Opening Doors

In her quest to create an anti-racist healthcare system, DeAnna Minus-Vincent, MPA, often thinks about her grandfather. Ms. Minus-Vincent, senior vice president and chief social integration and health equity strategist at RWJBarnabas Health in New Brunswick, N.J., says her grandfather was unable to look a white woman in the eye until the day he died. Even at 87 years of age, he lived in fear as a Black man in America.

His experience gets to the heart of why providing equitable, anti-racist and non-biased patient care is such a daunting undertaking. There are entire segments of society that have major trust issues with the nation's healthcare system. "It has been shown time and again that health care hasn't always been friendly to people of color, whether it's big issues such as the Tuskegee syphilis experiment or everyday occurrences where our feelings and concerns are blatantly ignored by providers," says Ms. Minus-Vincent.

In order to fix systematic discrepancies, healthcare providers must first recognize there's a problem for individuals who have been negatively impacted. RWJBarnabas Health is taking an important first step of acknowledgement by launching a system-wide diversity strategy (see "Ending Racism Together").

"We're acknowledging that minorities have a right to mistrust the healthcare system," says Ms. Minus-Vincent. "We've started down a path toward creating healthier communities by getting their input and working shoulder to shoulder with them to create an anti-racist organization."

RWJBarnabas Health is focused on improving the care of patients with limited English proficiency, according to Ms. Minus-Vincent. The health system ensures patients with language preferences other than English have access to interpreters and have their educational materials translated into language they can understand. RWJBarnabas Health is also revamping its admission processes and how it will build out its standard electronic health record.

"Our intake workers will be required to ask for a patient's race, ethnicity and preferred language, and that information will be a static field in the EHR, so every provider can see it," says Ms. Minus-Vincent. "This process change will come down to education and making sure staff asks about these things 100% of the time."

The surgical department at Stanford (Calif.) Hospitals and Clinics has incorporated cultural complications into its monthly departmental liability and mortality conferences, during which members of the surgical team gather to discuss incidences that occurred within their institution. "Using real-life examples is a powerful exercise," says Sherry M. Wren, MD, FACS, FCS(ECSA), vice chair of diversity at Stanford Surgery.

Providers at Stanford recently addressed the implantation of a porcine mesh implant in an observant Muslim woman, who was unaware the product was used in her surgery. Porcine meshes go against the religious beliefs of Muslims, as well as those of the Jewish and Hindu faiths. 

"Each case we review speaks to some demographic of our department, and allows staff members to have their voices heard — or at least hear that what they're experiencing is being voiced," says Dr. Wren.

When members of the surgical department discussed the care of the woman who received the porcine implant, for example, Muslim providers felt empowered to speak up and share how to best handle the situation moving forward. The case raised the staff's awareness of the issue and led them to disclose use of porcine products in the informed consents patients sign.

The discussions have become ingrained in the department's culture. "A faculty member used a personal example of her unintended ignorance, and that was a powerful way to engage the department," says Dr. Wren. "It's important to have leaders who are willing to discuss mistakes and the steps that must be taken to address identified issues. That lets the rest of the team know that efforts to provide culturally competent care isn't just lip service. It also inspires others to raise concerns or issues they might have."

Dr. Wren suggests addressing cultural competencies the same way you work to provide safer care by identifying and learning from near-misses, openly discussing what systems led to the potential errors and putting practices in place to avoid similar situations. She believes smaller healthcare systems or surgery centers can develop forums similar to Stanford's model by making discussions about equitable care regular agenda items during staff meetings.

Many clinicians don't have the proper training to react to cultural issues or understand their own implicit biases, according to Ms. Minus-Vincent. All too often, she says, these factors converge and lead to inequitable care and poor outcomes for minority patients. Her advice for facilities embarking on their own journey to provide more inclusive care: Under broad goals, create very specific and measurable priority initiatives.

Ms. Minus-Vincent admits that it's easy for well-meaning surgical leaders to overreach when it comes to building out their diversity, equity and inclusion programs. "Of course, we want to be able to do everything," she says, "but we can't boil the ocean."

Dr. Wren points out that programs established in other facilities might not work with your staff, who speak their own language and operate withing a unique culture. "Take ideas from other organizations, and make them your own," she says.

Providing culturally competent care ultimately demands an authentic commitment from leadership. "It's not about checking a box and moving on," says Dr. Wren. "Leaders who are committed to the cause are critical to its success." OSM