5 Questions: Hannah Valantine on weaving diversity into the fabric of biomedical institutions

After six years at the National Institutes of Health, cardiologist Hannah Valantine has returned to Stanford Medicine with new ideas for building a more diverse and inclusive campus.

Hannah Valantine

Hannah Valantine, MD, professor of cardiovascular medicine, recently returned to Stanford Medicine after a six-year stint at the National Institutes of Health, where she served as the inaugural chief officer for scientific workforce diversity, as well as a senior investigator at the National Heart, Lung, and Blood Institute.

At Stanford, she will continue her research on organ transplant rejection. She is also director of team science, in which scientists  from different fields  come together to work toward common research goals, and a senior adviser on diversity. 

Recently, science writer Tracie White spoke with Valantine about her accomplishments at the NIH and her ideas for improving diversity in the School of Medicine.

1. What was your goal when you took on the new leadership position at the NIH?

Valantine: My goal was to implement an integrated approach to enhancing diversity in the scientific workforce within that institution. The NIH has a research program that is very similar to those at academic institutions, with about 1,200 investigators and 3,000 postdocs. I used the NIH campus as a kind of test bed to see what could be accomplished at other academic medical centers, such as Stanford. I installed practical guidelines to create a culture of inclusivity. 

The first step toward this goal was stressing the importance of accountability and transparency within the institution. In the past, most diversity programs have focused on the individual — offering training and professional development as ways of combating implicit bias, or deeply embedded unconscious prejudices and stereotypes. At the NIH, I looked at what the institution itself can do. How it can change. It’s absolutely vital to implement both the individual and institutional approaches. 

2. What steps did you take to help combat implicit bias and increase diversity at the NIH?  

Valantine: One thing I helped implement at the NIH was requiring that demographic data be published in a way that can be seen by peers, rather than being hidden away. This accountability piece is critical for tracking data and incentivizing behavior.

The next step was setting up metrics for the institution’s inclusivity efforts. This includes measuring and interpreting such things as salary data. Are there gender, racial or ethnic gaps in salary? Another element of such metrics is looking at equity regarding research and administrative support. Is there racial imbalance at that level? And don’t forget to look at equity in your speaker series. Are your panels diverse? Finally, what is the diversity among your trainee populations, such as in your medical residency programs? 

When I got to NIH, I advanced methods of how to monitor and track all this. I created metrics for each department and set up a panel to meet with the chairs of the departments to review the results. The panel meets monthly to get reports from each department’s director and evaluate progress. We put this on a dashboard so that each department can see what the other is doing.

3. Can you discuss other steps you took at the NIH that could be used at other biomedical institutions?

Insisting on accountability and tracking data is just one piece of this puzzle. We also have to think about recruitment. While at the NIH, I worked on the idea of recruiting in cohorts — hiring a group of people based on their interest in topics such as health disparities or racial representation. 

For people in underrepresented groups, including African Americans, Hispanics, American Indians, Alaska Natives and Pacific Islanders, the feeling of being the only one is really daunting — even terrifying — and it can affect your ability to perform. And we must not forget sexual and gender minorities and those with disabilities. Recruiting cohorts of employees with diverse interests and hiring them together, as part of a group, can help create a culture of belonging.

The cohort model provides people from underrepresented groups with mentoring and resources. When I piloted such a program at the NIH, we saw a dramatic increase in the representation of women and racial ethnic groups. This is expensive, though. Now, the NIH is funding grants for other institutions to do something similar — to recruit in cohorts. It’s not enough, but it’s a start.

What we really need to succeed — the key to all of this — is tying all these metrics that I’ve talked about to the rewards system already established within the institution. This does not mean awarding a trophy or a gift certificate for achieving improvements in metrics. This means tying improvements to salary increases or promotions. I was not able to accomplish this at the NIH, but I hope Stanford will.

4. Can you give an overview of your efforts now that you are back at Stanford. Where do we go from here?

Valantine: My role is to help Stanford Medicine implement these systemic changes of creating transparency and holding people accountable in order to improve diversity, equity and inclusivity. We’re not going to accomplish this by doing just one thing but by creating an integrated approach.

Everybody needs to be well trained in conscious and unconscious bias and racism, and have the tools to combat them. It has to be woven into the fabric. 

Stanford Medicine has been working on faculty diversity and has made great progress with gender inequity. Almost 47% of the department chairs are women. My point is that if we can do this for gender inequality, we can do this for race and ethnicity, because the pool of qualified people exists. I will be advising leaders in the Department of Medicine on how to do this work, and how to do it rapidly.

I’ll also be leading efforts to conduct team science, a collaborative effort by scientists in different fields to work together, and applying for grants through the NIH. The key to team science is bringing together a diverse group of people. We want that collection of different ways of thinking to enhance our research and patient care. This will take cultural change. Much of the culture at Stanford supports individual research and individuality. This is an exciting way to increase diversity through science. 

Practical methods such as these can help eliminate that feeling of isolation, of not being included, which I think is driving people away from our wonderful career paths here at Stanford.

5. You are also a distinguished research scientist who has, for years, conducted clinical and translational research in heart transplant rejection. Can you update us on your latest work?

Valantine: My current research is built on technology I developed at Stanford with Stephen Quake, a professor of bioengineering. The technology uses donor-derived, cell-free DNA in the blood to monitor organ transplant rejection. While at the NIH, I enrolled a cohort of 500 patients from the local D.C. area, 40% of whom are African American. Unlike most clinical research studies, this one is rich in minority samples.

The study has evaluated the new technology’s ability to monitor organ transplant rejection. The findings were recently published in Circulation. But I plan to take this a step further. It will also help us understand the mechanisms behind how and why African Americans reject their organ transplants at higher rates than white recipients.

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