Healthcare diversity of thought and experience allows systems to care for an increasingly diverse population. True personalized care depends on tailored communication and care for patients, each who have unique backgrounds and needs.
Leaders can’t address care gaps among diverse populations until they have properly addressed healthcare diversity within the system itself. Both healthcare and the IT worlds have struggled with diversity in the past. But as time continues, decision-makers in healthcare strive to represent and fully understand the communities that they serve.
The COVID-19 pandemic highlighted health disparities in underserved populations. Disproportionate care outcomes became evident as low-income and minority communities were deeply affected by the novel coronavirus.
Building a diverse health IT or care team is not simply about inclusion, and it is not limited to demographic segments like gender or ethnicity. It also encompasses a need for varied skill sets and backgrounds, with an eye to having different personality types that can work together to maximize everyone’s potential and productivity.
Healthcare leaders weighed in on ways to improve healthcare diversity across the industry to improve outcomes for patients and teams.
Mikelle Moore, Senior Vice President and Chief Community Health Officer at Intermountain Healthcare, explained that barriers to care are more than access to a hospital or health insurance. Language barriers, historical mistrust, and other cultural factors can make the healthcare journey intimidating for some of the most at-risk communities—and it can cause them to delay care or avoid it entirely.
Intermountain Healthcare and United Way Salt Lake are members of an alliance that works to understand social determinants of health and find solutions at a system level.
To provide equitable care, healthcare leaders must first recognize disparities and find solutions for the problems that exacerbate them.
“For a long time at Intermountain, we thought the key to solving this was creating access to healthcare,” Moore said.
This caused the group to focus on clarifying its financial assistance policies and putting additional clinics in underserved areas, until they came to a realization.
“That isn’t the key. It’s got to be deeper—looking at the conditions in which people are living, their safety, their opportunity for education—and understanding how all of those things are different geographically,” she said.
According to Moore, there’s about a 10-year gap in life expectancy between communities on the east and west sides of Salt Lake City. As communities can be segmented by poverty or race, geography is important in understanding social determinants of health. One report posits that your zip code may be more predictive of your health outcomes than even your genetic code.
“Unless we’ve lived the challenges that people of color in low-income communities do, we are likely missing some important information,” said Bill Crim, president and CEO of United Way Salt Lake, who partners with Moore.
To United Way’s Bill Crim, healthcare diversity takes a new approach. Community health workers inform health systems on the challenges in their community; then, organizations can change their approach based on that knowledge comes next.
The COVID-19 pandemic highlighted that patients were prevented from seeking care by more than limited access. Moore said Intermountain had to switch gears and become more responsive to patient needs. They needed more community health workers to explain the disease and its treatment options to members of at-risk communities.
A good team of community health workers can communicate complicated health information to patients in culturally-appropriate terms and their own language. These are critical tools in fighting mistrust and misinformation, Crim explained.
“Community health workers are, by definition, members of the community. They’re not 53-year-old white guys who show up in their car in a neighborhood and try to figure stuff out,” Crim said. Healthcare systems need to have a healthy base of trained workers in the community to disseminate information in relevant terms, and to bring that community’s perspective to the table.
Their alliance works to work into the community to understand their needs and challenges.
“We have to ensure that the individual we're meeting and getting to know today has the help that they need, but then we're also looking at how we contribute to the way our communities are designed, built, and managed to influence those determinants of health,” Moore said.
Health systems should bring the community's "informal decision makers" to the table, Crim explained. This way, teams can invest the correct resources for the best results.
“It’s about co-designing solutions with them,” Crim added. “It’s about having those people at the decision-making table shoulder-to-shoulder with the executives of the health system and the CEOs of nonprofits and businesses. We don’t get the best thinking unless we put everybody in the same room”.
Healthcare diversity and its blind spots go beyond communication and engagement—there is even a dearth of physiological understanding. Anne Weiler, a successful startup co-founder and tech entrepreneur, views tools and initiatives that address those shortcomings as a massive opportunity, if taken seriously. In the past, diverse groups have not been included in clinical research or had specific treatments and tools built for their needs.
“There was a recent New York Times article titled ‘Is FemTech the Next Big Thing?’” she recalled. “Now let’s replace that with ‘ManTech.’ Is ‘ManTech’ the next big thing? You can see how ridiculous of a question that is.”
Weiler explained that the article treated closing care gaps as novel effort rather than a common-sense healthcare imperative. As the article explained, in 2019, startup tech companies looking to serve women’s biological needs raised $592 million in venture capital. Though this was a substantial amount, it pales in comparison to the entire industry sector as it is relative to overall health IT venture capital funding.
“There’s still this sort of condescending ‘Is this an opportunity’ [tone]. Yes, it’s an opportunity, not just for apps but things like EHRs to consider how they’re collecting data on women’s health. It’s an opportunity for clinical trials to ensure they are representing a diverse population,” she said. “It’s low-hanging fruit. We could be doing so much of a better job of both collecting the data and caring for diverse populations.”
“As a leader you have to question what you never had to question before to make sure your teams have a diverse set of ideas,” said David K. Butler, MD, longtime practicing physician and founder of Calyx Partners.
Leaders should seek a diversity of perspectives in their health system. This enables health systems to have a better understanding of patient populations in their care, Butler said. It can also help companies make better decisions overall.
Butler explained that to tackle care gaps, healthcare IT should leave some old ways of thinking by the wayside. When staffing teams, companies are often too narrow in their search. Predetermining candidates based on college, degree, and experience thresholds disqualifies talented people. Many of these applicants may not have had the financial ability to check all of those boxes. Health system leaders would do better to recognize these highly capable contributors.
Butler said that’s too often the case in health IT. However, some of the smartest companies in the world already know better, and it’s worth taking a cue from them.
“Don't let HR say, ‘We just couldn't find any qualified candidates'. The real question is, did you look at traditionally historically black colleges and universities? They pump out some really smart folks,” he said. “Or do you really have to have a college degree for this position? Google also knows this, [a lot] of their employees don't have a bachelor's degree, but they have some really wicked certifications and can do the job.”
To Butler, a diverse set of backgrounds in the room is a route to better decision-making. Distinct perspectives bring new ideas, but they also help teams avoid bad decisions. Diverse outlooks will be able to call out potential missteps that those in an insular group may not notice.
Health leaders must be critical and introspective to address diverse perspectives. Myra Davis, Chief Information Officer at Texas Children's Hospital, learned personally that self-evaluation isn’t easy, but can be highly rewarding.
Davis recalled an exercise conducted by her human resources department. She was asked to assess her teams based on the DISC personality profile, which typifies peoples’ personality styles by their tendencies towards dominance, inclusion, steadiness, and conscientiousness.
“What became apparent to me was that there were many ‘Ds’ on my team—and many of them I had hired,” she said.
Through this exercise, she realized that she was gravitating towards highly task-oriented, hard-charging workers who were familiar to her. However, this uniformity was scaring off different personality types that could have balanced the decision-making process.
“I realized I wanted to mix that up, because I didn’t feel good when I reflected on people who had left the organization and realized that I came across as intimidating,” she said.
Davis stressed that diversity of race, genders, and orientations is extremely important. Within that framework, so is healthcare diversity of work and leadership styles.
Although the takeaways from that exercise were difficult, Davis found them rewarding. Since then, she has ingrained the findings into her long-term leadership approach. Her goal going forward became to build a team that looked at health system diversity not just by demographics. Instead, she aimed to diversify personalities and voices within those groups.
“I aspire to do it again,” she said of the exercise. “If you don't understand where a person's coming from in terms of their personality profile or their situation, you're still not hitting the mark on creating inclusiveness and diversity in the work environment.”