At THMA’s recent Chief Human Resources Officer Forum, health system HR leaders gathered to examine growing regulatory and cultural pressures, with one session spotlighting the implications of a shifting federal landscape.
1. Executive Orders Create Compliance Risk Without Changing the Law
Health systems receiving federal funding—Medicare, Medicaid, or NIH grants—are under heightened scrutiny. Although executive orders don’t change laws, agencies like HHS and DOJ are stepping up enforcement, making grant certifications legally and financially riskier. In response, systems are conducting internal audits and strengthening compliance reviews.
- “No grantees can operate any illegal DEI programs—but we don’t know exactly what crosses that line.”
- “They will focus on civil enforcement but also criminal investigations—this is pretty unheard of.”
2. Rebranding DEI Requires Substantive Change
Many systems are rebranding DEI efforts under terms like “belonging” or “culture,” but legal experts warn that superficial shifts offer little protection. Without structural changes or a science-based rationale, rebrands can increase—not reduce—organizational risk.
- “It doesn’t matter what you call it because what really matters is what you’re doing.”
3. Equity Work Remains Legal When Framed Around Universal Outcomes
Equity-focused programs can continue if they emphasize broad access, community need, or quality—rather than identity-specific benefits. Many leaders are reframing these efforts using terms like “health justice” and focusing on universal quality metrics.
- “It is not illegal to care about diversity, it is illegal to provide care or access or a benefit to someone based on their race, sex, ethnicity etc.”
4. Workforce Polarization Raises Communication Risks
With employees increasingly divided in their values, internal messaging carries higher stakes. Systems are emphasizing transparency and psychological safety while being cautious with language that could trigger mistrust or legal exposure.
- “You cannot assume everyone in the room is supportive or non-supportive.”
5. Federal Agencies Are Becoming the First Call for Concerns
The DOJ and EEOC are urging employees to report directly to federal agencies, not employers—forcing HR to stay ahead of issues before they escalate. This shift makes proactive compliance reviews and rapid internal response systems critical.
- “How to ensure that you (HR leaders) are the first call.”
Why This Matters
These trends signal a fundamental shift for the entire C-suite. CHROs are navigating legal risk, cultural cohesion, and public trust, while the rest of the executive team—from CFOs managing funding risk to CEOs guiding institutional values—must engage collaboratively. The rebranding of DEI isn’t just a tactical move; it’s a strategic imperative to realign legacy programs around structures that are legally defensible, scientifically grounded, and culturally sustainable.