How health care organizations can tackle racism in patient care [PODCAST]

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“The new American Medical Association policy recognizing racism as a public health threat and providing an anti-racist approach to equitable care will have no effectiveness unless health care organizations get their own houses in order and actively do anti-racism work in their own institutions.

Although I’m not a health care provider, as a health care communicator whose role is dedicated to diversity, equity, and inclusion, I sit in rooms where health disparities in hard-hit communities due to systemic racism are regular topics of conversations. But in the hallways, on Zoom meetings, in texts and email conversations, I also learn about all how disparities due to systemic racism are rampant inside an institution and make organizational health equity seem like a faraway dream.

How can you fight to advance health equity and racial justice out in the community when you’re not doing the same within your own organization?”

Nikki Hopewell is a communications strategist.

She shares her story and discusses her KevinMD article, “Health care organizations: Clean up your house first, then you can tackle racism in patient care.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Nikki Hopewell. She’s a communication strategist, and she wrote the KevinMD article “Health care organizations: Clean up your house first, then you can tackle racism in patient care.” Nikki, welcome to the show.

Nikki Hopewell: Thank you so much, Kevin. It’s a pleasure to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Nikki Hopewell: Sure, absolutely. I’m a trained journalist. I have two degrees in journalism from Northwestern University’s Medill School of Journalism. Go Cats. I’ve parlayed that experience into marketing. I’ve been in this career for over 25, wow, years. I started out in print journalism, and my mom became ill with uterine cancer, and I took an interest in health care content marketing and just sort of dove in from there.

Since the start of my career, I’ve always been really interested in telling stories, but I always wanted to tell honest stories about how people experience the world and what we can learn from those experiences. I’ve always been a believer that stories really connect people and help us foster empathy, which, quite honestly, we just need a little bit more of right now.

Kevin Pho: So you work for a major academic medical center in Chicago. Tell me some of the challenges that you face from a communication standpoint, especially during the pandemic.

Nikki Hopewell: Sure. I am beholden to internal and external stakeholders, so some of the challenges are just getting that messaging out, especially to internal stakeholders, about the pandemic and about how it’s affecting the communities that we serve. It’s interesting: Our audience dives into our content from our internal newsletter, so that’s a lot of times where we put our stories, and I want to do it in such a way that people can receive the information. If you lay it out in plain facts, you know, black and white, it’s not terribly interesting, but it’s compelling when you tell it through the lens of someone’s personal story. So that’s what I often try to do.

That also extends to the community, anytime we’re trying to communicate a mission. We’re an anchor mission institution. We’re focused on health equity. We’re focused on eliminating and reducing that death gap, where from the West Loop to the, the Gold Coast area, all the way, maybe five to seven stops on the L to the west, in the western part of the city, you’ll find great disparities in health. So we’re really working to tackle those. It’s really about communicating to the community, “We are here to support you,” and we do this in a number of wonderful ways. So that’s the challenge that I’m faced with right now, especially during a pandemic: getting the community the resources that they really need so that they can have overall health and well-being.

Kevin Pho: All right, so let’s transition into the KevinMD article that you wrote, “Health care organizations: Clean up your house first, then you can tackle racism in patient care.” Now, for those who haven’t read that article, can you just walk my audience through it and maybe share the story of why you decided to write it?

Nikki Hopewell: Sure. I’ll start at the end first. When the AMA came out with this statement about its new policy recognizing racism as a public health threat, I got really excited, because I was like, “OK, this huge medical association is finally acknowledging that they need to get some skin in the game,” right, and really start working to make things better. The policy identified prescribed steps to combat racism, to help us get closer to that goal of health equity, where everyone gets what they need and, you know, pushes them toward overall health.

But the closer I looked at this policy, I felt like all these steps were kind of outward-facing, meaning they’re largely focused on the treatment of patients and/or community members, which is vitally important, right? It’s key, don’t get me wrong. But it didn’t seem to put a fine point on the fact that health care institutions can’t possibly make any real headway until they start to address how their own organizations are dealing with anti-Black racism within their walls, among their peers, from managers to direct reports. If you can’t examine the aspect of racism within your own organization and how it affects your providers, you can’t possibly be prepared to support this effort and how it affects the patients and community members that you’re trying to care for. Your efforts are just going to fall flat, full on, if organizations aren’t turning the lens on themselves.

After the murder of George Floyd, I had so many Black colleagues coming to me, who are providers, sharing stories of how they walked into work, Kevin, the next day, and it wasn’t even a topic of conversation, and they were having to push through incredible pain. And that’s just not OK. So when this policy came out, I really wanted to put health care organizations on notice and say, “Look, if you’re really committed to being anti-racist toward Black people, you can’t skip over the part where you look closely at what your organization needs to do to be better.” It’s really uncomfortable, but it’s so necessary if you want to make progress and truly advance health equity. So this article dives into, “Listen, it’s really time to look inward and make that change,” because only from there can you start to make changes with your community and your patient care.

Kevin Pho: I wanted to follow up on that story about George Floyd. I guess my question is, what should health organizations do in a situation like that?

Nikki Hopewell: I think transparency is critical. You can’t tiptoe around this. It’s just unavoidable. Having these uncomfortable conversations is necessary, and I think organizations really need to sit down and form some sort of task force or committee that’s dedicated to taking a pulse check of the internal organization: How are people feeling within? Which is what Rush did. They formed the Racial Justice Action Committee, which I talked about in the article, and it’s dedicated to figuring out how we can better navigate this path. There’s health equity outside of an organization, but in terms of health equity within the organization, that matters too.

So it’s a matter of starting to have conversations all across the organization, making sure that peers are checking in with other peers, and recognizing our own internal biases, right? We all have unconscious bias, things that we bring to the table that we don’t even realize. So we need to check in on that and figure out what they are, because if you can’t identify them, you’re not going to acknowledge them. It’s really about taking a pulse of the organization and checking in with everyone and saying, “Where are we at, and what can we do better? What types of things can we put in place, like committees, like task forces, like checks and balances, like governance?” All those things really help the organization get health equity internally.

Kevin Pho: So you mentioned that task force that Rush University created. What were some of the discussions within that task force, and what were some of the actionable suggestions that came out from their actions?

Nikki Hopewell: The Racial Justice Action Committee was formed with members from all across the institution, so different levels of hierarchy, different areas across the institution. They came together and said, “First, we need to figure out what’s really going on.” So they launched a survey across the organization. Everyone was invited to participate. I think we had about three-quarters of the organization weigh in, and, Kevin, they were honest. They were asked, “What things do you think need to change? Where could we be better?” Honestly, people said, “Listen, I have trouble with my managers. They don’t feel like, you know, I don’t feel like a valued part of the organization. I get passed up for promotions. No one seems to care about my concerns. If I do raise concerns, there’s going to be penalties, and it’s going to be punitive, so I don’t feel like I even have a recourse.”

So all those things were addressed, and finally, we brought in a consultancy to help us navigate through all these responses and figure out, “OK, what kind of recommendations can we offer up?” So there were recommendations for how to improve communications, how to improve hiring, how to improve dialogue between peers, how to check in in terms of mental health, how to help move us forward, and what ways we can be better as an organization. We ended up creating a very transparent set of recommendations. We shared it out with the organization overall. We had a town hall meeting, and people were, I think, encouraged.

But now is really when the implementation has to begin. We can’t just say, “OK, we’ve collected all of your information, and we’re just going to sit on it.” Now we have to really start acting. So we’ve put together some additional town halls that address concerns over, for example, “What happens when I file a complaint, when I feel like someone’s, you know, some sort of racist situation has occurred in my area? What kind of recourse do I have?” So we’ve set up things so people understand how the process works and that there is a process in place.

We’re encouraging people to have conversations within their departments, and people are like, “I’m not a facilitator. I don’t know how to do this.” So we’re giving them resources to help them facilitate these discussions and help them navigate them. We’ve had discussions with our community members, asking what they need from us as an organization. So there’s internal work and external work. It’s really a comprehensive strategy, and I think it’s going to prove to be very fruitful going forward.

Kevin Pho: Now, for organizations who want to look inward when it comes to the topic of racism, does this impetus need to come from the top down, or grassroots, from the bottom up? And if it does come from the bottom up, what are some things that individual clinicians can do to get those conversations going?

Nikki Hopewell: It’s a great question. I think yes to both, right? I think the grassroots piece is important, because that’s where the movement happens, and it gives people access and makes people feel like, “I don’t have to be a senior leader to get some input in and to get some skin in the game and become a change agent.” That’s the language that we use. We want people to take it upon themselves to step in and become change agents.

So what does that look like? That is having those difficult conversations. We started a book club, and we’re going to be reading “Caste,” right? So it’s diving into unfamiliar territory and just saying, “I didn’t know that I had this implicit bias. Help me understand. Help me grow.” It’s also about not putting the onus on our Black providers and clinicians, right, to explain everything, but maybe they can guide. And Google is a source, right? It’s a great resource where people can dive in and ask questions, and there are tons of anti-racist materials. We’ve provided some through our Racial Justice Action Committee so that people can get educated on what some of the issues are, how to talk about them, and how to manage them.

From a leadership perspective, it’s about really being open as a leadership team to say, “You know what? I admit we have faults. We need to change.” And then bringing those two things together, right? That grassroots initiative has to come into play, and the senior leadership has to laud it, has to celebrate it, has to encourage it, has to be a part of it. It can’t just be, “Here, you go off and do the work, but we support you.” It’s them getting skin in the game too.

We’ve had many leaders share interesting stories of racism that they’ve experienced. We have a VP of government relations who’s a 6-3, huge Black man. He took off his suit, because he wears a suit every day, and he literally decided to change uniforms and put on a food and nutrition uniform and walk through the halls. Kevin, no one acknowledged him. No one knew his name. No one greeted him. No one looked him in the eye. So it’s experiences like that that help us recognize, “OK, we need to do better, and here are the trouble spots.” Senior leaders, you need to dive in and admit that there are problems, and then those grassroots efforts will feel like, “OK, we feel like we can do this. We’re allowed to talk about this. We’re allowed to have these conversations.”

Kevin Pho: We’re talking to Nikki Hopewell. She’s a communication strategist, and she wrote the KevinMD article “Health care organizations: Clean up your house first, then you can tackle racism in patient care.” Nikki, one of the things that you mentioned earlier was the power of storytelling to change minds. Now, can you tell me what the role of stories could be in terms of tackling racism within health care organizations?

Nikki Hopewell: I think the challenge is always empathy, like I mentioned earlier, and I think what stories do is create empathy. If you can walk around in someone else’s shoes and experience their lived experience from their perspective, which is not always easy to do, right, that is a game changer. If you can present one scenario to one person that allows them to step out of their particular perspective and into another’s, even if just for a moment, they recognize the discomfort, and they can begin to say, “OK, I don’t get everything. I don’t understand it fully, but I get that piece of it.” From there, you can start to have a conversation, and things can begin to change. If you can’t get people to empathize, there’s no connection point, and stories are all about connection. So it’s really the role of storytelling, getting people to connect and understand we’re all in this together. We have to find some common ground. What is it? It’s empathy, finding that point of empathy.

Kevin Pho: My final question: What’s your take-home message that you want to leave with the KevinMD audience?

Nikki Hopewell: It’s really important to learn what allyship looks like and to begin doing the work. That means that you’ll have to be open to learning and open to recognizing that you yourself have some biases, and that’s OK. You’re not going to be perfect about it, and that’s OK too, as long as you’re willing to learn and be open.

Check in on your Black colleagues. Make sure that they’re doing OK, because this time is really difficult for them. Black people work twice as hard as their white counterparts to get one-third of the respect, right? So it’s about really leaning in, recognizing that you don’t know everything, but offering up some means of support: “Hey, how are you doing today? What’s really going on? I know this can’t be easy for you, but as best I can be, I’m here for you.” And just get comfortable, really, with learning how to get uncomfortable, and just move forward from there. That’s where change really can begin.

Kevin Pho: Nikki, thank you so much for sharing your time and insight, and thanks again for being on the show.

Nikki Hopewell: Thanks for having me, Kevin. It’s been a pleasure.

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