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In the US, a growing number of organizations and industries are seeking to affirm their commitment to and efforts around diversity, equity, and inclusion (DEI) as recent events have increased attention to social inequities. As health care organizations are considering new ways to incorporate DEI initiatives within their workforce, the anticipated result of these efforts is a reduction in health inequities that have plagued our country for centuries. Unfortunately, there are few frameworks to guide these efforts because few successfully link organizational DEI initiatives with health equity outcomes. The purpose of this chapter is to review existing scholarship and evidence using an organizational lens to examine how health care organizations can advance DEI initiatives in the pursuit of reducing or eliminating health inequities. First, this chapter defines important terms of DEI and health equity in health care. Next, we describe the methods for our narrative review. We propose a model for understanding health care organizational activity and its impact on health inequities based in organizational learning that includes four interrelated parts: intention, action, outcomes, and learning. We summarize the existing scholarship in each of these areas and provide recommendations for enhancing future research. Across the body of knowledge in these areas, disciplinary and other silos may be the biggest barrier to knowledge creation and knowledge transfer. Moving forward, scholars and practitioners should seek to collaborate further in their respective efforts to achieve health equity by creating formalized initiatives with linkages between practice and research communities.

Wicked problems are causally complex, lack definite solutions, and re-emerge in different guises. This paper discusses how new ways of organizing emerge to tackle changing manifestations of wicked problems. Focusing on the wicked problem of poverty, we conducted a longitudinal study of Fe y Alegria (FyA), one of the world’s largest non-governmental organization, which provides education for the poor across 21 countries in Latin America and Africa. Drawing on archival and ethnographic data, we trace the historical narratives of how FyA defined poverty as a problem and developed new ways of organizing, from its foundation by a Jesuit priest in 1955 to its current networked structure. Our findings reveal the ongoing cycle of interpretive problem definition and organizing solutions for wicked problems. First, since there is no “true” formulation of a wicked problem, actors construct narrative explanations based on their understanding of the problem. Second, organizational solutions to a wicked problem are thus reflections of these narrative constructions. Third, emerging and changing narratives about what the problem is inspire new organizational responses. Our findings provide insights into the dynamic relationship between organizing for wicked problems, narratives, and the changing manifestations of wicked problems and grand challenges more broadly.