From inclusion to control: structural racism in medical organization governance

Abstract

Abstract Purpose This study examines organizational racial power dynamics through a case study of the interactions between a Diversity, Equity, and Inclusion (DEI) Committee and the Board of Directors at an organization specializing in health care practitioner training. We explore how power—defined as control over resources by certain individuals while others lack such control—can be utilized constructively or destructively. Understanding the hoarding of power to maintain hierarchies, rather than fostering equitable systems, is crucial for driving proactive organizational change. Design Employing a case study methodology, we analyze the division of power within an organization and elucidate behaviors that led to the concentration of power, highlighting its detrimental use. We also examine how organizational leadership systematically undermined the DEI Committee’s efforts to establish an accountable, transparently governed organization committed to justice, equity, diversity, and inclusion. Findings Our analysis reveals that when existing power structures are threatened, they adapt to defend their dominance, often at the expense of the organization’s mission. A failure to integrate DEI principles resulted in the loss of relationships with field experts and inflicted harm on its members, ultimately leading to the organization’s collapse. Harm included symptoms of racial stress and trauma in racialized board members. In addition to exposing governance failures, this study illuminates the psychological and racial trauma experienced by affected members, linking structural exclusion to cumulative harm. This analysis is contextualized within current events, where similar patterns of dismantling equity-focused initiatives are observed at national levels. Originality This paper offers a unique and timely perspective on advancing organizational equity, particularly relevant for diversity consultants tasked with analyzing and resolving problematic organizational dynamics. We provide guidelines for distinguishing between appropriate Board governance and detrimental power hoarding, contributing to the broader discourse on fostering equitable organizational practice.Implications By examining the power dynamics between a Board of Directors and their Diversity, Equity, and Inclusion (DEI) Committee, this paper reveals how power hoarding undermines organizational objectives and can harm people of color. The findings highlight the urgent need for transparent governance structures and empowered bodies to address these imbalances. In the current climate, where justice and equity initiatives face increased scrutiny and rollback, this study offers critical insights for psychologists and diversity consultants. It provides guidelines to identify and counteract covert power dynamics, thereby advancing organizational equity and resilience against external pressures.