Equity and Actions Suite: Empowering Providers to Make Equity a Part of Patient Centered Care

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, this is James Burroughs, the senior vice president and chief equity inclusion officer at Children’s Minnesota. Welcome to Talking Pediatrics. I’m coming to you from the equity inclusion suite, and today we have two very special guests for you. I’m not going to tell you who they are, you’re going to have to figure it out as they introduce themselves. But I want to let you know that from a physician and clinician standpoint, we have heard you, for the time I’ve been here at Children’s Minnesota, which has been about five years now, we’ve heard from our clinicians that we want to see more people who have the training as we do, some medical folks that are student equity, and helping us learn equity and inclusion and helping us put it into action with our patients and families. And we have that for you.

I will say this, my department is changing. I’m adding on two amazing new doctors and also a nurse practitioner as well to the team. And we’re going to hear what you have said and put it into action to make sure that we’re serving our patients and family. So today’s going to be a special show. My first guest, I would love for her to introduce herself and her name is… I’m not going to tell you, because as I said, it’s a secret. She’s going to introduce herself, tell you a little bit about who she is, and then as we have that introduction of our next doc as well, we’re going to talk a little bit about the new equity and inclusion department here at Children’s and what it looks like for clinicians.

Dr. Whitney Wellenstein: Thank you for having me. I won’t say my name. But I’m very excited to have the honor and privilege of joining your team coming up later this year, James. So I’m a native Midwesterner, so I’m born and raised in North Dakota actually. I spent a lot of time in Minneapolis, did my undergrad and med school there, go Gophers. And then I trained as an OB/GYN in residency at Kaiser Permanente in Oakland, California, in the Bay Area. And that’s kind of where I got into some advocacy stuff around women’s health and things like that. But previously, had been more involved in kind of SNMA and diversity within the medical school and equity and things like that. I continued that in residency a little bit. We did some recruitment for underrepresented minority students there. And then I transitioned to fellowship in pediatric and adolescent gynecology at Cincinnati Children’s in Ohio. And then after that, I took my first big girl job at Children’s Hospital of The King’s Daughters in Norfolk, Virginia. And now I’m excited to be coming back to the Midwest pretty soon.

James Burroughs: And our next mystery guest?

Dr. Kade Goepferd: All right, well, I won’t say my name, but probably many of you recognize my voice. I have been at Children’s Minnesota for 18 years and have a role in our education department here as our chief education officer. I’m trained as a pediatrician and currently practice in the gender health program as the medical director of that program. I am originally from Iowa. I was actually born in Minneapolis, but raised there and then came to Minneapolis in 2000 for medical school. And I’ve been here ever since. So I did all my medical school training here. And my journey with regard to this work really started before medical school.

So when I was an undergraduate, I had come in planning to become a pediatrician, planning to go to medical school. And then when I was in college at a liberal arts college, I started learning about the way that the world worked. And I really came out as an LGBTQ person at that time and really started to understand the world in terms of inequity and social justice and oppression, and oppression with regard to race and gender and class and sexual orientation and gender identity. And really realized that my life work needed to be connected with really improving the world in that way. I felt like I needed to address social justice in some way in my career.

So I almost didn’t go to medical school, but spent a summer working up here in Minneapolis at a federally qualified health center and saw pretty quickly how medicine can be social justice work and all of the social determinants of health that play into someone’s health outcomes and them kind of living up to their health potential. And so I decided I was definitely going to stick with medical school and then make sure that my medical career involved really making sure that everyone had what they needed to thrive in terms of health and particularly, in my case, kids.

James Burroughs: Well, thank you both very much. And as you know, that’s Dr. Kade Goepferd because she’s the founder of this show that she allows me to graciously host, called Talking Pediatrics. So if you don’t know her voice, you haven’t been listening. Thank you for that. And also our other mystery guest is Dr. Whitney Wellenstein. And both of them, I’m so excited for them to be joining my team.

Now, for those of you think this, and this is for my CFO especially, they’re joining at a point two, so I don’t have two full-time physicians working for me and don’t have that budget today. But one of the things I wanted to encourage you all to talk about today, and I’m going to ask questions related to that, is what I’ve learned in the five years here is that I’m not a doctor, I’m a lawyer by training, I’ve done equity inclusion work for 20 plus years, but I’ve never treated a patient, I’ve never treated a kiddo, never talked to a family about that. And it’s a different level of how you work with from an equity inclusion lens our patients and families that I don’t have.

And when I realized that, I said, “Okay, how do I go out and get that?” I’m not going to go to medical school, I’m not doing that. It’s too late in life for that. And I’m not going to probably get any training, other than rounding that I could see on an early basis to supplement what I don’t know. But what I did think about is adding folks who have that passion that you talked about, Kade, and you talked about, Whitney, about wanting to do this work and do it differently to make sure that our patients are taken care of. So I want to start with you, Whitney. Why is taking on this role or working with my team, in addition to your 80% job, important to you?

Dr. Whitney Wellenstein: It’s one of those things that I think since I started med school, it’s the thing that fills my tank and makes me feel recharged. And it’s the thing that I’m passionate about within medicine for sure. I think, especially in the world of delivering reproductive health care and working in a lot of underprivileged locations, you just have to kind of almost change the way that you approach medicine and get a little bit more creative. And that’s I think where I thrive. And that’s something that I’m really looking forward to bringing in more of a formal role. Because up to this point, it’s kind of been on the side, things that are working on committees, task forces, things like that. But I’m really looking forward to having a team and the dedicated mission behind them.

James Burroughs: Kade, this is a switch up question for you because you’ve been doing this work for a while. Social justice is one of the things you have been passionate about, as you talked about, why come work with me now? I’m a little bit different than the rest, and we work together a lot, but what’s the impetus about joining the team in a kind of a semi-official role?

Dr. Kade Goepferd: I have done what I consider to be equity and inclusion work, integrated through both my medical practice and my administrative roles since I’ve been here at Children’s, it’s always kind of been woven through my work. As I get farther in my career, I’ve been here almost 20 years now, been in a senior leadership role for almost 15 years at this point, and I’m really looking ahead to what’s the change that I want to be a part of creating. And I want to always feel like I’m doing work that has meaningful impact. And obviously, when you’re in an exam room with a family, you’re definitely having a meaningful impact on that child and on that family. But through my work in education and some of the work I’ve done in advocacy for trans and gender diverse kids and LGBTQ kids, I really want to do more work that is going to change systems so that we can set up a better future.

And so I see joining your team as an opportunity to really do some systems work. I’m often talking about things like racism or bias based on gender identity or sexual orientation. It’s like the wiring in the walls of the hospital, it like it’s in everything. You can’t always see it. Sometimes you can feel it, especially if you put your finger in the electrical socket, sometimes it really jumps out and bites you, but it’s there. And I really want to spend the next phase of my career and of all of my work helping to rewire that. I really want to set Children’s Minnesota and really healthcare in general up so that it’s designed to get different outcomes, because right now our system is designed to get inequitable outcomes and it’s time we change that. So this is really a way for me to dedicate some formal time to that systems change.

James Burroughs: Let me ask you this, and this is going to be a question, I’m trying not to be biased. So I’m a lawyer by training, not a physician, and I talk about lawyers in a bad way a lot of times. So I’m going to put that hat on and talk about physicians. Why don’t you all get it? Why don’t you all get equity? Don’t they teach that in medical school? Don’t they teach you how to treat patients from all different kind of income status, race, ethnicity, gender identity? Why don’t you all get it? What’s in the way?

Dr. Kade Goepferd: You know, I think medical training in a lot of ways is in the way. Whitney and I are slightly different generationally in terms of our medical training, but I would guess had not that unsimilar of experiences in our training. It’s really not designed for critical thinking. It’s really designed to get you to learn a trade and kind of immerse yourself in that field. And a lot of times we’re kind of head down just surviving the training. And unfortunately, I don’t think we’re taught a lot of critical thinking when it comes to why are certain patients having outcomes that are different. I do think that more recently there’s been a wave toward doing some critical thinking, particularly in the quality improvement realm. And when we make sure that equity is a part of that conversation, we can look at it.

And then the other thing I think that we have to remember is that things like racial health equity, for example, it’s not about any one individual doctor or a group of doctors. It really is about a system. So I believe that systems are exquisitely designed to get the outcomes that they create. So our healthcare system has been intentionally designed to create racial health disparities. It’s been intentionally designed to be exclusive of LGBTQ populations. It’s been intentionally designed so that people who don’t have access to resources can’t access the same quality of healthcare. And so in order for doctors to get it, we have to start having conversations about the ways that our system is broken and the ways that we change that system. Because a lot of times I just think people aren’t seeing it. I always talk about kind of biases like you’re just swimming in the water and you don’t even notice the water around you. So that’s kind of my thoughts. But Whitney, I’d love to hear what you think.

Dr. Whitney Wellenstein: As overworked physicians, we often take the path of least resistance, which is falling in line as far as get through your training and then you take care of the patients in the way that it’s easiest with insurance, and you take the patients at face value in your clinic just to kind of get through your day. Where in reality, there’s so much more than just… It’s not a vacuum, it’s not just what’s happening in your clinic or fighting with insurance. It’s what kind of social support do you have in your clinic? What type of resources do you have in your clinic? What languages are those resources in? What neighborhood do these patients live in? How are they getting to the clinic? Are they in a food desert? So there’s just so much more to consider beyond this 20 minutes that you interact with the patients in a day.

And I do think from a medical training standpoint, there were some opportunities as we were coming up, but like I said, it was above and beyond. It was not part of the curriculum or things that you learned about if you wanted to learn more about equity or taking care of underprivileged populations. It’s something you have to go above and beyond on your own time to do, which we don’t have that much time. So it almost self-selects. If you don’t have that passion, then you don’t really ever learn more than what you’re just taught in medical school, which is why Kade is referring to. It’s tough.

Dr. Kade Goepferd: One other thing I might want to add is that I’m also a firm believer that we can’t change what we don’t measure and we also can’t change what we don’t hold each other accountable for. Doctors are often held accountable for work RVUs, for example, or making sure our notes are done on time, or sometimes even quality metrics we’re held responsible for. Like in primary care, how many of my patients have well-controlled asthma. And I will pay attention to the things that I’m held accountable for. So I think part of it is also changing what we’re expecting from clinicians so that we’re held accountable for the work of equity and inclusion, and it’s part of what we just come to expect as part of our jobs.

James Burroughs: What I’ve heard from some physicians, I want to ask you both about this is, “Well, James, if I do equitable care, it’s going to take longer. And you want me to see more patients, you want me to see the number of patients by every hour. But if I take the time to get to know the patients, the family, their language, their culture, they’re LGBTQ, learning about the things I may have blind spots to or may have biases to, it’s going to take me longer to serve patients.” What do you say to that as one of the barriers that gets in the way?

Dr. Whitney Wellenstein: It’s true. That’s a very valid mindset and I think it doesn’t all have to fall on the physician in the 20 minute visit. I think what we were alluding to is integrating this in clinical care in whatever way that may be, whether that be intake forms, whether that be support staff getting information, social work, et cetera. Being creative with the ways that we support these families and elicit that information, I think can be helpful to minimize extra burden on a sole person. But also I think part of it is kind of a mind shift switch of you’re not just taking this extra work on without reason, right?

So expanding the way that providers approach the patients, their mentality, especially if they’re being held accountable for certain things, they may consider that in the questions that they ask or certain things that they’re testing for, to provide better care in the end. Which I think in the end most, I would hope, providers, that’s their goal is to provide better care and have better outcomes. And I think it’s pretty clear just looking at how we’re doing in the US, there’s room for improvement. So I think kind of getting buy-in from not only the physicians in our hospital, the support staff in our system, but kind of taking it from the ground up as well from medical training, et cetera.

James Burroughs: Kade, what did you want to say to that?

Dr. Kade Goepferd: Yeah, I mean I think there’s ways that I agree with Whitney and then I also think there’s ways that I disagree. The things I definitely agree about is that our systems could be set up better to help us be successful. So for example, at Children’s right now we’re working on making sure that we’re asking every single patient the name that they want to be referred to, the pronouns that they use or that they want their child referred to, and getting some of that information upfront. We have that when you walk into the room, that takes away, what I would argue, is probably five to 10 seconds to ask that information.

But I also think, I agree with Whitney that there is some personal mindset component to this work. I think it actually, one, saves time in the end if you get to know your patients and families and their circumstances upfront because then you don’t spend as much time trying to figure out why the care solutions that you’re offering aren’t working. So you actually get to a better outcome faster. And I would argue that we should really not just care about providing the care, but we should care about the quality and the outcomes of the care that we’re providing. And if we don’t take the time to understand the individual circumstances culturally or socioeconomically or whatever it is of our patients, then they’re just not going to have good healthcare outcomes. And I think a lot of times we don’t realize that we actually are taking more time with patients who are more like us and we’re just not understanding that.

So I’m going to just put myself on the spot here. I had taken a health equity course maybe a decade ago back when I was doing primary care. And one of the things that I came to realize, I did a day where I was really intentional about how I interacted with each patient on my schedule. It was part of one of the assignments that we had to do. And what I noticed was the patients who were more like me, racially, socioeconomically, maybe had kids my kids’ ages, I was taking more time with them. I was connecting with them on like circumstance. We were talking about things that we in common. And I wasn’t doing that with patients who were more unlike me. And that was really a wake-up call for me.

And I really made an effort then going forward to stop doing that. And I kind of held myself to a couple of questions that I would just ask every patient. And instead of not taking the time with the patients who were like me, I tried to force myself to take more time with the patients who were more different than I was. And what I learned in doing that just made, one, my encounters go so much more smoothly with those patients, but also I think resulted in better care. And so I think sometimes we do need to challenge our thinking on that and say, “Is it really a lot more time?” Because I think that we give up our time when we don’t feel a personal resistance to it. So I think sometimes we have to look at that personal resistance.

James Burroughs: One of the things we want to have physicians do more of is get more into the community and participate in community. What are some of the ways you think, and I’ll start with you Whitney, that either you have done that on your own to build relationships in community or some of the ways you think we could do that here at Children’s when you get here?

Dr. Whitney Wellenstein: I think the way I’ve done it on my own mostly has come in the form of either mentorship or education. So specifically mentoring young Black women in medicine is definitely something that I’ve been passionate about. And it also just happens to work out that those are often the patients that I’m educating as well about their reproductive health. So I think just having a presence in that way. Showing diversity within medicine, I think is very important because I think we talked a lot about it’s really hard to be something that you don’t see. So I think that can be really helpful for improving the pipeline and things like that. Otherwise, for how to do it in Minnesota, I haven’t thought about that a ton. I am very excited because you know you have a personal draw to a place that you’re from and have roots down. And so that’s something that I’m really excited about coming to Minneapolis is that I feel more involved in the community and I have more purpose for that. So I’m really excited for that.

James Burroughs: Kade, how about you?

Dr. Kade Goepferd: One of the reasons I love being in the Twin Cities is because of the diversity of culture and communities that we have here, including my own community, the LGBTQ community. I feel very at home here. And what I have sort of learned outside the hospital walls is you just have to show up in community. I mean, you just have to go places that you’re kind of less familiar with, go to cultural celebrations that you haven’t been to before. And that really helps you not only understand your patients, but you may actually see your patients there and then you’re building trust and rapport just by showing up. So I think one thing that maybe Whitney and I could work on is making those types of opportunities more readily available to our physician colleagues, our clinician colleagues, and making teams more aware of them and specifically inviting what I would say is some of our clinical leaders to come with the DEI team to some of those in-community celebrations, volunteer opportunities, things like that.

Then I’d really love to see Whitney and I doing some work to create community within the walls of Children’s Minnesota. We are so fortunate here to have a number of employee resource groups. I think it’s good practice to just join all of them because then you get to hear about what types of events that they’re putting on. And I don’t have a disability, I don’t identify as Latinx or Asian in any way, but I’m a part of those ERGs so that when, one, I know when cultural celebrations are happening, two, I can attend them when I’m able to. And I think it’d be really great to create a community of clinicians who are really getting more involved with some of our ERG work in our internal community because then that builds trust on the clinical team. So then that way when you are having a hard time with a family or you’re not getting the outcome that you’re hoping for with a family, if you have a culture of trust and community among the clinical team members, then you can lean on each other in different ways.

So it’s really different if someone comes to me and says, “Teach me about the LGBTQ community. I don’t understand it. I’m having a hard time with a patient,” versus if I have a trusting relationship with someone and they’re working with a trans patient and something isn’t going well and they want to talk to me about it or ask my help about it, that’s really different because we already have some trust and connection and a relationship. So often in medicine, there’s a hierarchy between physicians specifically, but the clinical leads on teams and the rest of the organization. And I’d really love to see us breaking down some of that so we’re creating more inclusive community with the health care teams here at Children’s.

James Burroughs: When a physician is trying to do this work and they make not even a mistake, they misstep and they feel embarrassed by something that they did, how would you all encourage your colleagues to say, “Hey, just stay in there and keep doing this work, and it’s not something that you have to be afraid of doing”?

Dr. Kade Goepferd: One of the things that I always think about as a physician is that our jobs and our relationships with patients are a mix of credibility and relatability. So I think sometimes we’re afraid to admit that we made a mistake because we worry that it compromises our credibility. I would say no, it doesn’t. When you admit that you made a mistake, it increases your relatability because then you’re seen as a human being that is learning and that is growing just like all human beings are. And so I think sometimes it’s just kind of giving permission to say, yeah, don’t just ignore it if you do something wrong or if you learn later that you probably shouldn’t have said something. There’s an art to cultural humility, and really that’s what it’s about is being culturally humble and saying, “Gosh, I really got that wrong,” or, “I’ve been doing this thing the whole time and now I realize that probably wasn’t the best thing for me to be doing and I’m going to learn and do better.”

Then I think it is, don’t just say you’re going to try, try and get it better. And at some point when you just keep apologizing, then people really think you’re not actually caring because you’re not making the change. So I think apologize, white people do this a lot, straight people do this a lot, where we allow our guilt to get in the way of the apology. So then we are almost asking for some kind of absolution, “Oh, I’m so sorry, I’m so sorry, I’m really trying.” No, correct yourself, apologize quick and move on. It shouldn’t be the person who you offended their job to make you feel better about the fact that you offended them. And so I think that’s part of being culturally humble, is understanding this wasn’t about me. I made the mistake, I’m going to apologize and I’m going to make the effort to learn. But Whitney, I’d love to hear how you’ve handled that or what you think.

Dr. Whitney Wellenstein: Yeah, I echo everything you said. I think the only thing I would add is creating the culture of accountability amongst care teams and clinical teams has been something that I’m working for and I know a lot of other departments are working on in the way that you respect the patient and talk about the patient when they’re not around, using their pronouns when the patient is not in the room is a form of respect. And if someone on your team or whatever gets a name or a pronoun wrong or even uses a slur that is inappropriate, having that culture of correction and accountability. So not that it’s an attack if somebody on the team corrects somebody, but, “Hey, no, you used the wrong pronoun,” and, “Oh yes, thank you for correcting me.” And kind of having that open exchange even amongst different hierarchies, which is really challenging from trainee to attending, etc, can be tough. But I think really integrating that into care teams is really, really important.

James Burroughs: Anything that you want to add for your colleagues to think about as far as we’re moving forward in this equity inclusion work? We won’t talk about it today, but DEI and equity inclusion, those words have been, depending on where you are in the region or country, or LGBTQ, have taken a beating as far as their perception of what people think they mean. And also too how they get an opportunity to continue to be inclusive in different regions of the country and even here in Minnesota. Anything that you want to leave the audience with and saying, okay, here’s your hope for the future about how this work can be integrated, building new systems, and also too holding people accountable? Anything in that area that you want to leave the audience with? I’ll start with you, Whitney.

Dr. Whitney Wellenstein: It’s kind of tough because coming as an outsider. So I think what I’ll just say from the outside looking in is that you all have a really good thing going. And I’ve been at a few different institutions now and the fact that your institution, our institution, is at the forefront of these types of movements and being outspoken, and I think this podcast, all of this I think is really, really important and special. So I’m just really humbled and grateful to be a part of it.

Dr. Kade Goepferd: I want to just touch on something you said, James, about kind of what I’ve seen is almost the weaponizing of words like equity and inclusion and diversity and things like that. And sometimes I really want to try to reframe what we’re actually talking about because people get so caught up and they hear a word and then they almost have an immediate reaction to it. And when I think about inclusion, some people will say, “Oh, I’m not into all that wokeness,” or whatever. And I feel like, but are you into kindness and respect? Because that’s really what it’s about. Calling someone by the name that they use, referring to someone appropriately by a racial category that feels home to them, that’s just kindness and respect. So I think grounding in we’re talking about kindness and respect. And then when we’re talking about equity, we’re talking about making sure that we’re optimizing outcomes.

I became a pediatrician because I think every single child deserves the right to thrive. And some kids, they’re going to thrive regardless of me, whatever I do or don’t do. And some kids, they’re going to need a little bit more. And that may be because they have a chronic health condition, that may be because they’re coming in in a family situation that’s really tumultuous. And that may be because society has set their family up generationally to not succeed. So we just have to decide what do we need to invest where to make sure that all of our patients have good outcomes? That’s equity. So you can say equity or you can just say, “All right, these patients, they’re having good outcomes, great. These patients, they’re not having good outcomes. So what do we need to do for these patients to ensure they have optimal health outcomes?” And we can call it equity, and we can call it just making sure that all of our patients are getting their optimal health outcomes.

James Burroughs: I love that because as words get misused or mischaracterized, it’s less about the words, it’s less about what do our patients and families need? And every physician I’ve ever talked to, they want to give that family and patient what they need.

Dr. Kade Goepferd: Right.

James Burroughs: And that’s so important. Well, I want to thank you, Whitney, I want to thank you, Kade, for joining me at the equity suite here, and I appreciate you coming on this episode of Talking Pediatrics. Thank you all very much.

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.