IFDHE Podcasts

00:00:00:17 - 00:00:36:13
Tom Haederle
Hospitals and health systems across the nation are working hard to advance equity of care to all patients and to spread lessons learned and progress towards diversity, inclusion and health equity. The American Hospital Association's Carolyn Boone Lewis Equity of Care Award was created to honor the most outstanding examples of such work. The 2024 award was split among three health systems who are helping to chart the path forward for everyone.

00:00:36:16 - 00:01:04:22
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In today's podcast, Jackie Hunter, vice president of Health Equity Strategies with the AHA explores the winning strategies of this year's three Carolyn Boone Lewis Equity of Care Award honorees. Their discussion was recorded at the AHA's Leadership Summit in San Diego. Her guests are Dr. Clint Merritt, chief physician executive with Augusta Health,

00:01:04:26 - 00:01:32:09
Tom Haederle
recognized for its progress in dismantling structural barriers in their care delivery system and the communities they serve. Rosangely Cruz-Rojas, vice president and chief diversity and equity officer for Mainline Health, honored for creating strategies to influence equity in the surrounding community ecosystem. And Juana Slade, chief diversity officer with AnMed, distinguished for demonstrated excellence in advancing health equity in rural or small communities.

00:01:32:12 - 00:01:50:27
Jacqueline Hunter
Congratulations again on being recognized as the 2024 Equity of Care Award winners. This is a huge honor, and I am sure that comes with a lot of excitement for your organization and community. Clint, can you share with me what it means for your organization to win this award in your respective category?

00:01:51:00 - 00:02:15:18
Clint Merritt, M.D.
Sure. Thank you for being here. We feel incredibly honored. Augusta Health is a community, nonprofit health system in the Shenandoah Valley in Virginia. We earned the emerging category in the Carolyn Boone Lewis Equity Care Award, and that fits that we're on a journey. We've had many different projects that fit into the health equity body of work, which means we've engaged a lot of people in the organization and a lot of community partners.

00:02:15:18 - 00:02:22:21
Clint Merritt, M.D.
And so winning this award, it tells us that we're on the right track. It gives us a lot of energy. So we're incredibly honored.

00:02:22:24 - 00:02:26:22
Jacqueline Hunter
Great. Thank you. And I ask the same question to Rosangely, what about you?

00:02:26:24 - 00:02:49:19
Rosangely Cruz-Rojas
This is extremely exciting for us. We've been working on issues of health equity for about 13 years now, and it has been a period of going through a lot of learning, you know, doing the steps that you have to do in order to be able to understand what you need to do in terms of your work clinically, internally and some of the work we do in the community.

00:02:49:22 - 00:03:14:05
Rosangely Cruz-Rojas
And so going through that whole health equity transformation assessment, the HETA, two years ago, getting some of the information back, help us really organize some of the efforts. And we went into putting the application as a way to show and demonstrate the efforts we found in so many areas, and it was just simply amazing to get the reward back of being awarded the winners.

00:03:14:12 - 00:03:18:17
Rosangely Cruz-Rojas
We are in the category of transforming, which is for health care systems.

00:03:18:19 - 00:03:20:27
Jacqueline Hunter
Great. Thank you. And Juana, what about you?

00:03:21:00 - 00:03:39:03
Juana Slade
We're just incredibly proud. It's a long time coming. We've been at the work since 2001, and I think that this was an opportunity for us during that time to take a pause and establish the infrastructure that many systems around the country are really struggling now to try to get into place.

00:03:39:03 - 00:04:03:13
Juana Slade
But we had the time and the opportunity to engage internally across our system, but we also had the opportunity to establish relationships which are paying back benefits tenfold, because we have the trust of the community to be involved in the work. And that's not to mean that we're perfect, but we certainly don't have an issue with looking for our imperfections and then addressing them.

00:04:03:13 - 00:04:15:02
Juana Slade
And we've got both clinical and non-clinical partners leading the work. And it's just not only personally rewarding and gratifying, but it's gratifying for those individuals who've been working for so long.

00:04:15:04 - 00:04:27:01
Jacqueline Hunter
Great. Thank you. And Julie, you had referenced the Health Equity Roadmap. How was your experience with the Health Equity Roadmap thus far, and how does align with your organization's current strategic plan?

00:04:27:03 - 00:04:53:19 Rosangely Cruz-Rojas
So, and I said two years, I think it was really three, because we were part of the first wave of early adopters. That was 2021. We initially did it as a way to understand the different areas or pockets or levers where we needed to invest efforts and do work and help us really identify where we have opportunities, where we were more mature, what areas we needed to do better or integrate better with the rest of the work we were doing.

00:04:53:21 - 00:05:22:15
Rosangely Cruz-Rojas
It really ultimately became a way of us developing our own internal maturity model. In fact, we were just finishing our strategic plan for DREI. We call it DREI because we add respect, and in doing so, we went through the health equity transformation assessment, identify where we had priorities and prioritize in our strategic plan, those areas where we wanted to do additional efforts to continue to move to the next level.

00:05:22:17 - 00:05:30:24
Rosangely Cruz-Rojas
So it has become part of our maturity model, alongside with our community needs assessment and some other factors that we use.

00:05:31:00 - 00:05:35:24
Jacqueline Hunter
Great. Juana, how have your organization incorporated the HETA within your strategic plan?

00:05:35:26 - 00:05:52:16
Juana Slade
Absolutely. We, of course, completed the HETA as we had to do and as we were required to do as a part of the process. But actually, for us, it began about 15 years ago as a part of some work within the South Carolina Hospital Association under what we call the Health Coordinating Council.

00:05:52:24 - 00:06:19:18
Juana Slade
So the terminology was somewhat different, but the objective was quite the same. We wanted to identify those individuals, both inside our organizations across South Carolina hospitals, but we also wanted to make sure that those hospitals were identifying community partners, public health partners, business partners, and then bringing all of those resources to the table and then looking for ways to improve health outcomes for everyone.

00:06:19:21 - 00:06:44:24
Juana Slade
In 2017 AnMed replicated that approach for ourselves. So internally, we tried to do what we were helping the state to do. We came together. We brought individuals from across disciplines, from across the community, from our governance leaders. We wanted to make sure that everybody who could impact health being provided through AnMed was at the table to look for some solutions, and we took action.

00:06:45:00 - 00:07:11:12
Juana Slade
Dr. Michael Seemuller is our chief quality officer and he makes it his responsibility to make sure that we are re-stratifying quality measures across the organization. We have a director of patient care quality who was has the responsibility to do that at the bedside. And then of course, my primary responsibility is to make sure that we've got the cultural and linguistic competence inside the organization to do what's necessary.

00:07:11:13 - 00:07:30:26
Juana Slade
So, as I said, it's been a part of our character, the culture of the organization for a very long time. I know that for me, the most important part - we were talking about this the other day - the most important thing is to have this work embedded in our strategic plan. Because it doesn't matter if I think it's important,

00:07:31:01 - 00:07:39:27
Juana Slade
what matters is our governance leaders, our administrative leaders, operational leaders are holding themselves and us accountable for patient outcomes.

00:07:40:04 - 00:07:43:15
Jacqueline Hunter
And Clint, what is your experience been with the Health Equity Roadmap thus far?

00:07:43:19 - 00:08:10:19
Clint Merritt, M.D.
Yeah, we completed the health equity roadmap in 2022, and it came at a really good time for us because through Covid we had built a lot of community programing very organically, not only around Covid safety and vaccines, but a lot of work with housing and homelessness and food insecurity work with the Latino community. And we realized in completing the health equity roadmap, we engaged many of the leaders across the organization and the clinical teams to do the assessment.

00:08:10:20 - 00:08:33:20
Clint Merritt, M.D.
How are we doing? And we found there are some things we were strong at. Our community partners were incredibly strong, and our data and analytics were also quite strong. But then we had a lot of work to do, and it's very helpful to see sort of a structured framework to recognize we need a continuous building curriculum for team members to understand how they engage in reducing health disparities and care for the community.

00:08:33:22 - 00:09:05:17
Clint Merritt, M.D.
We need a governance structure engagement that defines how each of our committees and our boards have a role in advancing health equity for the community, and this helped us craft all that structure. And we put it together in a strategic plan in 2023, using a lot of the ideas and framework that came out of the roadmap. We also recast the organization's mission, which we had not done in a couple decades, and it was a mission statement that really leaned into inclusivity and diversity.

00:09:05:20 - 00:09:09:22
Clint Merritt, M.D.
to strengthen in the health and well-being of all people in our communities, it's been very meaningful.

00:09:09:25 - 00:09:22:15
Jacqueline Hunter
Great. And some of you have hit on this as well... but Clint, if you can elaborate on anything that you may not have referenced in regards to innovative strategies, that kind of came from the implementation of the HETA - Health Equity Roadmap.

00:09:22:17 - 00:09:49:06
Clint Merritt, M.D.
Yeah, we've been using data at the neighborhood level to understand where our opportunities lie, who we're not reaching. The health equity roadmap is also about those partnerships and listening well. So we are taking neighborhood level data on mental health, on addiction, on diabetes, and then meeting with neighborhood partners to share "here's what we're seeing." And then lead with listening at that point.

00:09:49:06 - 00:10:06:14
Clint Merritt, M.D.
And it's helping us craft tailored interventions for particular pockets in our community with engaged partners and that kind of approach of very tailored care for health equity seems to come through the Health Equity Roadmap. It's a philosophy that you see in that framework.

00:10:06:17 - 00:10:13:02
Jacqueline Hunter
Anyone else want to add anything additional in regards to any innovative strategies that you have implemented? Juana or Rosangely?

00:10:13:09 - 00:10:45:18
Rosangely Cruz-Rojas
One thing we, because of having the roadmap and understanding the areas where we have opportunities that we've been trying to communicate more clearly is what I call the 3P's of DREA. And the 3P's meaning people, patients, population, population as code for community. And we have a lot of work in all these different areas that until recently were reporting or being developed through different areas of the organization.

00:10:45:18 - 00:11:09:18
Rosangely Cruz-Rojas
So now with all of us being combined, we have an opportunity to say if an ERG employee resource group, or a DEI council is working on a particular area we can tie that back better to our community space and the more we want to do with our community partners. But also in any health equity initiative that we have been working through.

00:11:09:20 - 00:11:45:12
Rosangely Cruz-Rojas
An example just recently, our African-American and black African-American ERG was consulted for some issues and questions we have around providing palliative care consults for the African-American population. And they were able to not only give us recommendations, but also tell us where to go to get additional information and additional feedback on our processes internally. So we are seeing now this combined effort of the 3P's of the work we do in it internally to really accelerate the work we are doing in the health equity space.

00:11:45:18 - 00:11:47:20
Jacqueline Hunter
Great. Thank you Juana, anything to add?

00:11:47:22 - 00:12:07:15
Juana Slade
Well, character, this is sacred work. And that work has been embedded in our organization. And because of our long standing character, we've been able to provide the backbone for our Anderson County Safety Net Council. And one of the tenants is about making sure that we're looking for partners beyond the four walls of our systems.

00:12:07:22 - 00:12:30:21
Juana Slade
We are a founding member of a group in South Carolina that I mentioned earlier, called the Alliance for a Healthier South Carolina and our intent is to bring together people around the state who have similar purpose, whose missions are similar, but to convene those conversations to be at the table for those conversations certainly does take character, and one that I'm particularly proud of -

00:12:30:23 - 00:12:54:28
Juana Slade
we're in a partnership with the Urban League of the Upstate of South Carolina to co-host the Black Men in White Coats Youth Summit to provide outreach, education and field exploration for underrepresented populations. That had not been done in our state. And it certainly had not been done in Anderson County. So we're really proud of that. And then we look for opportunities to bring local dollars together.

00:12:54:28 - 00:13:18:21
Juana Slade
So our foundation, in partnership with the United Way of Anderson County is conducting, for the last few years, a joint fundraising effort to make sure that we're looking at people who are food insecure and those individuals who have opportunities for not only to receive or take a handout of food, but to understand how to prepare that food, and better yet, perhaps how to grow their own.

00:13:18:23 - 00:13:28:25
Juana Slade
So we think that because of the character, the longstanding character of our work, our voice is a trusted voice. We are not new to the conversation of DEI.

00:13:28:27 - 00:13:43:13
Jacqueline Hunter
So as we get ready to wrap it with our last question for you, if you can maybe name one thing and how does your organization, as we look ahead, how does your organization plan to continue to use AHA’s Health Equity Roadmap and advancing its mission of promoting health equity in your respective communities?

00:13:43:13 - 00:13:45:01
Jacqueline Hunter
So I will start with Juana.

00:13:45:03 - 00:14:09:18
Juana Slade
This is one of the levers is about community engagement and thinking organically, thinking outside of the box. Well, in 2020, at the height of Covid 19, the credibility of our organization allowed us to come together with several individuals, leaders from across the community and launch a program that replicates the work of the Equal Justice Initiative in Alabama.

00:14:09:18 - 00:14:36:29
Juana Slade
And we identified the five known victims of racial terror lynching. Now, what does that have to do with the work that we are doing as it relates to health equity? Well, it helps to know how we got here. And so understanding that there are reasons that people are reluctant to engage and to seek counsel and support from health systems, and why people may be reluctant to seek care from individuals who may not look like them or live like them.

00:14:37:06 - 00:14:56:27
Juana Slade
This kind of bold conversation in a community like Anderson has allowed us to expand the meaning of beloved community. And quite honestly, we think that having this conversation, acknowledging that there are founded reasons and the reluctance is going to eventually allow us to provide better care.

00:14:57:00 - 00:14:59:24
Jacqueline Hunter
Great. And Rosangely what about at Mainline Health?

00:14:59:26 - 00:15:28:13
Rosangely Cruz-Rojas
So we plan to continue using the framework both as part of our maturity model, but also as a way to measure our progress to many of the strategic initiatives that we have in place. I come from measurement. I used to direct the Department of Analytics and Process Improvement on the quality, safety and equity before. I'm very strong and really ensuring that over time, the only way you know that you're moving forward is by measuring.

00:15:28:20 - 00:15:59:01
Rosangely Cruz-Rojas
And so using a model like this help us understand where we still have gaps, where we have opportunities to continue to grow. Part of what I've been able to benefit as I examine that framework is that you see in the roadmap, if you were to mature and do more work in your community collaborations or, you know, engage your employee base resources, you have clear steps that some other organizations have done, and they are now documented that you could use that information to grow. For us,

00:15:59:02 - 00:16:23:09
Rosangely Cruz-Rojas
one opportunity that is in the horizon and we're going to be working on this year, is to continue to capacitate, provide capacity for our ERGs and the councils to do work that moves the bar around the strategic imperatives, particularly around these issues of health equity. I hear from some of the members of our organization and that they would like to be part of the solutions, work with us.

00:16:23:09 - 00:16:33:29
Rosangely Cruz-Rojas
So, while providing capacity and getting, you know, training for them to do process improvement, to be part of the initiatives, we probably will be able to scale up more of the work we are doing.

00:16:34:01 - 00:16:37:06
Jacqueline Hunter
Great. And Clint, will you bring us home, what's happening at Augusta Health?

00:16:37:06 - 00:17:02:08
Clint Merritt, M.D.
Thank you. As I think about the next few years in health equity work at Augusta Health, there's a few challenge areas that I think the roadmap gives us some guidance for. One is in the work with community partners who are really the experts on social drivers of health. How do we share data? How do we measure our impact in a way that helps all of our organizations set goals and move forward?

00:17:02:11 - 00:17:23:27
Clint Merritt, M.D.
I see a lot of meetings that focus around that, and that's sort of fits within the roadmap nicely. Related to that, showing impact, is making sure we continue to draw the connections of health equity work to value-based care models so that we have growing funding behind this work. And that looks so many creative ways right now

00:17:23:27 - 00:17:44:15
Clint Merritt, M.D.
so it's an exciting space. And then last at Augusta Health, we're continuing to lean into teaching the next generation of health care workers. We do a lot of education in nursing and pharmacy and therapy, and we just launched our first internal medicine residency program, first GME work three weeks ago. And these young folks coming out, they are very drawn to health equity work.

00:17:44:16 - 00:17:54:08
Clint Merritt, M.D.
It is in their passion. It's wonderful. And I believe they're going to help us be even better at that work with time and that's an exciting part of the work for the next few years for us.

00:17:54:10 - 00:18:13:29
Jacqueline Hunter
Great. Thank you. So thank you all for your time today and for sharing with us innovative, impactful initiatives your team has implemented to advance health equity. We appreciate your dedication to this vital work, and we look forward to seeing you continue the positive impact of your leadership. Thank you so much. As I close, thank you all for listening.

00:18:14:03 - 00:18:25:16
Jacqueline Hunter
For additional information from the Institute of Diversity and Health Equity, please visit our website at IFDHE.aha.org. Thank you very much.

00:18:25:18 - 00:18:33:22
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.

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.

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.

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.

00;00;00;22 - 00;00;30;29
Tom Haederle
It's well known that women make 80% of the health care decisions in the United States. Yet they occupy only 15% of executive C-suite positions. And for women of color, that ratio is even smaller. The importance of gender diversity in health care leadership is clearer than ever. And the glass ceiling, while still there, can be broken.

00;00;31;02 - 00;00;56;26
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. March is Women's History Month, a good time to celebrate ambitious, talented and successful women who serve in executive positions in health care. One such trailblazer is Dr. Roxie Wells, senior vice president, chief physician executive and strategy officer with Novant Health Coastal Region in North Carolina.

00;00;56;29 - 00;01;17;29
Tom Haederle
She is also a past member of the AHA Board of Trustees. In this podcast, hosted by Ogechi Emechebe, senior communication specialist with AHA's Institute for Diversity in Health Equity, Dr. Wells talks about her long journey from her childhood in rural Alabama and how mentors, inspiration and hard work brought her to where she is today.

00;01;18;02 - 00;01;23;12
Ogechi Emechebe
Thank you so much for joining me today. Before we get started, just tell me how you're doing so far.

00;01;23;15 - 00;01;34;09
Roxie Wells, M.D.
I am doing well. It's beautiful here in Wilmington, North Carolina. The sun is shining. It's a beautiful city. I couldn't ask for more. So I'm doing extremely well. How about you?

00;01;34;11 - 00;01;54;20
Ogechi Emechebe
I'm doing great. Thank you. So I'm glad to hear you're having really sunny weather. It's a little bit rainy over here, but we'll make it. We're really excited to have you today because the conversation is going to discuss the importance of gender diversity and health care leadership, specifically women in C-suite positions. So currently, about 15% of health care system CEOs are women.

00;01;54;22 - 00;02;08;15
Ogechi Emechebe
And you are a family medicine physician and also the senior vice president, physician executive and strategy officer at Novant Health Coastal Market. Can you walk us through your journey into health care and what inspired you to enter the field?

00;02;08;17 - 00;02;34;05
Roxie Wells, M.D.
Sure, I'm happy to do so. You know, years ago, I grew up in a rural community in Alabama. My mom served as a midwife for a large percentage of the African-American moms who were delivering in my town. She was actually trained...Back in the day, you could be trained as an apprentice by the family physician in towns and rural communities.

00;02;34;05 - 00;02;58;04
Roxie Wells, M.D.
And so she was trained by the family physician there. And I remember from being a very small child, seeing her leave and go to attend these deliveries. And as I got older, I recognized what she was doing and the importance of it. And then as I aged even more, even some of my peers were babies that she had delivered while I was small.

00;02;58;04 - 00;03;43;25
Roxie Wells, M.D.
And so it just kind of made me really think about health care as a career choice. Although I did not understand at the time that I could actually become a physician because there weren't physicians of color in my town, and I don't recall having women physicians in my town. It wasn't until I moved to a larger city in Alabama and then here in North Carolina that I really saw women physicians in action and women physicians of color in this career and that's sort of how I got into health care and how I became a physician, was just really recognizing that it was truly an option for me.

00;03;44;00 - 00;04;28;26
Roxie Wells, M.D.
It was something I've always wanted to do. I just didn't necessarily have the path to it. And so once I was able to be mentored by individuals at my university or individuals in my circle, I decided it is something I could do. And so I attended medical school at East Carolina University in Greenville, North Carolina. After I left there, I did my residency actually down here in Wilmington at Coastal Family Medicine and then went to practice at a rural community with the hopes that my being in that rural community would be another way for young people to see me and know what their possibilities could be.

00;04;28;29 - 00;04;51;06
Ogechi Emechebe
That's really great. So you said that you really didn't see women who looked like you or women in general until you got to Alabama and North Carolina. Then you started connecting with women who mentored you and prepared you to come into this position currently. So can you describe more about that mentorship and how did they prepare you and guide you to make sure that you are not only just breaking barriers, but you have a seat at the table?

00;04;51;09 - 00;05;28;02
Roxie Wells, M.D.
Well, you know, some of those women weren't necessarily physicians, but they were leaders in their fields, in their own right. And so they sort of transferred that leadership to me and they, I think, saw something in me that kind of piqued their interest in the things that we see when we look at leaders are people who are potential leaders and something about me stood out for them and they just started to mentor me and introduce me to people who were in the medical field and who were in the institutions of higher learning that could connect me.

00;05;28;05 - 00;05;54;29
Roxie Wells, M.D.
You know, a mentor at my HBCU Fayetteville State University here in Fayetteville, North Carolina, was one of the first African-American women to graduate with a Ph.D. from UNC-Chapel Hill. I mean, really, what better mentor could you have than Valeria Fleming, who had a Ph.D. in biomolecular science and who served as a mentor and as a teacher for me.

00;05;55;06 - 00;06;15;15
Roxie Wells, M.D.
I remember her calling me one day, and that's before we had cell phones. I didn't make it to class one day, and she called me and she said, Miss Wells, did you miss my class today? And I said, "well, yes, ma'am." And she said, "were you dead?" Well, no. She said, "well, that won't happen again, will it?" And I said, absolutely not.

00;06;15;16 - 00;06;28;09
Roxie Wells, M.D.
And it's that type of intentionality that actually helped propel me to become a physician. And to really think about leadership the way I think about it today.

00;06;28;11 - 00;06;33;24
Ogechi Emechebe
That's such an excellent story. I love that example about your professor holding you accountable. I liked that.

00;06;33;27 - 00;06;58;14
Roxie Wells, M.D.
She held me accountable and recently we just lost her about a week or two ago. But she held student accountable her entire career. She was tall and statuesque and just brilliant and smart and just exuded everything that you would want to be. And so she just kind of drew you in and you wanted to make her proud and you wanted to do the right thing.

00;06;58;14 - 00;07;07;02
Roxie Wells, M.D.
And she just mentored tons of young women and men, really through sciences and health care.

00;07;07;04 - 00;07;30;28
Ogechi Emechebe
So going off of that, it looks like you're really following her footsteps because let's talk now about the roundtable for black women CEOs. So I will give our listeners a quick summary about it. So in 2022, the AHA and IFDHE launched a roundtable for black women CEOs to promote impactful relationships and amplify the voices of black women who support hospitals and health systems

00;07;31;01 - 00;07;52;20
Ogechi Emechebe
as CEOs to grow. So this group offers a safe space for black women to learn, share their experiences, and also be really safe in an environment where they may not be able to share these experiences in a universal setting. So up to date, there are almost 30 members. I know you were instrumental behind the formation of the group. Can you tell us more about how this came about?

00;07;52;22 - 00;08;25;15
Roxie Wells, M.D.
Sure. Happy to do so. You know, I sat on the AHA Board of Trustees for three years and really started to ask the question, are there black women, other black women CEOs in this country? And if so, where are they and who are they? And really just set out to really find them. I basically wanted to look for a community where I felt safe and felt comfortable sharing vulnerabilities that I felt.

00;08;25;17 - 00;08;56;11
Roxie Wells, M.D.
Being able to ask questions, being able to really have unencumbered discussions about equal pay or any type of biases that that I may have noticed or that other women may have noticed. And really just asked AHA leadership about opening or forming this group. And when we first set out to really see who was out there, I think we started with about 17 women.

00;08;56;19 - 00;09;35;16
Roxie Wells, M.D.
And I'm going to tell you, we received photos and bios from them and the team at AHA sent them over to me for me to look at them. And when I first opened that email and started to look at those pictures, it became really emotional for me because I'm looking at a group of beautiful, powerful, thoughtful women in their own right who have risen through the ranks in various ways, some directly, some through circuitous routes, and that they are just performing very well in our field.

00;09;35;16 - 00;10;01;02
Roxie Wells, M.D.
And it was just an emotional experience for me. And so when we all came together for the first time at the AHA Annual Meeting about two years ago, we met for about an hour and a half and the emotion in the room was palpable. And that just made me realize the importance of forming that group. And we've continued to meet.

00;10;01;02 - 00;10;29;16
Roxie Wells, M.D.
We meet for business meetings four times a year, and in between we have social happy hours virtually. Two of our business meetings are in person, one at the Annual Meeting and one at the summer Leadership Meeting, and then the others are virtual. And we want to really look at ways to think about how we might improve quality of care for women of color.

00;10;29;23 - 00;11;12;10
Roxie Wells, M.D.
Think about how we may ask or teach people or lead people to stronger personal advocacy for themselves. Really think about personal well-being. Think about connecting with other women who may have some of the same challenges that you're having in your work roles or what have you. So it has been just a phenomenal opportunity to get to know amazing women who have storied careers in their own right and to really just celebrate all of the wonderful things that they're doing and then really to offer them a place of solace if it's needed.

00;11;12;12 - 00;11;35;20
Ogechi Emechebe
I really like that. So you said that this group has been very impactful and it's giving these women a space to just, you know, be vulnerable and share their - pretty much challenges and experiences in this field. Can you share some tips or advice that you have given them or some challenges that they're facing as black women in these roles

00;11;35;20 - 00;11;41;22
Ogechi Emechebe
and how do you all ensure that you can persevere through some of the barriers that you navigate?

00;11;41;25 - 00;12;26;00
Roxie Wells, M.D.
You know, let's make no mistake about it. They pour into me as much as I share with them. There's certainly a spirit of reciprocity in this group. You know, we discuss things from, I've had discussions about equal pay. Maybe the woman was a president of a hospital in a health system. How do you have the conversation with your system CEO about equal pay? Other things might include workforce issues and you're trying to figure out how to navigate the difficulty that we all are facing from workforce issues and making sure that our leadership teams are doing the things that they're supposed to do.

00;12;26;07 - 00;12;52;06
Roxie Wells, M.D.
When you have to have crucial conversations with individuals, whether that's a crucial conversation upstream to your system CEO or those people you report to, or whether they're crucial conversations to people who report to you. How to work through that and how to have those conversations in a way that really gets you to the place that you want to be with those individuals.

00;12;52;09 - 00;13;26;06
Roxie Wells, M.D.
So our conversations and discussions really, I mean, they range from personal: We've had members who have had personal issues, personal health scares and just talking about talking through that and what that looks like. So it really has become a community of women that not only share work and career concerns or challenges or experiences, but also talk about those personal things, well-being.

00;13;26;06 - 00;13;57;08
Roxie Wells, M.D.
How do you take care of yourself? What are the things that you do to really fuel yourself that's outside of your work life? How do you stay connected to your family? Understanding that many of us feel that there are extra hurdles that we sometimes have to jump to perform at the level that people would expect us to perform, although that may be higher than others.

00;13;57;10 - 00;14;29;28
Roxie Wells, M.D.
How do we stay true to self? How do we maintain those family and personal relationships? And how do we keep them separate from our work career goals and aspirations? And so we talk about things like that. And so it has been a wonderful experience. Our happy hours are really just to come together and laugh and celebrate each other. You know, everybody's on LinkedIn and you see all the great work that everybody's doing.

00;14;29;28 - 00;14;49;22
Roxie Wells, M.D.
And to be able to celebrate that, to be able to celebrate when one of our members are listed as the top 20 of something by Modern Health care or whomever. You know, we just want to celebrate those things and let those women know that you are phenomenal. We believe in the work that you're doing and we're here to support you.

00;14;49;25 - 00;15;22;01
Ogechi Emechebe
I really like that. It's key on being supportive of each other. So do you see a vision for the roundtable expanding beyond AHA? Essentially, do you see a vision for this being the blueprint for other systems or organizations to follow where they can offer a space for women or women of color to network with each other and amplify their voices, to not only develop a pipeline of diverse women leaders, but just to ensure that they feel supported and heard and that they can have just someone to lean on when they need it.

00;15;22;03 - 00;16;09;00
Roxie Wells, M.D.
I absolutely do. I think that it can certainly be cascaded throughout our field from the national level at AHA to the state associations, to different health systems or what have you. I mean we here at Novant, we have business groups of all types that fit this and we do have one for women of color. And absolutely, I think it's a great tool that can be mimicked throughout our field that would be helpful for women in general, and particularly women of color who who want to ascend to leadership roles. From an AHA perspective,

00;16;09;00 - 00;16;41;02
Roxie Wells, M.D.
right now, it's mostly CEOs or presidents or administrators. But I would love to see in the future other leadership roles actually become a part of the group at AHA. I'd love to see the expansion there, but we chose to start with the CEO, administrator, president, executive vice president role so that we could actually pull it together, make it succinct and really grow from that standpoint.

00;16;41;04 - 00;16;58;24
Roxie Wells, M.D.
Understanding that a smaller group giving thought to how we expand this would be best. And so I certainly hope in the future that we will expand beyond that CEO, president or administrator role and go to other roles within the C-suite.

00;16;58;27 - 00;17;12;16
Ogechi Emechebe
So can you tell me, given where you are today and then just looking back on your childhood from when you saw your mom, you know, working in the field, what have you learned along the way that you wish someone prepared you for?

00;17;12;19 - 00;17;47;12
Roxie Wells, M.D.
You know, that's a great question. I would actually think that ascending to leadership positions isn't as easy as people think it is. And especially for women and especially for women of color. You know, all hiring and mentoring leaders aren't as progressive as they purport to be. And what we do know is that is easier in most cases for people to mentor people like themselves.

00;17;47;14 - 00;18;22;01
Roxie Wells, M.D.
So when I talk about them not being as progressive as they purport to be, it's just easier for people to, again, just mentor people that are like themselves, people that look like them of the same gender or what have you have the same likes or what have you. And so I've found that it's somewhat difficult to break through that glass ceiling because there are still biases that are out there that prohibit movement past certain rungs on the ladder.

00;18;22;08 - 00;19;08;07
Roxie Wells, M.D.
But I do believe that, you know, the goal is to find people who are intentional and who are committed to ensuring that diverse leadership structure. And I've been blessed to have people who have been committed to and intentional about my success, whether they be coaches, whether they be mentors, whether they are friends who have had storied careers. The women in the roundtable have, you know, just pushed me to be a better version of myself. And then not only that, I think it's important to take all of those things that we've been given and lend them to others and to serve as coaches and mentors and friends, to those who are who are interested in becoming

00;19;08;07 - 00;19;10;24
Roxie Wells, M.D.
leaders in health care.

00;19;10;26 - 00;19;32;29
Ogechi Emechebe
So I really like your quote about finding people that are intentional about your success. And I think that leads into my next question about: do you think there is a role that men can play, if any, to ensure that they create a safe, friendly environment for women to thrive in? Because women can be doing the work to be mentoring each other and making sure that they are creating a support system.

00;19;32;29 - 00;19;43;29
Ogechi Emechebe
But if a lot of these positions are still held by men or trying to break these biases, what role can men play to make sure that they're also creating a safe space for women to thrive and succeed in?

00;19;44;01 - 00;20;08;00
Roxie Wells, M.D.
I think that's an excellent question, and I do think that there is a role for men to play to ensure that that women succeed in leadership roles in health care. And I've been fortunate again, some of the people that I mentioned before who have been instrumental in my leadership journey have been men, men of color, black men, white men have been very, very instrumental for me.

00;20;08;00 - 00;20;33;18
Roxie Wells, M.D.
But I think that you mentioned earlier that health care CEOs, only about 15% are women, the other 85% are men. But we do know, according to the U.S. Department of Labor, that 80% of health care decisions are made by women. And if that's the case, that it kind of seems a little uneven. So I do think that there are things that they can do.

00;20;33;18 - 00;21;04;24
Roxie Wells, M.D.
First of all, treat women as equals. Secondly, make sure that you are a proponent of equal pay for women, for equal work. Being coaches and mentors. And if a leader doesn't have the bandwidth to be a coach, pay for or sponsor a coach for women in your organization. So sponsorship is important. Being an ally is important and really calling out recognized, unfair, biased treatment.

00;21;05;01 - 00;21;32;29
Roxie Wells, M.D.
Walk the talk, right? Just don't talk about I am fair or what have you. But when you're around peers and you're hearing things that aren't necessarily appropriate, have those conversations. Call those people out. Bring those people back to a place of understanding that equity, equality is is important. Help them to understand the roles that women play in health care.

00;21;33;00 - 00;22;02;10
Roxie Wells, M.D.
We know that 70% of the health care workforce is composed of women. So we need to make sure that we are looking at that when we're talking about equity. Other things might be flexibility, making sure that you understand that the roles of women are often times much different than those of men outside of the workforce. And so what the expectations are for me at home might be different from the expectations from my male counterpart.

00;22;02;13 - 00;22;22;18
Roxie Wells, M.D.
I'm not asking asking for special treatment, but asking for flexibility. Go outside of yourself and go outside of the box and talk to various people in your organizations and see if you can build leadership bandwidth from individuals throughout your organization.

00;22;22;21 - 00;22;39;22
Ogechi Emechebe
That's a great answer. I really like that. I do think that men do play an instrumental role in ensuring that women thrive. So just having that collaborative partnership is key for everyone's success, really. So that is all I have for you, Dr. Wells. Are there any closing thoughts or comments you would like to add?

00;22;39;24 - 00;23;25;25
Roxie Wells, M.D.
Really, just to remind everybody that I was doing a little bit of research before this and looking at the population of the world in general. And it's 50-50. And so really thinking about if we are going to move forward in health care, if we're going to decrease the cost of health care, to include not just from a financial perspective, but from morbidity and mortality, we really need to be inclusive in making sure that the highest levels of leadership in health care are inclusive and quite diverse, because we all have different perspectives, we all come from different backgrounds, and having all of those individuals at the table just makes us better as a field.

00;23;25;29 - 00;23;39;14
Roxie Wells, M.D.
So I would encourage my colleagues across the country to just be intentional and intent upon making sure that there's diversity at the highest levels of leadership and your organizations.

00;23;39;16 - 00;23;46;15
Ogechi Emechebe
I love it. I really appreciate your time, Dr. Wells, and thank you so much for this powerful and informative podcast.

00;23;46;17 - 00;23;54;29
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.