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Foundational practices of structural change: the relationship of psychological safety and organizational equity

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Content Foundational Practices of Structural Change: The Relationship of Psychological Safety and
Organizational Equity
Stefani Bralock McCoy
Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education
December 2024

© Copyright by Stefani Bralock McCoy 2024
All Rights Reserved

The Committee for Stefani Bralock McCoy certifies the approval of this Dissertation
Lisa Coleman
Katherine Bihr
Anthony Maddox
Fredrick Freking, Committee Chair
Rossier School of Education
University of Southern California
2024

iv
Abstract
This study examined the role of psychological safety in promoting equity and inclusion within
the New York City Department of Health and Mental Hygiene (DOHMH). Specifically, it
explored strategies for cultivating leadership practices and accountability systems that create an
inclusive and psychologically safe work environment. This study utilized social cognitive theory
and critical race theory to understand the links between staff motivation, behavior, cognition, and
performance in an organizational setting. The study used a mixed-methods approach to examine
the research problem. There were 830 survey respondents out of 6,000 staff members who
participated. The quantitative research study allowed me to explore healthy organizational
practices and accountability systems toward a psychologically safe environment for staff
members. This research involved semi-structured surveys. The findings of this study illustrate a
significant divide in employee perceptions regarding organizational policies and programs
related to racial equity. These findings suggest that while some employees see apparent issues
with systemic racism within the organization, others feel ambivalent, possibly due to a lack of
information, program effectiveness, or fear of speaking out.

v
Acknowledgments
Thank you to my ancestors for paving the way and guiding me. Thank you to my mom, who
never let me give up on myself and always assured me of my intelligence and capability, even
when the world told me I was not good enough. Thank you to my magical wife, who has always
supported and encouraged me to keep going. I appreciate you for being on this journey with me;
you’ve made this process so much sweeter. Thank you to all my family and friends for your
support over the past 3 years. Thank you to my professors who shared their knowledge and
wisdom and for challenging me to give my best work.

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Table of Contents
Abstract.......................................................................................................................................... iv
Acknowledgments............................................................................................................................v
List of Tables................................................................................................................................ viii
List of Figures................................................................................................................................ ix
Purpose of the Project and Research Questions...................................................................1
Importance of the Study.......................................................................................................2
Overview of Theoretical Framework and Methodology .....................................................2
Literature Review.................................................................................................................3
Historical Context ....................................................................................................4
Psychological Safety................................................................................................5
Learning and Motivation (Training and Development)...........................................6
Self-Efficacy and Self-Regulation ...........................................................................6
Systems of Power (Leadership) ...............................................................................9
Equity and Anti-racism ..........................................................................................10
Summary................................................................................................................11
Conceptual Framework......................................................................................................12
Methodology......................................................................................................................15
Research Setting.....................................................................................................17
The Researcher.......................................................................................................17
Data Source: All-Staff Survey ...............................................................................18
Participants.............................................................................................................19
Instrumentation ......................................................................................................20
Data Collection Procedures....................................................................................21
Data Analysis.........................................................................................................21

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Validity and Reliability ..........................................................................................22
Findings for Research Question 1......................................................................................23
Organizational Influences......................................................................................24
Findings for Research Question 2......................................................................................31
Findings for Research Question 3......................................................................................36
Training and Professional Development................................................................36
Addressing Racial Inequities .................................................................................38
Organizational Accountability ...............................................................................43
Summary............................................................................................................................49
Recommendations..............................................................................................................50
Discussion of Findings...........................................................................................50
Psychological Safety and Organizational Equity Recommendation .....................52
Conclusion .............................................................................................................54
Limitations and Delimitations............................................................................................54
Recommendations for Future Research.............................................................................56
Identifying Unconscious Bias and Blind Spots .....................................................56
Enhancing Emotional Intelligence and Empathy...................................................56
Improving Decision-Making and Inclusivity.........................................................57
Supporting Long-Term Change and Transformation.............................................57
Promoting Vulnerability and Psychological Safety ...............................................58
Strengthening Organizational Trust and Communication......................................58
Creating a Culture of Continuous Learning and Adaptation .................................59
Conclusion .........................................................................................................................59
References......................................................................................................................................61

viii
List of Tables
Table 1: Data Sources 15
Table 2: Survey 19
Table 3: Selections Regarding What Would Increase Involvement 41

ix
List of Figures
Figure 1: Self-efficacy, Social Cognitive Theory 8
Figure 2: Conceptual Framework, Social Cognitive Theory 12
Figure 3: Critical Race Theory Framework 14
Figure 4: Percent responding on the extent to which the Health Department addresses racial
inequities across New York City and within the Health Department 24
Figure 5: Percent Responds to the Extent to Which Racism Is a Problem Within the Health
Department as a Workplace 26
Figure 6: Breakdown of Respondents Who Agree or Disagree About Whether Programs,
Policies, and Practices Work Better for White People Than for People of Color 26
Figure 7: Percent of Respondents Who Agree or Disagree About Whether Programs,
Policies, and Practices Work Better for White People Than for People of Color 28
Figure 8: Percent of Respondents That Agree or Disagree It Is Important to Them to
Understand the Beliefs and Values of the People They Work With 31
Figure 9: Percent of Respondents Selected How Comfortable They Feel Talking About
Racism With Colleagues With the Same Racial/Ethnic or Cultural Backgrounds As Their
Own or Different From Their Own 32
Figure 10: Percent Responding How Often They Talk With Their Supervisor(s) About How
Their Work Can Address Racial Inequities Externally and Internally (N = 830) 33
Figure 11: Percent of Respondents Selecting the Extent to Which the Training or
Professional Development Opportunities They Attended in the Past 12 Months Increased
Their Understanding 36
Figure 12: Breakdown of Respondents by Race/Ethnicity Who Answered They Attended or
Participated in Training or Professional Development Related to Reducing Racial Inequities
at the Health Department in the Past 12 Months 37
Figure 13: Percent of Respondents Answered How Active They Are at Addressing Racial
Inequities Within the Health Department 38
Figure 14: The Percentage of Respondents Answering Whether They Want to Be More
Active. The Sample Includes Respondents Who Are Not at All, a Little, or Somewhat Active 39
Figure 15: Breakdown of Respondents Who Want to Be More Active by Length of Time at
the health department Who Want to Become More Active in Addressing Racial Inequities 40

x
Figure 16: The Percentage of Respondents Answered How Comfortable They Are Reporting
Bias and Oppression at the Health Department 43
Figure 17: Breakdown of Respondents by Race and Ethnicity Who Responded They Are Not
at All Comfortable Reporting Bias and Oppression 44
Figure 18: The Percentage of Staff Answering How Confident They Are That the Health
Department Will Properly Handle Any Reporting of Bias and Oppression 45
Figure 19: Breakdown of Respondents by Race and Ethnicity Who Responded They Are Not
at All Confident the Health Department Will Properly Handle Any Reporting of Bias and
Oppression 46

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Foundational Practices of Structural Change: The Relationship of Psychological Safety and
Organizational Equity
Psychological safety is the antecedent factor for healthy relationships among
organizations’ staff and leaders and is the birthplace of equity. Psychological safety is a shared
belief held by team members who feel safe in interpersonal risk-taking without fear of
humiliation, retaliation, or reprisal (Edmondson, 1999). Feeling emotionally safe and supported
is a crucial component of staff members’ value system in the workplace. One of the significant
challenges and threats to an organization is how well the employees and major stakeholders feel
valued, seen, and heard. When an organization invests time in relationship building, valuing
staff’s input in significant decision-making, and prioritizing staff’s emotional and psychological
needs, the organization will function successfully.
Racism, unconscious bias, prejudice, microaggressions, and inequities can show up in
myriad ways that impact staff’s ability to operate in their roles and impede their ability to feel
psychologically safe and respected at work. In contrast, psychological safety can lead to
inclusive decision-making, increased job performance, interpersonal risk, cognitive consonance,
self-efficacy, learning and motivation, anti-racism, and equity. Once the foundation for
psychological safety is in place, staff will begin to speak on injustices, equity, and bias and
advocate for their needs to continue to be present at work and thrive in their roles.
Purpose of the Project and Research Questions
This study aimed to understand strategies and foundations for creating healthy leadership
practices and accountability systems that foster an inclusive, equitable, and psychologically safe
environment for staff at The New York City Department of Health and Mental Hygiene

2
(DOHMH). The problem of practice involves high levels of inequitable leadership practices and
accountability within organizations. Three research questions guided this study:
1. To what extent do staff members believe that the health department’s internal and
external policies, practices, and culture address racial inequities and emotional safety?
2. What are the organization’s values and beliefs regarding leadership and
accountability?
3. What environmental and behavioral factors influence equitable and psychologically
safe work environments?
Importance of the Study
Today, people know their rights regarding equity, equality, inclusion, and justice.
However, there is much more exposure to harmful and unhealthy work environments. Equity and
psychological safety in an organization are fundamental to a harmonious organizational culture.
Failure to analyze organizational equity and staff members’ emotional well-being through a
human development lens can create chaos when responding to critical incidents. Analyzing a
leader’s style and strategies through the four concepts, structural, human resource, political, and
symbolic, is vital to the health of any organization. Also, analyzing work culture and staff
psychological needs will help identify focus areas to strengthen the agency’s work to advance
racial equity and social justice. Internal equity within DOHMH directly impacts staff’s ability to
perform job functions to ensure positive health outcomes for NYC residents.
Overview of Theoretical Framework and Methodology
I utilized social cognitive theory to understand the links between staff motivation,
behavior, cognition, and performance in an organizational setting. According to social cognitive
theory, the social environment impacts human learning and behavior (Schunk & Usher, 2019).

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Individuals acquire knowledge, perceptions, cognitive development, and projected outcomes of
their actions through interactions with others. Thus, SCT theory can expose and analyze the
interconnected systems within organizational environments that influence behavior patterns, staff
self-efficacy, and expected outcomes.
Social cognitive theory is the psychosocial functioning in terms of triadic reciprocal
causation. Self-efficacy is acquired through several primary sources, interpretations of actual
performances known as mastery experiences, modeled experiences known as vicarious
experiences, and forms of social persuasion and psychological indexes. When individuals
perform highly, their self-efficacy increases, impacting the cognitive, motivational, affective, and
selection processes. Self-efficacy and self-regulation are directly linked to one another.
Additionally, I used critical race theory (CRT), which addresses systems of inequality. It
provides a framework through evidence-based research to help leaders and policymakers think
critically about race’s social construct and how it impacts people of color (Dumas & Ross,
2016). The theory helps frame the problem statement by analyzing psychological safety and
organizational equity through a systematic lens. It focuses on dismantling inequitable leadership
practices through a historically racialized approach. I used CRT to examine anti-racism through
leadership practices and the role of systematic racism in organizational policy and procedures.
Literature Review
This section will comprehensively review the current literature on psychological safety. It
will begin by discussing the historical context of psychological safety in an organizational
setting. Then, it will present an in-depth review of self-efficacy, learning and motivation,
performance, interpersonal risk, systems of power, equity, and anti-racism. The literature review
will outline challenges and barriers in previous research with an equity and anti-racist lens.

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Lastly, this section will conclude with a summary and the conceptual framework used in this
study.
Historical Context
Institutional oppression has been a leading cause of inequities in the workplace. The
enslavement of Black people contributes to society’s hatred and mainly to the systematic
oppression Black individuals face daily at work (Ross, 2020). For centuries, enslaved Black
people were forced to work in the most brutal and inhuman conditions as agricultural, domestic,
and service workers for unpaid labor. In 1776, slavery became the first labor institution in
America (Dal Lago, 2015). Although the United States abolished slavery in 1863, it did not
eradicate racism, oppression, and workforce discrimination against Black people, particularly in
the Ante-Bellum South. Black families began to migrate away from southern states for economic
opportunities. Franklin D. Roosevelt enacted The New Deal during the Great Depression to help
struggling American families and expand access to economic mobility (Solomon & Castro,
2019). In 1938, a 40-hour work week and a child labor ban, federal minimum wage, and
overtime requirements were introduced because of the New Deals Fair Labor Standards Act
(FLSA; Solomon & Castro., 2019). Consequently, the FLSA was not as fair as America would
have hoped.
In 2020, after the murders of George Floyd, Breonna Taylor, and countless other Black
deaths at the hands of police brutality and the subsequent uprising, organizations across the states
implemented diversity, equity, and inclusion initiatives to address the structural inequities in the
workplace, including DOHMH. In 2015, DOHMH partnered with the Center for Social Inclusion
and GARE to launch anti-racist equity work in the agency. The primary focus was to ensure our
staff (major stakeholders) felt safe in their job roles. An agency-wide survey data indicated that

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75% of DOHMH staff strongly agreed or agreed that racism was a significant problem in NYC,
and 84% strongly agreed or agreed that it was critical to discuss racism within DOHMH. The
survey also indicated that staff feel unsafe or uncomfortable expressing concerns to their leaders,
and staff do not feel reporting issues of racism or psychological safety would bring about change.
As a result, it is essential to understand which factors can create an equitable environment for
DOHMH staff.
Psychological Safety
Psychological safety is a rising phenomenon within organizations. Feeling emotionally
secure and supported is a crucial component of staff members’ value system in the workplace,
and staff and stakeholders are becoming more familiar with the importance of feeling safe when
expressing their ideas and identity in their work environment. Psychological safety is a shared
belief held by team members who feel safe for interpersonal risk-taking without fear of
humiliation, retaliation, or reprisal (Edmondson, 1999). Past research has focused heavily on
how psychological safety creates trust and emotional well-being and, in return, boosts
performance and productivity. However, past research has failed to analyze the relationship
between psychological safety and organizational equity. In recent years, there has been a
significant demand from employees, stakeholders, and society to create organizations founded on
anti-racism, equity, and justice. Thus, this study sought to expand the theory of psychological
safety and include the contributing factors that increase emotional safety and encourage staff to
build relationships with their colleagues, superiors, and subordinates that will allow organic
dialogue when feeling safe to discuss heavy issues of feeling protected and seen in their identity
while at work. When staff feel psychologically safe, they will feel comfortable enough to start

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having hard conversations to break the barriers of structural inequality and ask for what is
needed to feel valued in the workplace.
Learning and Motivation (Training and Development)
Learning in a team environment is extremely vulnerable. Learning involves the
interpersonal risk of being misunderstood and judged. Team psychological safety is “a shared
belief that the team is safe for interpersonal risk-taking” (Edmondson, 1999, p. 1). To form a
risk-taking environment in organizations, we must have an individualized approach to
community building among staff members. Once staff members feel emotionally safe,
comfortable, accepted, and valued, communal education and learning can occur. In social
cognitive theory, this type of learning cycle is called triadic reciprocity. Triadic reciprocity
encompasses three factors influencing a person’s behavior: personal factors, attitudes, values,
self-efficacy, and personality. Second is environmental factors that include actions of others and
social context. Last is behavior, which includes a person, actions, efforts, and choices (Lo
Schiavo et al., 2019).
The research is limited when analyzing learning and behavior to create equity and
eradicate racism, bias, and oppression. I intend to expand the relationship between learning,
motivation, and interpersonal risk to increase organizational equity and anti-racism. Training
retention decreases when a psychologically safe environment is not present during learning
platforms such as professional training and development, and learners might experience
cognitive overload while trying to self-regulate during uncomfortable environments.
Self-Efficacy and Self-Regulation
Self-efficacy is a person’s belief in their ability to execute any task needed to accomplish
perceived goals (Bandura, 1988). People believe in their efficacy through mastery experiences,

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vicarious experiences, social persuasion, and achievement (Bandura, 1988). Self-efficacy also
involves self-regulation. When an individual is plagued with negative thought patterns of failure
while accomplishing a set task, this can undermine performance. Self-efficacy can also be
determined by a person’s ability to control and self-regulate environmental stressors and
demands. Self-efficacy can be measured by an individual determination and perseverance to
overcome obstacles or mental setbacks to accomplish a set goal. The belief in oneself and the
confidence in one’s ability to succeed is the basis of self-efficacy. People often undertake certain
tasks based on their belief in how well they can execute them. It is a perceived belief in one’s
skill and knowledge level to make a choice that will ultimately lead to success. The literature
suggests that the stronger people’s self-efficacy beliefs, the more career options they consider
possible, and the better they prepare themselves educationally for different occupations
(Bandura, 2000).
Similarly, Freire’s Pedagogy of the Oppressed emphasizes the importance of critical selfreflection in liberation. The central problem addressed in the literature on the Pedagogy of the
Oppressed concerns the oppressed individual’s capacity to develop a pedagogy that can lead to
their liberation. In his foundational work, Paulo Freire (1970) asserts that the oppressed are often
fractured and divided in their identities and face the challenge of developing a liberatory
consciousness. This process, however, is only possible when they recognize themselves as
"hosts" of the oppressor. By this, Freire means that the oppressed have internalized elements of
the oppressive system, adopting behaviors, beliefs, and values imposed by their oppressors
(Freire, 1970). This internalization renders the oppressed inauthentic and disconnected from their
true selves, thus obstructing their ability to contribute to the creation of a pedagogy that can
facilitate their liberation.

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The duality between the oppressed and the oppressor presents a fundamental obstacle.
According to Freire, as long as the oppressed live in a state of duality, where to "be" is to
conform to the oppressor’s image, they remain incapable of recognizing their potential for
collective self-liberation. This duality creates a distorted sense of identity, where the oppressed
seek to replicate the ways of the oppressor in their quest for survival and recognition. In this
context, the development of a genuinely liberating pedagogy remains unattainable. Freire argues
that for the oppressed to contribute to the midwifery of their liberating pedagogy, they must first
undergo a critical process of self-discovery, wherein they understand that they and their
oppressors are victims of dehumanization (Freire, 1970).
The previous literature discussed the factors that cause an individual to have self-efficacy
and self-regulation to carry out a task. Figure 1 illustrates Albert Bandura’s concept of triadic
reciprocal determinism as influential factors of individual behavior and self-efficacy. The
literature does not provide a CRT lens, which can add another factor of influential behaviors
toward an individual’s belief system to succeed. This research sought to highlight elements of
CRT further to analyze the relationship between psychological safety and self-efficacy.

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Figure 1
Self-efficacy, Social Cognitive Theory
Note. Adapted from Psychology of Learning for Instruction (3rd ed.) by M. P. Driscoll, 2004.
Allyn & Bacon. Copyright 2004 by Allyn &Bacon.
Systems of Power (Leadership)
Power structures exist in most organizations. Once psychological safety is in place, the
staff member has the confidence and fearless ability to challenge the status quo without fear of
retribution, retaliation, reprisal, or the risk of damaging their reputation (Lucas & Baxter, 2012).
Psychological safety gives individuals the courage to not conform to outdated systems of
oppression and overcome the pressure to conform to inequitable systems of power and influence
from leadership. A threat to any organization is an individual’s ability to challenge the power

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structure, allocation of resources, incentives, reward systems, and strategic and operational
planning (Clark, 2020). Power is a social and hierarchal status that decreases vulnerability and
connection between staff and leadership. Many leaders have difficulty asking for something
because it puts them past their moral, emotional, and intellectual capacity (Clark, 2020). The
vulnerability blocks the ability to cross the threshold of innovation and create an environment of
psychological safety within organizations. In The 4 Stages of Psychological Safety, Clark (2020)
referred to the stage as challenger safety. This stage allows challengers within an organization to
challenge the status quo without retaliation, reprisal, and retribution. The individual challenger
can feel confident to speak their truth when something within the organization needs to change
(Clark, 2020).
As staff members challenge the status quo, leadership can create a psychologically safe
environment that supports individuals’ concerns and promotes equitable innovation. Leaders in
organizations operating in a psychologically safe, supportive environment spearhead change and
create new norms. For organizations to grow and become successful, staff must feel safe to
continue to produce work and show up as their whole selves. Organizations cannot thrive
without work production.
Equity and Anti-racism
Psychological safety is a core component of employee growth and well-being. However,
research has found that Black people and other people of color require different solutions to feel
psychologically safe at both interpersonal and organizational levels (Agbanobi & Asmelash,
2023). To fully comprehend what solutions Black people and other people of color need to
become psychologically safe, leaders must consider relevant historical and social contexts. For
example, discrimination against Black people for more than 400 years dates back to the

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American slavery era. While the system of U.S. chattel slavery technically ended over 150 years
ago, it continues to mark Black people’s ontological position in the workplace, education,
wealth, and social and economic mobility (Ross, 2020). Colonization and slavery birthed a
society of anti-blackness, which is society’s beliefs, attitudes, actions, practices, and behaviors of
individuals and institutions that devalue, minimize, and marginalize the full participation of
Black people (Comrie et al., 2022). Due to the historical context of Blackness, institutional
structures and hierarchies were built with a White hegemonic workforce in mind.
These systems still exist in most organizations and major companies, requiring different
solutions and leadership vulnerability to address Black psychological safety. Black employees
often experience microaggressions, bias, oppression, blatant racism, and disrespect at work and
in their everyday lives. The Gallup Center on Black Voices found that about one in four Black
(24%) people encountered discrimination at work (Lloyd, 2021). Additionally, Black individuals
are most likely out of all racialized identity groups to experience microaggressions in the
workplace (Lloyd, 2020). Thus, organizations must learn the historical residue of slavery and
anti-Blackness to understand their Black staff experiences. They must also create systems of
accountability to address inequities and emotional harm. Toward those ends, this research
examined the relationship of psychological safety for Black individuals as a foundation for
organizational equity and structural change.
Summary
The literature review presented the phenomenon of psychological safety as an essential
factor of self-efficacy and collective efficacy. The review also examined power structures and
lack of leadership vulnerability as determinants of implementing psychological safety in
organizations. Leaders committed to the emotional health of their employees in the workplace

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must ask themselves what the individual, interpersonal, and organizational costs of neglecting
psychological safety are and how a tailored approach to psychological safety might boost wellbeing and work outcomes in the organization (Agbanobi & Asmelash, 2023).
Additionally, Black and other people of color require different solutions for them to feel
psychologically safe. Leaders in organizations must learn the history of discrimination and
slavery legacy in the United States to truly understand the experience of racism, bias, and
oppression their staff face daily. Psychological safety is the foundation for creating structural
change, anti-racism, and equity in any organization. Research has found that without safe
environments, staff will not take interpersonal risks, feel uncomfortable voicing their ideas and
opinions, hinder their learning motivation and self-efficacy, and not challenge the status quo,
ultimately changing organizational culture.
Conceptual Framework
Social cognitive theory examines a person’s habits, patterns, and behaviors within a work
environment (Pritchard, 2021). Albert Bandura developed foundational elements to a social
cognitive study. The first is the person, their motivation, and what they know. The second is that
person’s actions (or behaviors) and how they are modeled. The third is the environment, meaning
an organization’s systems to ensure appropriate behaviors, which can include formal or informal
training, organizational culture, and policies and procedures carried out by leadership. Figure 2
shows the overall environment influencing the interaction between a person and observational
learning through the behaviors and actions of others and the individual (Pritchard, 2021). A key
factor in social cognitive theory (SCT) is learning through observation or viewing others’
behaviors. The SCT will provide a framework for understanding how certain systems of behavior

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and operation permeate organizations and why other behaviors are not supported in this
structure.
Figure 2
Conceptual Framework, Social Cognitive Theory
Note. From “Improving the Living, Learning, And Thriving of Young Black Men: A Conceptual
Framework for Reflection and Projection,” by D. C. Watkins, 2019, International Journal of
Environmental Research and Public Health, 16(8), Article 1331.
(https://doi.org/10.3390/ijerph16081331). Copyright 2019 by MDPI.

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I also used CRT, a tool for addressing systems of inequality (Figure 3). The theory
dismantles inequitable organizational practices through a historically racialized approach
(Delgado et al., 2012). It examines anti-Blackness in organizations’ policies and practices and
the role of systematic racism in hierarchal structures within leadership. In addition, CRT can help
emphasize the legacy of slavery, bias, and oppression of Black employees, which inhibits their
ability to feel psychologically safe.

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Figure 3
Critical Race Theory Framework
Note. From Diversity, Equity, Inclusion, and Anti-Oppression by UCSF Department of Family
and Community Medicine, 2024. (https://fcm.ucsf.edu/diversity-equity-inclusion-and-antioppression-0). Copyright 2024 by The Regents of the University of California.
Methodology
This study aimed to learn about equitable strategies and foundations to inform healthy
leadership practices and accountability toward an inclusive, equitable, and psychologically safe
work environment for all organizational staff. This section will present the overall research

16
design, the research subjects, and the sampling approach used in this study. I examined the
research problem with a mixed-methods approach (Table 1). Quantitative research allowed me to
explore healthy organizational practices and accountability systems toward a psychologically
safe environment for staff members. This research involved semi-structured surveys. This
research style focuses on honoring an inductive style, individual meaning, and the importance of
understating the complexities of a situation (Creswell & Creswell, 2018).
Table 1
Data Sources
Research questions All-staff survey
To what extent do staff members believe that the
health department’s internal and external policies,
practices, and culture address racial inequities and
emotional safety?
X
What are the organization’s values and beliefs
regarding leadership and accountability? X
What environmental and behavioral factors influence
equitable and psychologically safe work
environments?
X

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Quantitative data provided statistics to show the significance of this research
phenomenon and the amount of data on the impacts of Black staff and the overall health of an
organization. The interview and survey respondents involved a mix of staff and senior
leadership. Racism, prejudice, stereotypes, and microaggressions can show up in myriad ways
that impact our staff’s ability to operate in their roles and impede their ability to feel
psychologically safe, valued, and respected. The interview and survey captured staff and
leadership experiences related to racial equity and reducing discrimination and oppression.
Research Setting
Merriam and Tisdell (2016) discussed types of purposeful sampling, including selecting a
population that reflects the study’s average person, situation, or interest (Merriam & Tisdell,
2016). Psychological safety is mainly between senior leadership and staff members in a given
organization, so studying both parties and their relationships was important. Thus, all 6,000 staff
members were welcome to participate in the survey. I included a mix of races and ethnicities for
staff and senior leadership. This helped create credibility for the study using the average person
type that reflects the agency. The survey was held at DOHMH because conducting the study at
the worksite helped staff connect emotionally and mentally to the questions since they were
physically in the environment. I sent the survey to the staff’s agency email and provided a link to
direct them to Microsoft Forms. The survey took approximately 20 minutes to complete. Each
interview lasted between 45 and 60 minutes.
The Researcher
My positionality regarding the problem described above is very personal. I identify as
Black, queer, Latinx, woman, non-binary, educated, able-bodied, and healthy. I was raised in a
low-income household by a single mother, my sister, and a father battling drug addictions. I grew

18
up in a racist school district. In my junior year, I dropped out of high school due to unmet
academic needs, biased teaching practices, and a lack of confidence that I was intelligent enough
to earn an education. When I transitioned into the workforce, I experienced prejudice, bias, and
microaggressions in school and the workforce. Villaverde (2008, as cited in Douglas & Nganga,
2013) defined positionality as how an individual’s position is shaped by the interplay of power
and various social factors such as gender, race, class, sexuality, ethnicity, culture, language, and
more.
My work in public-facing organizations has provided me with ample knowledge to see
beyond the institutional and structural norms of inequality that harm the opportunity, access, and
emotional well-being of Black, Indigenous, and other people of color. In this study, I navigated
my positionality by examining my inherent bias against inequitable organizations that have not
changed their leadership and accountability practices to be inclusive, comprehensive, and
representative and continue impacting communities of color.
Data Source: All-Staff Survey
I coded all survey data by assigning identification numbers to link individual pre- and
post-survey data. Only the research team could access the file containing names/emails and
identification numbers. I analyzed survey data to elucidate the following constructs: staff
attitudes about race and racism, staff perceptions of DOHMH’s commitment to addressing racial
inequity internally and externally, and staff perceptions about and experiences using existing
resources and available opportunities to promote racial equity and psychological safety. The
survey consisted of 6-point Likert scale questions, one representing strongly disagree, five
strongly agree, and six prefer not to answer.

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Participants
Out of 6,000 staff members and 13 divisions, I planned to have a mix of five staff
members and five senior leaders per division. The survey respondents were of various races and
ethnicities. All staff members were welcome to take part in the survey (Table 2), and all received
a link to take the survey. The survey involved no interactions with human subjects. I used an allstaff email distribution list to distribute the survey and invite staff to participate. I did not use
advertisements or flyers.

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Table 2
Survey
All-staff survey questions Concept being measured
To what extent is racism a workplace problem within the health
department?
Psychological safety
It is important to me to understand the beliefs and values of the
people I work with.
Values and belief systems
My colleagues support different cultural viewpoints and identities,
including mine.
Inclusion
How comfortable do you feel talking about racism with colleagues
of the same racial/ethnic or cultural background as your own?
Psychological safety
My chief/deputy commissioner communicates regularly about
reducing racial inequities.
Accountability
How often do you talk with your supervisor(s) about how your
work can address racial inequities?
Psychological safety
Our team makes sure to center institutional and structural causes of
health inequities, including policies (e.g., who can be insured)
and practices (e.g., who gets served) in our content.
Collective efficacy
Our team prioritizes efforts to be more inclusive of communities of
color and marginalized groups in its community engagement.
Collective efficacy
Our team consistently provides interpretation and translation
services for people with limited English proficiency.
Collective efficacy,
psychological safety
How comfortable do you feel reporting bias and oppression at the
health department?
Accountability
Do you know how to report bias and oppression at the health
department?
Psychological safety
How confident are you that the health department will properly
handle any reporting of bias and oppression?
Accountability
What barriers have you faced/are currently facing in advancing
racial equity and social justice? open-ended)
Psychological safety
Do you believe your feedback on improving processes and
promoting equity in your work is welcomed, valued, considered,
or incorporated? Why or why not? (open-ended)
Psychological safety, DEI,
and accountability
Instrumentation
This longitudinal study measured changes in staff beliefs, attitudes, and perceptions over
time. I used a longitudinal design based on assertions that anti-racist transformation is

21
challenging and takes time (Coleman-Burns et al., 2023). Additionally, the health department’s
anti-racism and psychological safety efforts will be implemented over several years; therefore,
the survey aimed to capture any shifts in beliefs or attitudes over several years. I used a pre-post
survey design to compare staff responses at baseline to their subsequent responses. The survey
will be conducted every 2 years and will take approximately 20 minutes to complete.
Data Collection Procedures
The survey was sent to all DOHMH staff using Microsoft Forms through an email
invitation. Respondents completed the survey online in a setting of their choice. I reported survey
data only in aggregate (i.e., 38% responded X). The data were not analyzed or reported on
groups with fewer than five respondents to ensure that demographic characteristics or job
responsibilities could not identify staff. In the future, pre-test and post-test methodology will be
used to compare the prior year’s all-staff survey to the current year’s all-staff survey. The
intention is to observe measurable change in staff attitudes and perceptions of race, racism, and
racial equity practices within the agency. Each respondent will be de-identified, which means
identifiable information will be removed; however, they will be assigned a re-identification code
to protect personal information.
Data Analysis
I analyzed the survey data regarding staff attitudes about race and racism, staff
perceptions of the DOHMH commitment to address racial inequity internally and externally, and
staff perceptions and experiences using existing resources and available opportunities to promote
racial equity. I analyzed the data through ATLAS.ti using open coding and developed a
codebook with 12 codes. The codebook facilitated the survey data analysis by assigning
variables for each survey question. Each variable denoted the question or topic to help

22
differentiate and identify the variables. I used descriptive statistical analysis to convey the
essential characteristics of the data by arranging the data into a more interpretable form and by
calculating the numerical indexes, including the median, average, sample size, confidence
interval of average, standard deviation, minimum, and maximum (Johnson & Christensen, 2019).
I downloaded the data from Microsoft Forms and converted them to Excel. Second, I
created separate Excel files using a template for agency findings and each division. Tabs were
made within each spreadsheet, labeled “Raw Data,” to include the variables and responses in
long form, with rows representing participants and columns for the variables. Lastly, I made
additional tabs for each component of the theory of change. The codebook outlined the survey
questions associated with each element.
Validity and Reliability
Validity refers to the extent to which the survey measures what it is supposed to measure
(Creswell, 2014; Salkind, 2017). An anti-racist survey that measures staff perceptions would
include questions to assess how well the questions captured the intended constructs of racism,
bias, discrimination, and equity within health services. There are different types of validity to
consider. Content validity ensures that the survey includes questions that comprehensively
address all aspects of anti-racism. For example, questions cover racial bias, discrimination
against staff, institutional practices, diversity training, hiring, and ensuring no critical topics are
left out. Construct validity ensures that the survey measures the concept of racism meaningfully,
aligning with CRT and social cognitive theories and research frameworks of racism and
discrimination. For example, items will accurately assess individual, interpersonal, and
institutional perceptions of racism. Criterion validity checks how well the survey’s results
correlate with other established measures of this survey to capture staff and leadership

23
experiences related to racial equity and reducing discrimination and oppression. Face validity
refers to whether the survey measures what it claims to be at a superficial level. If health
department staff review the questions and find them relevant and appropriate for assessing antiracism, the survey has face validity.
Reliability refers to the consistency and stability of the survey’s results over time
(Salkind, 2017). The reliability of this anti-racist survey produces similar results under consistent
conditions and ensures that its measurements are repeatable. There are several types of reliability
to consider. Measures of internal consistency pertain to how well the items in the survey
correlate with each other. For example, the survey includes multiple questions addressing similar
concepts, such as racial bias in health department settings. These items correlate and consistently
measure the same underlying construct (Salkind, 2017). Another type is pilot testing. I
distributed the survey to a group of equity professionals to conduct a pilot test to identify
ambiguities, biases, and inconsistencies in the questions and to test the survey’s performance in
measuring the target constructs. A third type is feedback from experts. I consulted with the pilot
group of professionals in racial equity, health disparities, and survey design to ensure the
survey’s content was relevant, accurate, and aligned with current anti-racism frameworks. A
fourth type is sensitivity. I ensured that all survey language was culturally appropriate and
sensitive to the diverse populations served by the health department. This study addressed both
validity and reliability, and the health department can become a powerful tool for measuring
progress toward equity and identifying areas that need further improvement.
Findings for Research Question 1
The first research question asked the extent to which staff members believe that the
health department’s internal and external policies, practices, and culture address racial inequities

24
and psychological safety. This report presents the findings from the all-staff survey administered
in early 2024. The survey aimed to measure staff beliefs, experiences, and attitudes toward race
and racism within the context of DOHMH. In total, 830 staff members representing 13 divisions
in the agency participated in the survey.
Organizational Influences
Figure 4 shows that 44% of the respondents believe the Health Department’s focus on
addressing racial inequities across New York City and within the Health Department is not
enough. The perception that the health department is not prioritizing racial equity could stem
from a lack of visible, consistent commitment from senior leaders. Staff may feel that leadership
is not held accountable for addressing racial inequities within the organization. There may be
institutional resistance to change at the leadership level. Like many large organizations, public
health departments can be slow to change, particularly when those changes require challenging
longstanding policies, practices, and mindsets.
In some cases, leadership may hesitate to take bold action on racial equity because they
fear controversy or backlash from within the organization or from political or community
stakeholders. This fear of rocking the boat could result in tepid or non-committal actions that fail
to address significant racial inequities. Additionally, in many public agencies, equity work is
often seen as an "add-on" or secondary priority compared to more operational goals, such as
improving healthcare access or responding to emergencies. If employees feel that racial equity
work is not embedded in the department’s core mission, this could make staff feel that the
department’s efforts are insufficient. There may be a disconnect between the Health
Department’s public health goals related to racial equity and the organization's internal culture.
For example, while the department might publicly commit to racial justice if its internal

25
practices, culture, or policies do not align with these goals, staff may perceive the efforts as
insufficient or disingenuous.
Figure 4
Percent Responding On The Extent To Which The Health Department Addresses Racial
Inequities Across New York City And Within The Health Department
Note. N = 830
Not enough
44%
Not enough
45%
0%
20%
40%
60%
80%
100%
Externally across New York City Internally within the Health Department

26
Figure 5 shows that nearly two-thirds of respondents view racism as a problem within the
health department as a workplace, with 37% responding that racism is a moderate problem and
23% responding that it is a severe problem. Figure 6 shows that of the respondents who view
racism as a serious problem at the health department (n = 193), those who identify as American
Indian/Native/First Nations had the highest percentage (44%), followed by Black or African
American (34%), and Latino/Latina/Latinx /Latine or Hispanic (29%). This finding indicates that
a significant portion of respondents (around 66%) perceive racism as a problem in their
workplace. The fact that this is nearly two-thirds of the workforce suggests that racism is not an
isolated issue but a systemic or widespread challenge that needs to be addressed at the
institutional level. This perception likely reflects issues ranging from microaggressions,
discrimination, and unequal opportunities for advancement to potentially more overt racial
prejudices or exclusionary practices. This percentage is quite high, which suggests that racism
within the health department is seen not just as an occasional or fringe issue but as something
that impacts most employees in some way.

27
Figure 5
Percent Responds to the Extent to Which Racism Is a Problem Within the health department as a
Workplace
Note. N = 830.
Figure 6
Breakdown of Respondents Who Agree or Disagree About Whether Programs, Policies, and
Practices Work Better for White People Than for People of Color
Note. n = 193.

28
Such a substantial number of respondents acknowledging racism as a workplace issue is
indicative of a significant gap in organizational culture, leadership, and the current diversity,
equity, and inclusion (DEI) efforts. The disparities in how these groups view racism within the
health department speak to the unique ways different racial and ethnic communities experience
discrimination and marginalization. This information can be critical for understanding the need
for targeted interventions and support systems that address the specific needs of each group. A
one-size-fits-all approach to anti-racism efforts is unlikely to be effective in addressing the
nuanced and varied experiences of these communities.
Additionally, as Figure 7 shows, about one-third of respondents agreed that policies and
practices work better for White people than for people of color, whether intentionally or not,
while one-third neither agreed nor disagreed about organizational programs. This finding is
significant because it suggests that approximately 33% of respondents believe that the
organization’s policies and practices favor White employees over people of color, either
intentionally or unintentionally. This perception of racial disparities, whether overt or subtle,
indicates the presence of systemic inequality within the organization’s structures.
Racial inequities in policies and practices can manifest in many forms, such as unequal
access to opportunities for promotion, bias in hiring or performance evaluations, or disparities in
pay and benefits. These structural inequities can exist even if there is no overt intention to
discriminate. For example, if a policy is designed without considering the specific needs of
people of color or if its outcomes disproportionately harm marginalized groups, the result is still
racial inequity. Because historical legacies of racism and exclusion influence organizational
policies and practices, long-standing systems, practices, and cultural norms might have been

29
built in ways that implicitly benefit White employees, and undoing these entrenched practices
requires a conscious effort at deconstruction and reform.
Figure 7
Percent of Respondents Who Agree or Disagree About Whether Programs, Policies, and
Practices Work Better for White People Than for People of Color
Note. N = 830

30
The third of respondents who were neutral or undecided about the effectiveness of
organizational programs is a critical group to understand. Employees may not have enough
information or awareness about the organizational programs. This result could indicate that the
programs, initiatives, or policies addressing racial inequities have not been adequately
communicated to or implemented for employees. Employees not fully understanding what
programs exist or how they are designed to address racial disparities could explain the
ambivalence or lack of engagement. Alternatively, employees may be aware of these programs
but feel they do not have a meaningful or tangible impact on the workplace or racial inequities.
Employees may be indifferent or skeptical about their effectiveness if they perceive
programs as superficial or performative (e.g., one-time training sessions or symbolic diversity
statements without concrete actions). A neutral response could reflect a sense of resignation or a
belief that these programs are not substantively changing the organizational culture or structural
inequities. In some cases, employees may hesitate to agree or disagree with the statement
because of fear of retaliation or repercussions. For example, employees who feel that speaking
out about racial inequities could jeopardize their job security or career advancement might opt to
stay neutral, even if they privately think the policies or programs are ineffective.
In summary, the statement illustrates a significant divide in employee perceptions
regarding organizational policies and programs related to racial equity. One-third of respondents
perceived racial inequities in the policies and practices, while another-third remained neutral
about the effectiveness of organizational programs. These findings suggest that while some
employees see apparent issues with systemic racism within the organization, others feel
ambivalent, possibly due to a lack of information, program effectiveness, or fear of speaking out.

31
Findings for Research Question 2
The second research question asked what the organization’s values and beliefs are
regarding leadership and accountability. An organization’s values and beliefs are a foundation
for its policies, practices, and decision-making processes. When these values are clear and rooted
in a commitment to anti-racism and equity, they ensure that leadership decisions consistently
align with these principles. This alignment helps guide actions that support inclusive practices,
fairness, and justice throughout the organization. Without a strong framework around these
values, decisions might inadvertently reinforce systems of inequality.
According to survey results, most respondents (88%) agreed or strongly agreed that
understanding their colleagues’ beliefs and values is important to them (Figure 8). This result
reflects a strong collective belief in the workplace’s importance of interpersonal understanding
and empathy. The high percentage underscores several key insights regarding workplace culture,
collaboration, and organizational climate. This finding points to a growing recognition that a
diverse workforce is not just about demographic differences, as it also involves a variety of
worldviews, belief systems, and values. In multicultural and varied workplaces, cultural
competence—the ability to understand, appreciate, and effectively navigate these differences—is
increasingly valued.

32
Figure 8
Percent of Respondents That Agree or Disagree It Is Important to Them to Understand the
Beliefs and Values of the People They Work With
Note. N = 830
Respondents were generally comfortable talking about racism with colleagues. Still,
fewer respondents felt comfortable talking with colleagues of different racial/ethnic or cultural
backgrounds than with colleagues of the same racial/ethnic or cultural backgrounds (26%, Figure
9).

33
Figure 9
Percent of Respondents Selected How Comfortable They Feel Talking About Racism With
Colleagues With the Same Racial/Ethnic or Cultural Backgrounds As Their Own or Different
From Their Own
Note. N = 830
Responses regarding comfort levels in discussing racism within DOHMH revealed how
unsafe spaces significantly hinder equity work. The impact of non-participatory management is
that respondents expressed fear in speaking up about the ways the department fails people of
color. Staff feeling unsafe discussing racism or providing candid feedback stifles open dialogue
and prevents meaningful progress. The perception that leadership needs to be more concerned
with genuine participative feedback further exacerbates this issue, leading to a lack of trust and
diminishing the agency’s ability to address systemic inequities effectively. Fostering an
environment where all voices are valued and protected is necessary for the work toward equity
and justice to succeed.

34
Figure 10
Percent Responding How Often They Talk With Their Supervisor(s) About How Their Work Can
Address Racial Inequities Externally and Internally (N = 830)
Note. N = 830
The data provide insights into how supervision, communication patterns, and racial
equity discussions are perceived and practiced within the organization. Figure 10 reveals several
important dynamics, including the frequency of supervisor-employee interactions about racial
inequities and these conversations’ internal versus external focus. According to survey data,
supervisors talk less often about addressing inequities internally within the agency than
externally across NYC. Many respondents stated they never speak with their supervisors about
how their work could address racial inequities. This observation is significant because it suggests
that conversations about racial inequality within the workplace—especially about the specific job
that staff members are doing—are infrequent or nonexistent.
This result points to a potential gap in the organization’s commitment to addressing
systemic racism internally. The external focus on racial inequities may be part of a broader
Never
27%
Never
33%
At least once a
month
23%
At least once
a month
20%
0%
20%
40%
60%
80%
100%
Externally across New York City Internally within the Health Department

35
public relations strategy, where the organization seeks to present itself as a leader in advocating
for racial justice in the community. However, having these external commitments not reflected in
the internal culture and practices of the organization can create a credibility gap. Employees may
feel that the organization is paying lip service to racial equity, espousing progressive values
externally but failing to address those same issues within its walls meaningfully. Suppose
employees are not regularly engaging with supervisors about how their work can address racial
inequities. In that case, it might indicate a lack of integration of racial equity principles into dayto-day operations. For example, racial equity might not be embedded into performance reviews,
goal-setting conversations, or professional development opportunities, typically the domains
where supervisors and employees regularly interact. This lack of dialogue could signal that racial
equity work is not prioritized at the individual staff level despite being a more visible topic at
higher organizational levels or in external outreach efforts.
Additionally, Supervisors may avoid these conversations because they are uncomfortable
with the subject matter or unaware of how to address racial inequities in a productive and
supportive way. Employees may feel that discussing these issues with supervisors could lead to
negative consequences, such as a lack of support or potential career risks, especially if
supervisors do not value or prioritize such discussions. This absence of conversation might be
indicative of an environment where racial inequities are either overlooked or not given sufficient
attention despite the growing societal and institutional calls for racial equity. Without these
discussions, there is limited opportunity for employees to align their work with equity goals or
for supervisors to provide guidance or support.

36
Findings for Research Question 3
The third research question asked what environmental and behavioral factors influence
equitable and psychologically safe work environments.
Training and Professional Development
In the past 12 months, 48% of respondents (n = 397) attended or participated in training
or professional development related to reducing racial inequities at the health department. Forty
percent answered that their supervisor was highly supportive of them attending racial equity
training, which is a promising sign but also reflects an area for improvement. Supervisor support
plays a critical role in employee engagement with training and professional development
opportunities, especially regarding sensitive and potentially uncomfortable topics like racial
inequity.
Most respondents indicated that the training increased their understanding, with more
selecting somewhat or moderately. While 48% participation is a notable figure, it also means that
more than half of the employees (52%) did not engage in this type of training. This gap suggests
there may be several barriers preventing full participation, such as limited availability of training
opportunities, lack of time, lack of awareness about the training, or possible employee resistance
to engaging with issues of racial inequity. It could also reflect organizational challenges in
ensuring equitable access to training for all staff, particularly those in lower-level positions or
those who may not have direct access to training opportunities. Ideally, to significantly reduce
racial inequities, such training programs should aim for 100% participation, particularly in an
organization committed to addressing these issues. The fact that half of the respondents did not
participate may highlight a need for better outreach, more accessible training formats (e.g.,
virtual options), or a stronger emphasis on making such programs mandatory or incentivized.

37
Figure 11
Percent of Respondents Selecting the Extent to Which the Training or Professional Development
Opportunities They Attended in the Past 12 Months Increased Their Understanding
Note. n = 397
As Figure 12 shows of the respondents who attended training or professional
development in the past 12 months, attendance was highest among those who identified as White
(59%). The lowest proportion was reported by those who identify as American Indian, Native,
First Nations, or Indigenous peoples of America (33%). Among survey respondents who
attended or participated, more answered that the learning opportunities somewhat/moderately
(41%) increased their understanding of how equity is related to their work at the health
department.

38
Figure 12
Breakdown of Respondents by Race/Ethnicity Who Answered They Attended or Participated in
Training or Professional Development Related to Reducing Racial Inequities at the health
department in the Past 12 Months
Note. n = 397
Addressing Racial Inequities
The data analysis revealed that 70% of respondents are a little/somewhat active, 42% or
not at all active 28% in addressing racial inequities within the health department (Figure 13). Of
the 70%, 41% responded that they want to be more active, 35% are not sure, and 20% do not
want to be more active. The fact that 70% of respondents reported being a little or somewhat
active in addressing racial inequities indicates a significant proportion of employees who are at
least engaged with the issue. This result suggests that many individuals within the health
department know racial inequality and may address it through formal initiatives, informal
conversations, or individual actions.
A notable finding is that 42% of respondents reported being not at all active in addressing
racial inequities within the health department. Figure 13 suggests that a significant portion of the
workforce is either disengaged or feels powerless to contribute to efforts aimed at reducing racial
inequality. This non-participation could be due to various factors, including lack of awareness,

39
training, or resources, fear of retaliation, lack of organizational support, or a sense that
addressing racial inequities is outside their professional responsibilities. The fact that a
substantial portion of employees is not engaged points to a barrier to engagement within the
organization that needs to be identified and addressed to make systemic changes.
Figure 13
Percent of Respondents Answered How Active They Are at Addressing Racial Inequities Within
the Health Department
Note. N = 830

40
The respondents’ answers regarding whether they wanted to be more active varied by
their length of time at the agency (Figure 14). Most staff who worked for fewer than 5 years
responded that they would like to be more active than staff who have been at the agency for 5 or
more years (Figure 15).
Figure 14
The Percentage of Respondents Answering Whether They Want to Be More Active. The Sample
Includes Respondents Who Are Not at All, a Little, or Somewhat Active
Note. n = 583

41
Figure 15
Breakdown of Respondents Who Want to Be More Active by Length of Time at the health
department Who Want to Become More Active in Addressing Racial Inequities
Note. n = 583
When asked what would help them increase their involvement in addressing racial
inequities at the health department, nearly all respondents selected more information about racial
equity strategies and training related to racial equity and social justice principles (Table 3). The
results show that almost all respondents selected the need for more information about racial
equity strategies and training related to racial equity and social justice principles, indicating that
lack of knowledge and training are significant barriers to deeper engagement. This result aligns
with broader findings in many organizations where employees want more guidance on engaging
with complex issues. The need for more training reflects that staff, even if they are somewhat
engaged in racial equity efforts, feel underprepared or unsure about tackling these issues in their
day-to-day work. Many may be motivated to act but need more structured learning to understand

42
the theories, concepts, and practical strategies behind addressing racial disparities in a health
context.
Table 3
Selections Regarding What Would Increase Involvement
Number of times selected
More information about racial equity strategies 828
Training related to racial equity and social justice principles and
strategies
826
Specific tools and materials to help me implement racial equity
strategies
1
Prefer not to answer 1
Other: Not interested in increasing involvement at this time 1
More time during the day to be more involved 0
Support from my supervisor or manager 0
More resources (e.g., funding, staffing) dedicated to advancing
racial equity
0
Note. N = 830

43
Organizational Accountability
A key part of fostering a healthy and supportive environment is ensuring all employees
feel safe, valued, and respected. When staff know how to report bias and oppression, they can
take action to address harmful behavior and practices. Thus, they create a culture where
discrimination and exclusion are less likely to be tolerated, making everyone feel more secure
and included. The data analysis revealed that more than half (54%) of respondents know how to
report bias and oppression at the health department. Figure 16 shows how comfortable staff are
with reporting bias and oppression. Many respondents indicated they are somewhat/moderately
comfortable (42%) doing so. Notably, about one-quarter (24%) of respondents indicated they are
not at all comfortable.

44
Figure 16
The Percentage of Respondents Answered How Comfortable They Are Reporting Bias and
Oppression at the Health Department
Note. N = 830
Figure 17 shows the breakdown of respondents by race and ethnicity for the 24% (n =
203) who indicated they were not at all comfortable reporting bias and oppression. Among them,
the highest number of respondents preferred not to provide their racial or ethnic identity.

45
Figure 17
Breakdown of Respondents by Race and Ethnicity Who Responded They Are Not at All
Comfortable Reporting Bias and Oppression
Note. n = 203
When asked how confident they feel about reporting bias and oppression, less than 20%
of respondents felt confident that the health department would appropriately handle any reporting
of bias and oppression. In contrast, 44% were somewhat/moderately confident, and 33% were
not at all confident (Figure 18).

46
Figure 18
The Percentage of Staff Answering How Confident They Are That the Health Department Will
Properly Handle Any Reporting of Bias and Oppression
Note. N = 830
Figure 19 shows the breakdown of respondents by race and ethnicity who reported they
are not at all confident the health department will properly handle reports of bias and oppression
(n = 273). Those who identify as more than one race had the highest percentage (48%), followed
by staff who preferred not to provide their racial or ethnic identity (43%) and those who identify
as Black or African American (40%).

47
Figure 19
Breakdown of Respondents by Race and Ethnicity Who Responded They Are Not at All Confident
the Health Department Will Properly Handle Any Reporting of Bias and Oppression
Note. n = 273
More than half (54%) of respondents indicated they know how to report bias and
oppression at the health department. This result is a positive sign, suggesting that at least a
significant portion of the workforce is aware of the formal channels available for reporting such
incidents. Awareness of reporting mechanisms is crucial because it represents the first step
toward addressing issues of discrimination and oppression within the workplace. If employees
are unsure of how to report incidents, those issues are likely to go unaddressed, allowing bias and
oppression to persist. However, only 54% of respondents feel they know how to report,
suggesting that more than 40% are either unaware or unclear about how to engage with these
processes. This gap indicates a communication or training failure regarding reporting procedures.
It suggests the need for more precise, more accessible information about reporting incidents and
more substantial promotions of these resources, so employees feel confident utilizing them when
necessary.
Forty-two percent of respondents reported feeling somewhat or moderately comfortable
with reporting bias and oppression. This is a mixed finding. On the one hand, a significant

48
portion of staff feels somewhat comfortable using the reporting mechanisms. On the other hand,
terms like “somewhat” and “moderately” suggest uncertainty or hesitation, indicating that these
respondents may not feel fully confident or secure in reporting incidents of bias or oppression.
Moderate comfort could also imply a lack of empowerment. Employees might feel somewhat
comfortable with the process but may need more assurance or training to be completely
confident in reporting incidents.
A concerning 24% of respondents indicated that they are not at all comfortable reporting
bias and oppression. This represents a significant portion, suggesting that about one-quarter of
the workforce may feel completely disempowered or fearful of reporting such incidents.
Employees in this group might believe that reporting bias and oppression could lead to punitive
measures or negative career consequences. They may also fear social isolation or damage to their
professional reputation, especially if they are from marginalized groups or already feel
vulnerable within the organization. If employees feel that the system for addressing complaints is
ineffective or that previous reports have not resulted in meaningful outcomes, they may be
reluctant to engage with the process. This hesitance could stem from a lack of follow-through or
accountability on the part of leadership. Concerns about the confidentiality of the reporting
process may deter employees from coming forward, particularly if they believe their complaints
will be shared without their consent.
Training staff on reporting bias and oppression is not just a procedural matter; it is
integral to building a fair, just, and thriving organizational culture. It empowers individuals,
creates accountability, and fosters a work environment where everyone can succeed and feel
valued. When employees know how to report bias and oppression, they feel empowered to speak
out against injustice. This empowerment is essential for creating a positive organizational culture

49
where all voices are heard and respected. It encourages a proactive stance on social issues rather
than a reactive one.
Summary
The survey reveals that racism is widely recognized as a significant issue affecting the
health and well-being of people of color in NYC and within the health department itself. Nearly
two-thirds of respondents believe racism exists in the workplace, with about one-third indicating
that organizational policies and practices may unintentionally benefit White employees more
than people of color, suggesting systemic issues in the health department’s infrastructure.
Respondents value understanding their colleagues’ beliefs and values, though comfort levels
vary based on shared racial/ethnic or cultural backgrounds. While most supervisors support
participation in learning activities, only half of respondents attended any in the past year, with
attendance being highest among White staff.
The survey results indicate that addressing racial inequities is not a significant part of
day-to-day work, with 70% of respondents indicating they are minimally or not at all active in
addressing these issues. However, 41% of these employees desired to become more involved,
particularly those with less than 5 years of tenure at the agency. Respondents overwhelmingly
requested more information and training on racial equity and social justice to increase
participation. Most respondents felt the focus on the health department’s efforts to tackle racial
inequities must be improved. While just over half of respondents knew how to report bias and
oppression, their comfort with doing so varied, and less than 20% were confident that reports
would be handled properly. A significant portion (33%) needed more confidence in reporting.

50
Overall, the survey results highlight a need for greater transparency, support, and
involvement in addressing racial equity within the health department and improvements in the
reporting mechanisms for bias and oppression.
Recommendations
Social cognitive theory, developed by Albert Bandura, focuses on how people learn from
their environments through observation, imitation, and modeling and how personal, behavioral,
and environmental factors influence them. The theory highlights the importance of self-efficacy,
observational learning, and reciprocal determinism in shaping behavior.
Discussion of Findings
In the context of the health department’s need for greater transparency, support, and
involvement in addressing racial equity, as well as improvements in the reporting mechanisms
for bias and oppression, SCT provides a valuable framework for understanding how
organizational change can occur and why it is necessary to foster an environment that supports
equity.
Self-Efficacy and Confidence in Reporting
Self-efficacy refers to an individual’s belief in their ability to execute actions to achieve a
goal. People are more likely to take action, such as reporting bias or participating in equity
efforts, when they feel confident that their actions will lead to positive outcomes. The survey
suggests that a significant portion of respondents (33%) lack confidence in the health
department’s ability to handle reports of bias and oppression. According to SCT, if employees
believe that their reports will be taken seriously and lead to change, their self-efficacy to report
will improve. This can be achieved by creating a transparent system that consistently responds to
bias and oppression, fostering higher levels of trust and engagement. Increasing self-efficacy

51
could involve clear communication, ongoing feedback, and visible outcomes from reported
incidents.
Observational Learning and Leadership Modeling
Observational learning emphasizes role models in shaping behavior. Individuals learn
and adopt behaviors by observing others, particularly those in leadership roles. The survey
findings indicate that many respondents value the support of their supervisors for attending
training and learning activities, but attendance is still low, especially among people of color.
Suppose leadership actively models behavior that promotes racial equity (e.g., participating in
training, addressing racial inequities publicly, and demonstrating accountability for bias-related
incidents). In that case, staff are more likely to imitate these behaviors. The presence of visible
role models committed to racial equity and anti-racism will encourage more employees to
engage in similar actions. Organizational leaders must model transparency and active
involvement in equity efforts, demonstrating that addressing racial disparities is not optional but
a central part of the organizational culture.
Reciprocal Determinism
Reciprocal determinism posits that personal, behavioral, and environmental factors all
influence each other in a continuous loop. Changes in one area can lead to changes in the others.
The survey results highlight that many respondents feel that racial inequities are not adequately
addressed in day-to-day work, and a large portion desires more information and training. Social
cognitive theory suggests that to create lasting change, the health department must address all
three factors—individual behaviors, organizational practices, and environmental factors—in an
interconnected way. For example, employees may need more training and tools for personal
factors to recognize and address racial inequities. Providing opportunities for learning increases

52
their self-efficacy and involvement. Encouraging staff to participate in racial equity initiatives or
to report bias requires behavioral modeling and support from leadership. The organizational
environment must provide a safe, transparent, supportive system for reporting and addressing
racism. Improvements to reporting mechanisms—such as more transparent, accessible
processes—can facilitate action and ensure that employees believe their voices will be heard and
acted upon.
Building a Supportive Environment for Equity
Creating an environment that supports positive behaviors and provides reinforcement is
key to encouraging change. Transparency, support, and involvement in racial equity efforts are
key environmental factors influencing employees’ willingness to engage with these issues. A
supportive work environment, where employees feel safe to report discrimination and bias,
aligns with the SCT notion that individuals are more likely to engage in behaviors when the
environment reinforces those behaviors (through encouragement, clear policies, and visible
outcomes). Without a supportive and transparent environment, employees may not feel
psychologically safe or motivated to address racial inequities or report bias. Transparency in
handling reports and a clear connection between reporting and tangible outcomes would
encourage greater involvement and action.
Psychological Safety and Organizational Equity Recommendation
Clear communication and training on reporting and accountability will ensure that all
employees know how to report incidents of discrimination, bias, or harassment and feel
confident that their concerns will be taken seriously. This includes having explicit whistleblower
protections and safe channels for reporting. Training programs focused on bias, equity, and
inclusion should be mandatory, emphasizing the importance of psychological safety in allowing

53
employees to speak up. These programs should also include anti-racism training to equip
employees with the skills needed to identify and address bias and oppression in their daily work.
Systems for feedback and self-assessment will allow employees to regularly voice
concerns and suggest improvements to the organization’s psychological safety and equity efforts.
This could include regular employee surveys to assess feelings of psychological safety and
perceptions of equity. The organization should also implement anonymous feedback channels
where employees can safely report issues and propose solutions. Leaders should ensure that the
feedback received is acted upon promptly and clearly, demonstrating the organization’s
commitment to learning and improvement. The organization must leverage leadership’s
commitment to equity through transparent communication about the organization’s commitment
to creating an equitable workplace and ensuring psychological safety for all employees. To
ensure inclusive leadership practices, leaders should foster a climate where every employee feels
comfortable sharing their perspective, whether a new hire or a senior leader. They should also
actively seek diverse perspectives, including those of employees from historically marginalized
groups, in decision-making and policy development.
Mental health support should be integrated into the workplace to ensure that employees
who experience discrimination or bias have access to counseling and resources that help them
cope with stress, trauma, and burnout. Lastly, leaders should recognize and reward individual
and team efforts that create a more equitable and psychologically safe work environment. This
could include publicly celebrating diverse perspectives and contributions to the organization’s
equity work, empowering employees to lead equity-related initiatives, and giving them the
support and resources needed to succeed.

54
Conclusion
Social cognitive theory emphasizes the interconnectedness of individual beliefs,
behaviors, and environmental factors. For the health department to improve its approach to
addressing racial equity and enhancing reporting mechanisms, it is essential to Boost employees’
self-efficacy by building confidence that reporting bias or participating in racial equity initiatives
will lead to meaningful change. Leverage observational learning by having leadership model the
behaviors they wish to see, showing commitment to racial equity through action. Create a
supportive and transparent environment that reinforces positive behaviors, such as addressing
racial inequities and ensuring employees feel safe and empowered to report bias or
discrimination. By applying these principles, the health department can better align its practices
with its employees’ needs and work toward a more equitable and psychologically safe workplace
culture.
Limitations and Delimitations
When designing and implementing this survey to assess health department staff beliefs,
attitudes about race and racism, and perceptions of the agency’s commitment to addressing racial
inequities, it was essential to identify the study’s limitations and delimitations. These concepts
helped set the scope of the survey and clarify potential challenges and constraints that may
impact the findings. Since the survey assessed personal beliefs, attitudes, and perceptions, staff
responses may have been influenced by social desirability bias (i.e., the tendency to provide
answers that align with what is perceived to be socially or institutionally acceptable). Participants
may not have fully disclosed their true beliefs about race and racism due to fear of judgment,
professional repercussions, or lack of trust in the survey’s confidentiality. Given the limited
scope of questions, the survey may not have captured all dimensions of racial equity and

55
systemic racism, especially if the questions were too broad, too narrow, or not inclusive of the
lived experiences of all racial groups. The framing of questions may have unintentionally
omitted key aspects of racial issues that are relevant to different staff members, leading to
incomplete data about staff perceptions of racism and racial inequities.
Also, if a survey does not reach a diverse and representative sample of staff (for example,
racial or demographic groups may be underrepresented), the results may not fully reflect the
attitudes and perceptions of the entire target population. Pertinent to this study, staff members
who feel less comfortable engaging in race discussions or are more likely to hold biased views
might have been less likely to participate, skewing the results. Health department staff may
experience survey fatigue, especially if they are asked to complete multiple surveys or if the
survey is long or overly complex. A low response rate can lead to non-response bias, where nonrespondents’ opinions may differ systematically from those who did respond, limiting the
generalizability of the results. Lastly, some survey questions were open-ended; interpreting these
responses can be subjective.
Different researchers or analysts might interpret the same response differently, leading to
inconsistencies in the data analysis. Changing organizational dynamics mean that perceptions
about race and the health department’s commitment to addressing racial inequities may fluctuate
over time due to organizational changes, shifts in leadership, or policy reforms. A snapshot
survey may not fully capture the long-term trajectory of attitudes or the impact of any
interventions. Limitations and delimitations are essential for interpreting the results in context
and understanding the study’s generalizability, credibility, and utility in shaping future anti-racist
policies and practices within DOHMH.

56
Recommendations for Future Research
Further research is needed to understand organizational leaders disconnect in creating
vulnerable and transformative work environments. Leadership is pivotal in shaping the culture,
practices, and behaviors that define the workplace. However, even the most well-meaning
leaders can unintentionally create environments resistant to change, unwelcoming to diverse
perspectives, or inequitable. By conducting more profound research into leadership resistance or
lack of investment, organizations can uncover the root causes of these challenges and design
more effective strategies to foster vulnerability, authenticity, and transformation. Future research
can uncover a few essential areas.
Identifying Unconscious Bias and Blind Spots
Leaders, like all individuals, may have unconscious biases or blind spots that influence
their decisions, behaviors, and interactions, often without realizing it. These biases can manifest
in ways that perpetuate inequality, silence marginalized voices, or hinder innovation. Research
into leadership pitfalls can help identify where and how these biases emerge in leadership
practices, whether in recruitment, promotions, feedback, or day-to-day interactions.
Understanding these pitfalls allows leaders to take corrective actions to mitigate their impact,
creating a more inclusive and equitable environment. For example, a leader may unintentionally
favor certain employees based on shared cultural backgrounds or similar career experiences.
Research could uncover how this affects diversity and inclusion efforts, enabling targeted
interventions to ensure all voices are heard and valued.
Enhancing Emotional Intelligence and Empathy
Leadership pitfalls often arise from a need for more emotional intelligence (EI),
particularly when managing conflict, providing feedback, or handling sensitive issues like race,

57
identity, and privilege. Further research into leadership pitfalls can uncover areas where leaders
may struggle with empathy or fail to recognize the emotional needs of their teams. By
understanding these challenges, leaders can better develop their EI, leading to more
compassionate, empathetic, and supportive leadership practices. For example, a leader might
avoid addressing uncomfortable topics like racial inequity because they fear causing tension.
Research could explore how leaders can be trained to approach these conversations with
empathy and confidence, allowing them to create spaces where employees feel safe to be
vulnerable and engage in transformative discussions.
Improving Decision-Making and Inclusivity
Leaders often make decisions that directly shape organizational culture, but limited
perspectives or outdated assumptions can cloud those decisions. Further research into leadership
pitfalls can reveal how decision-making processes might unintentionally favor certain groups,
reinforce systemic inequalities, or discourage diverse viewpoints. By examining these dynamics,
organizations can develop more inclusive decision-making frameworks that ensure all employees
have a voice and that diversity and equity are prioritized in organizational choices. For example,
suppose a leadership team consistently selects employees from similar demographic backgrounds
for key projects or leadership roles. In that case, research might uncover this as a pitfall,
prompting implementing more inclusive processes that ensure diverse talent is recognized and
promoted.
Supporting Long-Term Change and Transformation
Transformative work environments require ongoing commitment and sustainable change.
Leadership pitfalls often stem from short-term thinking or a failure to embed long-term strategies
for addressing challenges such as racial inequity, diversity, and inclusion. Research can shed

58
light on why some leaders falter in sustaining efforts toward transformation or why change
initiatives lose momentum over time. Understanding these pitfalls can guide the creation of
frameworks for sustained leadership commitment to long-term change, ensuring that
transformation is not just a momentary initiative but an ongoing process. For example, a leader
may start an initiative to address racial inequity but fail to allocate resources or follow through
on commitments due to competing priorities. Research could identify gaps in leadership
commitment or accountability mechanisms, helping to create structures that ensure continuous
progress and alignment with equity goals.
Promoting Vulnerability and Psychological Safety
Vulnerability is a cornerstone of a transformative work environment because it allows
employees to share their ideas, mistakes, and experiences openly, fostering creativity and
innovation. However, leaders often struggle with creating spaces where vulnerability is valued,
mainly when addressing complex or sensitive topics. Research into leadership pitfalls can help
identify why leaders might avoid creating such spaces, whether due to fear of losing control,
concerns about undermining authority, or lack of awareness of the importance of psychological
safety. For example, a leader may feel uncomfortable allowing team members to share feedback
about their leadership style or decisions, fearing it will lead to criticism or disrupt harmony.
Research could uncover how leaders can shift their mindset to view vulnerability as a strength
and a critical element of growth, helping to establish an environment where everyone feels safe
to speak up.
Strengthening Organizational Trust and Communication
Trust is essential for creating a transformative work environment. However, leadership
pitfalls like inconsistency, lack of transparency, or failure to follow through on promises can

59
erode trust. Research can help leaders understand the dynamics undermining trust, such as
misaligned actions and words or a lack of clear communication. Organizations can develop
strategies to build and maintain trust by identifying these pitfalls through transparent decisionmaking, clear communication, and visible accountability. For example, a leader may promise to
implement diversity training but fail to do so in a timely or meaningful way. Research into
leadership pitfalls could uncover how leaders can better manage expectations, communicate
progress, and deliver on their commitments to rebuild and strengthen trust within the
organization.
Creating a Culture of Continuous Learning and Adaptation
Leadership is an ongoing learning process. Further research into leadership pitfalls can
uncover how leaders might fall into the trap of relying on outdated models, resisting feedback, or
failing to adapt to evolving workplace dynamics. This research can help organizations create
learning environments where leaders continually develop their skills, seek feedback, and adapt to
new challenges, especially those related to racial equity and social justice. For example, a leader
may resist adopting new strategies for addressing inequity, relying on old methods that no longer
work or alienate employees. Research can explore how leadership can cultivate a continuous
learning mindset, encouraging leaders to adapt their approaches and stay aligned with evolving
standards of equity and inclusion.
Conclusion
Further researching leadership pitfalls is vital for creating vulnerable and transformative
work environments because it allows organizations to identify and address the underlying
obstacles that prevent growth, inclusivity, and meaningful change. By understanding how
leadership behaviors, mindsets, and actions can either facilitate or hinder the creation of

60
psychologically safe, equitable, and innovative workplaces, organizations can take proactive
steps to improve leadership practices, foster a culture of vulnerability, and drive lasting
transformation. This research equips leaders with the knowledge and tools to navigate complex
challenges, build trust, and ensure that all employees feel empowered to contribute to the
organization’s evolution.
Equity and psychological safety are essential for fostering a positive and cohesive
organizational culture. When an organization fails to consider equity and the emotional wellbeing of its staff through a human development perspective, it can lead to turmoil, especially in
response to critical incidents. While people are increasingly aware of their rights regarding
equity, equality, inclusion, and justice, there is also a growing awareness of harmful and toxic
work environments. It is crucial to assess a leader’s approach using the four frameworks—
structural, human resource, political, and symbolic—as these directly influence the
organization’s health. Evaluating the work culture and understanding staff’s psychological needs
will help pinpoint areas for improvement, ultimately strengthening the organization’s efforts to
advance racial equity and social justice. Within DOHMH, internal equity plays a critical role in
staff’s ability to perform their roles effectively, which in turn impacts the health outcomes of
New York City residents.

61
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Abstract (if available)

Abstract This study examined the role of psychological safety in promoting equity and inclusion within the New York City Department of Health and Mental Hygiene (DOHMH). Specifically, it explored strategies for cultivating leadership practices and accountability systems that create an inclusive and psychologically safe work environment. This study utilized social cognitive theory and critical race theory to understand the links between staff motivation, behavior, cognition, and performance in an organizational setting. The study used a mixed-methods approach to examine the research problem. There were 830 survey respondents out of 6,000 staff members who participated. The quantitative research study allowed me to explore healthy organizational practices and accountability systems toward a psychologically safe environment for staff members. This research involved semi-structured surveys. The findings of this study illustrate a significant divide in employee perceptions regarding organizational policies and programs related to racial equity. These findings suggest that while some employees see apparent issues with systemic racism within the organization, others feel ambivalent, possibly due to a lack of information, program effectiveness, or fear of speaking out.

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Creator Bralock McCoy, Stefani (author)

Core Title Foundational practices of structural change: the relationship of psychological safety and organizational equity

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Degree Conferral Date 2024-12

Publication Date 01/23/2025

Defense Date 01/16/2025

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