IFDHE Podcasts

These podcasts feature conversations with hospital and health system leaders on a variety of diversity and health equity issues that impact patients and communities. Look for new episodes directly from your mobile device by using SoundCloud. You can also listen to the podcasts directly by clicking below.

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Hospital and health system boards are always looking to solve the most pressing challenges in health care. Asking the right questions and providing proper guidance can help establish plans to combat these issues. In this conversation, James Liggins, Jr., senior counsel at Warner Norcross + Judd, and vice chair of the board of directors at Bronson Healthcare, discusses his work developing a tool for board members that allows them to effectively understand and address areas of concern for their organizations.


 

View Transcript
 

00:00:00:19 - 00:00:33:14
Tom Haederle
Issues that continue to affect the entire health care field, such as cybersecurity, workforce and the lingering effects of the pandemic, are areas of vulnerability for most organizations. Their boards can help by asking the right questions and providing the guidance that helps hospitals and health systems develop effective plans to deal with these challenges. And now, boards themselves could get a little help with this important task.

00:00:33:17 - 00:01:00:18
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Today we hear from James Liggins, an experienced board member with Bronson Healthcare in Michigan. In this podcast hosted by Nikhil Baviskar, the AHA's program manager for trustee services, Liggins describes his work on a tool board members can use to help their organizations thrive in this complex and challenging era for health care.

00:01:00:20 - 00:01:19:04
Nikhil Baviskar
Hi James, great to see you here at the 2024 AHA Leadership Summit. Can you tell me a little bit about your organization as well as your board, specifically the composition, the history? And I would be remiss if I didn't ask about your involvement with our AHA Committee on Governance as well.

00:01:19:06 - 00:01:44:18
James Liggins, Jr.
Absolutely. So my name is James Liggins, I am the incoming board chair, actually, for my organization, which is Bronson Healthcare Group. It's located in Michigan. It is a four-hospital system, almost five hospitals now. We just brought in a behavioral health hospital as well. Maybe about 9000 employees, the largest employee in the area. So it's headquartered in Kalamazoo, Michigan.

00:01:44:21 - 00:02:04:00
James Liggins, Jr.
And then we pretty much are southwest Michigan as our region as a nine-region area. And I am the incoming chair, and I've been there for, I've been on the board there for about eight years now. I'm also a commercial litigator by trade, so I do business-to-business kind of litigation. The firm that I work for is called Warner Norcross + Judd.

00:02:04:02 - 00:02:33:11
James Liggins, Jr.
And then with respect to the American Hospital Association, I am a Committee on Governance member, and I've been a member for several years now. And the incoming chair for that committee as well. And that is really one of the highlights of my career with respect to board work, because it's a different type of committee and it's the flow is a little bit different than I'm used to, but I'm really enjoying the impact that it seems like it has over the entire health care industry and hospitals in general.

00:02:33:13 - 00:02:58:23
Nikhil Baviskar
Appreciate that and thank you for the shout out. We love having our COG members involved with so much of what we do. Specifically, you know, referring to the AHA, I wanted to next question ask you about the AHA Next Generation Leaders Fellow. So this is a program that you are expected to develop a project. And one of the reasons we have you here today is to explain that project as it is something that seems interesting for lots of people.

00:02:58:29 - 00:03:36:27
James Liggins, Jr.
Well, sure. So the Next Generation Leaders Fellowship is, I think I'm a little bit of a unicorn with it because it's normally for those who are kind of up and coming executives headed towards the C-suite kind of level in operations of hospitals. But since I'm actually a board member as opposed to operationally speaking, it's been very interesting. And the focus of what I really wanted to get out of it was the operational side of the health care industry as a whole, and the project that I've decided to focus on is actually kind of near and dear to my heart as a board member, because it really kind of stemmed from some of the dynamics that we

00:03:36:27 - 00:04:07:27
James Liggins, Jr.
received or experience as an industry from Covid, as well as now we're seeing some of the cybersecurity issues that, not some of them, a lot of them, and even CrowdStrike that just kind of impacted the airline industry and others. It really kind of started to concern me as a board member about those areas of vulnerability with organizations that, should they fail and we not have redundancies in those fields or in those areas, we could have catastrophic kind of impact for the organizations.

00:04:07:27 - 00:04:39:12
James Liggins, Jr.
And so my project was focused on the board side of this. How do we develop a tool that helps the board to ask the right questions, to make sure that our organizations are addressing areas of those types of vulnerabilities? They're called single points of failure, and it really comes from the technical side or technology side with the idea that if you have an app or you have a server that potentially if that's your only non-redundant system and it fails, then you're in trouble.

00:04:39:12 - 00:05:05:27
James Liggins, Jr.
And so, but that's organizationally-wise it can be applied throughout every industry. And so my thought was how do we apply that to the health care industry. And particularly from the board level. How do we develop a tool. And this is really interesting, how do you develop a tool that doesn't poke too far into operations as a board, but also allows you to do your due diligence to ask and inquire for the questions that the board members should be asking.

00:05:06:00 - 00:05:16:25
James Liggins, Jr.
And so that's been my project, is develop that type of tool, and it's been a wonderful process. And fortunately I have a organization that was really behind the idea of trying to help me to develop it as well.

00:05:16:27 - 00:05:35:11
Nikhil Baviskar
That is awesome. In a word. I think it's really great that you are looking at this from a board member’s perspective, because we don't usually see that. And I think calling yourself a unicorn is helpful as well, because it shows us that the board member does have a unique perspective on all of this. So the board tool sounds amazing.

00:05:35:11 - 00:05:38:27
Nikhil Baviskar
Can you tell me how it would work in practice and potentially give us an example?

00:05:38:28 - 00:05:58:21
James Liggins, Jr.
Sure. So in practice, the way it works is what you really want to do is work with your executive team. So to develop questions that kind of are focused on things like, so a single point of failure could be a person, you know, it could be a position, maybe a position that we don't have a succession plan for, we don't have.

00:05:58:25 - 00:06:19:27
James Liggins, Jr.
But if we lost that person, the system could come to a halt. It could be very catastrophic for us. It could be a vendor that is a single point of produce or production or service for the organization that we don't have backups for. It could be someone or a knowledge or a skillset, that if that skillset goes away, the organization as a whole is in trouble.

00:06:20:03 - 00:06:40:25
James Liggins, Jr.
And so what we develop was a, so you work with your team, and the reason why you have to work with your executives is because you really want to counteract and mitigate the defense, the automatic defensiveness that people might have when you start talking about areas within their responsibility, right? That at the end of the day, may look or reflect bad on them.

00:06:40:27 - 00:06:54:24
James Liggins, Jr.
So you really have to work to bring them into the process right from the beginning and help them to understand that this is going to be anonymous. The goal is not to single point anyone out. The goal is to make sure that the organization as a whole is as healthy as it can be.

00:06:54:27 - 00:06:57:08
Nikhil Baviskar
Have you been able to test this out as of yet?

00:06:57:13 - 00:07:19:23
James Liggins, Jr.
So I have the survey. We are working on implementation right now. And so the goal is by fourth quarter to implement it at Bronson. Yeah. And the cool thing is I'll just be moving into the board chair role. So I'll have some legitimacy and pushing this out to the organization as a whole. Because just as a regular board member, I'm not sure I'd be able to get it pushed.

00:07:19:23 - 00:07:29:18
Nikhil Baviskar
Well legitimacy matters, yeah, legitimacy matters. Well, James, thank you so much for your time today. I can't wait to follow up with you and find out how this works out.

00:07:29:18 - 00:07:46:08
James Liggins, Jr.
And one last thing I'll say, Nikhil, is on the Committee on Governance. You know, the goal is hopefully after I've had a year of implementation to talk to our committee about it as well and just let the committee members know what we're doing, they may decide that it's something that they may have interest in as well. And our members as well.

00:07:46:10 - 00:07:53:27
Nikhil Baviskar
We are at the Innovation Hub at the Leadership Summit. So perfect idea. So thank you again, James, for your time and we'll talk to you later.

00:07:53:27 - 00:07:56:02
James Liggins, Jr.
Nikhil, I appreciate the opportunity.

00:07:56:04 - 00:08:04:15
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.


 

Advancing health equity is a key priority for the American Hospital Association (AHA) and the American Medical Association (AMA), with both developing key initiatives and programs dedicated to these efforts. In this conversation, Joy Lewis, senior vice president of health equity strategies at the AHA, speaks with Aletha Maybank, M.D., senior vice president and chief health equity officer at the AMA, about the challenges in the health equity space, and the opportunities that can make a difference in health care across America.


View Transcript
 

00:00:00:16 - 00:00:24:26
Tom Haederle
Advancing health equity is a key priority for the American Hospital Association and the American Medical Association. Both organizations have many initiatives and programs underway to support these efforts. But this work is challenging on many fronts.

00:00:24:28 - 00:00:48:18
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. This podcast features a conversation between the AHA's Joy Lewis, senior vice president of health equity strategies and executive director of the Institute for Diversity and Health Equity, and Dr. Aletha Maybank, senior vice president and chief health equity officer for the American Medical Association.

0:00:48:20 - 00:00:57:00
Tom Haederle
Hear them discuss some of the top challenges and opportunities for advancing this pivotal work. And now, let's turn it over to Joy.

00:00:57:02 - 00:00:58:20
Joy Lewis
Is it fine to call you Aletha?

0:00:58:23 - 00:01:01:17
Aletha Maybank, M.D.
That is fine. Okay. Absolutely.

00:01:01:19 - 00:01:24:21
Joy Lewis
It's such a pleasure to have you here with me today. I've literally been waiting for this conversation for quite some time. And then you penned this...this piece we're going to talk about that was published in the New England Journal of Medicine in March, I think it was. And that accelerated our conversation today. But thank you for joining me.

00:01:24:24 - 00:01:56:28
Joy Lewis
And just for our audience, a little bit about your career that has spanned quite a few inaugural leadership roles, including the role you currently occupy as the chief health equity officer at the American Medical Association. You were also the founding deputy commissioner for the Center for Health Equity at New York City Department of Health and Mental Hygiene. And the founding director at the Office of Minority Health in the Suffolk County Department of Health Services.

00:01:57:00 - 00:02:27:20
Joy Lewis
You've taught medical and public health students on constructs related to health inequities, topics such as public health leadership and management, physician advocacy. I know that's a real area of emphasis for you. And community organizing and health. Maybe we can start by looking at, you know, given your background and experience in DEI and health equity, you, like many of us, are, really in a tough position right now.

00:02:27:22 - 00:02:59:22
Joy Lewis
Our nation is seeing significant backlash efforts toward DEI efforts, across the board, frankly. And as I mentioned you took pen to paper and, you wrote a piece entitled, “The Plight of DEI Leaders: Heavy Expectations and Limited Protection.” And in that piece, you shared quite a bit about your personal experiences, about the attacks, the criticisms you're facing as a leader in this space.

00:02:59:22 - 00:03:23:09
Joy Lewis
So let's start with something a bit closer in and a little more personal about how are you feeling and how are you coping with the demands of your role and the broader political environment within which we find ourselves, and maybe touch a little bit on why now? Why did you choose to write this piece at this particular time?

0:03:23:12 - 00:03:43:14
Aletha Maybank, M.D.
Sure. Thanks, Joy, for having me on. Great to be in conversation and share space with you all the time, because I think that's an important part of how we cope. Truthfully, to be in community with one another, sometimes. And it helps support our own kind of experience to have shared validity of what we are going through.

0:03:43:15 - 00:04:09:03
Aletha Maybank, M.D.
You know, in this environment, though, there's so much, you know, and there's so much, so many constant reminders of how people don't fully value other people. And for all these reasons that, you know, I just sometimes, you know, I could say, of course, I understand some historical nature and context and stories that people have been told.

0:04:09:05 - 00:04:36:13
Aletha Maybank, M.D.
But, you know, when you're not rooted in that way. And I wasn't raised in that way, and it's still just so hard to want to even understand, you know, especially when people are harmed. And I, you know, the context of people being harmed should be appalling for all of us. But it's not. That just becomes exhausting. And you may have heard me say before, I feel now, especially at this point in my career, I didn't feel it as much earlier.

00:04:36:13 - 00:05:14:26
Aletha Maybank, M.D.
But I’m paid to convince people to care about the humanity of others. Is really my overarching role because that's at the core of it. If we all actually valued each other and even in not understanding each other, knowing we don't know what we don't know. So a lot of my work is really in creating those kind of environments of which that happens, like I believe in the context of proximity. And that in order to actually get to that space of, of seeing and understanding being proximate to someone you know, Bryan Stevenson talks about that.

00:05:14:26 - 00:05:30:09
Aletha Maybank, M.D.
Many people have talked about that. I think about, again, how I was raised by my mother. She, you know, grew up poor in another country but ended up having a, you know, a decent amount of privilege here because of the work she put it in her. She's a smart, brilliant person,so was able to create a lot for me.

00:05:30:14 - 00:05:49:10
Aletha Maybank, M.D.
I did not grow up in the way that she did, and she recognized that and said, I can't have this, I don’t know if it's a false sense, but I need to have a more global sense of the realities of others. And so she would place me in the people's homes that did not have what we have. You know, and so I learned a lot about that and as a context growing up.

00:05:49:10 - 00:06:07:06
Aletha Maybank, M.D.
But that's important in the work that we do. We talk a lot about the data pieces, which are important terms of accountability and seeing change over time. But I don't feel that that's the point of which people actually change their will and want to do better and be better and lead better. And so that's where I come back to

00:06:07:06 - 00:06:37:15
Aletha Maybank, M.D.
I feel like a large part of my role is convincing people to see the humanity and to care about others in ways that are different than their own self-interest. And I wrote that piece, you know, in all honesty, because I was feeling a lot of pressure, from within institution, outside of institution, not really being, not knowing if people really see the complexity of the experience.

00:06:37:17 - 00:06:53:14
Aletha Maybank, M.D.
And I knew just based on what was happening already and the kind of the news stream, folks like you who I was in conversation with. And so I wanted to create this space where I was going to kind of speak to it. The first iteration of this was actually a love letter. And it was a love letter to

00:06:53:15 - 00:06:54:08
Joy Lewis
To yourself.

00:06:54:09 - 00:07:15:26
Aletha Maybank, M.D.
No, a love letter to DEI colleagues across the country. Okay. With a different frame that was a little bit more and it started off more so kind of I see you, I feel you, you know, and it was more directed towards, you know, the leaders themselves. Now there's a secondary piece of that to how it turned out to be when I had to condense it, because of where it ended up being published.

00:07:16:01 - 00:07:35:17
Aletha Maybank, M.D.
So I, you know, I wrote it because I felt the desire, one, to be in like solidarity with many of us doing this work. I wanted you all to be seen and heard in a way that typically people are not talking about it and people aren't asking us really how it is. There are a lot of assumptions being made.

00:07:35:19 - 00:08:18:28
Joy Lewis
Wow. There's so much there, so much to unpack, starting from even your land of origin, at least in terms of your mom's history and where she's from. And, you know, I actually come from a very similar experience as being born and raised in Jamaica, where being black is actually celebrated. Right? The vast majority of Jamaicans look like me, and when you're the predominant culture — and granted there's white Jamaicans, Indian Jamaicans, Chinese Jamaicans — but the motto there, the Jamaican motto is "out of many one people."

00:08:19:00 - 00:08:43:05
Joy Lewis
So everyone actually sees themselves first as Jamaican. It was shocking when I at 14 years old, came to Brooklyn and granted, there's quite a Caribbean community there. But quickly I started to realize it's a different game. It's a different way in which the dominant culture relates to black Americans.

00:08:43:07 - 00:09:07:14
Aletha Maybank, M.D.
When you see yourself as presidents, doctors, all the rest, there's nothing telling you can't be or can't do, right. But when you get to an American society, no matter, even if you're in a predominantly black community or neighborhood, the structures and the systems and all these institutions that we work with, the work that we are doing, continually tells us we're not present, we're not seen, we're there in limited numbers.

00:09:07:16 - 00:09:34:01
Joy Lewis
Well, thanks for taking, carving out some time. It sounds like it was cathartic for you to actually write this piece. And it's been well received by those of us in this space alongside working alongside you and others. So in the article, you mentioned that DEI leaders cannot be held accountable for their institutions’ decisions, right? Specifically, you have,

00:09:34:01 - 00:10:01:14
Joy Lewis
“But higherDEI leaders cannot be held personally accountable for their institutions’ decisions. We are being scapegoated for our institutions’ decisions. While we have no power to make these decisions on our institutions’ behalf.” So can you provide a little more insight? And, what were you thinking as you were reflecting on being scapegoated? What in fact should DEI leaders be responsible for?

00:10:01:15 - 00:10:21:04
Joy Lewis
Because it's certainly a mixed bag out there. And if you can share with our listeners a little bit more about your vision for our role to work behind the scenes where we're really trying to change people's hearts and minds, which is a tall order.

00:10:21:07 - 00:10:42:01
Aletha Maybank, M.D.
It's a very tall order. But and because all these are very personal, because it's all about value, it's all about how we value people. Correct. So what I meant at that moment, I was getting a lot of, you know, the hardest part is when you feel like you're misunderstood. And when you work in an institution like the ones we work in, there are a lot of assumptions.

00:10:42:03 - 00:11:02:16
Aletha Maybank, M.D.
Unless you know me personally, you know, and you know how I show up and you know my level of courage and my level of, you know, being very direct. And I am not my institution. You know, I am Aletha Maybank who is our chief health equity officer. Do I have influence at certain points? Absolutely. But I am not over the power of my institution.

00:11:02:23 - 00:11:32:17
Aletha Maybank, M.D.
My institution has a board. It has a House of Delegates. There's an executive vice president. I'm supporting and working on behalf of these members and responding to policy that's passed. I don't create policy. I don't create statements or positions. And to get held accountable for it. And that's what was happening, and is happening was really hard because whether I align with positions or not, it's not my decision.

00:11:32:17 - 00:11:55:00
Aletha Maybank, M.D.
And as an individual, it's really hard to take on the burden of an institution that's been around for over 175 years plus. I would be held accountable for the work that I'm to do. My work was to facilitate a process to begin to embed equity into the entirety of the enterprise of the American Medical Association. And that has been my work really in my former roles as well.

00:11:55:02 - 00:12:12:26
Aletha Maybank, M.D.
And so following that roadmap, that usually means I need to create a strategic plan of some sort and create a team that can help do that, but also work with others across the entire enterprise. It's not just about me and my team, it's about also how I manage up and how I manage across and how I work with colleagues.

00:12:12:28 - 00:12:27:13
Aletha Maybank, M.D.
That's the nature of my work. How well I facilitate my, this process and help support creating and contributing to the culture, the policies and the practices within the institution and how we measure them.

00:12:27:13 - 00:12:55:06
Joy Lewis
You know, for you, it's 175 years, for me, we just celebrated 125 years last year. I mean, there's legacies, legacy thinking. There are structures in place that support the fact that we've been around this long, right. And so it is certainly a challenge. And for those who think we are not being disruptive enough, right,

00:12:55:06 - 00:12:59:27
Joy Lewis
it's just it's hard to hear that.

00:13:00:00 - 00:13:23:12
Aletha Maybank, M.D.
It is hard. And I think in the article I made sure, I want to acknowledge the role and the critical nature of our external organizing. That is paramount. It is absolutely paramount. We have changed and movements have been structure of change because of the organizing that happens locally in our communities, nationally, on a consistent day to day basis.

00:13:23:12 - 00:13:44:18
Aletha Maybank, M.D.
The shoulders that we stand on. And because these institutions were not set up for us or by us, and most people who have been historically marginalized or colonized, we have to stop some level of the bleeding because these institutions weren't set up, they were harming us. And so we need to be here on this inside. And this is a hard part of the work

00:13:44:18 - 00:13:57:15
Aletha Maybank, M.D.
truthfully. I don't feel this is a healthy work to doing equity work on the, that's what I've learned at this point in my career. I'm not saying it's not necessary, but I'm also clear it's also not fully healthy.

00:13:57:18 - 00:14:08:28
Joy Lewis
I think I've also heard you say just in our conversations, you know, here and there, that you, you actually look forward to a day where our roles would not need to exist.

00:14:09:02 - 00:14:28:23
Aletha Maybank, M.D.
Yeah. That's with anything and these aren’t, we aren't new to these roles, right. Roles probably came around in the ‘60s as civil rights you know. And then they started to hire the first of everything, you know, first blacks of everything to be in this, these institutions maybe a little bit before that. But you know, then you start to see the evolution and you have these laws and structures are passed.

00:14:28:23 - 00:14:59:13
Aletha Maybank, M.D.
Somebody had to do the work of ensuring equal opportunity and access, that is afforded to us, you know, through civil rights law. But nobody ever really fully thought about the harm that's caused by all this. I think it was a good thing at one level. But these roles haven't fully evolved to a level of understanding and structure that more has to be in place to protect the individuals and those who are doing this work within the institution.

0:14:59:15 - 00:15:12:17
Joy Lewis
So leaning into that a little bit more, how can these institutions protect us and help us feel safe when the there's this noise all around?

00:15:12:19 - 00:15:41:11
Aletha Maybank, M.D.
Right. A couple examples and I'll start first with kind of, you know, the frameworks that are used. And I believe we should have frameworks that we use to, or plans whatever you want to say, that are built on some previous models that have existed. And so I've in our strategic plan and I mentioned, you know, that we've used the Government Alliance for Racial Equity that's been in evolution in development for over 20 plus years

00:15:41:13 - 00:16:17:17
Aletha Maybank, M.D.
as a foundation. Just so that there's a level of consistency around the communication, people, staff are able to understand and buy into it. The part that has always been missing is the trauma-informed piece to it. And so I do believe and so we added that kind of around it, I would say California Department of Health has probably done some of the best work around ensuring that when they implement models of equity and frameworks within their institution, they're also building in trauma-informed systems and supports and ensuring that there's training from across as it relates to trauma-informed support, so that that safety . . .

00:16:17:20 - 00:16:27:05
Aletha Maybank, M.D.
And I don't want to say, I think these institutions become more safe. I don't want, there's no ultimate safe within this in a context of these institutions.

00:16:27:05 - 00:16:28:20
Joy Lewis
It's a continuum, right? Yeah.

00:16:28:20 - 00:16:50:13
Aletha Maybank, M.D.
And I think, yeah, you know, we can create safer environments where people feel more included and they can show up as themselves and be themselves, and be responsive. So that's just, that's one thing. I think the other critical nature is, is top level leadership. If top level leadership is not on board with any of this, I don't see a point in doing any of this work, period.

00:16:50:15 - 00:16:51:24
Joy Lewis
Couldn't agree more.

00:16:51:27 - 00:17:22:08
Aletha Maybank, M.D.
It doesn't work. You know, I think the ability to that leadership then to create spaces or to allow their teams to have space and to develop space that inform some level of what is happening in terms of culture at the institution is absolutely critical also. Because again, you're getting ideas again from the folks who are most proximate to the experience of what it means to be an employee.

00:17:22:08 - 00:17:42:04
Aletha Maybank, M.D.
It's different. My experience is way different than other staff members. Like, I understand where I'm positioned. I am at a position of power to some level and a large level, truthfully, compared to most team members. Now, I'm not saying I have...as I've mentioned, I'm very clear about my limits, very clear.

0:17:42:09 - 00:17:45:23
Joy Lewis
But there's influence that you can, you can certainly wield.

00:17:45:26 - 00:18:00:29
Aletha Maybank, M.D.
Absolutely. And so we have, you know, we have to do all that. But that's important, the leadership showing up and creating that space, having that consistency, communicating around it as well, not making assumptions that people know what it is. You have to have the comms plan.

00:18:01:01 - 00:18:03:13
Joy Lewis
And you have to be redundant in your communication around it.

00:18:03:13 - 00:18:22:02
Aletha Maybank, M.D.
That's right. Yeah. And so those are the things — that's kind of at the organizational space now for us who are doing, you know, more specifically for us is doing this work because that's all helpful for our work. Right? That's all helpful for how we were able to lead in this work. How the employees are helps us, right?

00:18:22:05 - 00:18:41:08
Aletha Maybank, M.D.
Because who could who do people come to, you know, when there are problems? I'm sure you have heard many things that aren't particularly job-related to the role of, you know, chief health equity officers to some level. But you've heard, I'm sure, many complaints because you become the safe person that folks want to come to. Right.

00:18:41:10 - 00:18:51:19
Aletha Maybank, M.D.
And if the institution is not showing up, the systems aren't working for staff, they're going to come to us and that burns us out. We have to hear all these stories and we don't know what to do with them half the time.

0:18:51:20 - 00:19:05:20
Joy Lewis
No, you're spot on. Yeah. So you need the environment to beripe to do this work and to be supporting the work and to be supportive of the leaders who are, who are occupying these roles.

00:19:05:22 - 00:19:40:09
Aletha Maybank, M.D.
It's the context of physician burnout, right? If you think about it in that way, right. It's the same thing system, structures, culture. Does it work for patients? It's not going to work for our physicians, right. Or other health care workers and providers. They're going to burn out. But the one other thing that I'll say in terms of protections is now, in light of getting death threats, and I know several of us have been in this space, I think, you know, there has to be the responsiveness and ability for our own kind of HR security department, whatever it is, that if we need security detail, we need safety plans,

00:19:40:09 - 00:19:42:08
Aletha Maybank, M.D.
that needs to be provided as well.

00:19:42:10 - 00:19:53:12
Joy Lewis
That's right. So down to the very granular tactical like, yes, some folks may need protection outside of the workforce, outside of the workplace.

00:19:53:14 - 00:19:54:00
Aletha Maybank, M.D.
Absolutely.

00:19:54:05 - 00:20:26:23
Joy Lewis
So one of the things I think I struggle with is not having folks show up for usright? So having to be that person at the table who consistently raises the equity considerations into whatever the conversation is that we're having. And, you know, I guess some of our critics would say that's a failure of on our part to, to embed equity into whatever the organization's doing.

00:20:26:25 - 00:20:55:19
Joy Lewis
You and I know that is not — again, the system is designed to produce the results it's producing. So how do you get colleagues to be more than allies? But to actually own some of this work in a way that's meaningful and impactful to, to move the needle? What guidance would you offer up? In terms of taking actions and not waiting for the perfect evidence to act?

00:20:55:22 - 00:21:17:00
Aletha Maybank, M.D.
Well, there's two quick two questions in that, but the first, this is where a top-level leadership is critical. And because I've been to several different institutions with different types of leadership, I understand the critical nature of when you have a leader that really holds your own colleagues accountable. You know, I've been in situations where I didn't have to do . . . that wasn't my role.

0:21:17:03 - 00:21:40:08
Aletha Maybank, M.D.
My role was to establish the framework and the process to embed equity, not have to actually hold the accountability of my colleagues. And, you know, some of that is done now. But the challenge, if that's not done at the leadership level, the reality is not everybody wants to do this work. That's just real, right? So we have to accept that.

00:21:40:08 - 00:22:07:15
Aletha Maybank, M.D.
So if we really are committed as an institution, then it's going to require somebody other than me who's the boss of other folks to hold people accountable. The other part of it, what I found is the better my relationship is with and I'm talking about individual colleagues, the more likely they are to show up with me. Now, some people are going to do that naturally, like they're just going to do that.

00:22:07:15 - 00:22:24:27
Aletha Maybank, M.D.
And I've had that. I've had that where I am, I've had that before. But I realize the more tense my relationship is with somebody, the more resistance it is, the harder it is to get them. And so I, you know, there's a part of me and it's hard because I have to care about the entirety of the institution.

00:22:24:29 - 00:22:56:29
Aletha Maybank, M.D.
But there's a part of me that at this point, I'm exhausted. And so I'm going to go to naturally, the folks who are ready and willing and just going to show up and step up, because that's where I have, that's where my energy, that's what I can handle right now. It's hard to continually fight folks, and it might not feel like a literal fight, but to constantly push up against resistance that can show up in so many different ways.

00:22:57:01 - 00:23:25:27
Aletha Maybank, M.D.
And that's the other part of it that folks don't realize it. Like people can resist with a smile on their face and the decisions and what you get blocked out of. And you know it's very isolating, as I know many of us have experienced. And you just get to a point where you almost sometimes question like, why are we doing this work?

00:23:25:27 - 00:23:47:16
Aletha Maybank, M.D.
You know, I understand the why, but there's an element of like, why? Like there's just it feels just so harmful and so frustrating, you know? But you have to then remember that there were harder fight, people were fighting harder fights than we are. And so that's kind of the obligation to it and also the hope of it, right?

00:23:47:16 - 00:24:16:00
Aletha Maybank, M.D.
. Because we know that their work and efforts did help, did help things get better from the inside and outside. And so we are here, just as you said, continuing that legacy with the same hope that what we put forward is going to help people overall, everybody, not just even a singular group of people, but it's going to help everybody because it's going to help our society, it's going to help culture, and it's going to help the human condition and way of being.

00:24:16:00 - 00:24:24:15
Aletha Maybank, M.D.
And so, you know, that's I don't know what helps you kind of move forward. But that's what I know . . .

00:24:24:18 - 00:24:42:03
Joy Lewis
That North Star around,you know, making lives better, creating better conditions for people to show up in their own lives and be able to have access to those opportunities that are going to yield the outcomes that they want personally for, for themselves, for their families, for their communities.

00:24:42:03 - 00:24:42:28
Aletha Maybank, M.D.
We have to believe it.

00:24:43:01 - 00:24:43:24
Joy Lewis
We have to believe that.

00:24:43:24 - 00:25:02:01
Aletha Maybank, M.D.
I only believe it because it's happened in the past, that's for me. You know, I only believe that that is possible because I have read, seen, witnessed it happen in the past across legacies and generations. Other than that, I don't know why I would believe it.

00:25:02:03 - 00:25:25:04
Joy Lewis
Yeah. One of the things I'm compelled by is this notion of doing the work of equity coalition style. That's something I can get excited about. No, no one entity has all the answers. None of us in and of ourselves are going to be able to move the needle in a way that is, as significant as we say we want as a society.

00:25:25:04 - 00:25:50:00
Joy Lewis
So you have been behind the rise to health coalition: AMA, IHI, other partners, including the AHA. Can you say a little bit more about the power of coalitions to actually sustain the work that is happening today for future generations? How do you lean into coalitions to make that happen?

00:25:50:03 - 00:26:16:28
Aletha Maybank, M.D.
Yeah. So and I thank you for the question, because I'm also like really digging into making sure that when people when we say coalition, coalition could just mean a group of people coming together. But it's not just that. That's not how change happens. There's a context. I used to teach community organizing and health to public health students through Meredith McClure's book. And you mentioned it just a second ago.

00:26:17:01 - 00:26:42:00
Aletha Maybank, M.D.
Anything that has produced change and any group of people have used tactics and strategies as it relates to community organizing, no matter who it is, right? And I think that's poorly realized and understood by those who are not community organizers. Organized medicine gets it because that's what organized medicine is. It's organizing, right? Yeah. And what is organizing about?

00:26:42:00 - 00:27:13:14
Aletha Maybank, M.D.
It's building power with people so that people pay attention to the power. People pay attention to power, financial power, political power, collective power, people power. That's part of the point of being organized is to build power. And so to me, that's the nature of what a coalition at this day and age needs to be about, not just a group of organizations that come together in their individual contexts, have different ideas, but how do we build power to create and produce change?

00:27:13:16 - 00:27:32:14
Aletha Maybank, M.D.
How do you build power so that people pay attention to you and you become a relevant entity, so that what you say and your influence is critical? That's the nature of AMA and AHA, right? You know, there's so much power, whether it's financial power, political power or financial power, I would say, and so we have a lot of influence.

00:27:32:14 - 00:27:41:03
Aletha Maybank, M.D.
So people listen to us whether I would or not. I'm just saying they respond to that. Certain structures respond to that. Not everybody listens to us.

00:27:41:10 - 00:27:43:09
Joy Lewis
But we're seen as relevant.

00:27:43:11 - 00:27:50:20
Aletha Maybank, M.D.
To a certain segment of people. For those other people who hold power in political spaces. We're not seen as relevant to everyone.

00:27:50:23 - 00:27:51:18
Joy Lewis
Exactly.

00:27:51:18 - 00:28:20:25
Aletha Maybank, M.D.
If we are not meeting their needs. So I say that the coalition, to me, the vision is like, again, the opportunity to build power, the opportunity to be in community and the opportunity and you have to communicate within the context of that community, want to learn from one another and what we can do at our individual institutions. But then ultimately, collectively, what can we do to push, to advocate and to create changes that are structural?

00:28:20:28 - 00:28:40:29
Aletha Maybank, M.D.
You know, and so that is absolutely needed. And then there's this other word of solidarity that's also been a little bit challenged in my vocabulary, and me trying to understand what it means to, to be that and what it means. And there are a lot of different, you know, there's different contexts to that. I recognize our theories around it.

00:28:40:29 - 00:29:01:20
Aletha Maybank, M.D.
But the ability to be in solidarity for me means we have a similar vision and outcome. But we may not have the same like theory of change in tactics all the time, but there is a time where we need to come together for certain aspects of it, to push something forward, which means sometimes we may have to let something go.

00:29:01:23 - 00:29:29:16
Joy Lewis
So I'm going to give you the last word. I mean, there have been several nuggets here along the way. And so I wonder, is there any last, you know, reflection from the piece you wrote from just thinking about the larger societal pressures, the political environment, you know, the space with in which we find ourselves today.

00:29:29:19 - 00:29:37:00
Joy Lewis
Any words of encouragement for your colleagues who are doing this very difficult work?

00:29:37:02 - 00:30:21:11
Aletha Maybank, M.D.
Well, if it's for my colleagues, my DEI colleagues, 'cause the audience matters, right? I understand when decisions have to be made, because I also think there's a certain point in time if you are not healthy, we have to do what's best for ourselves at the same time. And I say that because I think we need that as, not that people are going to just jump all of a sudden, but to just have that relief and give yourself permission that what you're experiencing is real and you shouldn't have to necessarily suffer through it at this given time, you know. And it's up to you at

00:30:21:11 - 00:30:45:08
Aletha Maybank, M.D.
whatever point in time you want to be committed to it still. And that's fine if you want to stay. You know, nobody should knock anybody for their choices around how we do — or maybe not how we do but if we choose to do this work or not. And then I would say just for the larger context, there's no question that we all need to figure out how we're showing up at this moment in time.

00:30:45:10 - 00:30:55:12
Joy Lewis
Well, I can't thank you enough for your time spent today. It has been, hopefully reflective for you and instructive for our listeners.

00:30:55:15 - 00:31:03:25
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

Access to quality mental and physical health services can be a complex challenge, but for individuals of color and people with severe or chronic mental illnesses, finding treatment can be exceptionally hard.  In this conversation, Tracey Lavallias, executive director of behavioral health at Penn Medicine Lancaster General Health, discusses potential solutions to make access easier for patients, including cultural competency training, medical interpreter services, and most importantly, integration of mental and physical health services.



 

View Transcript
 

00;00;00;17 - 00;00;29;27
Tom Haederle
Access to quality mental and physical health services can be a challenge for many people, even those with good health insurance and plenty of care providers nearby. However, for individuals of color, various ethnicities, and people dealing with severe or chronic mental illness, finding the treatment they need is even a steeper hill to climb.

00;00;30;00 - 00;01;00;27
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Studies have shown that among individuals diagnosed with a severe or chronic mental illness, black people are less likely to seek out treatment than whites, often facing barriers such as cost, transportation and even provider bias. In this podcast hosted by the AH's Rebecca Chickey, senior director of Behavioral Health; Tracey Lavallias, executive director of behavioral health with Penn Medicine,

00;01;00;27 - 00;01;23;19
Tom Haederle
Lancaster General Health, talks about the steps Penn Medicine has taken to increase access to care among underserved patient populations. They include cultural competency training, help with language barriers and most importantly, integration of mental and physical health services that are more likely to flag a problem and direct a patient to the care they need. Let's join Rebecca and Tracey.

00;01;23;22 - 00;01;56;11
Rebecca Chickey
Thank you Tom. Indeed, it is an honor and a privilege to be here today with Tracey. Tracey and I are going to be talking about the value of integration. And when I say integration, I mean integrating physical and behavioral health, in particular the value of integration as it relates to improving access to care for historically underserved patient populations: individuals of color, various ethnicities, as well as individuals with severe and persistent or chronic mental illnesses.

00;01;56;14 - 00;02;27;29
Rebecca Chickey
Often you may think of disorders or conditions such as schizophrenia or bipolar disorder when you think of someone with a severe or chronic mental illness. All of those patient populations that I've just mentioned often struggle even more than others to improve access to care. And Tracey has experience and expertise in having seen the value of integration and how it can reduce stigma and increase access to care.

00;02;28;01 - 00;02;53;12
Rebecca Chickey
So enough about me. I'm going to turn now to Tracey and say, Tracey, can you share with the listeners a couple of things. One: What are the realities of the challenges of accessing mental health services and treatment for addiction for individuals of color as well as, what are some of the reasons for those challenges?

00;02;53;15 - 00;03;28;08
Tracey Lavallias
Well, first of all, Rebecca, thank you for having me. I appreciate the opportunity to discuss this very important topic. We have been on this journey at Penn Medicine for a long period of time. And one of the things that you mentioned was the disparity amongst individuals of color versus individuals who are white. So I'll give you a little bit of information that we found. That even when diagnosed individuals are diagnosed with a mental health disorder, Hispanics and blacks are traditionally less likely to seek mental health treatment than whites.

00;03;28;11 - 00;03;53;02
Tracey Lavallias
This has been highlighted in many studies and it certainly has manifested in our particular environment here. There are a variety of barriers to receiving mental health care for individuals of color, some reports. We did a recent study here in our community about the stigma associated with mental health. Recently there was a campaign called Five Signs that helped to reduce that.

00;03;53;02 - 00;04;16;24
Tracey Lavallias
But we're still not at the level of where individuals can speak about mental health in the same way that we speak about physical health. And that has been exacerbated in the, communities of color. Also, biases of providers. Interestingly enough, we spent a great deal of time just having a campaign to reduce the biases of our provider community.

00;04;16;27 - 00;04;39;26
Tracey Lavallias
we focused on our emergency department here. We've also focused on our treatment providers. We've instituted things such as cultural competency to try to reduce those barriers. In many cases some of our communities of colors have poor health literacy. We do have a large immigrant population. And so, as you know, mental health means different things to different individuals.

00;04;39;29 - 00;05;05;17
Tracey Lavallias
And the interpretation of mental health is perceived differently in certain cultures. So that's an issue. Sometimes its poor insight into navigation. And our mental health system, particularly in state of Pennsylvania, is not easy to navigate. So in some cases, being able to navigate the health system and the insight into navigating a health system calls for some concern for those populations.

00;05;05;20 - 00;05;32;22
Tracey Lavallias
There's geographic inaccessibility. And what I mean by that is poor transportation. In many cases, these individuals don't have an opportunity to access it because of not having transportation and the right means. And then there's other things like linguistic, or as I stated earlier, just cultural barriers. And so in many cases, the language is not being spoken in a way that can be communicated in order for these individuals to receive care.

00;05;32;23 - 00;05;47;04
Tracey Lavallias
So, you know, those are the realities that we deal with on a regular basis. And some of the things that we work to try to reduce, to make sure that those individuals have the same level of access that our white patients do.

00;05;47;07 - 00;06;21;16
Rebecca Chickey
Well, it's particularly timely that we're having this discussion now, Tracy. For the listeners, we are releasing this podcast in the month of July, and July is Minority Mental Health Awareness Month. And the challenges that Tracy just described, I will share, just briefly, a personal journey. I am white, and I had a family member who was suffering from major depression and had what I would call the the "golden egg" of health plans and many connections.

00;06;21;16 - 00;06;54;11
Rebecca Chickey
I've been in this field for over 30 years, and so I know the chiefs of psychiatry at stellar organizations across the country. And even so, trying to get treatment for my family member, it took over two months to get in to see a psychiatrist. And even then, they did not take my health insurance. As an individual who is connected, reasonably educated in trying to navigate the mental health system as well as having, you know, stellar health insurance

00;06;54;13 - 00;07;23;04
Rebecca Chickey
thanks to the American Hospital Association, it was still a struggle. We want to talk about the value of integration. But first I want to ask you about another patient population. As I mentioned earlier, those with severe and persistent mental illness, chronic mental illness. I don't know if the listeners know this, but, individuals with chronic mental illness usually die somewhere between 15 and 25 years earlier than individuals without schizophrenia or bipolar.

00;07;23;06 - 00;07;45;29
Rebecca Chickey
And you may jump to the conclusion that that might be due to higher suicide rates. Indeed it is not. They die most often from their physical illnesses, which they are not taking care of because of lack of access to both physical health and mental health services. So can you speak a little bit to that? Because that's also a health disparity.

00;07;46;01 - 00;07;52;17
Rebecca Chickey
And, I wonder how you have been addressing that and what you know about their challenges and the realities.

00;07;52;20 - 00;08;18;03
Tracey Lavallias
Yeah. Rebecca, you bring up a really important point, and I appreciate the conversation around this. And in fact, we, try to stress this issue locally and any opportunity we get to kind of speak about this. But these are preventable diseases. In many cases, the individuals with serious mental illness, interact with and die from earlier than the same population

00;08;18;05 - 00;08;59;03
Tracey Lavallias
that does not have a serious mental illness. Things such as, you know, cardiovascular disease, diabetes and, you know, complying with insulin. These are different types of things that are preventable. The largest percentage of care in our particular - in any network - is through primary care. And we have found that individuals with serious mental illness do not seek this level of care out, as much as they should. In particularly those, as you spoke about earlier, those that are in minority communities, they have not access the primary care services as much as we would like.

00;08;59;03 - 00;09;30;17
Tracey Lavallias
In many cases, those individuals seek care in traditional mental health or inpatient environments. In many cases, we found them in our emergency department. So the fact of the matter is that individuals with significant severe mental illness do not access their primary care as often. And then you add on top of that those individuals that are communities of color access - those primary care resources and less.

00;09;30;19 - 00;09;44;19
Tracey Lavallias
And subsequently it leads to those factors that cause premature death. Cigarette smoking, things of that nature or diet and those types of issues that can be addressed if they went to a primary care physician.

00;09;44;21 - 00;10;01;01
Rebecca Chickey
So now that we painted a unfortunately fairly bleak picture for the listeners here, let's give them a bit of light, a bit of hope. How can and does integration help to reduce these disparities? Give me some examples.

00;10;01;04 - 00;10;35;25
Tracey Lavallias
What we found here, in fact, what my doctoral dissertation was done on our primary care offices here ... we did a study on  - this is going back, maybe seven years ago now. And we utilized four primary care sites here. And we went to look about three different factors, actually, we were really focusing on. First factor was, was there a reduction in the issues that we just spoke about, some of those issues that were preventable.

00;10;35;28 - 00;11;03;09
Tracey Lavallias
Did they actually comply with the primary care physicians, recommendations for those individuals that were receiving integrated care within a primary care practice? And the other components that we spoke about, we wanted to see if there was a reduction in the emergency room utilization of those individuals that received primary care and mental health services within the primary care practice.

00;11;03;11 - 00;11;29;06
Tracey Lavallias
And the last factor that we focused on was, whether or not those individuals sought care in our emergency department. Remember I spoke about traditionally those individuals sort of surfaced in our emergency department due to the lack of primary care resources. The study found that we have 50% reduction in those individuals receiving care, under primary care integration.

00;11;29;06 - 00;11;55;25
Tracey Lavallias
So they're less likely to come to the word see department. There was a significant reduction of stigma in the primary care office, based on the fact that these individuals did not seek services or receive services under the umbrella or title of a mental health facility. There was more compliance with the recommendations of their medication management or the recommendation of their primary care physician.

00;11;55;27 - 00;12;22;13
Tracey Lavallias
And this was primarily based on the fact that they may have been depressed. There may have been other factors that, were focused on their mental health issues that caused them not to take their physical health medication. So the fact that we were integrating care within a primary care office and allowing these services to be seen as seamless, really improve the quality of care for those individuals.

00;12;22;15 - 00;12;45;15
Tracey Lavallias
And as a by-factor of that, there was a significant increase in provider satisfaction. So not only did the patients get better and services delivered in a more quantitative fashion, but the provider satisfaction just increased. So I think that's the positive side of integrating mental health into your primary care offices.

00;12;45;17 - 00;13;15;21
Rebecca Chickey
So I'm going to emphasize again, some of the key points you just said. One, with all the workforce challenges that are out there right now, if you can improve provider satisfaction, that is a positive impact. Equally, perhaps even more importantly, what you said is that you improved patient outcomes. That's what we got into healthcare for in the first place, right, is to improve individual's quality of health and ability to live their best lives.

00;13;15;23 - 00;13;31;23
Rebecca Chickey
You reduced stigma through integration and then, I'm going to connect the dots here. So please keep me honest if this is not the case. But you said you reduced visits to the emergency department by around 50%, and so that's correct?

00;13;31;24 - 00;13;33;00
Tracey Lavallias
That's correct. Yeah.

00;13;33;03 - 00;13;57;07
Rebecca Chickey
And every emergency department visit, it's not the least costly level of care, I will say. And so you have you're reducing the total cost of care for that individual as a whole. And you're also improving access to other emergency services because the emergency room is not treating someone who could have been treated in a lower level of care.

00;13;57;09 - 00;14;10;25
Rebecca Chickey
Well, is there a story that you might want to share for the listeners? Of course, not identifying a name, but is there a story that you might want to share to, illustrate this on a on a personal level?

00;14;10;28 - 00;14;42;02
Tracey Lavallias
We had an individual and I spent a lot of time with this individual, and he was a parent of a individual that was a chronic behavioral health patient. And what I mean by chronic symptomology had become so severe that she would cycle through our emergency department on a regular basis. This situation all escalated up to our CEO and CEO sent the information to me.

00;14;42;02 - 00;15;10;28
Tracey Lavallias
So I had several conversations with the parent of this individual who was really reaching out for help and really didn't have the ability or capacity because he had been dealing with this particular issue for such a long period of time. It manifested in complaints. But really, when you drill down and you had a more conversation, it was about access and the fact that this individual had not accessed our services within our PCP.

00;15;11;00 - 00;15;35;23
Tracey Lavallias
One thing led to another, and I'm shortening the story because of the time frame. But imagine this situation went on for about six months. We began to build a bridge with the parent who in fact begin to build a bridge with the daughter. We connected this daughter with our integrated care within our primary care offices, they're currently in all our primary care offices now.

00;15;35;23 - 00;16;06;13
Tracey Lavallias
So we integrated them based upon the location that was closest. She immediately connected with the therapist there. There was less of a stigma associated with the services that she received. And, she just got better, significantly better, throughout the course of time. Her parent was a conduit because she was limited linguistically and really reached out to us to talk to us about the care that they received in this environment.

00;16;06;15 - 00;16;37;17
Tracey Lavallias
The therapist, the integration of the primary care doctor, addressing the physical health needs. She became much more compliant with her physical health medication which was a conduit to her being in the emergency department as well. So I point that story out just to say that that is probably one that came to my attention, but that's the norm for what we've what we have seen in our primary care offices when we integrate our mental health clinicians there.

00;16;37;19 - 00;16;50;22
Tracey Lavallias
And has been certainly a positive outcome for the system because these individuals are receiving timely care and just getting better, Rebecca. And so I'm really, really proud of the work that they've done there.

00;16;50;25 - 00;17;09;23
Rebecca Chickey
I think what you just described was truly patient centered care. So thank you for doing that and for sharing that story. As we close out the podcast today, is there a call to action that you'd like to perhaps challenge or encourage the listeners to consider doing?

00;17;09;26 - 00;17;29;07
Tracey Lavallias
A couple things? One thing that I would say is that you had, alluded to this earlier. There are significant challenges from a workforce perspective to be able to keep up with the amount of patients that need health care. So in the medical field, you can see it nationally that there's just not enough providers, not enough individuals going into the field.

00;17;29;09 - 00;17;53;14
Tracey Lavallias
So I encourage those who have an empathy for this population to go into this field, contribute in any way that you can to this population so that these individuals will have the same quality of life that we've grown accustomed to. The second thing that I would say is we talked about the disparity between the physical health and the mental health, and really trying to close that gap as relates to stigma.

00;17;53;17 - 00;18;32;18
Tracey Lavallias
We talked a little bit about it earlier. I would like to prioritize things such as mental health first aid. You know, we get first aid in many of our jobs that we go into, particularly in the health care field, and it's a way to sort of prevent the physical issues if you're so encountered and trying to stabilize the patient. The same things are taught as it relates to mental health first aid, the ability for individuals, loved ones, family members, friends to engage with individuals because in most cases, they're the ones that see them first to be able to do some of their first aid, mental health, first aid, things that can stabilize the

00;18;32;18 - 00;18;46;21
Tracey Lavallias
patient prior to them engaging with the system. It would broaden our ability to have access, and it creates the opportunity to reduce stigma. So in those cases, I think that would be my two calls to actions.

00;18;46;24 - 00;19;12;24
Rebecca Chickey
Thank you so much. I think I'm about to quote Maya Angelou, but as you were saying that, this quote came to mind: "Once you know better, do better."
And that would be my call to action. So as we close this out, there are a number of resources, around the value of integration, the value of integrating physical and behavioral health that can be found at

00;19;12;26 - 00;19;28;14
Rebecca Chickey
www.aha.org/behavioral health. This podcast will be available there and of course on AHA's Advancing Health podcast. Tracy, thank you so much for the work that you do and your willingness to share your insights and expertise with us today.

00;19;28;16 - 00;19;35;14
Tracey Lavallias
Thank you so much, Rebecca. I appreciate you the opportunity to discuss this important topic. And I'll see you soon.

00;19;35;17 - 00;19;43;21
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

John Bluford’s distinguished career in hospital and health system administration has spanned more than four decades, and he has been recognized by Modern Healthcare and Becker's Hospital Review as one of the Most Influential People in Healthcare. He is also the founder of the Bluford Healthcare Leadership Institute (BHLI), a professional development program that introduces talented minority undergraduate scholars to health care administration. In this conversation, Bluford describes how the Institute is training young and diverse talent to assume leadership roles.


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00;00;00;19 - 00;00;42;23
Tom Haederle
John Bluford's distinguished career in hospital and health system administration has spanned more than four decades. He's been recognized as one of the most influential people in health care, and served as chair of the American Hospital Association in 2011. He's also the founder of the Bluford Health Care Leadership Institute, a professional development program that introduces talented minority undergraduate scholars to health care administration with the expectation that this pipeline of talent will ultimately help to eliminate health disparities among populations dealing with sustained hardship.

00;00;42;25 - 00;01;08;05
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this podcast, hosted by Joy A. Lewis, senior vice president of Health Equity Strategies with the AHA, Bluford describes how his institute trains promising young talent to assume leadership roles... the impact they've made...and how to deal with pushback in some quarters against DEI efforts in general.

00;01;08;07 - 00;01;14;25
Tom Haederle
This podcast was recorded at the American Hospital Association's Annual Membership Meeting in Washington, DC.

00;01;14;27 - 00;01;19;20
Joy A. Lewis
Good morning John. Thank you so much for joining me today. Is it fine to call you John?

00;01;19;20 - 00;01;21;02
John W. Bluford, MBA
Please do. Good morning to you.

00;01;21;02 - 00;01;46;10
Joy A. Lewis
Because I am sitting with the John Bluford. And this came together rather quickly, so I guess my timing was right. Thank you for carving time out of your busy schedule to join me in conversation today. Today's conversation is a really important one. We want to focus on how might we think about ways to create a diverse talent pool of health care leaders?

00;01;46;12 - 00;02;11;24
Joy A. Lewis
We know how important it is to have a diversity of thought, different perspectives weighing in, making decisions that then lead to better health outcomes for the patients and families and communities that we serve. So currently, you are the president, but also the founder of the Bluford Health Care Leadership Institute, which was established over a decade ago in 2013.

00;02;11;27 - 00;02;33;03
Joy A. Lewis
And your program trains and mentors and prepares early careerists to occupy, to advance through into leadership roles in health care settings. And I guess in addition to how you're spending your time today, we should talk about your tenure. Your career portfolio, which includes...

00;02;33;03 - 00;02;33;12
John W. Bluford, MBA
It's been a long one.

00;02;33;12 - 00;02;36;09
Joy A. Lewis
I know! Spans over 50 years.

00;02;36;12 - 00;02;40;03
John W. Bluford, MBA
Oh, just about...not quite over 50, but we're getting there.

00;02;40;04 - 00;03;15;15
Joy A. Lewis
Okay. I want to be like you when I grow up. So, former president and CEO, president emeritus of Truman Medical Centers in Kansas City, Missouri. Prior to that, CEO of Hennepin County Medical Center in Minneapolis, Minnesota. So let's start there. Can you walk our listeners through your journey and I guess leading into this question around what were some of the conditions that you observed, you witnessed inside hospitals and health systems that you led?

00;03;15;21 - 00;03;24;25
Joy A. Lewis
And also, as a former chair of the AHA's Board of Trustees, that led you to create the Bluford Health Care Leadership Institute.

00;03;24;27 - 00;03;56;02
John W. Bluford, MBA
Thank you very much, Joy. It's a great lead in. And I would start by saying that these 45 plus years in the business have always been in urban settings. Large tertiary teaching hospitals that dealt with underserved patient populations. So that has been my story from day one. As an epidemiologist for the Center for Disease Control and the areas of Saint Louis, Missouri.

00;03;56;04 - 00;04;30;17
John W. Bluford, MBA
Pruitt-Igoe housing project, which is the first federally funded housing project in the country. And that is kind of where my orientation comes from. More recently as a CEO -and I've been retired for ten years -but I'll say recently as a CEO of two major academe training centers, I discovered that there was not a pipeline of diverse talent coming through graduate school programs for hospital administration.

00;04;30;19 - 00;05;13;20
John W. Bluford, MBA
How do I know that? Because I was a preceptor for several programs across the country between the late 80s and 90s, and I consistently got very talented scholars to come to my institution to fulfill their requirements for graduate school. But none of them were diverse candidates because they weren't in the pipeline. And the genesis of the program that's in place right now is a request that I made to the Hennepin County Board of Commissioners to give me some funding to go to Morehouse College and recruit an undergraduate student to come to Minneapolis and work with me for the summer.

00;05;13;25 - 00;05;14;20
Joy A. Lewis
Just one.

00;05;14;22 - 00;05;16;28
John W. Bluford, MBA
Just one. You got to start somewhere.

00;05;16;29 - 00;05;17;11
Joy A. Lewis
Yeah.

00;05;17;14 - 00;06;01;01
John W. Bluford, MBA
Right. And that one student stayed with me for two years while I was at Hennepin, followed me to Kansas City, Missouri, and ended up working for me for 17 years. So that project was very successful in one respect, but not a lot of players. Secondarily, because of the success of that one student and my love for doing that kind of work and mentoring, I did the same thing when I got to Kansas City, Missouri, and that has led me to go to primarily HBCUs, Fisk University, Spelman College, Morehouse, Florida A&M University, North Carolina, and A&T and Hampton University,

00;06;01;01 - 00;06;01;27
John W. Bluford, MBA
more recently.

00;06;01;28 - 00;06;03;20
Joy A. Lewis
Not Howard, my alma mater.

00;06;03;22 - 00;06;05;10
John W. Bluford, MBA
But it will be there next year.

00;06;05;11 - 00;06;06;11
Joy A. Lewis
Okay.

00;06;06;13 - 00;06;35;01
John W. Bluford, MBA
And solicit and recruit some very, very, very talented and smart scholars and convince them that health care is a good career path for them and go for it. That's one reason for the BHLI,  and the other is a wonderful experience that I had in the early 80s as a participant in Harvard University's mid-career programs. I was 31 years old at the time.

00;06;35;04 - 00;06;51;22
John W. Bluford, MBA
And that experience just exposed me to how the sausage is really made in health care. And I wanted to expose these young people to that type of experience. I could go on and on, but that gives you a little bit of the seeding of the Bluford Health Care Leadership Institute.

00;06;51;24 - 00;07;25;26
Joy A. Lewis
And again, the early beginnings, rooted in looking at expanding and providing exposure to those from historically underserved, marginalized communities and giving them an opportunity to even consider health care. Absolutely right. So if anyone visits your website for BHLI, they will see the Institute is described as an intense professional development program. Can you share a little bit more? What does that mean?

00;07;25;26 - 00;07;29;00
Joy A. Lewis
What does intense mean in this example?

00;07;29;02 - 00;07;52;21
John W. Bluford, MBA
Intense. It's a two-eek program, seven days a week. Each day, our scholars are picked up by an executive van or bus at seven in the morning, and their day ends 12 hours later, as the last couple of hours of the day, they're working on a case study that they will present to a community audience at the end of the program.

00;07;52;23 - 00;08;17;06
John W. Bluford, MBA
So intense, in my view, means first and foremost, looking for very serious scholars that want to be successful and hopefully in the health care field. The idea is that we are preparing them not for the next level, but the level beyond that. We want leaders, not mid-careerists.

00;08;17;08 - 00;08;27;29
Joy A. Lewis
And we know that there's typically this plateauing that occurs when you get to the midpoint. How do you then move into the more executive senior leadership roles?

00;08;28;02 - 00;08;58;17
John W. Bluford, MBA
So we have a very strong didactic experiential curriculum with leaders from the industry all over the country coming in and sharing their stories, their personal stories. People like Mr. Rick Pollack, for example, or Mr. Wright Lassiter, for example. I think we've had four past chairman of the boards from the AHA. Mindy Estes comes to mind. Kevin Lofton has been a couple of times.

00;08;58;24 - 00;09;34;14
John W. Bluford, MBA
Jeanne Wood has been. So they're get experience and wisdom from the top of the industry. That's number one. Number two, not only didactic and experiential learning, but we really focus on executive presence and what people call soft skills. I don't agree with that terminology. I think they are essential skills. And by that I mean presentation skills, language skills, appearance skills, self-awareness skills.

00;09;34;16 - 00;09;59;26
John W. Bluford, MBA
How to network skills. We drill that into each and every one of these scholars every day and all day. Even though we do have some social activities, but it's not a frat party. You're still on stage. So we have golfing outings, and we've done bowling before, and we go to the performing arts. And we tour a couple of museums in Kansas City, high end.

00;09;59;29 - 00;10;09;06
John W. Bluford, MBA
But we're constantly looking at our scholars and observing our scholars and how they interact with each other and others.

00;10;09;06 - 00;10;09;17
Joy A. Lewis
How they show up.

00;10;09;17 - 00;10;19;24
John W. Bluford, MBA
How they show up. Good point. And we don't grade on the curve. If we catch something that's out of order, we pull them aside and said, you might want to reconsider how you're doing that.

00;10;19;27 - 00;10;21;11
Joy A. Lewis
No partial credit, huh?

00;10;21;11 - 00;10;25;09
John W. Bluford, MBA
No partial credit. And I think that's very enlightening for these students.

00;10;25;11 - 00;10;33;08
Joy A. Lewis
That's helpful. To your point, there's the didactic component, the experiential component. But then there's the: how do you read a room?

00;10;33;11 - 00;10;55;16
John W. Bluford, MBA
Exactly. There are two things that I could have mentioned too: etiquette training, because part of the interview process is often how you perform at dinner or lunch. So we do that and we have speech coaches come in and really help on the presentation skills. So the underlying theme of that, sometimes it's not how much you know, but how well you can communicate what you know.

00;10;55;20 - 00;11;02;22
Joy A. Lewis
That's right. Very comprehensive. I don't know what you do with folks like me who are not morning persons. At seven a.m.?

00;11;02;22 - 00;11;06;09
John W. Bluford, MBA
They get on board real soon or they're left behind.

00;11;06;09 - 00;11;28;03
Joy A. Lewis
They don't have a choice, right? That's right. So a little bit more about, I get the goal here. To your point, it's not mid-career. It's preparing folks for those senior leadership roles. What's been the impact when you look back over the past decade since the inception of this program? Where have your scholars landed? What have they gone on to do?

00;11;28;06 - 00;12;00;08
John W. Bluford, MBA
I'm glad you asked that question. And that's the best question of the interview, because we can talk a lot about what is and what is and what we want to be, but what's the impact is the punch line. And we have been quite successful in our goal. Now remember, the goal is to train culturally sensitive, talented individuals to ultimately impact health care disparities among minority and vulnerable patient populations over the next two generations.

00;12;00;14 - 00;12;01;21
Joy A. Lewis
That's tall order.

00;12;01;23 - 00;12;34;23
John W. Bluford, MBA
That's a tall order. We've got time, and it's going to take time to get it done. And in that regard, in round figures, we've had 150 participants come through the program over the past 11 years, 11 or 12 years. We've had 120 internships that have resulted from those students coming through our program. Now, internships are fully paid summer internships after their two-week didactic experience in Kansas City.

00;12;34;26 - 00;12;51;27
John W. Bluford, MBA
And those internships have been in 50 sites across the country. And the punch line is this: out of 121 students who've actually graduated from undergraduate school, because I interview them as freshmen and sophomores. So they're very young.

00;12;52;00 - 00;12;52;29
Joy A. Lewis
And you're doing the interviews.

00;12;52;29 - 00;13;22;08
John W. Bluford, MBA
And I do the interviews personally. Out of the 121 that have graduated, 100 of them are in health care space today, 83%. And the others are lawyers, and on Wall Street, they're doing well for their own personal careers. But 100 of them are in health care. So just give you an example, and this is a one hour interview in itself where some of these students are and more importantly, what they're doing.

00;13;22;11 - 00;13;49;24
John W. Bluford, MBA
And you can project what they're going to be doing in years to come. But we've got one of our scholars who was in our program in 2014. He is now the surgical specialty clinic director at Henry Ford Hospital. We've got another young lady. She's the pharmacy infusion manager at Emory Hospital's Winship Cancer Center, and she took me through a tour of this new facility.

00;13;50;02 - 00;13;52;29
John W. Bluford, MBA
It is really awesome. And she's in charge. 
00;13;52;29 - 00;13;53;12
Joy A. Lewis
And she's in charge. She's at the helm.

John W. Bluford, MBA
She's at the helm. And we've got another young lady, and I think you're going to meet her at your program in Kansas City later this summer. She's a deputy director for policy and human services for the governor of Kansas, and she's working on access to mental health and Medicaid expansion, which, as you know, is a big issue.

00;14;16;09 - 00;14;30;03
John W. Bluford, MBA
So we've got young people five, six, seven years in their career with no ceiling, doing meaningful and important work with good compensation.

00;14;30;06 - 00;14;35;22
Joy A. Lewis
That's critical. And, well, you started out with them getting paid internships. I noted that.

00;14;35;22 - 00;14;57;16
John W. Bluford, MBA
Absolutley. And they get paid for their two-week tenure in Kansas City as well. It's a $2,000 stipend because we realize while they're there they could have been working their summer jobs. So we want to be competitive to get the best students. And the best students are being paid for their time right now. Let me tell you a little bit about these sites.

00;14;57;18 - 00;15;30;17
John W. Bluford, MBA
I mentioned 120 internships, 50 different sites. The American Hospital Association membership and its leadership has been very valuable connectivity for us because we're placing our students in their institutions. So we've had students at Duke University, Johns Hopkins, Atlantic Health in Morristown, New Jersey, Advocate Atrium have taken a lot of our students. Truman Medical Center's my old stomping ground.

00;15;30;18 - 00;16;03;23
John W. Bluford, MBA
Obviously, it's taking a lot of students University Health and Cleveland, several Blue Cross Blue Shield programs across the country. Saint Luke's Hospital, Dr. Estes' old place, has taken several of our students. Aeon on a long term consultancy..so it just goes to show that networking and the loyalty and concern among my colleagues in the field are paying dividends as well and helping us do this.

00;16;03;23 - 00;16;35;20
Joy A. Lewis
Amazing, amazing impact. So when you started this Leadership Institute again in 2013, the environment was quite different, the external environment. And so what we're looking at right now are some serious - as my CEO Rick Pollack likes to call them - motivated adversaries with deep pockets who are waging a war against anything that smells or looks like diversity, equity, inclusion.

00;16;35;22 - 00;16;55;08
Joy A. Lewis
So again, we're in a very different place today. How are you thinking about the existing world that you're training these young folks to show up in? How are you preparing them to be successful with all the headwinds in the midst of these anti-DEI efforts?

00;16;55;13 - 00;17;47;15
John W. Bluford, MBA
That's a great question, and perhaps one difficult to answer, but it's easy for me. One, we started before these anti-DEI and affirmative action related mentality surfaced and as such very narrowly focused on teaching, mentoring, coaching, and perhaps more importantly, sponsoring the scholars in our program. And that sponsorship, that coaching, that teaching was very specifically directed toward dealing with health care disparities in America, specifically among minorities and underserved patient populations. Rural America, the different pockets that need the support.

00;17;47;17 - 00;18;21;12
John W. Bluford, MBA
And we wanted to make sure they were culturally sensitive to the issues of socioeconomic determinants, etc., which I now favor the public policy determinants of health, and be laser focused on that and eliminating the disparities. So we don't talk a lot about DEI or anything. We talk about disparities, socioeconomic determinants, and how you can position yourself to get in a decision making role to make a difference.

00;18;21;14 - 00;18;33;15
Joy A. Lewis
And the disparities have been there. They have a long tail, to your point, well-documented. So keeping a focus on the elimination, not the reduction, the elimination of those disparities.

00;18;33;15 - 00;18;34;07
John W. Bluford, MBA
Zero.

00;18;34;20 - 00;18;47;29
John W. Bluford, MBA
And we hope that we've given them enough time frame over the next two generations to make a difference. I certainly don't want my grandson's children to experience some of the same disparities.

00;18;48;00 - 00;19;02;05
Joy A. Lewis
Correct, correct. And I like the break down. You've done a really good job of distinguishing between mentoring and sponsorship, for example. Those two tend to get conflated and we know they're very different.

00;19;02;07 - 00;19;27;27
John W. Bluford, MBA
I think many of us who've had the pleasure of serving in this industry were helped quite a bit by someone that was in those positions that we wanted to get to. And it's not unusual for me to pick up the phone and call a colleague of mine and say, you know, Joy Lewis has been in your operation now for four years, and I understand she's doing well.

00;19;27;27 - 00;19;29;24
John W. Bluford, MBA
We want to see some growth in her career.

00;19;29;27 - 00;19;30;11
Joy A. Lewis
Right.

00;19;30;13 - 00;19;31;17
John W. Bluford, MBA
Yes.

00;19;31;19 - 00;19;51;13
Joy A. Lewis
Makes sense. Appreciate that. So we're coming up on time here. But I want to ask. It would be foolish to have someone of your stature sitting here and not solicit some piece of advice from you to these young scholars. What is it that you wish someone had told you?

00;19;51;15 - 00;20;23;20
John W. Bluford, MBA
You know, I've had such a positive journey, and I wish someone would have told me about what an opportunity and blessing it's gonna be to help and serve the community in which I work. It's hard work, but the work is twice rewarding when you see the results. That's a very powerful statement. And I tell everyone, at least in my case: never had a job.

00;20;23;23 - 00;20;42;08
John W. Bluford, MBA
It's always been a mission, not a job. And that's how I've gone about my work. Compensation and those kinds of things have always been secondary. And I tell people all the time, if you're going in it for the money, then do something differently. But if you go in it and do well, get your money.

00;20;42;10 - 00;21;13;09
Joy A. Lewis
That's powerful, John, and very compelling. This notion of you're in it because it's your cause to make lives better at the end of the day. So I can't thank you enough for your continued leadership. You lay the mantle down in terms of CEO-ship roles a decade or so ago, but you continue to add to that almost 50 year legacy that we referenced earlier, really impressive and impactful career that you've had and continue to have for many of us who are in the trenches here.

00;21;13;09 - 00;21;20;00
Joy A. Lewis
So it's great to be in community with you and to have this conversation. And thank you for your time.

00;21;20;05 - 00;21;22;03
John W. Bluford, MBA
Thank you for inviting me.

00;21;22;05 - 00;21;23;20
Joy A. Lewis
Absolutely.

00;21;23;23 - 00;21;32;03
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

In this conversation, Ogechi Emechebe and Christopher Torres, Senior Communication Specialists at the AHA, are joined by Fred Hobby, former president and CEO of the Institute for Diversity in Health Management, to reflect on his achievements during his time at AHA. Fred also shares critical ways for health equity champions to mobilize and move the field forward.


View All IFDHE Podcasts

Fred Hobby, former president and CEO of the Institute for Diversity in Health Management

Fred Hobby
Former President and CEO
Institute for Diversity in Health Management

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