Interview with an Upstander

I first met Paul D'Aquila during his employment interview for the healthcare professional liability insurance carrier where I was already employed. He was an experienced and knowledgeable industry attorney, and our team was excited to have him join the organization. After years of witnessing his exceptional work ethic and his knack for unapologetic EDI allyship, I dubbed him our resident "upstander." (No, I did not tell him about the new moniker.)

Mission statements and EDI policies alone cannot change a less inclusive workplace culture. Instead, research concludes that employees' everyday EDI support and related actions, or allyship, are key to addressing issues and advancing interventions. Workplace allies can inspire others to act as change agents and assist with creating a culture of inclusivity. These allies are often termed "upstanders." An upstander is someone who intervenes when an individual or group is verbally or physically attacked, bullied, or excluded by others.

While the onus to create organizational culture change cannot fall solely to individuals, organizations and systems are composed of people. Thus, activating individuals collectively to build workplace environments rich in belonging and inclusivity can have a lasting impact. In this article, I will share an interview with one of the most notable upstanders I know, Paul D'Aquila, RN, Esq.

"Changing the day-to-day experiences of people in the workplace means you have to change the culture. If you're going to change the culture, that means you need all employees at every level to activate and to be part of the solution," says Rachel Thomas, co-founder & CEO of LeanIn.Org and OptionB.Org.
        

Question: Can you give me a brief overview of your nursing career and subsequent entry into healthcare law and risk management?

Answer: My first job as a nurse was in a small emergency department in a Catholic-run hospital in Inglewood, California. It has since closed. I joined nursing at a time when there were very few males, so most of my mentors were women. Because of the physical location of the hospital, they were African American. As a matter of fact, that was the most diverse team I have ever worked with. We had African Americans, Asians, Latinx, Hispanic, and LGBTQ team members. It was the most enjoyable time I've had doing direct patient care. We were a close-knit group. Later, I moved from there to an oncology unit. It was the height of the AIDS epidemic, and we were treating as many AIDS patients as those with cancer. That was a difficult time, but I am glad I got to help so many people. However, law school had always been a dream of mine, and I decided to just go for it.

At the time, I did not know I could marry the two professions, so after passing the bar, I went to work in the district attorney's office and tried cases. I found I was still able to help people who were disadvantaged in some way. I did pro bono work to assist the elderly. Later, because I missed healthcare, I became Healthcare General Counsel at St. Vincent Medical Center. It has since closed. Then, I became the Director of Risk Management and Patient Safety for a large professional liability insurance carrier. Now, I'm at a large university health system, serving as the Director of Professional Liability. Throughout my career, helping patients, families, and employees gave me the most joy and satisfaction.

Question: When you worked in the district attorney's office, you said you were doing some pro bono work for the elderly. Can you elaborate?

Answer: Sure. At that time and until this very day, I do pro bono work for older people who are financially abused. I help with probate law dealing with wills and trusts. These folks are so vulnerable, and abuse is rampant. I also sit on the board of a non-profit animal's rights group to assist with legal issues. I've always been for the underdog, you might say.

Question: So, you've always been an upstander. Is that fair to say?

Answer: Well, maybe it would be better to say that I was taught to do the right thing, and I've always tried to be true to that. I think in certain situations, that is what is meant by upstander. Also, I can't take credit. Growing up, I lived in an all White community, but diversity and inclusion were always important to my mother, Annmarie D'Aquila. She took every opportunity to surround our family with people of various cultures and opinions. She also did not tolerate overt or passive mistreatment of her friends and colleagues. She was the first upstander I knew. She led the way. So often, strong women lead the way.

Question: How has your mother's influence on you manifested in the workplace as it relates to allyship?

Answer: Like I said, earlier in my nursing career, I was the only male nurse in the emergency room where I worked. At that time, males weren't readily accepted in the nursing profession. So, sometimes I would get a snide remark or two. However, discriminatory conduct toward African American nurses was constant. I could not and would not let it pass, whether it was overt or a passive slight. I always addressed it if I was anywhere nearby. I always spoke up. That is how I was raised. I also want to add that I wasn't helping only because they were African American. I was just doing what was right to help a fellow human being. No one deserves that kind of treatment, certainly not while at work. My mother taught me that.

Question: Can you talk more about your current role and how EDI allyship has been integrated into your work?

Answer: As the Director of Professional Liability (PL), my primary role is to mitigate risks associated with PL claims and give risk management consultations to leadership, providers, and staff. I absolutely love what I do.

Question: Sorry, I have to interrupt. You and a colleague (Gabriela Goldberg) were given an award from the University of California (UC), Office of the President, in 2020, for proactively reducing claims and suits at UCLA. Correct?

Answer: Yes, I wouldn't have brought that up, but I'm glad you did because it may be important for folks to know that while I was doing my everyday work, I was pushing for reform in risk management. Allyship should be part of what we do, not a special project. In the early days, White men held all the (risk management) leadership positions in most organizations. Now, while you see more women, we still lag behind other professions with including minorities or historically marginalized groups. This is an issue nationwide. It is not something that is going on exclusively at one organization. I can count the number of minorities that I know in the risk management field here in California on one hand. The lack of inclusion is also evident with the defense attorneys and law firms that many healthcare organizations use. Someone might say, why is this so important? Well, representation is always important, especially when critical decisions are being made about members of a diverse community. We must admit that Los Angeles is one of the most diverse cities in the nation. We often give consultations related to life-changing matters for so many patients and families, so it is important that we consider being more inclusive with the make-up of our team of decision-makers. California should really be leading the way.

I wanted to do something to address this at some level. At the UC, the Chief Diversity, Equity, and Inclusion Officer, Komal Chokshi, also wanted to find a solution. So, a group of us came up with a plan for an EDI pipeline project to incentivize law firms to actively recruit and hire minority candidates and then assign a certain percentage of our cases to them when they were thought to be ready. It is slow going because PL law is not really glamourous and often doesn't pay as much. However, I am proud that we got the program off the ground.

Question: What are some of the other things you have done as an EDI upstander and ally?

Answer: Working with the wonderful UCLA risk management team, we've been able to revamp our tracking systems to include patient race, gender, and EDI concerns. We are also now tracking claim awards based on race. We want truth, transparency, and fairness to guide our efforts. My colleague, Joann Wortham, and I had the honor of presenting for the Institute of Healthcare Improvement (IHI), the American Society of Healthcare Risk Management (ASHRM), the Southern California Association for Healthcare Risk Management (SCAHRM), and other organizations about the need for our industry to protect healthcare professionals who belong to underrepresented groups from discriminatory conduct by patients and families. This year she and I are focused on speaking up for the rights of transgender healthcare providers in the workplace. I work with the best team in the business, in my opinion, and we all understand the importance of this work and the need for everyone to do their part.

Question: Before I let you go, can you tell us about the national honor you were just given?

Answer: Okay, let me just say I had no idea I had even been nominated by a peer. That in itself was the real honor. I received notice a few days ago that I won the top award for a risk management professional in our industry, ASHRM Health Care Risk Management Professional of the Year 2022. It is a nationally coveted award. I'm flying to Boston in September to accept it. I'm really just speechless.

Author: Joann Wortham, RN, MSN, JD, is a senior risk consultant and workplace culture expert.

Disclaimer: No statements in this article represent the opinions or views of the University of California, Los Angeles (UCLA), the UCLA Health System, or the University of California System at large.