What’s Your Job Description When You’re a ‘Health Equity Leader’?

(upbeat music) - Welcome everyone to the intersection podcast. The intersection is a project of the Robert Wood Johnson Foundation. It's a space for advocacy and healthcare leaders to talk to each other and share about how they're trying to build an anti-racist healthcare system. You can find us online at [email protected]. I'm Anton Gunn and I'm honored to be joined today by three guests to discuss the role of health equity officers. Amy Delaney, the Director of Diversity, Equity and Inclusion at Carl Help in Champaign, Illinois. Christina Harris, a physician is the Vice President and Chief Health Equity Officer as Cedar Sinai Medical Center in Los Angeles. And Rashonda Highley-Thomas, a lawyer and the Executive Director of Advocates for Justice in Education, a community-based advocacy organization in Washington, D.C. I'll never forget the first time I had an equity conversation with a physician leadership group in my institution and I had a very longstanding physician leader who told me, "Anton, you shouldn't use the word equity." And I said, "Well, why not?" He says, "Well, when I hear the word equity, I think about equity in my house and I don't think you want me thinking about equity in my house." So we had this long conversation in discussion. So my question is, when you come into an organization in a senior leadership role, how do you help people gain a clear understanding of what equity is and what equity is not, especially when they already think they already know what the answer is. Christina? - Pretty early on in my time here, I wrote a piece just for our internal Cedar Sinai magazine where I made the parallel between health equity and just true at its core patient-centered care. Person-centered care would have you. Because I feel like people get afraid of this term health equity and they're like, "Well, I don't know what it is. I don't know how to do it." And I wanted to draw the parallel that it really is just meeting the person where they are. We do it so innately. No one in any C-suite, any hospital would ever question this idea of giving person-centered care, right? Making sure that everybody is, we do this intrinsic, we. So for me, I sometimes make that analogies for people to see like, we're already doing this. We just need to ask different questions and you can do this too. And then I think with that parallel, they recognize like, no, this is really our job because we care about people, everybody reaching their peak outcome. And then I try to use equity as much as I can, as well, the worst. Because I think it is important for them to know. - Amy? - Yeah, I think it's such an important question. And to me, you can't help someone better understand equity without helping them understand inequity and recognizing where inequity exists, but then asking the right questions about where those inequities come from. A lot of that has to do with having conversations about sources of inequity, including, and this is not a comprehensive list, but broadly, we can categorize those sources into interpersonal biases. So in the actual delivery of healthcare, where my cognitive, sometimes conscious, often unconscious biases influence how I treat people. And that often becomes then conversations where a thousand times I have heard clinicians say, well, I treat everyone the same. And it's like, well, first of all, no, you don't, because you have a human brain. You are subject to human biases, even if you intend to or you want to when you have good intentions, that is not how it works. And also, not everyone is the same. Not everyone comes to us with the same goals, with the same values, with the same skills and abilities to care for and prioritize their own health. Christina, I'll pause. Do you have something to echo in the comments? - Absolutely. We know that in so many other clinical scenario situations, but then it's just an extrapolation of that, right? So it's like helping people see that treating people the same is not the goal, because people are not the same. And there are lots of intersecting factors that affect what people bring to us and how we can best meet them where they are and interact with them. But then we also have to talk about structural inequities and social drivers of health and the different barriers and opportunities that people face as they journey to and through a healthcare experience. One of the weaknesses in many healthcare organizational is the AI and health equity efforts as they only look at bias. They say, oh, we did unconscious bias training check. We did it and we have to look at the whole picture and see the structural sources of inequity as well. And to be clear, like we're healthcare organizations, we cannot solve all of the social and societal inequities and injustices that exist, but we need to see them and we need to know how they affect individuals and communities as they come to us to be able to move toward equity in the care and service we provide and in the opportunities that people have for health. - Irresound it, go ahead. - I agree with everything, but they also run true for me although we're not a health organization but this also goes to the importance of having community members as a part of your organization. So we had a system for the way we conducted intake for individuals who were seeking support. And one of our parent staff members pointed out that the way it was structured led to some inequities meaning that those with more time in higher means had the ability to repeatedly call and get what they needed versus those who may not have had the same luxury in time to spend all day trying to connect with someone. Like structurally thinking about where the inequity lies within the organization and having people who have lived experiences to be able to share and identify what those are that may not be seen. - Yes, great. So I thought would be really important for us to unpack and it really starts from your perspective, Rashada. How do you approach the community with humility? What does connecting with the community look like optimally? And how do you ensure that those efforts are sustainable given that some institutions priorities change, sometimes people change roles. So what does this sustainable connection to the community look like from a practical sense, Rashada? - At our organization, Advocates with Justice and Education and we are the family to family health information center for DC every state has one where we support families, which are with disabilities and special healthcare needs and also work with other professionals in the field as well. And I think for us, what is important is first, building trust, make no assumptions or judgment. We are different and uniquely situated in that, oftentimes family are reaching out to us for assistance with every staff member that interacts with a community member building a level of trust. And one of the ways I think that we have done that and done this successfully is that majority of our staff are parents who have navigated both the health system and education system in DC. So there is a level of understanding and connection with the community because we hire numbers of the community in this work. And that may be something too for hospital systems or even without equity leaders, how are you engaging community bringing community in and being a part of the decision making and the work in order to help build that trust, not make assumptions or assume that you know more because you have more letters behind your name, lived experience is highly important if not more important than the work that we do than the Greece. Very good. Anything you want to add, Amy? Well, I appreciate the way your question included the word humility and I think Khrushandas' answer illustrates that and to me that that relationship building has to come with the humility of you might not like what you hear. And once you hear that information and start building that relationship as a healthcare organization, you're accountable to respond and to change based on what you hear. It cannot just be listening and community partnership building for the sake of saying we did this. It has to be to truly act on what you learn from those sometimes uncomfortable conversations. And to me that's what humility really is seeing and learning where we can do better. Christina? One thing I'd add, I often refer to this as like the community institution ecosystem in my view. And I'm fairly new to the world of like hospital administration and such. Given that I'm running the health equity efforts, I need community there because community thinks differently. They approach problems differently in a way that big, your critic, vertically structured organizations need. And I think it's a matter of really valuing their contributions. So we have as institutions, we have technical expertise, clinical competence. Well, the community also has technical expertise. It's a little different. They have more linguistic and cultural competence. Hospitals and medical systems are very good at the biomedical model. Communities tend to think more about the biopsychosocial model. So as I think about the people I interface in the community, I'm like, how do I get them at the tables in the hospital where we're making decisions? 'Cause they think differently. They approach things differently in a way that If we could take on one little bit of that, we would be better off. great. Now I want to pivot to thinking about the future. So let's be clear. I don't believe that any of us on here, when we graduated from high school, we planned to be an equity advocate and leader, some might, but most did not. You ended up in this career path for a reason. So I want to go back to our former selves, go back to that high school student or that freshman in college. What advice would you give to an emerging leader or someone who's passionate about promoting equity? What advice would you give somebody who's just getting started, who's not a senior leader, who's not an leadership role? Doesn't have the big title, the big responsibility, but just a passion and an interest in equity and justice. What would you say, Christina? It is not uncommon after I do a talk to maybe master students or some sort of learners that I'll get the question. I want to get into a DEI position. What does this look like? Can you can you recommend any fellowships or training? And I think that is great. And I have answers to those things. But my, my bigger response is usually if you want to be an equity or an advocacy or diversity or what have you, you can do that in any area, in fact, for every one she felt equity or one diversity officer, there's about a million people at an institution who are supposed to be doing this work. And I think sometimes better to have someone who is the equity leader and equity minded running something that does not have the word equity in it at all. I'm just doing patient experience and I'm going to do it with an equity lens. I'm doing quality with an equity lens. So that is always my response because I think, and I get it, people want to do their passion work, that drives them and drove them to medicine or drove them to what have you, but you can do that anywhere. Right? Yeah. Very good. Amy? I have two things that kind of relate to each other. One would be pragmatic advice to build your research skills, whatever your area of expertise is, whether that's someone like Christina coming in with a medical and clinical background or like me with a social science background or like Roshanna with a legal and attorney background, right? To build your skills in analyzing and telling the story of data because I'm sorry, we don't make progress in health equity by making the moral case. We don't make progress by making the business case. We make progress when we can show people the data, the reality of the disparities and gaps that exist in our communities. I'm telling the story of how and why that gets there. And sometimes that requires a little bit different skill set than like a super data analytics approach. I know some of the work that I've done has been asking for additional slices on data. So first we look at the data stratified by race, but then we also need to look at race and gender and we need to look at race and gender and geographic location to see how some of these intersecting factors and barriers may be affecting people. And that's a skill set to figure out how to ask for those data even if you're not the one slicing it yourself. And then to that end, I would advise those with visions of doing this work, no matter what role they're in. This is kind of silly and pragmatic, but work on your public speaking skills, convincing people to come along with you and to change their minds, to change sometimes their hearts, to change their norms and practices. That's a communicative relationship building process that sometimes happens in big venues, sometimes in smaller meetings and conversations. I'm trained as a social scientist. I have data skills. I have gone to meetings and presentations where I'm sharing these statistics, these national statistics, these data points and all of that is helpful, but I reach more people when I can tell a story, when I can talk about a patient's lived experience. And when I can reflect even sometimes my own lived experience in ways that make people change. We need people to change. We need systems and processes to change. Being a skilled storyteller and public speaker I think is absolutely necessary for this type of leadership. No doubt about it. I had a mentor tell me many, many moons ago, Anton, facts tell the story itself. And if you can't tell a good story, you're not going to sell anybody on the idea of what you need them to do and how they have value. And so you got to be able to tell great stories. Rashana, how about you? What advice would you give to someone jumping into this work at a very early age or even wanting to get on this path at some point? I would say I agree with Amy. One of the things I thought about was research. In addition to public speaking skills, writing skills are just important, especially in my field. We are attempting to have some kind of influence in being able to read and hold the reader's attention and get your point across quickly and swiftly. But I also say, because we do work with young people, I also have kids, is that the power you have to start that work now within your own communities, whether it's in your school setting, whether you are involved in a club or a group or whatever it is. Ultimately, what you're looking to do is ensure that their fairness in everyone has equal access to whatever it is. And they can start that work there to even build their skills or even their resume. But also interpersonal skills, which Amy referenced about relationships and that emotional IQ and how important that is, you can be as smart as all our doors. But if you don't know how to interact with people, then that's going to be a challenge. You hit the nail on the head. That was great framework for us. I want to talk about resources. And what do I mean resources? This podcast and everything we're doing at the intersection is about giving people tools that they can use. I want to hear about your go-to resources on how you stay current and what do you do to develop yourself so you continue to grow to help people to be more effective in that? What conferences do you attend or programs you participate in? What's on your learning development plans? So you stay current to what's happening in the field and what do you need to do to continue to advance this work? Where should I spend my time if I wanted to be a very good, savvy, health equity leader who's having a massive impact like the three of you haven't? Christina, you first. There are dedicated health equity conferences. I've attended the AHA conference a couple of times. And it is nice to have the bullets of health equity. The wonderful piece of that is opportunity to network with people. We are all creating this from scratch and across the country. I think we collectively as health equity leaders need to do a better job sharing resources with each other. I will say like every conference I come back with like contacts and I'm like what are you all doing about this? And I'm always reassured because the things that we're stuck on are the things that they're stuck on too. I think if you are academics there's also I have the academic homes, Society of General Internal Medicine. I also think there's utility and going to quality conferences that typically health equity is integrated in there. It might not be a full health equity like whole symposium. But understanding the challenges and the language of quality officers, of patient safety officers allows you to be able to create your narrative that will fit within the infrastructure that they are approaching problems with. Very good. Rosanna, you're going to jump in there? We have the benefit of being a part of a national network of both parents training and information centers and family and family health information centers. And we had the convening every year with each other and equity is always on the agenda for our organization's group. We also have found great resources even with Robert Wood Johnson foundation in the different webinars that they put out, especially being a relatively new grantee just from the last three years that we found a lot of support in community solutions for health equity, our national program office. Fantastic. Amy, how about you? Building a network has been one of my most important resources and really grateful through this process to be expanding that network even a little bit further. A couple small things. I'm not great at using LinkedIn, but I do have some folks. I follow on LinkedIn where I gain great perspective. I don't post much, but I, you know, what's that called a creep a little and see what folks are sharing. I creep. Oh, yeah. Oh, that could go into my library of resources. A couple kind of tactical things. I block my first two hours of my work day every Thursday that's called research and professional development or something. How often do I actually use that time for what it's blocked for? Can't tell you the last time to be honest. But I hold that and within that meeting hold, that's kind of where I stash. I couldn't make it to that intersection webinar, but I'm going to put the link in here to the recording so I can watch it or listen to it when I'm driving between locations or whatever. So it becomes this kind of stash and that structure has been helpful for me to keep track of those things I want to read in between meetings or when I have the time and space. Another very, very specific resource. But I always evangelized for this when I was a professor and I'll use any space I can. It's the cited by button on Google Scholar. When I find an article that I think is important or impactful, I plug it into Google Scholar and then I hit that cited by button. And that's really helpful in my work educating and providing evidence for things as well. Because I can find the 1999 study in the New England Journal of Medicine that found disparities in cardiac cath recommendations for women and black patients, then I can hit that cited by and find the 25 study since then that have replicated or built on those results. And it's so helpful for building that body of research, which back to your point earlier, Anton, I have to tell the story for beyond just the statistics and the data as well. I love that cited by button, and I think it should be used more. I think you just dropped a massive jewel right there and a massive tool for people to use. This Google Scholar, that's fantastic. Okay, so I got one last question. I'm an organizational development practitioner. I help leaders be better in every organization that they're in. And a part of that is their growth and development. So my question for you is what's on your current individual development plan? Like what's next for you to help you to get better as a leader? Not just a DEI practitioner or an equity practitioner, but what do you need more of to be better as a leader so you can have greater influence and greater impact? That's what Rashonda laid out for us today. And Rashonda laid out for us is about influence and impact and decision making. And I'll start with you, Christina. That's a hard one. Where to begin. I've been a leader throughout my career in different spaces and venues. This last two years has been a leadership journey because it has required something very different of me. Who would have thought at the age of 46? I'm coming into different leadership styles. I would say that I am working on being more clear about what I need from people. Okay. What I need people to do, what are the resources that I need and not feeling bad about asking for it? Very good. Fantastic. Rashonda, how about you? Well, I'm a big believer in the seven habits of highly effective people. And constantly shopperening my saw. And so I'm always looking. So even though I've been in the ED position for eight years, I still feel like a baby in that there's a lot that I don't know and I still need to learn. And coming into the organization that was really small, I still am the hand-on, be all HR operations, chief development officer, all of those things. So I am constantly engaging in learning opportunities about how to strengthen my skills in every aspect of those areas. And also how can I work to build a capacity so that I can give those things to other people? That's where I am. It's sound like you learned how to delegate more than it is in how to get to be. How about you? Yeah, I'm going to sing the same chorus here, delegating and asking for help. My previous career was as a college professor, which is a very individual and autonomous job. My program of research was mine and mine alone. Even if I was collaborating on papers and research projects, it was my research and my accountability. Teaching classes, I fully owned the syllabus and the delivery and the grading and all of the work of my classes. And it's hard for me to ask for help. And it's hard for me to delegate and exactly as Christina said to be clear about what I need and what I'm asking for because it's hard to let go of things. So as much as we preach the importance of collaboration in this work, sometimes that's easier said than done, particularly when you feel like the subject matter experts on some things as well. One of my professional development objectives right now is to be closer to clinical spaces and to better learn about and understand the operations side of health care delivery because again, that's not my background. But I have a lot of thoughts about how we could and should do it better. And I need to get closer to that. Like Roshanda said, do a little bit more learning about current state to better inform future state. Well, fantastic. Well, we're going to end on that note. I want to thank Amy, Christina and Roshanda for your time and participating in this discussion. It's been insightful and I've learned a lot. And I appreciate your work and your help. I want to thank the audience for listening to the intersection podcast, for more information on upcoming events and to join our mailing list, visit us online at [email protected].