Hartford HealthCare Podcast
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Hartford HealthCare Podcast
Health Equity: Examining the past, present and future
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Hartford HealthCare’s Steve Coates talks with Sarah Lewis, Vice President of Health Equity at Hartford HealthCare, and Dr. John Santopietro, Physician-in-Chief of the Hartford HealthCare Behavioral Health Network, to discuss the urgency of addressing health equity, why it’s important, particularly within our Black and Hispanic communities, vaccine hesitancy, and efforts underway to ensure diversity and inclusion within Hartford HealthCare and the communities it serves.
For more information and resources about health equity and the vaccine, go to HartfordHealthCare.org/vaccine
Or maybe it's just because being um a person of color in this country is hard, and because many systems are aligned um against the wellness and the the fullness of many people of color's lives. And so if we can just be open about the fact that we do see that and that we know that it's not right, I think that helps in building that trust.
SPEAKER_00Welcome to more life. In this episode, Hartford Healthcare's Steve Coates talks with Sarah Lewis, Vice President of Health Equity at Hartford Healthcare, and Dr. John Santo Pietro, physician-in-chief of the Hartford Healthcare Behavioral Health Network. They'll discuss the urgency of addressing health equity, why it's important, particularly within our Black and Hispanic communities, vaccine hesitancy, and efforts currently underway to ensure diversity and inclusion within Hartford Healthcare and the communities it serves. Here's Steve Coates.
SPEAKER_03So I would add another T, which would be transparency. I think that as providers and scientists and public health people, all the different ways that we identify ourselves within this system, it really helps to just sort of tell the truth about where we're starting from. And so if we can uh just be open about the fact that we do see that and um and that we know that it's not right, and within our system, we're we're working on making those long-term changes, um, I think that helps in building that that trust. And sometimes on our team, we think about what would it look like to have a trustworthiness index um and where are we on that? Um and that's that's a process, you know, it's it's never a static um uh aspect of the way that a patient or a community member thinks about our system. Um, and so the the the piece, and you mentioned some of the other pieces of the puzzle when it comes to vaccine equity, trans access to transportation, access to technology. Um we have to, you know, we talk about health equity being meeting people where they are. And so sometimes that literally does mean meeting people where they are and bringing vaccines, mobile vaccines to people. Um so we've already done a number of mobile vaccine clinics with um a number of congregate housing uh uh providers, um, uh people uh experiencing homelessness, staying in shelters, and we're expanding that into community sites. Um, and that's that needs to be part of our plan in addition to for people who want to come to our um our permanent clinics, um such as our sort of mega sites that we're rolling out, getting access transportation for those folks. Um, and the folks who just want to make it an easy online registration, um calling into our access center, making it easy through all of those different avenues so that however someone decides to come to us for their vaccine, um, it's it's as easy as possible, and they feel as though we respect their decision, however, they've made to come made it to come to us.
SPEAKER_01And John, let me open this up to you as well. We're seeing similar rates of vaccination where people work as well, places like Hartford Healthcare where it's widely available.
SPEAKER_02Yeah, I I was um I was thinking about uh adding another T, but I can't make this a T. It's a C. Um and it's one of our leadership behaviors and values, and it's curiosity. And one of the things that I I've noticed in my own conversations and when I see others have success in talking with people about uh, let's just say the vaccine in particular, it's when they are curious. You know, what is what are you thinking? You know, what what are your thoughts about it? What are your concerns about it? And and even at times I've seen it uh lead people to be curious about well, what was your last experience with the healthcare system like? Which which gets into really interesting territory, I think, that uh Sarah is pointing to. So we have the the immediate issue before us, which is we need uh we need to be vaccinated, but but it what it does is it uh it shines a light on a much larger picture to be uh curious about so that we can take action.
SPEAKER_01So we have plenty of marketing, not just from Hartford Healthcare, but really you can't turn on the TV or listen to the news without seeing something about the importance of the vaccine. Is this really a one-on-one conversation about the importance of getting the vaccine?
SPEAKER_02You know, Steve, that is that's exactly where I go with it too. And uh I uh and I I'm uh I'd be interested, Sarah, in your thoughts about it. But I I sort of think it in some ways it has to be one-on-one. I mean, it has to be both. I mean, we have to have larger messages and education and and uh transparency. But I it's hard for me to imagine how we're gonna do this without getting one-to-one.
SPEAKER_03Yeah, and and I think it's right just to to ask ourselves and be curious about what our colleagues' experiences are in taking the vaccine and um where do they see barriers? And and for some people it it it may be around hesitancy, it may be something else. And again, that curiosity is so helpful. Um, each and every one of us is an ambassador of sorts, right, for um for everything that Harvard Healthcare does. But in this specific instance around um vaccine acceptance and um and so if if we can help someone else get to their decision around the vaccine, then maybe then they feel empowered to help a family member or or a friend or someone in their church. Um I have heard just anecdotally from a number of colleagues that it's sort of a family decision, that um one person in the family is um is if they're the first to get vaccinated, they have had that conversation with their family about it. And the family members, everyone's sort of weighing in on it. And so, and that might be the case in a lot of different ways. Maybe it's among friend groups or it's among colleagues in another in another company. Um, but I think we do need to make space for people to be both to be curious ambassadors to sort of combine.
SPEAKER_01So earlier this year, Hartford Healthcare President and CEO Jeff Flax outlined a 10-point plan to address equity in healthcare and also ensuring diversity and inclusion inside of Hartford Healthcare. Now, the system is already engaging colleagues through our diversity, equity, and inclusion councils. Talk a little bit about that and also how this is bringing structure uh to our efforts.
SPEAKER_02Well, I'll go a little bit, uh Sarah, and then let you speak more in depth, I think. Uh, you know, so um uh I can't say uh how meaningful it was to see Jeff and leadership of this organization get fully behind this effort. Uh in the it's one of those things. It was a moment, and those moments come and go, and if you don't seize them, you know, they're they don't come back sometimes. And and so we did. Um we had uh in the behavioral health network um been uh laying some uh groundwork within the BHN around uh diversity, equity, and inclusion for a couple of years, which put us in a good uh position to be able to um observe just what you're asking about, Steve. And um I am incredibly encouraged, having having uh you know become familiar with uh several organizations in my career, I think we have an opportunity and almost a responsibility because of our opportunity to engage in this work. And uh when we engage it, um things happen hopefully on two levels. One is structural, so change happens structurally. And then uh as the psychiatrist, I would have I would have to say uh process-wise as well, the nature of our interactions, the the actual culture itself begins to change. And I can uh certainly speak with optimism about what I see happening there. People are already making uh inroads and really sharing with each other, listening to each other, where people enter what we think of as brave spaces to be able to really share and really be open to listening and uh reflecting uh on uh themselves.
SPEAKER_03Yeah, and um it's really exciting to see it coming together uh this year from a sort of balance scorecard perspective and again the 10-point plan perspective, it's really about laying this foundation for a culture of equity and inclusion across the system. And so um the way that folks relate to one another in our organization, we're we're hoping to create just expand that sort of window of opportunity for how we relate to one another and know ourselves as Hartford Healthcare colleagues. So um just tomorrow, our Hartford, our first colleague resource group is gonna launch, our African-American, Black and African-American colleagues resource group. Um we've got nearly 40 people from around the system who identify as black and African-American who are coming together to um uh work uh in conjunction with our system-wide strategies as teams to contribute in a way that's new to them, but is also very much in line with um our success long-term as a system. Um it's an opportunity for their for their direct supervisors to to see them in a different sort of leadership role and for them to um have opportunities to mentor others and to be and to be mentored. Um, and we're we'll be rolling out additional colleague resource groups over the next few months, a Hispanic and Latinx uh colleague resource group, um, Asian American and Pacific Islander, and also LGBTQ, I plus, um, and that's all within this first um this fiscal year. Um and so these are the structures that we can then build additional um, you know, it's just sort of the scaffolding that we can build additional um pieces around as we go forward.
SPEAKER_01So, how were the DEIs, the diversity, equity, and inclusion councils formed and how can people get involved?
SPEAKER_03Well, what's interesting is that we're very fortunate to have um a number of colleagues of uh excuse me, um, DEI councils across the system, and a number of them were stood up within the behavioral health network before, as John mentioned, um, before our system-wide council was created. Our system-wide council has um leadership from across the regions. Uh, we have you know clinical representation, administrative representation, um, a variety of backgrounds and training. Um, and that's that system level council is meant to oversee and just sort of drive the overall strategy for how we operate in terms of education and training that's related to diversity, equity, inclusion, and belonging, um, how our you know, how we can relate to our clinical space and uh driving equity through quality and safety, for instance, um, our the way that we engage with our communities, the way we we connect with our colleagues. Um, and in terms of the way things get stood up, I don't know if, John, if you wanted to sort of talk about your observations of how these the initial committees in the BHN were arranged, because I think that's it's a really interesting story.
SPEAKER_02Yeah, sure. And um, you know, just to speak a little bit about um maybe you know, why is BHN uh why had BHN leaned into this? In a sense, I think um all organizations are compelled right now to be doing this work. There's a kind of moral imperative. But in healthcare, um, I think we have uh even more of a reason. We we uh we're interpersonal in what we do, it's based on trust. Um and then in behavioral health, even more so, do are we set up to do this work because you know we're generally self a self-reflective um group of people, and uh uh uh and a good amount of uh behavioral health work is actually social justice work. So um I just can't say enough. I wish I could list all the names uh it just to thank the people. Um this work was ongoing before I got here in the BHN, and they've really um they'd already set up uh to your point, Sarah, um, a committee structure within the D the BHN. So um, in addition to a steering committee and councils at the campuses, there um were groups that were organized around looking at policies and procedures, looking at education, looking at the uh community and looking at clinical care. To your point or question, Steve, you know, um hopefully in a year from now, we will be able to look at numbers on dashboard uh that that give us data about what is the experience of our BIPOC, you know, patients and and staff members, you know, in in behavioral health, it would be things like uh how are antipsychotic medications getting distributed uh looking, uh cutting the data by race. Uh do we have a policy on what to do if a patient is using aggressive and overtly racist, you know, language? Things like that. But um I I also want to emphasize you can't just um go from zero to 100 miles an hour. You have to build the infrastructure. If you don't build it, then it it uh it will collapse. And I think that uh Sarah has been and her team have been doing an incredible job um at a system level building to structure building the structure to make this work safe, possible. Um I can't remember what was the we went the uncomfortable that you have a phrase about our department? Yeah.
SPEAKER_03Department of Discomfort.
SPEAKER_02The department of discomfort. The department of discomfort.
SPEAKER_03I think uncomfortable.
SPEAKER_02Exactly.
SPEAKER_03Yeah.
SPEAKER_02Uh and and only structure will allow us to get there. So really you there needs to be some discomfort for us to get there, right? Yeah, and and you know, Steve, some of the most uh incredible moments that I've observed in the work that uh Sarah and her team have put together or the BHN team has put together is in moments when uh people generally not of color, um let's say, uh, have a moment of of uh of awakening, right? Of realizing, you know, geez, I think of myself as a good person because I am a good person, I do good work. How could it be that that I just you know said something in that way that now that I look at it reveals, or I had a thought, or I had a discussion or or a scenario where I realize that I do have internalized bias, because everybody has internalized bias. And that's a that's not an easy thing to do. People have to step across a threshold to be able to even just realize that themselves and then to share it with others. And but those moments are happening. I wish we could measure those, you know, because that they're happening and they're happening with more frequency.
SPEAKER_01In the short term, I think some people might be skeptical. Let's say we've been here before, we're just going through the motions. Why is this different? And how do we judge short-term progress? Because I think if people can see some sort of progress, they might say, hey, we're really making a difference.
SPEAKER_03So um thanks for asking that. I was talking with a colleague the other day, and um I said that my hope comes from the the observation that the window of opportunity around equity and justice in healthcare seems to have widened and opened far quick far more quickly than than I would have expected. Um, and and this was because of um the pandemic and because of um George Floyd being killed last year and and the sort of social reckoning and racial reckoning with race in this country. And I see it, I see my job as wedging as much stuff in that window so that it doesn't close. And so that we keep it open and that becomes the new normal where we're constantly interrogating how are we doing on equity, how are we doing on justice and healthcare? Um and so from an internal perspective, I think that we're doing a really great job. I mean, I I um and I I know it's dangerous to sort of pat yourself on the back before you've you've reached the end of your um year during which you're gonna be held accountable for your success. Um, but I think it's important to recognize um the enthusiasm around participating in diversity, equity, inclusion, um, and belonging conversations. There's something that we're going to be evaluating, which is um on our employee engagement survey this year around I feel like I belong, and that's something that we we do measure and track over time. And to the extent that our data will allow us to, we want to be able to evaluate um what is that experience of belonging like for our colleagues of color? And um, are we doing are we doing the work that we need to do once we can sort of quantify retention rates and um and departure rates by um by race, ethnicity, gender, identity? Are we are we keeping talent? Are we are we recruiting more talent? Um we have a partnership or we we're participating in the Institute for Healthcare Improvements, pursuing equity learning and uh action collaborative. Um it's an it's a fantastic um opportunity for us to work with other organizations from around the country, and actually there's some international participants as well. So we're putting as many resources as we can internally and externally towards uh achieving these objectives and measuring them. First, you have to make sure whether you're putting the right resources in the right place. I think we are. And then secondly, you have to um you have to measure those outcomes over time. And I think to your point, though, we we do have some opportunities for short-term evaluation of success. Um and then, as John was saying, about the long-term game, have we built that muscle so that we can keep being empathetic with one another?
SPEAKER_02One of the things that's so enjoyable about working with you, Sarah, is that you do have the long view. That there's there's never been a moment in my working with you when uh this is about uh you know short-term um gains at the expense of long-term gains. That said, which is absolutely true, this is ongoing. This is not gonna stop. This is work we have to always be be engaged in now. That said, I I agree there are um and from my point of view, the way that we view things, you know, in Behaver Health, um, there are a lot of you know things that that uh that are uh signals of success. I mean, I'm uh uh uh words are important, obviously, to people, you know, psychiatrists, right? Um can you imagine a year ago, you know, or or a little over a year ago that uh that we would be using the words we're using. I mean, didn't hear anti-black racism, you know, is a term that was used in many organizations. White supremacy. I mean, these are these are um even just in the sort of uh the dialogue that you um uh hear, there actually have been academic papers published on uh the statements that went out by leaders and what words did they use and as a way of assessing, you know, where an organization is on their journey, and it is a journey, and we're in a we're in a stage. But I I do uh stay in touch with a lot of different organizations across the country through boards and national work. And one of the things I I spend uh time assessing is where are we on that on that journey? And I think we are doing a really good job. There's a lot of signs that we're moving at a good pace, a really good pace, but not at the expense of setting up that uh structure, and certainly not at the expense of of uh you know diluting ourselves that this is something we're gonna tackle and and leave behind us. This is ongoing work.
SPEAKER_01Sarah, last we spoke just weeks after the George Floyd killing, you did express hope that America was talking more about issues of race, equality, and inequity in healthcare, a good thing. And then there seemed to be a groundswell of support to do something and to do it now. Here we are many months later. On January 5th, we have a historic election in Georgia with the first black and first Jewish senators being elected there. The very next day, an insurrection at the Capitol, with some of those participating, waving Confederate flags, wearing clothes with white supremacist messages. Is it one step up, two steps back, and are you still feeling that same hope you felt months ago?
SPEAKER_03Again, with the with the vigilant hope, you know, um uh it's it I think it's helpful to be grounded in history and helpful to be grounded in in the reality of of our checkered past as a country and the way that um that white supremacy has been woven into our narrative as a as a country um from its founding. Um there are some ills that keep plaguing us that we um are seeing brought to the fore even more powerfully. Um sometimes they're more um hidden and insidious, but um these days they're they're right out in the open. And um and so the the hope and the inspiration and the the absolute thrill that I felt, that many others felt um on January 5th, um was it has not been diminished. I still feel incredibly power uh empowered and um and proud of the work that many black female organizers did on the ground in Georgia to make that happen. Um and and then at the same time, it's sort of not surprising that the next day there was that that um that attempted coup or uh you know uh riot in our um at our capital um and that a Confederate flag was just was being waved around inside that building um for the first time in 2021. Um and so we have a lot of bones that are unburied that are actually sort of sanctified and honored in this country that are it's and and so when you don't bury the bones of of a confederacy that tried to, you know, render the company, the country into um it's very difficult to actually live your values as a society. Um that external reality, of course, affects what we do here, but it's what what I think we can be hopeful about is that it's not our job in Harvard Healthcare to fix that, but we can talk about it. We can talk about how it can affect um how that sort of emotional trauma of having visualized that and seen it, which I experienced. Um I'll never get that picture out of my head, um, uh can affect us, but can also that's another opportunity for healing and for empathy and for for coming together and thinking about how um shining a light on our shared history can actually um sort of heal those wounds in a sort of new and creative fashion. Um so but we but we just have to keep being honest and transparent about about what we're seeing. And if and when we are able to do that, we are able to reimagine a future that we haven't had yet, and and that's that's what keeps me going.
SPEAKER_00Thank you. Steve Coates, Sarah Lewis, and Dr. Santo Pietro. For more information and resources about health equity and the vaccine, go to Hartford Healthcare dot org/slash vaccine. Thanks for listening to more life.