Clockwise from upper left: Betsy Nabel, Tim Ewing and Wanda McClain participate in a discussion during the summit’s opening session.

As a hiring manager, Jonathan Santiago has come to appreciate how one small word, “or,” could put new job opportunities within reach for people from disadvantaged backgrounds.

When positions require a college degree, they often discourage otherwise qualified candidates with relevant experience from applying. Some people might not have earned a degree due to socioeconomic barriers or personal challenges, said Santiago, who serves as the Brigham’s director of Materials Management.

Instead, degree requirements could be changed to a “degree or relevant experience” option. This is one way to build more equity into hiring and promotions, Santiago explained during a virtual panel discussion at the Brigham’s second annual Health Equity and Racial Justice Summit.

“Educational opportunities are not always there or readily available,” Santiago said during a session on advancing employee equity at the Brigham. “That ‘or’ will open the door for employees who may not feel comfortable applying due to a lack of educational background but who have the experience and commitment to succeed.”

The idea was one of the many explored during the full-day summit on Oct. 7. Participants discussed various ways the Brigham can address racism in policies and practices, as well as create more equitable systems. Talks also focused on using a racial justice and equity lens for all aspects of patient care, research, community outreach and education.

“Culture change happens when a critical mass of people can work together in the same direction,” said Tim Ewing, PhD, vice president of Employee Diversity, Equity and Inclusion, during the summit’s opening session. “Boston is an epicenter of excellent health care. We have the opportunity to be an epicenter for health and anti-racism.”

While the Brigham has made progress in these areas, speakers noted that the work never stops.

“COVID has laid bare and visible the inequities that have hidden in plain sight,” said Wanda McClain, vice president of Community Health and Health Equity.

Understanding the Issues

The summit’s nine workshops and panel discussions drew more than 600 virtual attendees. Keynote speaker Karilyn Crockett, PhD, the City of Boston’s first chief of equity, invited viewers to reflect on what it means to combat racism and inequity.

“How do you challenge yourself to undo the global legacy of anti-Black racism in your daily habits and beliefs? It starts by admitting that we have a problem,” Crockett said. “No question this summit is evidence that Brigham Health is doing that active and important work. The journey towards racial reconciliation and healing begins with believing that Black, indigenous, Latinx and Asian people have experiences, worth, skills, concerns and authority that should not just be considered but prioritized.”

Across multiple sessions, speakers emphasized the need to examine the current state of inequity. Understanding where gaps lie helps ensure responses are effective, experts said.

As one example, McClain highlighted the Brigham’s recent community health needs assessment. This tool is helping gauge the unique needs of patients and the community. So far, it has revealed that housing, economic opportunity and child care services are key determinants of a community’s collective health, McClain said.

During a discussion about confronting racism and structural inequities through research, Cheryl Clark, MD, ScD, a hospitalist and researcher in the Division of General Medicine and Primary Care, stressed the need for a community-engaged approach.

Ewing and McClain acknowledge and thank members of the summit’s Planning Committee.

“If we’re going to transform, we really have to understand what structural inequities look like on the ground. When we have that understanding, we can start to innovate what comes next,” said Clark, who also serves as director of Health Equity Research & Intervention in the Center for Community Health and Health Equity.

In terms of employee equity, achieving a fully inclusive culture at the Brigham will require an honest, unflinching examination of long-held norms, said David Verban, a senior diversity and inclusion consultant in the Office of Diversity, Equity and Inclusion.

“The Brigham culture was created by a dominant, white, medical-educated culture. For some people, it’s not a challenge to assimilate because they’re used to it,” Verban said. “Those who don’t fit those categories are tasked with an additional burden, and it’s a stressor to be expected to assimilate to a culture that is unfamiliar.”

‘Equity in Action’

Speakers also discussed the need to address health equity and racial justice issues outside the traditional scope of health care. For some providers, this has meant advocating on issues such as food scarcity and housing insecurity, which greatly affect health and well-being.

Earlier this year, the Brigham launched several initiatives to help those disproportionately burdened by the pandemic. These programs included virtual visits to make care more accessible; teams to address language barriers; and distribution of food boxes, care kits and diapers at community-based testing sites.

“This is equity in action,” McClain said.

Speakers also examined ways to shift the perspective on internal decisions. Last year, Environmental Services leaders began discussing a plan to offer their staff the chance to expand their skills and pursue advanced certifications. But it raised a question: Are we unintentionally paving the way for employees to leave for greener pastures?

The leadership team quickly concluded the benefits of supporting professional development far outweighed any potential consequences. Plus, it was simply the right thing to do, explained George Player, CME, FMA, vice president of Facilities and Operations.

Since Environmental Services launched the training program last year, about half of its 450-plus employees have achieved at least one of the two certifications for hospital and operating room cleaning. There has been no related departure of staff leaving for outside job opportunities.

“I would love to see everybody stay, but it’s most important to me that our employees succeed wherever they go,” Player said.

Taken together, all these examples demonstrate the importance of continuing to incorporate equity and anti-racism into every action, said Brigham Health President Betsy Nabel, MD.

“Health equity has always been important to our institution,” Nabel said during the summit’s welcome address. “But we haven’t gotten there. We need to own it. And, collectively, we have a lot of work ahead of us.”