Brigham Community Affirms Commitment to Health Equity
The World Health Organization defines health equity as the fair opportunity everyone should have to attain their full health potential and articulates that no one should be disadvantaged from achieving this potential.
Brigham Bulletin invited all faculty, staff and trainees to reflect on how they are addressing health equity in their own work and their suggestions for advancing health equity at the Brigham. We hope you enjoy these thoughtful contributions, and we invite our employees to add their own and keep the conversation going by following the instructions below.
Instructions
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20 Responses to “Brigham Community Affirms Commitment to Health Equity”
I think it is critical for employees throughout Brigham Health to look inward and ask how their work can contribute intentionally to improving both care and context for patients, communities and each other. We all need to come together to create our vision for how we can provide more equitable care.
— Cheryl Clark, MD, ScD Equity; Hospitalist, Hospital Medicine Unit; Division of General Internal Medicine and Primary Care
In terms of broader opportunities to foster health equity at the Brigham, I would like to target one specific, known area of inequity and work on improving that tangible measure.
— Sunil Eappen, MD, MBA Senior Vice President, Medical Affairs, and Chief Medical Officer
— Betsy Nabel, MD President, Brigham Health
As the vice president for Community Health and Health Equity, I have the privilege of leading a team focused on advancing health equity in all aspects of our daily work. This means ensuring everyone has an opportunity to achieve their best health outcome. Our focus and commitment to that goal began nearly 30 years ago with the establishment of what is today known as the Center for Community Health and Health Equity (CCHHE) to address the wide and persistent gap in infant mortality that existed between black infants and white infants. Today at CCHHE, we work collaboratively with our community partners, clinicians and other members of Brigham Health care teams on strategies to increase access to care for vulnerable patients. In addition to our work on maternal and child health, we also focus on social factors known to improve health outcomes. These include promoting employment and educational attainment through programs such as our Students Success Jobs Program, and supporting those experiencing interpersonal violence, trauma and abuse through Passageway, the Violence Recovery Program, and our Jamaica Plain Neighborhood Trauma Team. All these efforts are informed by our triennial Community Health Assets and Needs Assessment.
Our work continues. We are currently leading a Brigham Health-wide strategic planning process on health equity, working across the Brigham Health family to continue to build on our organizational commitment to health equity in all aspects of our mission, in clinical care, research, education and community. We look forward to partnering with all of you to advance health equity in all that we do.
— Wanda McClain, MPA Vice President, Community Health and Health Equity
For the past seven years, many members of the Brigham community have come together to foster education around trauma-informed care. This theoretical framework embodies six guiding principles through a lens of health equity and social and racial justice. We plan to continue to advance this work though three committees — Education, Research and Policy — with the goal of improving the patient experience and staff wellness. I believe that in order to imprint health equity into our organizational DNA, we must utilize a health equity lens that ensures that everyone has fair and just opportunities.
— Annie Lewis-O’Connor, PhD, NP-BC, MPH, FAAN Founder and Director, C.A.R.E. Clinic; Co-Director, C.A.R.E Center; Associate Scientist, Division of Women’s Health
— Kai Lam, MBA Senior Learning Technologist, Human Resources
• As of October 1, 2018, we modified the Department of Surgery compensation system to be based upon work performed rather than cash collected to eliminate the motivation of an individual surgeon to treat any patient differently based on insurance status.
• Our surgeons provide backup coverage for cardiac surgery and transplantation surgery at Boston Medical Center, our regional safety net hospital, to enhance access to surgical expertise in that resource-constrained system.
• Our Center for Surgery and Public Health is conducting a national clinical trial of cultural dexterity training to affect patient outcomes.
• Our global surgery initiatives program, led by Robert Riviello, MD, MPH, focuses on increasing surgical capacity in sub-Saharan Africa through leadership of the Human Resources for Health program, providing both direct care and workforce training in Rwanda.
— Gerard Doherty, MD, Surgeon-in-Chief, Brigham Health; Crowley Family Distinguished Chair, Department of Surgery
I believe we have opportunity to be a leading health care organization in advancing health equity. The May health equity event brought together many people in our organization who are both committed to and are building skills and relationships to advance this work. Our next steps will require engaging more people at every level of the organization, accessing good data to clearly enable us to evaluate where we need to strengthen our efforts and honest conversations about opportunities for improvement. Fundamentally, we need the courage, resolve and cultural humility to take active steps to create the changes that are needed and partner meaningfully with one another and with our communities to create lasting change. I feel confident that with these efforts, the Brigham is positioned to realize this vision as a leader in health equity.
— Michelle Keenan, Director, Community Programs, Center for Community Health and Health Equity
— Ron M. Walls, MD, Executive Vice President and Chief Operating Officer, Brigham Health
Advancing health equity at the Brigham requires three actions: align, measure and spread. There is wonderful work happening throughout the organization. Imagine what would happen if we were moving in the same direction: healthier people and healthier communities.
— Tim Ewing, PhD, Vice President, Employee Diversity, Inclusion and Experience
This work is focused on addressing long-standing intergenerational and collective traumas. Before healing can take place, a transparent and honest examination of past and current health-equity-related harm is required, which will likely result in an increase in the number of equity-related harm events being reported, increased discomfort among staff and possibly even patients, and increased perceived conflict. Importantly, this is a signal of success, not failure.
Our challenge is to see, hold, support and guide our staff and patients through this experience with the aspirational goal of improving patient and staff well-being. This might be measured in a number of ways, including, but not limited to, reducing variability in outcomes by race, gender, etc. over time; improving the experience for staff and patients who have been historically marginalized; and/or increasing individual and organizational readiness for change.
Success defined in this way is not a hard endpoint, but a process of healing and recovery on an individual and organizational level.
— Karthik Sivashanker, MD, Department of Quality and Safety
— Eve Rittenberg, MD, Primary Care Physician
I have stayed at the Brigham for the past eleven years because of the transformative training and work of the Division of Global Health Equity. Brigham Health is in a position to be a leader in health equity because of our unique institutional commitment to global health for the past two decades. I believe we can and must collectively dream up a future for the Brigham where our commitments to domestic health equity and community health within our institution parallel our global commitments. Health inequity within our walls is a patient safety emergency and we have a chance to address it head on if we work together across departments and disciplines to learn together and to prioritize it.
— Michelle Morse, MD, MPH, Assistant Program Director, Internal Medicine Residency; Associate Physician, Division of Global Health Equity; Hospitalist, General Internal Medicine
— Nawal Nour, MD, MPH, Chief Diversity and Inclusion Officer for Faculty, Trainees and Students
In my role, I am meeting people every day. And when folks ask, “What’s going on?” I take the opportunity to talk about all the good work that is happening in the area of diversity, inclusion and equity here at Brigham. I am an educator, and I try to be a resource for others.
— Lianne Crossette, EdM, Lead Organizational Development and Learning Consultant, Human Resources
My team ensures that performance on key organizational data (patient satisfaction, hospital acquired conditions, etc.) can be analyzed by race, language, ethnicity, gender, sexual orientation and gender identity. This allows leadership and providers to understand where there is variation in outcomes so that Brigham Health can focus on the areas where there is the biggest gap.
— Tom Walsh, MBA, Vice President, Analytics, Planning and Process Improvement
We can stay on course as an institution by continuing these courageous conversations and supporting innovative and effective programs that translate our growing understanding of health disparities into interventions that promote health equity. Building on the experience of its diverse clinical, education and research portfolios, the Brigham has the potential to be a leading voice in advocating at every community level — local, state, national and international — for fundamental changes in the criteria by which we recognize and support legislation that impacts every aspect of health. Empowering its staff — both clinical and administrative – to participate in these advocacy efforts can help nurture individual self-efficacy and community empowerment, both of which are crucial components of resilience.
— Nomi Levy-Carrick, MD, MPhil, Associate Psychiatrist, Division of Medical Psychiatry, Department of Psychiatry; Co-Chair, Partners HealthCare Trauma-Informed Care Initiative
• Mentor with the Student Success Jobs Program
• Member of the National Society of Genetic Counselors‘ (NSGC) Diversity and Inclusion Task Force
• Guest Associate Editor for the Journal of Genetic Counseling’s upcoming Special Issue on Minority and Health Disparities in Research and Practice in Genetic Counseling and Genomic Medicine
• Mentor with the Minority Genetic Professionals Network
• Project Leader for the upcoming NSGC Implicit Bias Online Course
• Attendee at numerous Partners workshops, trainings and meetings on diversity, equity and inclusion
• Serving as a health care provider with minority identities myself and hoping to role model and inspire prospective minority health care professionals to enter the field
As Brigham and Women’s Hospital is big and has a multitude of individuals, projects, and departments that may be working deliberately toward health equity, I suggest a “hub” people could refer to when seeking out participation and/or ideas to get involved with such efforts. This Brigham Bulletin feature is a great step toward a potential hub! Other ideas are a quarterly newsletter or column dedicated entirely to diversity, equity and inclusion efforts and projects happening at the Brigham with corresponding contact information as well as “tips and tricks” that individuals can incorporate into any role they hold at the Brigham.
— Nadine Channaoui, MS, CGC, Licensed Genetic Counselor, Heart and Vascular Genetics Center
— Yilu Ma, MS, MA, CMI, Director, Interpreter Services
In his comment above, Dr Karthik Sivashanker has astutely described the challenges we face in measuring how equitable the care we deliver to our patients is, and in reducing the variability that exists in clinical outcomes across dimensions such as race, ethnicity gender, age, language, etc. As the Medical Director for Data Science and Analytics, I cannot overemphasize how important it is to correctly capture these variables and to incorporate them into the analytics we provide to our leaders and front-line staff to support them in our continuous journey towards the Brigham Health’s vision of A Healthier World. As we expand the role of artificial intelligence in our data and analytics strategy, our ethical responsibility to ensure the equity of these tools and solutions increases too. I have been at the forefront of this issue, educating my peers and trainees about the biases inherent to, or augmented by, artificial intelligence and machine learning.