Healthcare has long had its issues with equity when it comes to the quality of care and how it delivers care outcomes to patients from diverse backgrounds. In the early 2000s, the National Institutes of Medicine laid out a path toward leveling the way healthcare delivery occurs, but two decades later, problems persist.
In recent times, it has become a more widely recognized fact that people’s environment, the social constructs they operate in and the resources available to them to improve their health and wellbeing is the primary driver of health outcomes. This scope is commonly known as Social Determinants of Health (SDoH) and has become a focus for policymakers, healthcare data scientists and care providers alike.
In their upcoming book, Reigniting the Human Condition — A Pathway to Diversity, Inclusion and Health Equity, authors Jennifer Mieres, Elizabeth McCulloch and Michael Write showcase how Northwell Health (No. 1 on The DiversityInc Specialty List for Top Hospitals and Health Systems in 2021) has focused on DEI in healthcare on a foundational level for the past 10 years. The book analyzes the various environmental factors impacting the ability of community partners to provide patient care and then presents a working blueprint on how to create care plans that account for SDoH.
Mieres, a renowned cardiologist and Professor of Cardiology at Hofstra University, highlighted why the trio from Northwell Health, New York’s largest healthcare provider, chose to start their journey focusing on social determinants as a vehicle for change.
“It’s about expanding the healthcare delivery model to meet patients where they are and take into account their health literacy, culture, language, education and race or ethnicity,” she said. “Healthcare has been designed to focus on the acute care delivered in patient interactions, but we know that physician-patient interactions only account for around 20% of what contributes to an outcome. The other 80% is everything else that happens in their lives.”
A Framework for Success
When that journey began, there was little to no framework or guidance for a health system to follow in creating a healthcare delivery model that took DEI into account. The book outlines a framework that Northwell has developed for the past decade.
“Looking back, it’s amazing how much we had to build this from scratch to try and create this human connection within healthcare,” says McCulloch, Associate Vice President of Diversity & Health Equity at Northwell. “We had to use a variety of modalities to create this and trial it. We used data and surveys, formed committees, implemented policies, changed policies, put policies out and then took them back to adjust them. It really was from the ground up.”
The framework was built on foundational pillars that create a more holistic approach, categorizing the different aspects that needed to be addressed to ensure equity within healthcare delivery and infusing the human connection into it all. Those pillars are:
- Leadership commitment
- Education development
- Language access
- Community partnerships
- Workforce development
- Supplier diversity
The thread that weaves these pillars together is the human connection that needs to exist to deliver care grounded in developing relationships of mutual trust and helps patients feel respected, understood and heard.
Doing this work required a great deal of leadership buy-in and engagement with Northwell care team members. A great deal of effort was put into creating a culture of what came to be known at Northwell as “shared vision, shared mission and shared leadership.”
“We took a multimedia approach and leaned on the power of storytelling to get buy-in from people,” Mieres said. “That might have been video, arts or written messages. We had campaigns where both employees and leaders from the medical school and the health system talked about what dignity and respect in care meant to them, why diversity mattered and what communication meant. It was almost like a movement that we started.”
Part of that process involved getting physicians and clinicians invested in the philosophy of patient as a partner through Employee Resource Groups. They became ambassadors for the project and change agents within the organization. Michael Wright, Northwell’s Vice President for Diversity and Health Equity, was keen to note how important this was for spreading the message throughout the entire health system and making patients feel it.
“The ERGs understand the culture, values and language of how to frame the message of equity, diversity and inclusion so that it can get embedded into what works within the business,” Wright said. “They now see themselves as architects on this journey with us and that helps get them fired up and committed to the mission.”
Over the course of the 10 years, the team learned a great deal about driving educational sessions and making them something that care providers wanted to participate in. They had to create a culture of lifelong learning within their teams. As they went along, the team had to build their evidence for a business case that would allow them to acquire more resources.
“In the beginning, DEI wasn’t as widely accepted or thought about, and when we’d sit down to talk about these topics with clinical staff, it was in one ear and out the other,” McCulloch said. “They saw it as one more thing that was being added to their plates, whether that was teach-back method or securing an interpreter, understanding how their bias was impacting their connection with patients, etc. We really had to take the time to understand their why and what matters to them so we could cater the education to them. Ten years ago, we had to bring lunch, coffee, all kinds of things, but as we improved the sessions, now we can’t keep up with the demand for these sessions.”
To change the management perspective, the team held a mantra that would serve any business attempting to go on this type of journey: “if it’s not written, it doesn’t exist.” Documenting and taking inventory of efforts, policies, successes and failures helped iron out the kinks along the way.
COVID-19 and the events of the last two years have also had an influence. The pandemic has highlighted health inequities in ways that were difficult for some to understand before. For many, the impact of COVID-19 is a call for healthcare redesign and expansion. For the Northwell team, it’s nothing new, but they’re glad to see other healthcare organizations getting on board.
“The National Institute of Medicine, now the National Academy of Medicine, wrote the template to do it at the turn of the century, and we in healthcare read it and largely ignored it,” Mieres said. “It’s a struggle for many healthcare organizations because when we get right down to the business of it, we operate on slim margins. At the end of the day, you have to make enough to have the trains run on time and turn the lights on. Reinvention is desperately needed to continue doing that, and it’s time we as a society come together to collectively reboot healthcare.”
The book has a release date of March 29.