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Briana Contreras, associate editor of MHE, spoke with Dr. Maria Hernandez, founder and CEO of Impact4Health. Maria shared not only how healthcare inequities remain to be an issue and what needs to be addressed, but also the progress that has been made over time through awareness, conversations and laws, especially due to the heightened awareness of inequities caused from the COVID-19 pandemic and the tragic deaths of George Floyd, Breonna Taylor and many more - which have now occurred over a year ago.
Below is a brief Q&A of the interview with Hernandez that has been edited for clarity.
Q: How did the tragic killings of George Floyd, Breonna Taylor, and unfortunately, many others bring more awareness of the inequities in healthcare that affect many groups? Have there been any changes since?
A: We had two really major events happen in our country at the same time that brought attention to the inequities: one in healthcare and one in the criminal justice system. I think that because people saw this painful moment (in the media), everyone seemed to feel real passionate about what to do. So inside healthcare environments, I think you're seeing far more structured organizational response to bias, discrimination, certainly systemic racism, and so on. I think the Black Lives Matter movement made it all the more important to address.
We know in addition to there being health inequities, healthcare still suffers from a significant amount of bias in its own population of employees. If you look at most healthcare systems, there's diversity, but it's not necessarily blended in with the leadership or the executive team. It tends to be quite focused and concentrated at the front lines. I've never met individuals, people of color, who don't want to advance their career, and don't understand the importance of being seen as potentially becoming an executive.
So what's happening? Well, there's bias inside healthcare as well about our own community, our own staff. I think both of those events really made for the perfect storm to actually say we need to do something, not just about how we serve people of color, those disenfranchised, underserved communities, but we also need to look at ourselves and understand "what are we doing internally that makes it so hard for people of color, even in some environments, women, to navigate to those sweet opportunities, and the systemic bias, unconscious bias?"
Those are trainings that we're doing a lot of work in right now because I think this situation has really created that energy and that focus to actually get something done.
Q: What new laws were passed to improve health equity and have they been successful?
A: I think it's important to know there is a huge initiative on its way. It's called the Health Equity and Accountability Act of 2020. If you look it up, it really has simply been introduced. That means that there's a lot more that it needs to go through in order to be passed as a law. If you look at the sort of list of activities that are going to be required, as a part of this action, this particular act, it's going to focus on the kind of data that hospitals need to look at. In order to track inequities, it's going to look at standards of care to meet the underserved communities in a neighborhood. There's many different elements to this. It's not passed, it's basically just getting started. I'd say that's the right thing to look for. That's the right thing to be doing. It might take almost five to six years before that gets done.
So what's happening in between is that you're seeing different states look at what they can do as well. So here in California, for example, just last year, legislation was passed that all OBGYN physicians need to take an unconscious bias course. Again, that's because unfortunately, maternal health in this country is such that women are at the risk of dying, black women are at the risk of dying at two and a half times the rate of others, that approaches third world countries. So it's completely unacceptable because most of those deaths are preventable. So to begin to address that, I think that this was the right thing to do that.
California, one of the larger more populous states is saying, "What if we start to really require this kind of training?" So I think we're gonna see more of that.
Probably the other legislation that isn't quite legislation, but it seems to be seen as a standard that healthcare is trying to address, is the culturally and linguistically appropriate services standards (CLASS). Those were announced by the Department of Health and Human Services way back in 2000. There were a multitude of reactions to that. One of them is that translation services are more common, they're still not required by federal law. Some states do. But that was one of the big heavy lifts inside those standards.
Another was looking at culturally competent care as type of training that people needed to engage in, that the list is really great in and I'm super excited that that's been around for so long. Unfortunately, not everyone is practicing all of those standards. Again, that's one of the things that we try to come in and do and ask, "Are you aware that these are some of the things that you could be doing to reach those communities that you are most concerned about?" So I think we're starting to see more energy around mandating these practices.
I would love to see that hospitals, federally qualified health clinics and faith based nonprofits that serve communities, I'd hope they would feel that they themselves need to help further this work and that they themselves can hold on to those standards for their own benefit and for the benefit of the community and not have to wait for a law to pass. It certainly does help that we have something on the books that potentially could really organize this work. We need to see how far this goes.
I think that the Biden administration is definitely speaking a lot about health equity and they too are looking at, again, how to enhance some of the standards that would would really be a step in the right direction.
Q: What can healthcare networks do to improve equity and inclusion for staff and patients?
A: The number one thing that we need to start off with is looking at the data. We cannot just be comfortable saying, "On average, our patients experience our hospital in a very positive way." We need to now start looking at data through those demographic groupings that are so important.
So it's race, ethnicity, language preference, sexual orientation and gender identity. Those are major groups of demographic information that we need to look at. It's hard to do, believe it or not. As much as we think that all this data is collected on us inside our medical records, not all hospitals have started to actually ask those questions of people as they come in for care. It's a journey now to try and catch up and collect that data on the patients that are being seen. So that's number one.
I think the second is that someone has to be responsible for looking at that data. I can't tell you how often we find out that a hospital might have that data available, but no one's asking about it. Peter Drucker once said, "If it isn't being measured, it's not being managed. My new thing is, if no one's asking, and everyone's even asking to measure it, we're in trouble. Right? So that energy that focuses on asking those tough questions, "how are we doing with those different communities that we serve?", "how do they experience our facility, our staff, our services?" Those are the tough questions that have to start actually, even at the board level. The boards of hospitals need to be able to hold the c-suite accountable to those metrics, and that information, and to really get out in the community and talk to people about "what can we do to improve?", "how can we make this better?"
So there's plenty of activity out there now that I think is headed in the right direction. I would say those two are the primary places to start. It's the data. It's what you know about that experience, and making sure you're responding to the communities with feedback and and testing the waters with them about what you're going to try and do, and not try to do it in a vacuum. So having a Health Equity Council formed with community members, is often a good way to hear that voice at the table.
Q: Anything else you'd like to share with our listeners?
A: The only other thing I'd share, it's something that I'm being asked in different interviews about what patients can do, right? So if you're a person of color, and you're about to go in to see your physician, what should you try to manage and look out for?
One of the interesting statistics that I read along the way is that physicians interrupt their patients 18 seconds into their appointment. That might not be hard for someone who's really comfortable speaking English (to the physician), or someone who doesn't have some anxiety about the authority figure that they're working within their patient experience.
I talk a lot about having a patient advocate with you - someone who's going to be there to support you during your appointment - a family member, a trusted friend, someone who knows what your concerns are, who can watch the interaction, support you and make sure you're getting your needs met. It can be sometimes really intimidating, or there's other factors at play -the person might be really anxious, and having someone there that they are comfortable sharing the information with is key.
So bring your own patient advocate. I think that's important for for families of color to know.