From 'Brave Spaces' to Battling Bias in Patient Engagement

Applied Clinical Trials recently chatted with Ashley Moultrie, director of diversity, equity, and inclusion (DEI) and community engagement for Javara, an integrated research company that provides clinical research access to patients at the point the care. Javara achieves this by embedding staff and infrastructure into large healthcare organizations.

Moultrie has been with the company since November 2020, ascending to her current position in February. She is a member of the Association of Clinical Research Professionals (ACRP) Diversity Advisory Council.

In the following Q&A, Moultrie details new approaches in DEI Javara is implementing internally and shares her thoughts on current progress and remaining roadblocks in employing effective DEI strategies in clinical research.

ACT: You were just recently named Javara’s first director of DEI & community engagement. Could you take us through what you have been working on and how your first months on the job have been?

Ashley Moultrie: Coming in as the inaugural director, I have had both the opportunity and challenge of analyzing, evaluating, and centralizing the many amazing initiatives currently happening across our organization in an effort to establish our baseline. A baseline that speaks to how diverse, how equitable, and how inclusive our people, places, and processes are across the board.

From site operations to finance to regulatory and HR, we are evaluating every cross-functional team spanning the entire company.

While establishing a baseline or foundation of any kind can serve many great purposes, my primary aim in evaluating our organization in this manner is to establish what gets measured. Because what gets measured, gets done. I know that all across Javara great things are happening, but serving in this role, it is my responsibility to ensure we are making strides from good to great; and from great to exceptional.

In conjunction with these efforts, my first months in this role have included working to develop “brave spaces” for all our internal team members. Similar in nature to “safe spaces,” I have mindfully chosen brave spaces as I do not particularly care for the latter term. These spaces are an opportunity for teammates to find community with one another, share concerns or ideas for action, feel seen, feel heard, to have fun, and perhaps most importantly, to be free to rediscover authenticity in the workplace.

Whether it be Javara teammates who identify as differently abled, as a racial or ethnic minority, or as an LGBTQIA+ person, brave spaces are curated specifically for them.

To date, the most exciting external-facing efforts for me have been working on our Community Needs Assessment, being deployed across all Javara locations and surrounding communities. This work includes first identifying community members, and then illuminating their most salient needs, and how we, as an organization, can support in fulfilling them. It has been a gratifying, challenging, and exciting first few months, and I look forward to all the great things to come.

ACT: Could you break down the acronym DEI and explain to our audience what each letter stands for?

AM: It is no secret that there are now countless definitions of “DEI” circulating among us in our modern society, and I could write a book about each and every one. However, I think the simplest way to understand DEI is through this analogy: Diversity is being invited into the board room; Inclusion is being given a seat at the table; Equity is how justly you’re treated during the conversations happening therein.

Many industries are actively striving—albeit with lacking sincerity at times—to recognize diversity; attempting to invite folks previously excluded into the room, be they individuals who look different, love different, learn, or live differently than the historical Western majority.

Consider, for example: What percentage of your organization is non-neurotypical? How many are female? People of color? Differently-abled? When it comes to diversity, we must start here. But this is only the beginning.

Though written as D-E-I, following the analogy provided above, from diversity we delve into inclusion. So, you’ve made it in the door, you’re in the board room. Diversity, check. But will you get a seat at the table? Will you get a chance to provide insights, and knowledge? Will your voice be not only heard but valued?

Of those who are non-neurotypical, brown, female, or differently-abled, how many are considered—much less consulted—in process-creation and decision-making? And not just during national recognition months, not just as spokespeople for Pride Month or Ramadan. I mean the everyday decisions that dictate the trajectory of many. Things that affect your entire organization, things that are foundational.

Then, and only then, can we turn to equity. Equity, which is all too often incorrectly referred to as equality, is that final stage: I’ve been invited in, I’ve been given a seat at the table. What are you going to do to ensure my experience as the greenest, newest, member is as fruitful and seamless as for those who have been here all along?

If I join as a person of color, will I be given cliff notes to catch up on the several hundred-year head-start of those before me? If I come to the table using an assisted seating or hearing device, is the table at an appropriate height to ensure my chair fits properly? Will there be captions for video or audio presentations? What if I join as an LGBTQIA+ individual? Will I be misgendered during conversations and dismissed in my efforts to correct my colleagues?

That is, in sum, to say that without ensuring equity in experience, diversity and inclusion efforts hold no true meaning.

ACT: What do you think are currently the biggest pain points for DEI in clinical research? How can they be addressed?

AM: For decades, as an industry, we have completely disregarded—that is, not considered or engaged—massive portions of our global population. Until extremely recently, approximately the last three to five years, the entire industry has catered to a very specific demographic of straight white men. For context, approximately 46% of the US population identify as non-white. This same demographic makes up only 22% of clinical trial participants.

Given these statistics, it is essential that we address historical discrimination and exclusion relentlessly through intentional engagement with all those who have, and who continue to be, underrepresented and or underserved. However, in order to employ truly meaningful engagement, we must first acknowledge and address our previous failures, biases, and unjust behaviors as an industry, providing assurances for what is to come.

ACT: How can DEI be applied in the field of clinical research and what benefits can it bring to patients?

AM: In the US, current clinical trials do not accurately reflect the American population. While progress has been made, the need for more diversity among patient populations is loud. Without representation, health equity is simply a vision, not an obtainable reality. DEI efforts guide us toward real change. Likewise, engaging with minority physicians with whom patients have an established rapport and direct, personal, or community-based connection is invaluable. Those with the lived experience are those who know best. It is time to let them lead.

Ultimately, the foundation of all DEI efforts must be rooted in trust and unity, and for an organization such as Javara, that begins within our organization and expands outward, impacting all those we serve. However, on a larger scale, these efforts have a much greater influence on healthcare advancement.

From the communities we work in, to the employees we hire and the partners we deploy, DEI truly can and must be applied to all elements of Javara and organizations in clinical research for the benefit not only of our patients, but for all involved.