Pursuing Health Equity: Part Two

Speaker 1 (00:03): Welcome to 340B Insight from 340B Health. David Glendinning (00:12): Hello from Washington, DC and welcome back to 340B Insight, the podcast about the 340B drug pricing program. I'm David Glendinning with 340B Health. This episode is sponsored by SUNRx, SUNRx offers a comprehensive 340B solution to get the results your 340B Program deserves. With program requirements being complex, SUNRx helps covered entities optimize their 340B Program with transparent fees, compliance solutions and high touch customer care. It's 340B, simplified. Visit sunrx.com to learn more. David Glendinning (00:50): We are back today with the second episode of our two part series on how 340B hospitals are pursuing health equity. Three hospitals we spoke with were featured in a new report from 340B Health describing the work that nine 340B hospitals and health systems are doing to help eliminate racial and ethnic disparities in our nation's health system. David Glendinning (01:12): If you have not already, please be sure to listen to that first episode right before this one in your feed. You will hear from some of the experts at Brigham and Women's Hospital in Boston, Rush University System for Health in Chicago and St. Louis Children's Hospital. Our guests has spoke about the importance of pursuing health equity, how COVID-19 has further highlighted racial and ethnic health disparities, and specific examples of how their work to address social determinants of health is linked to health equity. You also can find our full report in the show notes. David Glendinning (01:46): For this second episode, we come to you from the virtual podcast booth at the annual 340B Coalition Winter Conference, which started February 16, and we'll run through February 24. This must attend event for 340B stakeholders covers all things 340B, including the latest updates on program operations and compliance, manufacturer developments, advocacy and research, the pandemic response, and more. Most of the recorded sessions will be available to register on demand after the conference has ended, so there's still time to sign up for full access. You can visit 340bwinterconference.org to learn more and sign up today. David Glendinning (02:30): And now for the second of our two part series on hospitals featured in 340B Health's new equity report. Miles Goldman sat down again with some of the equity experts at these 340B hospitals. Here's miles with more of that story. Miles Goodman (02:44): Thank you, David. The 340B hospitals I spoke with strongly emphasized the importance of collecting and analyzing various types of data to identify disparities and then set measurable goals. Rush University System for Health's Rukiya Curvey-Johnson, Director of Community Health and Engagement, and her colleagues have significant experience with this. Rukiya Curvey-Johnson (03:09): Using a data driven approach is actually used in both clinical and nonclinical areas for our team through the community health needs assessment, which is completed every three years. We identify priorities and strategies and goals for that period. And then we collect timely relevant data on key metrics on a monthly basis and report out on a quarterly basis on these metrics to be able to inform our work. Really to help us think about how our strategies are working? How do we need to pivot? When do we need to change and where things have gone well and where they haven't? And by having timely data, this helps us to manage expectations and resources in a way that we can be more impactful for our communities. Miles Goodman (04:02): And Rush is seeing positive results from their efforts. Rukiya Curvey-Johnson (04:07): One of our overarching goals is to be able to reduce the life expectancy gap between the Lakefront neighborhoods in Chicago's West Side neighborhoods by 50% by 2030. And so actually there's a 16 year gap at birth, and we are working towards improving the health, economic vitality and wellbeing across all neighborhoods. And given that long arc, if you will, of a goal, we know that we have to focus on those areas that affect life expectancy like education, like access to care and other resources for managing chronic diseases and such. Rukiya Curvey-Johnson (04:45): And so for example, one of our goals is to provide mental health first aid training to over 500 community members over three years. We're more than halfway towards our target at this point. And then one area that we have made some tremendous progress on that is really close to my heart is addressing those educational attainment gaps. We provide outreach efforts to school communities, we've reached over 3000 students and family members in our partner schools. And despite COVID, we have found a way to also provide 250 plus paid work-based learning experiences to area high school students, putting them on a path to family sustaining wages. Miles Goodman (05:33): Dr. Cheryl Clark, Director of Health Equity, Research, and Intervention for the Brigham and Women's Hospital Center for Community Health and Health Equity, says using data was powerful for the hospitals work toward addressing disparities from early in the COVID-19 pandemic. Dr. Cheryl Clark (05:51): The data were really useful for understanding the diversity within our hospital. One important change that we had to make at our hospital was using technology in unique ways. The pandemic disproportionately affected African-American, LatinX population and people from diverse groups. And that also meant that we needed to communicate quickly across diversity, including preferred language. And so we had to rapidly increase the ability to have good conversations in preferred language, even as we were also dealing with the early part of the pandemic where we didn't have adequate protective equipment across the country. One of the strategies that we used was bringing in electronic devices and tablets so that we could access multiple languages in real time to make sure that we had culturally appropriate conversations with our patients and with their families. Miles Goodman (06:57): Data also can help the hospital workforce. Greta Todd is the Executive Director of Diversity, Inclusion and Community Affairs for St. Louis Children's Hospital. She told us how employee engagement surveys are an important source of data for improving equity in the hospital workforce. Greta Todd (07:16): Well, I think many hospitals do these employee engagement surveys. And when we looked at that and dis-aggregated that data by race and sliced data even further by job code. We can see very clearly that our black nurses were having a different experience than any other job group in our hospital. So that led us to a couple of different things. One was, once we realized this, when we asked that question of our black nurses, one example that we did was we learned that they felt very isolated as a result. There were very few of them in our hospital. Something like 3% of our nursing workforce were black compared to 97% white. Greta Todd (08:01): And so what we did was we created an African-American nurses affinity group. It was a group where they could come together, have a safe place to talk and have fellowship, get mentoring. We provided access to senior leaders. It just gave them a place to call home. And we've seen that have a really dramatic impact on those African-American nurses. The other angle to that was it also led our hospital to create very specific goals around recruiting more African-American nurses in any given year. And so we set a clear, measurable goal, and that was a focus area for us to increase. Miles Goodman (08:43): Another way Todd suggests supporting a hospital's workforce is by providing it with cultural competency skills. Greta Todd (08:50): For me, and for us at St. Louis children's hospital, I would say that cultural competency is the ability to interact effectively with people from other cultures. But there's kind of some caveats here. So when I talk about other cultures, I'm not just talking about people from overseas or from other countries, there are many cultures that are right here in the United States. There's definitely a black culture, there's a white culture, there's a culture around foreign-born people, there's a teen culture, there's many, many cultures embedded in the United States, so it's not just about people being from a different country. Greta Todd (09:28): The other thing I'd like to say about cultural competence is, I like to think a bit more in terms of a cultural humility versus competence. Because competence implies that you have achieved something, you are competent, you are done. But actually none of us could ever know every single thing there is to know about every single culture. I think that cultural competence is really important in terms of the final outcome that patients experience at your hospital. It helps providers to understand where patients are coming from, will help them guide their communication with them and will make families and patients feel much more comfortable with the information they're receiving from the provider, if it is done in a way that is culturally competent. Miles Goodman (10:14): And Todd has many great examples of how St. Louis Children's has woven cultural competency into its workforce training. Greta Todd (10:22): All of our employees, their second day on the job, go through a new employee orientation and four hours of their orientation is dedicated to learning about diversity, equity, inclusion, gaining awareness about their unconscious bias, understanding other people's worldviews, and really setting the expectation that cultural competence is a required skill at our organization. We have ongoing trainings for all of our leaders though. We've learned that it doesn't do a lot of good to just throw a training out across all of the staff if our leaders are not a well-prepared and skilled up in holding people accountable for cultural competency, for being able to facilitate these kinds of difficult conversations that sometimes arise as part of this. Miles Goodman (11:14): Todd says one particular cultural competency story comes to mind. Greta Todd (11:19): We had a unit that is emerging in it's cultural competence to become aware that our predominantly white nursing workforce was avoiding the task of washing the hair of our black patients. It was just something they noticed and kind of through humble inquiry began to ask why. And so when we asked our white nurses why they weren't washing the hair of black children, we found out that they just didn't know how to do it. So that led us to creating a video that was literally a step-by-step demonstration of how to wash the hair of a black child, taking them through every step of the way on how to comb it, wash it, condition it, all of those things. Greta Todd (12:05): But this also revealed a problem in supply chain because the only supplies that were stocked in the unit and the only supplies that we could order through our supply chain were products that were made for white hair. Hair care is so important in the black community. It's so important to get this right, and we're still not fully there but this was a step in the right direction. Miles Goodman (12:30): Todd also shared an example of how unconscious bias can affect care. Greta Todd (12:35): We had a member of our team who is emerging in her cultural competence, and she realized that there were some children who could not color pictures of their own families, because we did not have crayons that were the right colors. So you think about the typical Crayola pack. It has black and white and some peach tones, but not the tones that represented the various skin colors of people of color. And actually Crayola makes a pack of multicultural crayons but they are special order and they're in addition to the traditional crayon pack, so back to supply chain, right? I don't know that people understand that equity work could have so much to do with supply chain, but this is an example of where we had to work with our supply chain to get those very specific color crayons. Miles Goodman (13:28): Rush has been working toward health equity for more than a decade. And the progress for them also hasn't come without challenges along the way, explains the Health Systems Curvey-Johnson. Rukiya Curvey-Johnson (13:40): It's critically important for senior leadership to be at the table and to incorporate health equity into the strategic plans, into all of the mission and sort of vision driven initiatives that the health system puts into place. We actually incorporated health equity as one of our four strategic pillars in 2016, and then began additional efforts to work with other organizations because we knew that we could not do it alone. Rush collaborates with local and national organizations to address health equity by really putting in comprehensive and sustained investment efforts of time, talent and funding. We're a member of organizations like democracy collaborative, the Alliance for Health Equity, the Healthcare Anchor Network, and the Institute For Health Improvement pursuing equity initiative. We know that it requires a comprehensive collaborative team-based approach to work towards undoing decades of structural inequities and some of the injustices that we have seen across our communities. Miles Goodman (14:55): Both collecting and analyzing data are key parts of any equity effort. Dr. Clark from Brigham and Women's explains. Dr. Cheryl Clark (15:03): We still are thinking through how to collect data well for disability to understand the needs of people with disabilities, and also to better understand the needs of patients across a spectrum of sexual orientation and gender identity. So there's still a lot of data and a lot of strategies that need to be developed to do that well. Miles Goodman (15:25): And Todd from St. Louis Children's has recommendations for other hospitals. Greta Todd (15:30): If I had to give one piece of advice, I would say to be prepared, to be absolutely unflinching and courageous in this work because it is hard. And one of the most important things you can do to help you in these efforts is to ground yourself in data. If you are backed up by good data that shows the disparities that you can see in your community, in your hospital, that will help you make those arguments to help pursue this equity work in your hospital and be more successful. Miles Goodman (16:00): 340B hospitals are tackling one of the biggest challenges of our time pursuing equity and eradicating disparities in care and health for the 340B professionals involved in this work, this mission is critical to their careers. Rush's Curvey-Johnson sums it up this way. Rukiya Curvey-Johnson (16:20): And I would ultimately leave my colleagues with this. We know that our value to the community is often measured in lives, touched lives saved and lives improved. And it's not easy, but it's work worth doing. David Glendinning (16:36): Thanks again to Brigham and Women's Hospital, Rush, and St. Louis Children's Hospital. Please read the full report to learn more about all the great work they and the other featured hospitals are doing to ensure that all patients receive the healthcare they need and the opportunity to achieve the health outcomes they deserve. We are immensely proud to help tell their stories. If you work for 340B hospital, be sure to mark your calendars for our exclusive webinar on Wednesday, March 10. We will be discussing the federal regulations establishing a long awaited 340B Administrative Dispute Resolution Process. The ADR Process is intended to help settle claims of alleged 340B overcharges by drug companies. So it might play a significant role in the current fight over drug company restrictions on 340B contract pharmacies. You can find the link to register for this webinar in the show notes. As always, we welcome your episode ideas and feedback as we plan out future episodes of 340B insight. You can email us at podcast@340bhealth.org. We'll be back in a few weeks. As always, thanks for listening and be well. Speaker 1 (17:50): Thanks for listening to 340B insight, subscribe and rate us on Apple Podcasts, Google Play, Spotify, or wherever you listen to podcasts. For more information, visit our website at 340bpodcast.org. You can also follow us on Twitter @340bhealth and submit a question or idea to the show by emailing at podcast@340bhealth.org.