Equity Actions:
Equitable Health Care for All: Addressing Disparities and Driving Change

Dr. Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to the Kid Experts, where the complex is our every day. Each episode, we bring you intriguing stories and relevant pediatric health care information as we partner with you in the care of your patients. Our guests, data, ideas and practical tips will surprise, challenge, and perhaps change, how you care for kids.

Welcome to Talking Pediatrics. I’m your host, Dr. Kade Goepferd. Making sure that each child and family has the unique resources and care they need to reach their full health potential is the definition of health equity. On equity actions, Children’s SVP of Government and Community Relations and Chief Equity and Inclusion Officer James Burroughs interviews guests and tackles subjects that help us work toward equitable and inclusive care for all kids.

James Burroughs: Hello and welcome to Talking Pediatrics. I’m James Burroughs, your host, coming to you live from the equity suite, and today I have two special guests that are going to talk to you a lot about nursing and equity. And those things you know go hand in hand already because nurses are some of the most equitable caregivers that I know of in the hospital system. But we want to talk about the importance of it, not only from a nursing standpoint of how you do the job, but why is it important for our patient care and our families as well. Today I have with me Yinka Ajose and Tonya Montesinos. Welcome ladies.

Yinka Ajose: Hi.

Tonya Montesinos: Hello.

James Burroughs: I’m so glad to have you here. We’re going to have some fun today and we’re going to have some entertaining conversation about very important issues as well. So let’s start off with easy questions. Like Yinka, start off with telling our audience who you are and what you do here at Children’s.

Yinka Ajose: Again, my name is Yinka Ajose. I’m the senior director for clinical operations here at Children’s, going on two and a half years where the time go. I’m responsible for providing the overall strategic direction and leadership of clinical operations within our patient care services. So pretty much every area that rolls up through our chief nursing officer, I support.

James Burroughs: Tonya, how about you? What do you do?

Tonya Montesinos: I am the senior Director for clinical practice. I have the honor of working with what we affectionately call the SPICE team. So the members are comprised of our simulation team, professional development, informatics, our clinical nurse specialists, ERTC, which is our emergency response training center. So all of those persons who support our onboarding and ongoing development of our clinicians. It’s been two years since I’ve joined the staff here at Children’s following Yinka’s lead, and really excited to be here with this great group of kid experts.

James Burroughs: Let me ask you this from a nursing perspective, and I’m sure you have had lots of experience in nursing and seeing lots of things. Why is this thing we call equity important as far as the work that you do or the teams that you lead? Why is that important to you all?

Yinka Ajose: When people look at what we do, they want to know how we deliver. And part of delivering the best care is knowing that we are equitable. It’s knowing that we have a diverse set of clinicians or employees that work and look like the patients we take care of. It’s all about ensuring that we have the right skill sets and we’re all have different perspective and views that we can bring to the table. While we might be different in some areas, know that we can lean on others to do more and to learn more about the kids that we take care of.

Tonya Montesinos: So nurses, I would say, are the closest to our patient care, right? They’re the ones who are here 24/7. So having them be equipped with that skills, knowledge is important because they are delivering that exceptional care that we expect each and every time. So every family, regardless of race, religion, sexuality, how they’re composed of their family members, we want them to receive the best care. And so looking for our nurses to ensure that we do that the same way each and every time is important. As Yinka said, based upon the patient populations that we serve here at Children’s Minnesota, whether it’s in Minneapolis or St. Paul or from our outstanding region and Coon Rapids, et cetera. We really want to be sure that those families feel welcomed and cared for and that as they have those interactions with our staff, that they feel like again, they’re treated as human, they have a positive experience, and that they go out and really rave about the care that is given to them each and every day.

James Burroughs: Are there things that get in the way of providing equitable care though? How do you make sure that there’s not too many barriers in the way of making sure that equity is provided to all our patients and families, and they may be the only Somali family in the ward, they may be the only Hmong family, they may be a family who wears a hijab. And how do you make sure that the barriers don’t get in the way? What are some of those barriers as well? Ty, I’ll start with you on that one.

Tonya Montesinos: First and foremost is looking at the persons that we hire. We want to be sure that as we work with our schools of nursing, that they have a good foundation of cultural competence. We want our nurses to be respective of the differences between the patients we serve and to be sure how to best care for them because different ways. And so the more experience that they have in doing that, again, the better outcomes that we have in the hospital. So I would say it starts really with that foundation of making sure that nurses who are hired here at Children’s know we’re here to serve that diverse population and we have resources to do that. So it’s okay to say, I don’t know, but we want to be sure then that we equip them with, again, skills, knowledge, resources to what are those things that we should know and to help them learn and grow so that they can get better every day.

James Burroughs: Yinka, what are your thoughts on that?

Yinka Ajose: So we could go out to schools and get nurses of diverse background or network, but I think it’s important to note that they’re also shopping for the right place to work. And how do you know that is by looking at the population of people who actually work here. And so I’m going to go out on a limb and say, even starting with our CEO has demonstrated that with the named senior vice president of communications now, his team is 50% diverse. Now if you look around in our Twin Cities of hospitals or organizations that are there, I don’t think anybody can boast about that. And so that is what is going to attract people of diverse background because again, it starts from the top. It’s looking at where the buck stops, and that is with our CEO and truly working on ways to ensure that we are diverse and we do represent the backgrounds and the diversity of the people that we take care of. You always look towards your leader if there is no mission or vision, the plan perishes. So again, it takes a lot to be able to be at the forefront of this.

Tonya Montesinos: James, I would add, as a newcomer to Children’s just a couple years in and had worked prior at an organization in the Twin Cities, I think that as Yinka is noting that value of ensuring that there is diversity amongst the staff and that we continue to cultivate that knowledge for everyone has been so integral to me and was really the draw for me to come to this organization. And so as Yinka noted, I think there’s the walk, the walk and the talk, the talk, and it’s reflected in that that we are really aiming on a mission. And so if I think about my role, how do I serve that is really to look at how do I advocate? How do I ensure that persons have equitable roles within some of our professional governance on committees? Are there opportunities such as in the nursing world, precepting, charge nurses, clinical nurse instructors, interns. We want to be sure that we’re really offering and promoting how do we help persons succeed? And so from my standpoint, if it’s how do I help mentor, how do I help advocate, those are ways that we can engage in ensuring that shows up each and every day.

James Burroughs: You mentioned preceptors, you mentioned charge nurses. One of the things I want to talk about is I’m new to health care. I’ve been in children’s five years, but I had no health care background. And what I’ve learned is working with the nurses, working with physicians and the clinical side staff is I may not know the things that get in the way or the biases or barriers around equity. And not knowing that I said, okay, how about we partner and come up with a position that’s shared amongst us and say we have someone who has knowledgeable and skills about the clinical side, but also about the equity side. And we partner together around that and we are creating a position that we’re working with the both of you on around that. Why is that important? Having someone who has that knowledge and skill, not only about the medical side, but also the equitable inclusion side as well. Is that important?

Yinka Ajose: Oh, yes.

James Burroughs: Why is that important?

Yinka Ajose: I mean, they can help with educational programs. They can help develop and implement training programs for staff on topics such as cultural competencies, implicit bias and health disparities. They definitely will be promoting DEI, instrumental in fostering a culture of diversity, equity, and inclusion within the hospital, and ensuring that all families and patients feel welcomed to their care here at Children’s and make sure that their needs are met.

Tonya Montesinos: And I would say too, coming with that clinical lens, really honor that that has been appreciated as part of this role. So again, meeting the unique needs of patients is different on a day-to-day basis versus perhaps someone in marketing or someone in IT, et cetera. But I think if the way that we combine that to not only have the clinical expertise, but also that expertise in building programs for equity and inclusion will help us succeed because they’re able to bridge the gap and really see the vision for how do we bring providers to see how we can implement this in their work. What are those things that I hear from them that maybe are unconscious biases that we need to talk about? How do we really bring to light those situations that we hear day-to-day? And then how can we continue to move forward into building a robust program?

James Burroughs: Let’s talk about the broader look at health equity in general. One of the things that we focus on, and we’ll make sure is we end a lot of these disparities that are impacting our patients. Some of them are the social determinants of health, which impact patients even before they come through the doors, as you both know, which could be employment, it could be economics, it could be climate, it could be neighborhoods that you live in. It could be lack of food security or lack of foods in your neighborhood as well. How are you educating, how do you plan on educating your staff around some of those health equity issues to help them address as more of a global addressing of disparities?

Tonya Montesinos: I think it’s great, James, because nurses really have a front seat to this. So first thing that a patient does when they come in is you get an assessment and we do a little, tell us a little bit about you, your background, et cetera. So we do that admission history and really that is so imperative to help us launch forward to say, what else can we provide for this family to deliver care, right? Because your hospitalization is such a short episode, but then there’s the long care that happens when you leave our doors. So how can we do that? And you mentioned many different factors that could interfere or impact their health overall. So our nurses are equipped with then saying, Hmm, who are the resources within the interprofessional team that I know that I can make a consult to that I can phone a friend and say, Hey, this is what I heard. Can you come in and talk to them? Whether it’s financial counseling or like you said, food determinants. How are ways that we can support them? And I think we’re fortunate here to be able to have true experts to make that happen. And nurses are really at that front door to be able hearing that and then being able to, I always call them the integrators of care. They’re the one who brings the team together and then they make the magic happen.

Yinka Ajose: Yeah, great. So looking at the patients from a holistic view of what they need, and yes, you’re right, our nurses are right in the center of that. But yes, tapping into other resources like our social workers and our case managements and our care coordinators, and ensuring that those roles also have backgrounds that can meet the needs of our patients as well. So while, yes, this is the forefront of the nurses, there are other disciplines that the nurses pull together to make sure that yes, we have a commitment, not just while they’re in our four walls, but what happens outside of our four walls and what can we do to ensure that they’re not coming back through the ED? So what are things that we need to put in place so that they have the skills set or things they need to, so be able to sustain themselves outside of our four walls?

James Burroughs: Let me ask you this. How will we know we’re successful? So we got this new role, we got equity embedded in the work we’re doing, you as leaders are doing and you’re with your teams. Three to five years from now, how will we know we’re successful and that we’ve accomplished some good things?

Yinka Ajose: I think part of it is what is the community saying about us? What does our referrals look like? Who are we truly seeing coming through our doors? Are there people that will say, yeah, my mom gave birth to me here and now I’m here to give birth to my own child. Is that what we are seeing? So I think it’s good to have the ears close to the community and to learn what they’re saying and what they’re doing, and to ask the question, what could we do better? Are we meeting those needs of the community? So I would say, one, what the communities are saying and two, what are our teams saying? What does this referral look like? Recruitment, are we truly as diverse as we want to be? And so I think those are the two areas that would let us know if we’re successful or not.

Tonya Montesinos: To touch on the second part of what Yinka said, not only the community, but the internal staff. Do we have all the resources to meet the needs of our patients and families? How are we reflective upon that? I’m excited for implementation of Epic because especially as we think about that continuum of care, how are we internally gauging? Are we communicating appropriately? Do we have the right information that we’re gathering? Can we connect them to those resources? So I think we’ll see some of that in our staff engagement too, of do I feel prepared to help serve my patient to the best I can or the family that I can? And I think that that continues to be our job in the next few years as we build a different and better foundation.

James Burroughs: I love the fact that Epic’s coming because we can build it from the ground up with all the equity stuff. Yes,

Tonya Montesinos: Exactly. 

James Burroughs: So we won’t have to add on for pronouns, we won’t have to add on for gender identity. We’ll have to add on for that. It’s just part of what we’re going to be able to do to make a person feel valued and included as well. I want to thank you ladies for coming, but also to give you the last words about what do you want the audience to know. Our audience is mostly clinical professionals who are looking to hear from us about great things about the pediatric work we do, but also some takeaways. What do you want them to take away from this discussion today that you want to leave with the audience?

Tonya Montesinos: I would say I’m excited about the future. So it’s really the momentum continues and I think as an organization, whereas we’re still growing, we’re still learning, we’re still evolving, we’re finding those ways to again, meet both the needs of our patients and families and of our staff. How do we continue to embed this in our day-to-day life? So it’s kind of like you said, it’s part of our language. It’s part of what we do every day. It’s not an add-on, it’s not something different, but that we’re really helping persons be the best that they can be.

Yinka Ajose: We are just celebrating a hundred years in existence and looking forward to the next a hundred. This is the pivotal point. This is the most exciting time to be part of Children’s and to lean in on all the work that we’ve been doing. I honestly feel this is the time that we’re going to be launching something even greater for the next generation to come. So I’m very excited to be here at Children’s, excited about the work we do here, excited about the team we have. And it’s just a great opportunity to get more people on board.

James Burroughs: I love it. I love it. In the future, I hope that more people are like us. Some are not like us, not right now. They’re not like us, but some of us should be more equitable. Some of us should be more accountable. Some of us should be more inclusive in health care, and hopefully we’re the leaders in that. Well, Yinka and Tonya, thank you for coming on Talking Pediatrics and joining us at the Equity Suite. Thank you for your time and glad to have you here.

Yinka Ajose: Thank you. Thank you.

Dr. Kade Goepferd: Thank you for listening to Talking Pediatrics. Come back next time for a new episode with our caregivers and experts in pediatric health. Our showrunner is Cora Nelson. Episodes are produced, engineered and edited by Jake Beaver and Patrick Bixler. Our marketing representatives are Amie Juba and Krithika Devanathan. For information and additional episodes, check us out on your favorite podcast platform or go to childrensmn.org/talkingpediatrics.