Q
How do you ensure a health equity solution is impactful in local communities when there isn’t a broader playbook to draw from?
Organizations that are anxious to make long overdue progress on equity can make the mistake of searching for a playbook and using approaches that have been successful in other communities. This type of thinking overlooks the unique needs that exist. In the South Side of Chicago, where we operate, the neighborhoods are still ultra-segregated, years after redlining was outlawed. We are solving for many generations of problems and lack of action. Community isolation and a lack of trust and access are longstanding challenges. Sustained and focused effort and resources are needed to make a difference. Our initiatives are pinpointing the specific needs of these communities, such as transportation, access to healthy food and pharmacies and more care provided closer to where people live.
Q
There’s a lot of conversation about addressing health equity but not much focus on the traits leaders need to be successful in making an impact. What do you think C-Suite and board leaders need to bring to the space?
Number one, you need to be focused and get comfortable talking about the issues and biases. UChicago Medicine has developed educational programs that provide a variety of settings to learn about and discuss equity issues and biases. We have traditional didactic classes, small group discussions and experiential opportunities to help people manage discomfort and become ready to problem solve.
Second, you have to put a lot of energy and action into the issues. There’s been willingness to talk about topics that used to be off limits, but that talking has to lead to action. If we don’t act, these problems will still exist 100 years from today. The problem is clear—systemic racism. Now we need to tackle it.
Third, you can’t do anything to the community. You must work with the community. Ask people what they want and challenge assumptions that might lead you to conclude that problems are unsolvable. Communities may lack the resources to solve these chronic issues, but the ideas and ability to take action are usually present.
Fourth, look at your employee base. Over fifty percent of our employees — and our patients — are people of color. When I started at UChicago Medicine, our leadership team didn’t reflect our own population. We focused on promoting women and people of color to leadership roles, with an emphasis on promoting from within. Early in my tenure, a group of Black staff members came to me with the following pitch: “Mentorship is really important in career development, and we realize that White men could be good mentors. We’d like to be paired with White leaders to teach us what it takes to lead.” We followed up on that suggestion. The feedback from everybody involved has been incredibly positive. Leadership has a better understanding of frontline challenges, and the mentees say they’ve appreciated learning about organizational dynamics.
Health equity goals are also incorporated into our leadership incentives. We track promotion opportunities across the organization and look at quality data using an equity lens. While some of the information can be surprising and uncomfortable, such as discovering our hypertension screening percentage was lower among Black patients, we always challenge ourselves to take immediate and aggressive action.
Q
How do you inspire employees to think beyond the obvious solution and look for the root causes?
We must think creatively about our future workforce, especially since there are 700,000 underemployed people on the South Side. About 30 percent of our new employees come from the South Side. We know we can’t fix everything, but if we recruit here, it means more people can earn a decent living, begin a career trajectory and have access to good tuition benefits. If you come into UChicago Medicine via Environmental Services, you can work your way up, get training at the University of Chicago and be eligible for jobs that can pay $100K a year.
Q
When it comes to Medicaid, how do you ensure patients are being treated fairly?
My team has frequently heard me say that we should not make assumptions about Medicaid patients. Often, Medicaid patients are people in transition, like students and people who are in between jobs. If you treat everybody well, whether they are on Medicaid or have commercial or private insurance, they will come to see you throughout their lifetime.
Q
How do you build trust?
As the communities surrounding our campus have changed, UChicago Medicine has had a mixed history in how successfully it has responded to these changes. In the late 1980s, our trauma center closed. For communities in the South Side, that meant if someone needed immediate care, they would have to go to the North Side. Under pressure from the community, the leadership team reopened an adult trauma center in 2018. Responding to pressure doesn’t build trust. Doing the right thing in the absence of pressure is always the best option.
The good news is that our trauma program is now one of the best in the country. We unfortunately care for a large number of gunshot wound victims, but we have a state-of-the-art trauma program to treat them.
Then it comes down to people. We recruited Brenda Battle in 2012 to run our community program and eventually lead our Urban Health Initiative, which is our community and public health division focused on eliminating health disparities and promoting health equity. Brenda has demonstrated extraordinary passion and provided visionary leadership to advance health and racial equity within UChicago Medicine and as a national DEI advocate. Her basic premise is that we cannot operate a health system with two systems of care – one for the poor and one for the affluent. The relationships she has built through direct dialogue with the community are the reason we have made such significant progress and a high level of trust has been built with community members.
Building trust takes a lot of time and it takes hiring the right people. It pays to invest in your community. We see that over and over again as we fulfill our commitment to being a community-facing health system.