President and CEO of Meritus Health
Maulik Joshi, President and CEO of Meritus Health, discusses the importance of having a quality improvement mindset and advancing as a field to enable better patient outcomes.
What does it take for the C-suite to make an impact in health equity?
The main traits to succeed in health equity are action-orientation and a quality improvement mindset. Equity is a combination of diversity and disparities. You have to be representative of the community. It’s to understand diversity and inclusive culture so that people of color, different genders, people of all backgrounds have access to healthcare. It’s great for organizations to have a Chief Diversity Officer or a Chief Equity Officer, but you need to work in all components.
Collecting social determinants of health is a major data collection activity. We’re systemically collecting and analyzing data; however, data collection can sometimes be an avoidance of doing hard work. We need to consider health equity as a quality improvement issue for leaders.
There’s a difference between hope and real improvement. We’re lacking quality and discipline as leaders, increasing leadership and governance. Our efforts should all have a measurable aim, a team that performs testing, makes change interventions, and tracks all the way, and we don’t.
Why isn’t healthcare leadership approaching the issue with that quality perspective lens, and what can they do about it?
Leaders need to further develop a quality improvement skillset; it is something we should have as a competency. First, there is still a will issue—racism as an example. If you ask most leaders, it’s about money, workforce, health equity, quality, but not with the same level of “passion” as when the George Floyd death happened. Second, there’s a lack of will building in some leaders. Third, it’s really hard. There aren’t a lot of great stories of organizations going from A to B and with a roadmap of “here’s how to do it”. We need to build that case – like we built patient safety to reduce infections. This won’t be that easy because we’re building on a long time of inequities; but it doesn’t mean we can’t have ideas, new and meaningful interventions. The last one is accountability. Are boards holding leaders accountable for quality? Leaders aren’t being held to the same level of rigor and frequency for other metrics when it comes to health equity.
So how can boards be asking the right questions to change that?
Fifteen years ago, I interviewed a lot of members, and I believe there’s still a level of education and development in governance in this topic, it’s an ongoing thing. Sometimes you need to change board members, sometimes you need to change leaders. You need the skillset. Once you establish skillset then you go through the same rigor. We should be asking ourselves, are we interviewing diverse candidates for leadership positions? Is this something we track? It comes back to a quality improvement framework to do this work.
Are there any metrics that would be ideal if boards were asking about X, Y, Z?
I’m a firm believer in leadership diversity because it drives change. We have a leadership dashboard, to track the percentage of leaders that are nonwhite. We review it on a monthly basis. We also track that same information for our nursing leadership. We look at the percentage of open leadership positions that have diverse candidates in the final roster of candidates. We also hold unconscious bias training once a year, and we will add an inclusion question to employee pulse surveys too. We publish a health equity report on our website, looking at a dozen quality metrics that allow us to see where disparities are, and we track on a monthly basis where we measure health disparities by race and ethnicity and spoken language. These are just a few of the metrics we focus on.
What are the core competencies for people leading in health equity?
Context matters. Having people who understand it is really important. So one is, are leaders from a diverse population in terms of background and lived experiences? Individuals have different backgrounds and experiences to provide them context to do this work. Are they from different educational institutions, that we don’t yet have on the team, or are they coming from historically Black colleges and universities (HBCUs)? Then it’s relationship building and your expertise.
In parallel with that how do you think it will play out on the health equity side? Who is going to take the helm for the outcomes?
Organizations say, ‘We’re struggling to hire people, let alone to hire a diverse leader, I can’t even find a person.’ It’s going to be a challenge. Equality and patient safety will take ongoing work, science and examples of things that work – and people to try to learn these things.
There’s still a need to link strategic priorities together – workforce, bottom line. Have you seen leaders tell the story all in one thing?
We have a strategic plan, pretty well baked, and working towards it constantly. One goal is to be a great place to work, and you can’t be a great place to work unless you have an inclusive culture. It’s all in how you bake it throughout your organization.
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