Brigham Community Affirms Commitment to Health Equity

We care. Period. logoThe 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”

  1. Cheryl Clark, MD, ScD

    Cheryl Clark headshotI am a hospitalist physician and health equity researcher. My work addresses the ways social determinants of health influence equity in the risks and resiliency factors underlying cardiometabolic diseases and cancer. I have worked with local communities and national research groups to understand how to improve the context of health and health care utilization for African Americans and other groups.

    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

    Reply
  2. Sunil Eappen, MD, MBA

    Sunil Eappen headshotWe are working to roll out unconscious bias training for all of our Collaborative Case Reviews, Root Cause Analyses and Morbidity and Mortality conferences in the coming year — an effort led by Karthik Sivashanker, MD, of our Quality and Safety team — and to measure the impact of this training. Karthik and I are also working on a three- to five-year plan that would ensure every employee at the Brigham is trained in how unconscious bias affects the care of our patients and families. This will cover every facet of how our employees interact with a patient and family, including clinical care and nonclinical interactions, such as at the cafeteria.

    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

    Reply
  3. Betsy Nabel, MD

    Besty Nabel headshotDuring my medical training, I traveled with the Flying Doctors in Kenya’s capital city of Nairobi to provide care to those in need. The experience instilled in me the belief that access to quality health care is a basic human right and ignited my commitment to health equity. As an institution, health equity is part of our DNA and one of our founding values. It is at the core of our culture work. By living our values, we create the best possible experience for our patients and colleagues. By committing to health equity, we will deliver the highest-quality, safest care.

    — Betsy Nabel, MD President, Brigham Health

    Reply
  4. Wanda McClain, MPA

    Wanda McClain headshot
    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

    Reply
  5. Annie Lewis-O’Connor, PhD, NP-BC, MPH, FAAN

    Annei Lewis O'Connor headshot
    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

    Reply
  6. Kai Lam, MBA

    Kai Lam headshotI’ve been trying to educate myself and my team on how to identify disparities in learning as a starting point. The team and I recently attended a session at the Brigham Education Institute Knowledge Center and posed this question, and while we didn’t walk away with actions, consensus was reached that it was a good place to start; more sessions like that one would be helpful to our internal education around health equity and how we can foster it. Also, forcing difficult conversations could be a great way to engage employees to discuss things in a safe environment.

    — Kai Lam, MBA Senior Learning Technologist, Human Resources

    Reply
  7. Gerard Doherty, MD

    Gerard Doherty headshotWe have a variety of local, national and global efforts, including:

      • 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

    Reply
  8. Michelle Keenan

    Michelle Keenan headshotIn my work in the Center for Community Health and Health Equity, I have the honor of working with staff and communities to assess, design and implement programs that create the conditions to good health in our local neighborhoods. Many of these efforts focus upstream on education, employment and, more recently, housing stabilization. However, despite the many good efforts at the Brigham and throughout the city, significant health inequities for communities of color persist, and income inequity is deepening in Boston. We have many residents of our priority neighborhoods, particularly residents of color, who face dire economic challenges and struggle with health conditions that are preventable. We have a moral imperative to contribute our organizational expertise and thoughtful use of resources to contribute to eliminating these inequities.

    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

    Reply
  9. Ron M. Walls, MD

    Ron Walls headshotOne of the ways that I think about health equity is through the lens of the social determinants of health. Our new SUCCESS program gives young people who have faced great challenges in their lives the opportunity to work, and grow their career, at the Brigham. Creating these career paths, providing mentoring, and ensuring that people have the opportunity for upward advancement will help not only the program participants, but their families, too.

    — Ron M. Walls, MD, Executive Vice President and Chief Operating Officer, Brigham Health

    Reply
  10. Tim Ewing, PhD

    Tim Ewing headshotRemoving barriers to high-quality patient care and employee advancement places equity in the mission of the Office of Diversity, Equity and Inclusion. We are addressing health equity in our work by incorporating health equity education (unconscious bias, institutional racism, intersectionality and cultural humility, to name a few) into the three- to five-year Leadership and Learning Plan for the organization. In addition, we are better able to address health equity needs when we have leaders and employees who represent the populations and communities impacted by inequities. Cultural dexterity matters.

    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

    Reply
  11. Karthik Sivashanker, MD

    Tim Ewing headshotIn my new capacity as the Medical Director for Quality, Safety, and Equity, I will be focused on promoting excellence in health care access, treatment and outcomes for all Brigham Health patients. The goal is to use comprehensive strategies that create and sustain an integrated model of quality, safety, experience and health equity.

    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

    Reply
  12. Eve Rittenberg, MD

    Eve Rittenberg headshotI work with a multidisciplinary team of clinician educators to advance an understanding of the impact of trauma both on health and on the experience of health care. Trauma-informed care is fundamentally rooted in the principles of health equity and social justice, with the goal of shifting our approach to patients away from “what’s wrong with you?” to “what has happened to you, and how has that affected your health?”

    — Eve Rittenberg, MD, Primary Care Physician

    Reply
  13. Michelle Morse, MD, MPH

    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

    Reply
  14. Nawal Nour, MD, MPH

    Nawal Nour headshotAt the Center for Diversity & Inclusion, our mission is to recruit, retain and advance diversity faculty, trainees and student within our organization. We recently launched the Aspire Initiative, a program to support departments in their efforts to attract and retain diverse faculty. In collaboration with leadership and the Graduate Medical Education Office, Brigham Health is offering a cost-of-living stipend for economically disadvantaged residents to offset the cost of living in Boston. This past year, we have worked in collaboration with the Social Justice Taskforce, our diversity and inclusion partners in Human Resources and other key stakeholders to create and implement an organizational strategy focusing on diversity, inclusion, and equity. As we look toward the future, we are more energized than ever to continue creating an environment that is energizing, inclusive and equitable.

    — Nawal Nour, MD, MPH, Chief Diversity and Inclusion Officer for Faculty, Trainees and Students

    Reply
  15. Lianne Crossette, EdM

    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

    Reply
  16. Tom Walsh, MBA

    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

    Reply
  17. Nomi Levy-Carrick, MD, MPhil

    Nomi Levy-Carrick headshotI strive to address health equity in my own work by explicitly acknowledging the impact of socioeconomic determinants of health, adverse events, and sources of resilience across the lifecycle — incorporating it into everything from clinical assessments and educational curricula to research questions and program development. This has provided much-valued, proactive collaboration across specialties, exploring possibilities for primary prevention while striving to mitigate the impact of cumulative trauma for those whose distress is limiting their ability to survive and thrive.

    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

    Reply
  18. Nadine Channaoui, MS, CGC

    Nomi Levy-Carrick headshotI am a clinical genetic counselor within the Heart and Vascular Genetics Center who chips away at health care disparities every day. I wake up and go to sleep thinking about it! As a team, the cardiovascular genetics group is continually considering about ways to improve the individuals who access our services. Outside of my direct collegial team, I hope to contribute to more equitable health care through my roles as:

      • 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

    Reply
  19. Yilu Ma, MS, MA, CMI

    Yilu Ma headshotAs professional interpreters, we’re fully aware of our duties and responsibilities — namely, providing professional, competent, culturally appropriate and timely interpreting and translation services to limited-English proficiency patients, their families and hospital clinicians. Research shows health inequity exists because of, to a large extent, the breakdowns of communication and/or misunderstandings among people. As the population becomes increasingly diverse, more and more patients with language barriers and hearing impairments come to the Brigham from across the nation and the world. Therefore, this communication challenge is becoming ever more intense. Thankfully, we have a team of professional medical interpreters who are skilled in bridging the language and cultural chasms and helping clinicians and patient navigate the social and cultural nuances and differences. I can’t imagine delivering the highest-quality, the safest and equitable care without the contributions of these professionals. We are proud of ourselves and of what we do as part of the team.

    — Yilu Ma, MS, MA, CMI, Director, Interpreter Services

    Reply
  20. Hojjat Salmasian

    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.

    Reply

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