Equity Actions: What Do We Really Mean, and What Does It Really Take, To Achieve “Health Equity”?

Transcript

Dr. Angela Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, where the complex is our every day. Each week we bring you intriguing stories and relevant pediatric healthcare 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 the most amazing people on earth, kids.

Welcome to Talking Pediatrics, I’m your host Dr. Angela Kade Goepferd. We talk a lot about health equity, but what do we really mean by that? And what would it look like for a healthcare organization to truly invest in all of the ways necessary to achieve equitable health outcomes? Join guest host James Burroughs, VP and chief equity and inclusion officer, as he interviews Duane Reynolds, a national health equity leader, about removing systematic barriers in order to optimize health for all of our patients.

James C. Burroughs: Hello, this is James Burroughs, vice president, and chief equity and inclusion officer for Children’s Minnesota and I’m here again from the equity suite here at Talking Pediatrics. I’m excited today because we have with us Duane Reynolds and Duane, he doesn’t like to be called this, is an expert in the field of health equity, is an expert in the field of doing things differently so we can get better outcomes for patients that have been underserved. And also too, he’s a good guy as well, and a friend. So welcome Duane. How you doing Duane?

Duane Reynolds: James, thank you so much for having me on your show. It is a pleasure to be here with you today, and you’re right, I don’t necessarily like to be called an expert, but I try to do my best in terms of advancing this work.

James C. Burroughs: I want to get started too, but let’s talk about who you are. I don’t do long introductions to folks. I want them to tell their own story. So who are you, Duane?

Duane Reynolds: I have been in the healthcare field for over 25 years now in various capacities, which I think is part of the reason I sort of ended up where I am today. I started my career in organizational development for a large health system, went on to run faculty practices at academic medical centers, did a stint in management consulting, where I took on my first role as an inclusion and diversity leader. In addition to my consulting work that eventually parlayed into being the leader of a practice called the Inclusion and Health Equity Practice, which was developed to really help organizations move forward on this journey.

From there, I was a leader of the American Hospital Associations Institute for Diversity and Health Equity and helped them develop their strategy, really working with hospitals across the country on advancing health equity, diversity, and inclusion. And now I’m an entrepreneur, which is a first in my career hat, but something I’m very proud of. And it’s allowing me to do something that is very purposeful and meaningful for my life, and hopefully is leaving an impression and change in the industry around health equity and belonging.

James C. Burroughs: Why did you get out of the corporate or nonprofit area to do your own thing?

Duane Reynolds: I’ve always had an aspiration to be an entrepreneur, and it really dates back to my grandmother, believe it or not. She was an entrepreneur in a time where it was very difficult for a black woman to have a company and be successful, but she did. And I was extremely risk averse in my career and never really thought that I could do it. But I think that sometimes the universe aligns correctly. I was just ready to make a change where I could control my destiny a bit more and do the things that I thought were necessary to really help the healthcare field make movement on this journey. And it just so happened that it coincided with what was happening with the pandemic and social unrest and, for better or for worse, it actually propelled my company extremely fast for a young organization.

James C. Burroughs: Health equity is a popular topic. I’m in the field of healthcare, as you know, and people want to bring out health equity, health equity, social determinants of health. Give the audience a simple definition, simple phrase or frame around that, because I think sometimes people get caught up in saying the words, but not doing the work. What’s the work around this health equity work we talk about?

Duane Reynolds: Yeah. So when we think about health equity, it’s about an individual’s ability to attain optimal health. And there are barriers that get in the way of that, and those barriers are not just about individual behavior, but really systematic challenges that are in place. So when we think about advancing health equity, it’s complex in that it deals with the healthcare delivery system, but it also is broader than that. When we start talking about social determinants of health, that’s about the environment that people live in that is either conducive to helping them achieve optimal health or not. So for instance, if you live in an environment where there are lots of factories that have pollutants, children in that environment may have higher rates of asthma as a result. And so that isn’t something that the hospital is necessarily responsible for, but it’s something that the hospital or healthcare delivery systems should be concerned about. If we’re talking about trying to create health and equity among different populations.

James C. Burroughs: Social determinants of health, as you mentioned before, the environment is one of them, employment is another, how people are being employed and whether they can afford quality healthcare, housing, what their living situation is. There are many more, but what I see sometimes is healthcare systems saying that, man, that population has so many social determinants of health that are going against them. And 80% of healthcare, health and wellness, is social determinants of health, we can’t do anything internally. So it’s not really our fault that racism is happening and structural racism, systemic racism. How do you not let healthcare systems like my own, like Children’s and others, off the hook, just by saying it’s social determinants of health that cause it and they can’t do anything.

Duane Reynolds: If we think about the mission of healthcare organizations, it is about taking care of patients, taking care of our communities. And if we’re true to that mission, then we have to think about factors that sometimes are outside of our direct control, but factors that we could indirectly impact by working with other organizations, like community-based organizations, corporate organizations, philanthropic organizations, to take on larger challenges.

Why? Because it benefits us as a society. It’s not just about the hospital and what they’re doing. It’s about how the hospital is being a good corporate citizen, and a good steward of the financial resources and other resources that they have that can ultimately impact a person’s health. So if we really are paying attention to our mission in a real way, then it behooves us to be able to look beyond our own walls and think about how we impact.

So the easy cop-out is to not have to address those things and to just think about the healthcare delivery system inside four walls, but the moral and right thing to do is to think about all of the factors that are ultimately impacting a person’s health, and part of what has to happen and is happening is that the financial incentives are starting to change, moving towards more value based care. Meaning that we’re on the hook for whether or not a person achieves quality outcomes, experience and reduction in cost of care. When we are on the hook for that, we have to think about all of the factors, not just the delivery system factors, but all of the factors that impact health. And so as our financial incentives continue to change, it’s going to be that much more important that hospitals and health systems organize themselves and think strategically about how they impact social determinants of health.

James C. Burroughs: One of the things that I need to do better, and I think healthcare systems around the nation, around the world, need to get more people of color, Black, Latino, Asian, Native American, in the healthcare fields of nursing, doctors, patient-facing clinic positions. We have a shortage. I think 92% of our docs and nurses are white. That wasn’t necessarily done intentionally, but the systemic racism and structural racism that we have in this country have led to that. So what kind of advice can you give me to change that so our doctors and our nurses and our patient-facing staff better reflect the patients that we serve, which we serve about 54% patients of color and Native American families. But we only have 7% doctors and nurses of color and Native American descent. How do we do a better job in that area?

Duane Reynolds: That’s a really good question. One that’s important because of the concept of concordance, which is basically patients tend to do better in terms of outcomes and experience when they receive care from a provider who looks like that, who represents their background. And so I think the first thing that I think about is inside of the organization, the diversity of race and socioeconomic status happens at the staff level of most healthcare organizations, right? So we probably have more African-American, Latino folks who are working in frontline staff positions. If we pay attention to those individuals and intentionally develop them and their careers, then we automatically are building on a pipeline that is there. So these folks may be working in medical assistant positions, they may be licensed practical nurses, they may be nurses. And we could be investing in that group of people that are already associated with our organization to ultimately do things like pay for them to go to school and further their education, and potentially come back to our organization after those years.

So, I think oftentimes we overlook that talent group. The other thing is, I think we have to really reach out to a younger generation and expose them to the medical field. So what is it to be a physician, a physician assistant, a medical technologist? How do you get them exposed and interested in the field so that they even understand that it’s an option for them? I think part of the challenge is sometimes when you are a part of a community where you don’t have the resources or the educational system, or exposure to individuals who are part of the healthcare system, then you don’t always know what’s available to you. And so that exposure becomes very important, and hospitals and health systems can be partnering with their school-based organizations or community-based organizations to create a pathway that allows individuals to understand what is there and what is possible.

James C. Burroughs: So my last question for you, Duane, is in your business or your personal life, either one, what’s your hope for the future? What do you hope we can do differently around some of the things we’ve talked about, either health equity, community partnerships, giving people optimal healthcare, what’s your hope for the future?

Duane Reynolds: I think my first hope is that we learn to understand each other and our commonalities as human beings and that we learn to give each other grace. I think there’s so much divisiveness now in our society that we have forgotten that there are probably more similarities in who we are than difference. So I hope that we, as a country in particular, can get to a point of greater peace and understanding of our humanity, our shared humanity. As a healthcare system, I hope that we get to a point where the system is intentionally recreated to serve all types of demographics effectively, and effectively means a lot of different things, but ultimately we’re leading to quality of care that is equitable, and experience that is equitable. So those are really my two hopes and desires for the future.

James C. Burroughs: Well, thank you very much Duane, and those are great hopes and I really want to thank you and your company, Duane, are there any final thoughts you want to leave with our audience today?

Duane Reynolds: I would say oftentimes people think that health equity is about a particular population, the African-American population, for example. Health equity is about all of us, every race, creed, ethnicity, sexual orientation, it’s about all of us. And so we need to be invested for our own wellbeing and the more that people can learn about what inequities exist and how they can help to change the situation, the better off we’re going to be in the long-term.

James C. Burroughs: And that’s a great way to end the show. Thank you, Duane Reynolds. I appreciate you, founder and CEO of the Just Health Collective. Thank you for being with me at the equity suite and Talking Pediatrics. Have a great day now.

Duane Reynolds: Thanks James. Appreciate it.