Profession & Career

ESCMID Panorama

C. Designing Equality Actions

This final section is devoted to how to design equality actions on the basis of a diagnosis of inequality. Different aspects influencing the design process are discussed in this section.

C1 – As with assessment, first step to take is that of defining the scope of action: single departments or units; divisions; the entire hospital or university. Some suggestions are given in this regard.

C2 – The second topic is understanding which actions can be implemented and who may promote them. A discussion is also proposed about how to develop equality actions and, when possible, a more comprehensive equality action plan.

C3 – Other two pivotal issues are then introduced: how to involve the leaders and how to ensure long-term sustainability to the action designed.

C4 – Finally, a few words are devoted to the spirit underlying this Resource Tool: pushing CM/ID professionals to develop their own approach to inequality which could be fully tailored on features and needs of their own institution.

Making a diagnosis of inequality in the working environment is necessary to understand which are the major problems to address, establish priorities and identify which measures can be realistically adopted. In fact, the possible initiatives to promote may be of different type and nature, including: e.g., awareness-raising actions (campaigns, public meetings, web-based debates, etc.); provision of new services and support schemes (childcare facilities, flexible working hours, mentoring initiatives, etc.); new regulations and procedures (concerning recruitment and promotion, language used in the official documents, harassment and bullying, etc.) and establishment of new structures (gender equality office, diversity managers, etc.).

However, moving from diagnosis to action is a long step to take and some attention is needed for preventing disappointing results. Hence the need to set up a thoughtful design process which is as detailed and comprehensive as possible.

Providing some tips to design equality-oriented actions is the aim of this section.

C1. Defining the scope of action

Even more than assessment, designing equality actions requires a clear identification of the scope of the actions to implement, e.g., a single department or laboratory, a hospital division, a faculty, the university or the hospital as a whole. It is quite trivial to say that the larger the scope, the higher the complexity involved.

Defining the scope of the action is important for many reasons: e.g., setting the objectives; selecting the targets of the actions; identifying the concerned offices and leaders; assessing the resources which are to be deployed.

There are no specific guidelines to follow for defining the scope of action. Nevertheless, some suggestions can be given (see Box 6).


Box 6

Some suggestions for defining the scope of action

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

When defining the scope of equality-oriented actions, it is important to consider the following aspects.

  • The scope of the action should be consistent with that of the diagnosis
  • The scope of action should also be tailored on the available resources
  • Some inequality issues can be addressed only at the level of the entire organization. In defining the scope of the action, it is necessary to be aware that, depending on local contexts, some inequality problems cannot be coped with at the level of single department or laboratory and sometimes not even at the level of the division or faculty. For example, pay gap or equal access to leadership positions cannot in general be managed at the smallest organizational level since they often require changes at the level of the institution (e.g., hospital, university, research organization). Therefore, the scope of action may be different according to the type of problems to be dealt with.
  • The scope can be defined so as to leverage upon existing policies and measures. In many organizations or national contexts, specific policies and measures are in place for promoting equality and diversity management. Mapping such policies and measures can be useful for defining the scope of the action in a way which may facilitate to get support and to access available resources.
  • The scope might be gradually enlarged over time. It is to keep in mind that the scope of action may be enlarged over time. For example, it may be useful to start with actions which can be immediately designed and conducted at the level of a single department or laboratory so as to get some first visible results and only then enlarge the scope of action in order to address problems requiring the involvement of higher organizational units.
  • The scope of an action may encompass more than one institution. There is also the possibility to define the scope of an action encompassing different institutions, such as local health authorities, national scientific societies or clusters of hospitals. This may institutionally reinforce and make more visible the actions made in each of the hospitals involved. Moreover, when a university hospital is concerned, the scope of action may preferably encompass both the hospital and the university, even though not all the university staff work in the hospital and not all the hospital staff work in the university.
  • The scope may be defined through participatory approaches. The identification of the scope of action can be also identified using participatory approaches, e.g., on the occasion of a public presentation of the results of the diagnosis or organizing ad hoc initiatives.

C2. Which actions? Who designs them? And who implements them?

On the basis of the results of the diagnosis of inequality and the decision about the scope of action, it is possible to start with the design process of the actions to be implemented.

However, two preliminary questions are to be considered: who designs the actions? And who implements them? The answer largely depends on the institutional context and other variables. Some possible cases can be made in this regard (see Box 7).


Box 7

Who designs the actions? Who implements them? Some possible cases …

Who designs equality actions and who is going to implement them are two issues which evidently have an impact in coping with inequality issues. Some possible cases can be mentioned.

The "package" solution. In many cases, the team that carried out the inequality assessment is the same in charge of designing the actions and implementing them. In this way, the three operations are organized as phases of a unique process. This situation mainly occurs when funds are made available from the beginning and a strong institutional support is ensured.

The "step-by-step" solution. On the contrary, inequality assessment, design process and action implementation may be three different and separate activities. This may occur especially when funds and institutional involvement are not ensured from the beginning. Thus, the assessment may lead to collect enough resources to design possible actions and this step may in turn lead to get enough resources to initiate some of the planned actions. In this framework, each operation may be led by different players. For example, the assessment process and the design of some actions may be activated even by single health workers or groups of them, but the implementation of new measures will probably require the involvement of the management and at least some leaders (at the level of the single unit or the institution as a whole).

The "starting-from-practice" solution. It is to consider that even the order of the three steps may be changed. One can start with the implementation of a single action (e.g., an awareness-raising initiative, a course on gender issues, a mentoring scheme, etc.) so as to create a favorable context. This will allow for the recognition of the need of conducting an inequality assessment, with the involvement of other actors.

The "scaling up" solution. Finally, it is also possible that an initiative to promote equality in a single unit or sector of the institution may scale up to involve the entire organization. For example, in some cases, gender action plans promoted by the European Commission in specific faculties and managed by an ad-hoc team have led to the establishment of a gender plan at university level managed by university structures.


Over the time, many methods and tools have been developed to address multiple kinds of organizational inequality and favoring fairer conditions for all.

Some examples of methods and tools are provided with reference to gender inequality as well as to other or multiple forms of inequality. A schematic typology of some of the most used tools to fight inequality at the workplace is also offered.

It is important to bear in mind, particularly when resources are limited, that any action can be of critical importance, both in itself and as a "bridge" towards other actions to be launched in the future.

However, when a certain amount of resources are allocated, the development of action plans or similar long-term programs is often proposed, including different components and based on an integrated and holistic view of inequality-related problems.

Whatever the size and the number of actions, there are a set of aspects which should be considered in the designing process. An incomplete list of them is presented here.


C3. Leadership involvement and sustainability

Another key question pertaining to the design of equality actions concerns the involvement of the leaders of the organization. There are several reasons to seek such involvement and several strategies to attain that objective.

Beyond the involvement of leaders, it is equally important that the new proposed actions are permanently embedded in the institution. To this aim, the issue of the long-term sustainability of the actions should become part of the design process from the beginning in order to timely envisaging future institutional arrangements for each action carried out.


C4. A self-tailored approach

All the materials provided in this section as well as in the previous ones, cannot be understood as guidelines or, worse, prescriptions about how to deal with the problem of inequality in the CM/ID sector. Rather, they are to be viewed as resources for feeding a process which is fully in the hands of those who concretely promote equality actions in their own department, hospital or faculty.

There is in fact only one possible approach to address inequality, i.e., an approach which is fully tailored on the features and needs of the institution where the actions are going to be implemented. Even though there are recurrent patterns of inequality mechanisms, their actual mix differ from institution to another. Consequently, it is up to those who promote equality actions to find the most appropriate mix of solutions for neutralizing them or limiting their impacts.