“We have to be willing to sacrifice people’s comfort for other people’s liberation.” It is a powerful quote from Angela Kade Goepferd, MD, chief education officer at Children’s Minnesota, that sticks with me.
She shared this perspective during a panel on diversity, equity, and inclusion that we hosted as part of Humanize Health, an event (this year held virtually due to the pandemic) for healthcare leaders who are committed to keeping humanity at the center of all healthcare strategies, decisions, and interactions.
Dr. Goepferd’s insight was in response to a question I had been struggling with for nearly two years, ever since hearing a presentation by Rick Evans, chief experience officer at NewYork-Presbyterian (NYP) at the in-person version of Humanize Health, where he talked about the Respect Credo at NYP. The Respect Credo was part of an organized effort to revitalize the core value of respect across the health system.
Mr. Evans shared that as work surrounding the Respect Credo entered its second year, the organization had tackled many surface issues of respect and was now facing more complex challenges, including when a patient expressed a bias against a care team member because of their race, gender, or sexual orientation. Too often, he said, those patients were passed along to other health systems, and became someone else’s problem. But Mr. Evans went on to say that a culture of respect requires that these patients get exceptional, respectful care – while not compromising the environment of respect, equity, and inclusion for team members.
I have been wrestling with this dilemma ever since Mr. Evans posed it. Does respect and a commitment to inclusion require that a bigoted patient gets his way when requesting a white male doctor? If both the discriminator and those discriminated against deserve respect, what is the right response?
I think Dr. Goepferd’s statement is a critical step toward resolving that dilemma because it lays bare the false equivalency of the two positions. Not accommodating people’s biases (conscious or otherwise) is uncomfortable, but it can be done with respect. Being discriminated against for race, sex, gender identity or other protected trait is inhuman. If your basic humanity is institutionally allowed to be called into question, there is no longer a question of respect. The efforts to promote diversity, equity, inclusion, and belonging is one of justice and liberation – fundamental elements of respect.
Promoting Diversity, Equity, and Inclusion
Dr. Goepferd was joined on the Humanize Health panel by Wayne Boatwright, MHA, CDM, vice president of diversity and inclusion at Hackensack Meridian Health, and James Williams, MA, executive director of diversity, inclusion, and equity in the Urban Health Initiative at UChicago Medicine. The panel was moderated by Louis Hart, III, MD, director of equity, quality, and safety at New York City Health + Hospitals. Their collective wisdom, experience, and humanity was illuminating.
The panelists started by sharing their personal experiences that cemented their commitment to diversity, equity, inclusion, and belonging. One panelist shared a story about he and his wife going to a celebratory dinner, where he was dressed in a fine suit and was handed a $5 bill and a car ticket because he was mistaken for the valet. Another panelist shared how he was told there was no way he would succeed in a newly created job to promote equity (a job he has succeeded at for almost 20 years). We also heard how a panelist was asked to represent the Black perspective in majority-white meetings (despite being half white), and we heard how another panelist was excluded for coming out as queer.
The panel’s insights were too many to enumerate in full in a single article. But a few highlights stand out:
Balancing patient preference with care team member dignity:
In addition to Dr. Goepferd’s insight, Mr. Boatwright suggested standing by team members. “We are very, very comfortable in saying to the patient, “We would not provide you with a clinician who does not have the skills to help you. They are the best we have, and we believe they will do a tremendous job for you.”
Mr. Williams also stressed the need to promote diversity in the care team. “We start with specific recruiting goals for our prestigious school of medicine. More than 70% of our patient population are people of color. And then we have specific actions to retain the stars from residency and fellowship to be attendings, all the way up to be our chairs of medicine.”
Overcoming the diversity gradient of frontline jobs and senior leadership positions:
Healthcare leadership typically shows an over-representation of white men relative to frontline positions.[i] Mr. Boatwright said, “You have to call racism what it is and then build intentional efforts to create diversity. Be comfortable calling out the numbers and hold recruiters accountable.”
Mr. Williams added, “I just created a cultural dashboard so we can look at diversity data the same way we look at financial data and quality data. We need to make sure people use the term, “racism,” and promote people of color into leadership positions in our organizations.”
Dr. Hart warns of potential pitfalls of this well-intentioned work if not done correctly. “We must avoid being too paternalistic in our actions. By infantilizing historically underrepresented people as being so oppressed and downtrodden as to require saving, we take away the dignity of the very people we are trying to empower.”
Making space for intersectionality:
Dr. Goepford laid the foundations. “There is interpersonal intersectionality – figuring out our own identities and how we interact with each other. And then there is collective or community intersectionality. Any time we create liberation for one identity, it makes it easier for us to continue to do that for others.”
Mr. Boatwright distinguished visible (readily apparent on visual inspection) from non-visible identities. “How are we doing with people who don’t so readily show their identities. If you’re not doing well with someone whose identity is visible, I can assure you that there’s a deficit for people who don’t have the opportunity to say, ‘I am different and need these skill sets.’”
Challenging systemic bias in health systems and in communities:
Mr. Williams suggested a wholistic organizational perspective. “Race is not the risk factor, racism is. And then you start to look at community – where people live, work, play, worship. Then you ask, ‘How can we as an economic anchor on the South Side of Chicago have an impact? How can we convene people and invest resources and bring additional resources to eradicate racism?’ That’s our fundamental work.”
Dr. Goepferd added, “Racism is like the wiring in the walls. It is in every policy, every electronic medical record that we use, every way that we’ve traditionally approached patients. We can measure it, but at some point, we just have to assume that there is bias and racism wired in. If you’re privileged, the wiring seems fine. If you’re not, the lights keep failing. We can’t just wait for all the lights to go out. We have to go looking in the walls for the faulty wiring. And to do that we have to listen to the people who have been telling us it’s there and start valuing and amplifying their voices.”
Dr. Hart describes this strategic approach of constant internal examination of a health system to ensure clinical and operational patient-care models are producing health equity. “This work requires a proactive approach and must include continuous investigation, cataloging and monitoring of explicit, implicit, institutional and structural biases within the health system. It is vital to have the IT and governance infrastructures in place to ensure that leaders are transparent and accountable with the process.”
Gratitude
We all have deep work to do – as individuals, leaders, institutions, and as a nation. I’m grateful that these conversations are happening, and proud to be part of an organization that supports them. I’m even more inspired when leaders and organizations – especially those with privilege – take meaningful action to fix the faulty wiring in their walls and sacrifice their comfort for liberation. We need to get uncomfortable. We need to stand solidly for liberation. For, as activist and artist Lilla Watson proclaimed, “…Your liberation and mine are bound up together…”
[i]https://ifdhe.aha.org/system/files/media/file/2020/03/diversity_disparities_Benchmark_study_hospitals_2013.pdf