D, E & I: VIEWS FROM LEADERSHIP SERIES - Quita Highsmith, Vice President and Chief Diversity Officer at Genentech

Coulter Partners: How did your journey as a "diversity champion" begin?

Quita Highsmith: My journey began early. My mother would say to me, “of those to whom much has been given, much is expected”. She said that we have to speak up for change and bring others along.

A game changing moment for me was when I was working in advocacy at Genentech before I became Chief Diversity Officer. I was leading a group engaged with patient advocacy organizations, and in 2017, we were planning a patient summit. I wanted to have a diverse set of patients, but we could not identify a single patient of color that had participated in a study. I started to ask why that was. This led me and a colleague to co-found Advancing Inclusive Research®, Genentech’s initiative to address barriers in clinical research participation for racial and ethnic underrepresented groups. When we were looking at the studies, 85 to 90% of participants were white patients, so only 10 to 15% were from other racial and ethnic groups. It really opened my eyes and I started to ask, why is that happening and what can we do about it?

CP: You have been described as a "change maker" for Genentech. Could you describe what happened next, as well as some of Genentech’s current D, E & I initiatives and successes?

Quita: Firstly, we founded an External Council for Inclusive Research, which consists of researchers, patient advocates, and thought leaders across the healthcare industry, to help us think critically about what we needed to do. They took a hard look at our clinical research inclusion/exclusion criteria and the sites that we were going to, and they helped us identify diverse investigators. Then we started to think about how to engage with more historically marginalized people. They helped us understand that we can't blame patients of color for not wanting to participate when we hadn't been engaging with them and building trust. Some patients of color may not have healthcare coverage or have unaffordable insurance premiums. There are no clinical trial centers in some of their neighborhoods, so transportation can be a challenge and the financial burden of participating in clinical research can often be high if you have to think about childcare or take time off work.

One of the things we did during the pandemic, which I'm very proud of, was our study called EMPACTA for people hospitalized with COVID-19 pneumonia. The study team prioritized enrolling minority patients often underrepresented in clinical research, resulting in 85% identifying as people of color. In 2020, these communities were hit badly by the pandemic, and in response, we launched the first global, Phase III COVID-19 clinical study to primarily enroll patient populations that have been disproportionately affected by the pandemic. We went to Kenya, Brazil, and Mexico. Normally we would go to the Ivy League schools, but we were instead in Jamaica, Queens in New York, and in the Navajo Nation! There is a lot of fake news when it comes to doing clinical research with communities of color. People think it will slow the study down, and we proved that this was totally false. It was one of the fastest enrolling studies that we've ever conducted. Patients of color want to participate in clinical research just as much as anybody else. We built partnerships with community hospitals because often it's taboo for industry to go to a hospital that they haven't done a clinical study in before, because of getting through the Institutional Review Board (IRB). The people at these community hospitals wanted to do clinical research and they were able to work with us very well.

We had to streamline the process so many times. You usually have to be a near perfect patient to get into a study, so we re-evaluated and streamlined our eligibility criteria to remove unnecessary requirements and bias from the process. We leveraged fully remote monitoring, and our team was working with the sites, having weekly calls to address any issues right from the beginning. It didn't take us weeks to know about something, we knew immediately. From the start of the study, we had our first site initiated after 10 days, which was a record time. It was 16 days from protocol to first patient in, another record time. We were doing all of this during the pandemic.

Part of the issue with the reward system in pharma is we celebrate the first patient in, and that means you go to the places you have traditionally gone because you know you can get through their IRB. What we really should celebrate is the last patient in and having data that is reflective of the population that has the disease.

CP: What does D, E & I mean to Genentech and what strategy are you following to promote best practice?

Quita: Diversity & Inclusion is multifaceted. It is complex and there are a whole host of systemic issues. There is no magic solution, it is grinding hard work, and it takes commitment. We have to be transparent in our data on what our employee and patient representation looks like. We have to be intentional about what we want to do and focus on those areas. We cannot deviate, because we need results. Like any other business initiative, it can't be about goodwill. It has to be about results, and we have to be bold in our actions in order to make a change.

If you only focus on representation, you alienate a large percentage of the population, because you are met with “they're trying to take my seat with an unqualified person.” We want to change the narrative.

We also have to think about retention. Once someone comes into the organization, we want to foster a culture and an environment where the employee feels valued, included, and that they can contribute their best.

Diversity & Inclusion can't be an add-on; it has to be fundamental to the business. Our D & I strategy is centered on three pillars: fostering belonging, advancing inclusive research and health equity, and transforming society. The last one is about thinking beyond the employees and our medicine and thinking about how we make investments in our communities through partnerships, and the people that we engage with. It's thinking about how we spend our money, who we spend our resources on, and how we engage with the next generation of scientists, so they see that Genentech and this field of biotechnology is a great place for them. Having a three-prong strategy has helped people see themselves in our work.

CP: Genentech recently published their annual D & I report with some very impressive commitments to move the needle, both internally and externally. Could you tell us about some of these?

Quita: What I have seen is that you must have leadership commitment at the very top of the organization. I'm very fortunate in that I report to the CEO, Alexander Hardy, and he has been a staunch champion. We are making bold moves. Our commitments include doubling black and Hispanic representation among top leadership ranks, we're committed to achieving equitable Asian representation at the leadership level that is reflective of our workforce, we're working to spend 1 billion with diverse suppliers, we're investing in our kindergartens to careers program, and each of our clinical study teams are prioritizing Diversity & Inclusion. Achieving these commitments is made possible as a result of the support we receive from our CEO and senior leaders to advance Diversity, Equity, & Inclusion.

In addition to our commitments, all of our Vice Presidents have a Diversity & Inclusion plan which includes actions that they will take to advance each of our strategic D & I pillars. We learned early on that people want to do the work, but some simply do not know where to start. As a result, we provided an actionable D & Iblueprint, from which our leaders had the opportunity to choose what they thought they could deliver on. For full transparency and accountability, we also publishedtheir plans on our intranet, so any employee in the company can see what that leader says they are going to do.

CP: How are you working with your leadership to ensure best practice behaviors and processes are instilled not just at the top of the organization, but at all levels?

Quita: What we have to watch is what I call the “frozen middle”, this is managers that don't necessarily believe in Diversity & Inclusion and think it's political. We have over2,000 managers and even though they might only have one hire, they are hiring the vast majority of the people. It is about convincing middle management that for that one hire they have, they need to slow down. They need to think about what's missing on their team. It's often hard for them because if they only have one or two people on their team, they tend to want to hire as fast as they can. We're implementing what we call Inclusive Hiring Practices. We're going to ask managers to take unconscious bias training, and we have laid out some dos and don'ts in the interview hiring process.

CP: Diversity without inclusion is insufficient. In your opinion what makes an inclusive leader?

Quita: I believe inclusion is the key piece. When we think about Diversity & Inclusion, I use the term “glocal”. We want to think strategically about Diversity & Inclusion at a global level, but it has to be implemented locally. What might make sense in the US might not make sense in the UK, Middle East, Asia, or Africa. However, inclusion resonates worldwide. We're thinking about the leadership behaviors and processes that enable people to bring their authentic selves to work. As an example, I once went to a leadership conference, and someone told me to act like an older white male. I thought to myself, if I'm going to have to act like that then this isn't the place for me because I will never be successful. I will always be judged against that standard. I told my immediate manager, who, luckily, was livid. People often have good intentions, because the person who said that saw that people who came through the program and had been promoted had acted like this older white male, so there wasn't any room for somebody else who was authentic to themselves. There is often a rigid definition of what a leader looks like, and if you don't fit that norm then you are excluded, even if you have a track record of strong success. Inclusion means that we accept people and encourage them to bring their true authentic selves to the job and don't try to mold them into something else.

CP: Another challenge with Diversity & Inclusion is that it is so specific to the individual. What is inclusive for you is very different to what is inclusive for me. How can we work around that?

Quita: That is true, but there are some things that are universal. Respect is universal. Here in the US, we just had these shootings for example, and you could just take a moment at the beginning of a meeting to say, “We've just seen the news, how are you feeling?” That little bit of grace is so important in making people feel included. It's about recognizing that others might have a challenge with how they're feeling that day.

The other thing that is important in inclusion is understanding that there are going to be differences, for example in where a person was raised or what education they have. Acknowledging and being accepting of people who had a different path makes such a difference for people to feel included.

Quita Highsmith