-depth interviews, focus groups, public meetings, etc.). Some examples are provided here.

Such methods are usually thought to assess inequality in large organizations and not in small departments or organizational units. Therefore, it is advisable to adapt them to the concrete context where they should be applied or to take them as inspirational sources for developing one's own methodological approach, if necessary.


B6. Data, information, indicators

To assess inequality in a given working environment, it is necessary to identify which specific information are the most effective to portray the situation. This process is not always simple, given that the amount of relevant information is potentially huge. Some tips for managing the selection process of relevant information are given here.

Many authors and institutions proposed sets of data and information to be used as indicators for assessing inequality in different kinds of working environment. In many cases, such sets are embedded in wider approaches including inequality dimensions and even specific procedures to follow.

In general, two main tendencies can be observed.

  • Indicators for assessing how the institution addresses inequality. In many cases, the proposed indicators are chiefly aimed at understanding how the organization is managing inequality. This approach is prevalently used when many forms of inequality are considered and when diversity management is concerned. Not rarely, indicators are proposed in the form of a checklist. To get an idea of which indicators may be used, some examples are provided here.
  • Indicators for assessing inequality within the institution. In other cases, indicators are proposed to directly measure inequality and to monitor how inequality changes over time, regardless of measures and policies devised by the management. This approach is often used when gender inequality is mainly or exclusively considered. Some examples are given here.

Cases where both tendencies (that of analyzing how the organization addresses inequality and that of analyzing inequality within the organization) are mixed together also exist.