IFDHE Podcasts

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

00:00:00:13 - 00:00:26:21
Tom Haederle
Whether it's flying an airliner, coaching a football team, or running a hospital or health system, the skills and experiences of the people at the helm make a big difference in the success of the journey. That's why the recruitment and diversity of composition of the Board of Trustees is vitally important.

00:00:26:23 - 00:00:52:02
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Everyone uses health care a little differently. And the board that brings a wider range of viewpoints to its oversight of a hospital or health system is better positioned to meet the variety of patients' needs as we hear today's podcast hosted by Sue Ellen Wagner, vice president of trustee engagement and strategy with the AHA.

00:00:52:05 - 00:00:54:03
Tom Haederle
Sue Ellen, over to you.

00:00:54:06 - 00:01:12:23
Sue Ellen Wagner
Thank you Tom. I'm happy to be with Schonay Barnett-Jones, trustee at Children's National Hospital in Washington, D.C. Schonay is also a member of the American Hospital Board and the AHA's Committee on Governance. Schonay, It's great to be with you at the AHA 2024 Leadership Summit.

00:01:12:24 - 00:01:14:18
Schonay Barnett-Jones
Thank you for inviting me.

00:01:14:21 - 00:01:45:17
Sue Ellen Wagner
Our topic today is board recruitment. Board recruitment is an important part of good governance. The composition of a board is a major factor in board effectiveness. And diversity is an important strength. When I mention diversity, I'm referring to gender, age, race, experience, disability, etc. According to the AHA's 2022 Governance Trends reports, hospitals and health systems are making some progress on gender diversity, but need to improve on recruiting younger trustees.

00:01:45:19 - 00:01:55:13
Sue Ellen Wagner
And when I say younger, I'm referring to people 50 years and younger. Can you comment on the importance of board recruitment and having diversity be part of the recruitment process?

00:01:55:15 - 00:02:18:20
Schonay Barnett-Jones
Absolutely. Firstly, I'd like to commend boards who are continuing their diversity journey. This is hard and intentional work, but it makes a difference in the level of effectiveness to support organizational and community needs. Generally speaking, as you know, boards traditionally consisted of an older demographic with the same experiences and in many cases, same gender, race, and level of financial contribution.

00:02:18:22 - 00:02:42:20
Schonay Barnett-Jones
Board recruitment is important to ensure an infusion of new ideas, levels of experience and to maintain sustainability in the marketplace. And having a diverse or provide space for varying perspectives to be heard because everyone uses healthcare differently. What we understand is that Gen Z, Gen X, and millennials view health care through a tech lens. They want everything online.

00:02:42:20 - 00:03:17:07
Schonay Barnett-Jones
They want it quickly and readily available. But their expectations of how health care should work for them are very different from their parent's generation. So in order for boards to better support our organizations, we must be reflective of our communities and this younger demographic in particular. We can't get their input unless they're invited to participate. We must keep in mind also that they may not have the financial wherewithal for charitable contributions at the level that most boards are, but they bring talent and they bring commitment, and those are very valuable assets to any board.

00:03:17:13 - 00:03:44:05
Sue Ellen Wagner
I agree with that. Thank you. Hospitals and health systems are often challenged with recruiting new board members for a few reasons. Some of those you just mentioned, one being competing for board members with other organizations in the community. And then second, being a hospital or health system board requires significant dedication of time. Can you respond to these challenges and how hospitals and health systems can overcome these challenges?

00:03:44:06 - 00:04:09:10
Schonay Barnett-Jones
Yes. It's important to cultivate your own board talent. Hospitals and health systems have so many community touchpoints that really just go untapped. We don't look at all of the community assets that we have. I would look to the community-based organizations, professional organizations and internally for recommendations. Also to ask your current board members to access to their networks.

00:04:09:12 - 00:04:36:24
Schonay Barnett-Jones
I joined the Children's National Hospital Board at age 42. I was by far the youngest board member there. However, prior to that, I had been actively engaged in committee work and chairing the Patient and Family Advisory Council, but only because my daughter's nurse invited me to participate. Wow. So my experience is lived experience. My daughter Olivia is post-cardiac transplant, and we have spent a significant amount of time in hospital settings.

00:04:36:26 - 00:05:06:00
Schonay Barnett-Jones
So my contributions to the board table are really a lens through that of a consumer and the voice of patients and families. But to your second point, board work grows legs. And anyone who is on a board understands exactly what I mean. And so your members often end up on multiple committees with varying time needs. So you really have to be honest upfront about the time commitment and the expectations so the candidates can make good decisions regarding their ability to serve.

00:05:06:02 - 00:05:11:06
Schonay Barnett-Jones
And then you also have to be very creative with scheduling and the use of technology to support your members.

00:05:11:08 - 00:05:14:17
Sue Ellen Wagner
Great points. Time is of the essence.

00:05:14:18 - 00:05:15:21
Schonay Barnett-Jones
Absolutely.

00:05:15:24 - 00:05:19:28
Sue Ellen Wagner
Can you share some board recruitment strategies that will be helpful to others?

00:05:20:01 - 00:05:43:25
Schonay Barnett-Jones
Yes. Yes. Firstly, I think you have to understand your current board landscape so you know where your gaps are and don't end up with a mini law firm on your board. I have a colleague who mentioned that he had 16 attorneys on his board, and I said, you actually have a law firm, that's not a board. And so we joke about that, but I think he is in the process of trying to make some changes to that.

00:05:43:27 - 00:06:15:21
Schonay Barnett-Jones
But in all seriousness, you must diversify your recruitment team and those persons who vote on your board candidates to add balance to the process. The diversity lens should permeate throughout your recruitment process, and not to be solely focused on your candidates. Based on your board's needs matrix, recruitment should be from various industries obviously, community partners and consumers. But I think that diversifying the recruitment team is key and is a linchpin in the entire process.

00:06:15:23 - 00:06:21:23
Sue Ellen Wagner
Yeah, really good points, Schonay, is there any additional information that you want to provide to our listeners?

00:06:21:26 - 00:06:46:13
Schonay Barnett-Jones
You have to be intentional about your diversity efforts. It is hard work. It is not the easiest path to take and not to give up because it gets hard. But really dig in and know that at the end of that journey that you will have far reaching impacts and to your organization and your community, and those decisions will transform health care for those people in your community.

00:06:46:15 - 00:06:54:22
Schonay Barnett-Jones
So I think that you have to just really continue to work at it, keep your efforts up and continue to move forward.

00:06:54:25 - 00:07:02:10
Sue Ellen Wagner
Excellent point. Schonay, thank you for your time during this podcast. AHA appreciates your leadership and the insights you shared.

00:07:02:14 - 00:07:04:01
Schonay Barnett-Jones
Thank you so much for having me. Have a great day.

00:07:04:01 - 00:07:05:22
Sue Ellen Wagner
You too.

00:07:05:24 - 00:07:14:05
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 - 00:00:36:13
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.