Making Healthcare Inclusive Part 1 (An Industry In Transition)

07/09/2018 03:52PM

Our nation’s demographics are shifting, and with those shifts come challenges and—more important—opportunities for growth.

No industry feels it more than healthcare.

The Cultural Demographic Shift (CDS) is my term for what happens when segments of the population reach critical mass or numbers sufficient to have a significant effect on what we do and how we act. It is the most significant shift of the 21st century—especially for an industry like healthcare, where cultural differences affect how people seek care and where they get their health information.

I refer to the audience that is directly influencing the CDS as shift populations™. Historically, they have been called minorities or underrepresented populations. But given the magnitude of the CDS, shift populations are defining and introducing new ways ALL populations want to be led and served. People don’t want to assimilate—they want to be and be known for who they really are. This means that we have to get to know each other all over again.

Last fall I wrote about the CDS and the corresponding need for the healthcare industry to listen to and recognize people as individuals. Today’s article kicks off a two-part series that digs deeper into how to treat people as individuals within large, complex healthcare organizations.

Individuality is at the core of every burning issue in healthcare today: precision medicine, population heath, big data, value-based medicine, reduction in admittance, mergers and acquisitions, reimbursements, consumerism, etc. Individuality is also at the core of every solution that will influence the industry’s future.

Organizations know they need to account for diversity, but the first step they take is usually tactical. It’s usually focused on diversity initiatives managed separately in various silos of the organization, all based on achieving compliance. But where diversity is about compliance (which is important), inclusion and individuality can solve for both compliance and growth.

In fact, inclusion and individuality should become business competencies—at the center of the organization’s growth and transformation strategy.

In healthcare, the big focus right now is the shift from volume to value-based-care, but the reality is we can’t examine that shift without the context of the cultural demographic shift. Two massive shifts are happening simultaneously:

  • A shift to value—making us more accountable for individual health outcomes.
  • A shift in demographics—a shift in the very populations of individuals whose health we’re accountable for.

How can we improve the health of people if we don’t even know them? How can we know them if we don’t see them as individuals?

The process of finding ways to better understand cultural segments of the population helps organizations gain skills and methods for being better able to adapt to all individuals and their unique health needs. That’s important, because the key is this: seeing and serving people as individuals. Then, designing systems to make sure those individuals are included at every level.

My organization’s research was shared with a handful of healthcare senior executives to learn how they’re approaching these shifts within their own organizations. The challenges of inclusion and individuality are big, but companies are taking steps and making progress.

Leadership Acknowledges Importance Of Inclusion

To achieve inclusive enterprise leadership, leaders throughout the organization must know what it means to be inclusive and be equipped to carry it out. Leaders need training and tools, they need access to inclusion-based metrics and systems for measuring them, they need processes in place to help the organization evolve as its patient, employee and community populations evolve. That’s a tall order.

Carl Armato, president and CEO of Novant Health, reported that he is excited that one of his company’s “inclusion metrics shows that individual team members believe that our organization values people from different backgrounds.” It ranked in the 91stpercentile.

Inclusion metrics are not common. To have identified “believing our organization values people” as important, and then to have a way to measure it across the organization, is the first step to being able to address it.

That’s one way to know how far along your own organization is when it comes to inclusion. If you can’t easily put your hands on some data from across your own organization that tells you whether or not people feel included or valued, then there’s your starting point.

Novant Health’s commitment to measurement leads to a specific and significant example of how effective you can be when you’re paying attention. According to Armato, Novant Health segments its “clinical, patient satisfaction and team member engagement data by race/ethnicity, language, age, gender, payer source, etc.”

The company identified a disparity and developed an intervention to close the gap. Armato explains: “In 2015, there was a 39% point difference in re-admission rates between African American and Caucasian patients. We narrowed the gap in 2016 where there is only a 20% point difference, and we continue to make progress.”

Armato attributes the improvement in re-admission rates to the high use of care coordinators in case management and wellness and clinical programs, such as disease management programs for diabetes.

Diverse Workforce Today And Into The Future

Several leaders acknowledged the importance of making sure their clinical and non-clinical workforces reflect the diversity of the populations they serve. And in a few cases, organizations have created their own graduate school programs to ensure a workforce into the future.

“To meet the needs of our patients, we must address workforce shortages, particularly with physicians and nurses,” said Carrie Owen Plietz, EVP & COO of the Hospital Division for WellStar. “At WellStar, we have two Graduate Medical Education programs, where we train the next generation of physicians who will hopefully stay in the area to practice. Additionally, we have programs with local nursing schools to cultivate and grow nursing talent.”

Southern California-based City of Hope also has a graduate school, the Irell & Manella Graduate School of Biological Sciences, and actively seeks to increase the diversity of the graduate students accepted into the Ph.D. program. Initiatives include expanding the roster of local universities at which they actively recruit (to make sure they’re targeting diverse students), increasing recruiting at large conferences geared toward underrepresented minorities in science, and offering opportunities for high school and undergraduate students to have on-campus research experience.

Beyond a healthy pipeline, to achieve inclusion and individuality organizations also need to proactively measure how current employees feel about their individual impact, their ability to reach their potential, and their ability to collaborate across the organization.

Getting Beyond Episodic Care And Into Continuous Care

In the area of patient experience, several companies mentioned strategies that involve getting beyond a system of treating people simply when they’re sick—in the middle of an episode—to helping people better manage their health on an ongoing basis.

Gyasi Chisley, Senior Vice President for strategy and payment policy and innovation for UnitedHealthcare, said his organization is starting to change the ways it engages with patients as well as providers, in order to move toward continuous care. For example, last year UnitedHealthcare launched a program called Navigate for Me, which offers a life coach—not just a health coach—for members suffering from two or more chronic diseases.

“There's opportunity for us to keep healthcare at the forefront,” said Chisley, “Not just when you've made a New Year's resolution and you're trying to lose weight. Not just when you've been most unfortunately diagnosed with cancer. Not just when you’ve got that annual checkup. But you're thinking about your healthcare just like you're thinking about ‘I've got to go buy groceries this week.’”

Tim Huval, Chief Human Resources Officer for Humana, also acknowledged the importance of this strategy: “The right mix of data analytics, in-home care and personalized solutions can improve health and reduce friction. By predicting who might suffer from a diabetic foot wound, and intervening appropriately, we can prevent an amputation. In-home weight monitoring can head off a congestive heart failure-related trip to the emergency room. It’s all about tending to a person’s whole health, removing pain, hardship and cost before they even occur.”

Gary S. Kaplan, MD, Chairman and CEO of Virginia Mason Health System put it this way: “We have moved from the old healthcare mindset of ‘We’re the experts – it’s all about us’ to “It’s all about you.’”

I will dive deeper into patient experience in part two of this Making Healthcare Inclusive series.

Proactive Prevention By Understanding Social Determinants 

The key with preventive care is making sure people throughout an organization are equipped to know their community well enough to understand the factors that have the biggest influence on the health of the populations they serve. Organizations need partnerships and processes in place to learn about how a particular population approaches health and wellness, and to share that knowledge throughout the enterprise—so insights don’t get stuck in a silo, but instead get shared across the organization.

Several leaders mentioned the importance of understanding, as Tim Huval from Humana put it: “Health happens outside the doctor’s office.”

UnitedHealthcare is proactively expanding the scope and quality of the data made available to health providers—with a goal of improving the conversations that providers and patients can have with each other while in the room. In addition to patient data, there’s also demographic data based on zip code, or even as granular as city blocks in some markets.

“We equip our providers with this data so they can have a meaningful, sustained conversation with our members,” said Chisley. “We’re also engaging our members a little differently too.”

Chisley explained that they’re using that granular neighborhood data to better understand each individual patient. “That’s going to give us a peek around the corner as to what we need to do for that specific member. Regardless if you’re 9 or 99. Regardless if you’re black, white or green. We can try to make sure your care is customized, is dignified, and has a different slant in terms of its delivery. We’re using that data to start a conversation, to start a relationship.”

The process of investing in the Cultural Demographic Shift at every level— enterprise leadership, workforce representation, patient experience and preventive care —creates a way to operationalize inclusion and individuality throughout your organization to drive growth. Not only will you connect better with shift populations, but you create a way for all individuals to gain the influence they seek.

If your health organization is working toward inclusion and individuality, evaluate its progress and learn about the performance indicators your organization should be solving for by taking the following assessment

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