The Path to Equity Starts at the Top - Part 2

By Janice Sparks, PhD

Recently, I wrote a blog in relation to the headline, Hamstrung by ‘golden handcuffs’: Diversity roles disappear 3 years after George Floyd’s murder inspired them. The NBC News article highlights the loss, in major corporations, of diversity, equity and inclusion (DEI) officers who were hired in early 2020, due to many organizations that are reducing or eliminating these positions. 

This article made me think about these roles in healthcare. Specifically, does this trend exist in healthcare? How does the presence or absence of these roles impact the development and implementation of health equity interventions, and does the trend reflect a healthcare organization’s commitment to advancing health equity? This is of particular importance in light of the growth in health equity policy development and increasing state contractual requirements mandating compliance to Medicaid and other publicly funded programs. 

The industry with the largest number of chief diversity officers is education, at 26%, and healthcare comes in at 8%. The figure for healthcare is concerning because findings show that healthcare leadership and governance teams that reflect the communities they serve are more committed to including community voice in their decision-making. This commitment is conducive to best care practices, leading to better health outcomes. Collecting data on hiring trends for these roles is important and tells a story about the status of the roles and waning interest. While there is a trend to monitor activity around chief DEI positions, the same level of data tracking does not appear to exist for chief health equity officers (CHEO). 

To be fair, CHEO roles are new for most organizations, so monitoring trends pertaining to them may not be on the radar. Spring Street is encouraged by the fact that so many of our community-based health plan colleagues and other healthcare entities are committed to advancing health equity and have hired CHEOs. These advances have the potential to move the needle on health equity and disparity reduction. But now that these roles have been secured, what does an organization do to monitor and retain the CHEO role?  

DEI in general is under attack, and related roles face the same challenge. Failure to monitor CHEO hiring and retention practices puts hard-won appointee wins at risk for diminution or elimination due to political dynamics, fading interest, limited resources, and loss of appetite for continued attention to the issues that initiated their implementation. 

As an industry, we should be monitoring these positions and ensuring that the roles continue. The federal government could also track hiring and retention patterns of CHEOs among federally funded healthcare organizations. This could shed light on the link between an organization’s ability to lead in the area of health equity and health equity advancements. 

The questions posed at the beginning of this post will remain as CHEO roles evolve, and it will be interesting to watch what happens over time. The hope is that the growth of these roles remains to advance disparity reeducation and achieve health equity.  

Coming Back 5 Years Later

Five years ago, I was just coming back to work after the death of my husband after endured 17 months of treatment and suffering from pancreatic cancer. The journey as his wife, caregiver, and number-one fan was the most life-altering and humbling experience I have been through. It was an existence where everything mattered (life, love, connection) and yet nothing mattered (mail, social media, formalities) at the same time.

I wrote this article attached here to highlight some of the takeaways I had from the experience. As I read it now, I’m transported back to the time when I was writing it. I had been searching for a way to create meaning from everything my husband had endured and to honor all of the generosity, grace, and goodwill that we benefitted from.

I still stand by everything in the article. The deep connections we made with providers, family, and friends around this higher purpose are a marvel of the universe that I feel privileged to have been a part of. And I remain deeply gratefuly to the incredible providers who cared for my husband. But the article doesn’t include the most profound and difficult misfires of treatment.

Despite my education, privilege, empowerment, and informed status as a healthcare insider seeking care at elite cancer treatment facilities, I was unable to protect my husband from avoidable suffering. We experienced it both personally and in witnessing the experiences of those around us. A few examples include:

Failed care: The ways in which hospice utterly failed us when their protocols for escalation didn’t precisely match my husband’s symptoms, leading them to ignore pleas for help until he was hours from death.

Medical error: The day when my husband experienced a cascade of five medical errors within 24 hours, none of which were likely reported, and which resulted in a dramatic late night surgery.

Avoidable suffering: The failure to address extreme pain, and then later to ignore all symptoms that weren’t precisely pain.

Administrative labyrinths: Learning to bypass weekend ‘don’t call us’ phone trees by randomly calling in-house phone numbers until we found someone at their desk who could transfer a call to an admin on the GI floor.

And so on.

During our many trips to the ER and hospital, I primarily donned my wife and caregiver hat, but I could never entirely take off my healthcare system hat. I kept thinking – if only someone were shadowing us through this day, and documenting each step of the journey, there is no way this madness could continue. The mass acceptance of the inanity is a collective venture, not born out of bad intentions, but endured by everyone along the way.

Guiding other family members through the healthcare system during the past five years has been discouraging; little seems to have improved. I can imagine that the friction these experiences create for patients is also wounding to the clinical and administrative professionals witnessing them. There are few bad actors, but a mostly broken system is enough to create harm. And it is a system that I am a part of.

As we sit on the precipice of dramatic change in healthcare, enabled by emerg ing technology and new business models, we must use this moment to ensure that we get it right. We need to make sure that healthcare is accessible and equitable, kind, and personalized. We need to honor the incredible compassion and skill offered by humans in the system, and also take an honest look at the pain the system itself can cause. We can do better.

The Path to Equity Starts at the Top - Part 1

By Janice Sparks, PhD

News travels so fast and things evolve so quickly that sometimes we may miss taking the time to think about change, transformation, and the movement associated with swift evolution.  

A few months ago NBC News published a story with a headline that reads, Hamstrung by ‘golden handcuffs’: Diversity roles disappear 3 years after George Floyd’s murder inspired them. To summarize, the article highlights the loss in major corporations of diversity, equity and inclusion (DEI) leaders who were hired in early 2020 after George Floyd’s murder; however, now many organizations are reducing or eliminating these positions. In over 600 companies, Revelio Labs found that since late 2020, DEI role attrition outpaced non-DEI roles by 40% and 24% respectively.  

So why is this happening?  

There may be a couple of reasons: First, although organizations had good intentions in creating these roles, they did not count the costs of what it would take to sustain them and did not understand the deep-rooted complexities of things like institutional racism and what it would take to overcome the challenges. Second, organizations are, understandably, unsure of how to address DEI in the “right” way. This may be why some are shifting from a single role to using Environmental, Social and Business Governance, or ESG, models to address DEI. While integrating this work organizationally has potential staying power, a DEI lead should remain in place to oversee, shepherd the process, and hold the organization accountable to DEI commitments established through ESG efforts. 

The reduction in DEI roles reflects progress, and no business has a magic wand that will instantaneously craft the right organizational configuration. These statistics, while alarming, should help us think about not only the why, but also the what: What can be done to sustainably create organizational cultures that reflect dedication to the cause? Hopefully, over time, we will see commitment reflected in visible change and measurable outcomes. 

In future posts, I’d like to explore whether this trend also appears on the healthcare landscape, what it means internally for an organization, and possible external implications related to service delivery and addressing health equity for the community at large. Spring Street is evolving too, and we hope to continue working with organizations that are committed to making real, impactful, sustainable change. 

The Political Determinants of Health, by D. E. Dawes

The Political Determinants of Health by Daniel E. Dawes provides a fresh take on a very familiar topic in healthcare—social determinants of health. Dawes takes the position that the social factors that we pinpoint as social determinants of health are often categorized as politically neutral items. Challenges such as poverty, homelessness, housing insecurity, or transportation inaccessibility are external factors that contribute to compromised access to healthcare, but in and of themselves aren’t political. Dawes contests this perspective by asserting that these factors are inherently developed political items in our politically charged society.  And these factors have come about as a direct result of political movements and decisions.  

From this point of view, Dawes provides a history of the quest for health equity in the United States reaching back to the early days of our country. He covers the eras of slavery, post-slavery, the civil rights movement, and continues through to the development of the Affordable Care Act.  

While I'm well versed in the more recent aspects of this narrative, hearing the story of the development of the Affordable Care Act through the perspective of health equity was illuminating. I also found the acknowledgment that these factors contribute deeply to the health status of our population to be refreshing. To that end, social determinants of health are not inherent to life or society but are a result of political decisions that have been made regarding most aspects of our lives. This assessment was especially interesting to me given the current political climate as well as the importance of voting as a political determinant of health. 

This book was well researched and intriguing in the presentation of Dawes’ argument. He is adept at using metaphors to help illustrate his points and uses this literary device to great effect in setting up his narrative as well as his alternative view of society. Throughout this work, the use of metaphor provides insight as to how unjust (and perhaps even unnecessary) some of the political decisions concerning inequality have been.  These are a disservice, not just to the people who are disadvantaged by them, but also to society as a whole.  

I would recommend this book to anyone interested in exploring social determinants of health, as well as those looking to see what steps we can take individually and collectively to reduce the disparities of healthcare. Everyone in this country deserves to have their potential fulfilled and everyone in this country deserves access to a life well-lived.