A Seat for Everyone

REGENIA: Hi there. Welcome to the Heart of Health and Science. Today, we are talking about health equity, what it means for a healthcare organization to achieve it, and why it's so important. I want to talk a little bit about the initiatives that we have at Liberty Hospital, specifically around the topic of healthcare equity. I have the opportunity to talk to two experts in this field today—or who I consider to be experts: Thomas Murphy, vice president of human resources, and Lindsay James, our director of quality outcomes and health equity officer. So, I want to welcome both of you to the podcast today.

Thomas, I'd like to start with you and ask how healthcare equity differs from equality, as people see it, understand it or know it to be.

THOMAS: It's a great question, and, you know, Lindsay, you'll be able to weigh in on this as well, specifically from the perspective of health equity and healthcare equity. Equity is all about ensuring we treat people fairly and consistently and that we have policies and practices that enable everybody to succeed consistently. That's where my role in workforce development and human resources comes in. Health equity is about recognizing and making changes to improve disparities in healthcare among those different populations of our patients and our community.

REGENIA: When I first started nursing, an instructor taught me that you really need to care for patients whose values and beliefs align with your own. That way, you can provide the best care possible for them. I was previously taught that. Over time, I realized that it doesn't matter the belief system or value system of the patients I'm serving. What matters is that I'm providing unbiased, nonjudgmental care to each person. It is not our place to judge people for their decisions or life choices. It is our role, as healthcare professionals, to provide care and to do so to the best of our ability—to everybody across the board, no matter what. I hope at least that over time, the mantra around diversity and different values that people hold dear has changed so that we treat people with high-quality care and honor.

That's what we're here to do. I want to switch over to you, Lindsay, and ask you to explain a little bit about what health equity means in general. I don't know if people really understand the terminology. It's not something that comes up in everyday conversation.

LINDSAY: It's funny you say that. When someone asks me my job title, I say, "Health equity," they're like, "What is that?" So, I think you're right. I think there are a lot of people who aren't quite sure what that means or where we get that term, but in simplistic terms, it is having a seat at the table and making sure that everyone has a seat there, giving people the same opportunity as everybody else, regardless of their gender or their class or their economic status, race, ethnicity, age, that everyone has a seat there and that we all can reach, that health level of health that we want in our lives. We're all on different spectrums. You have highly active and healthy individuals. You have chronically ill individuals, and you have the aging adult populations.

But everyone has a version of their best health and quality of life, and we must make sure that we all have that opportunity and fill in those gaps when they can't be reached. So, we need to find those community resources or resources within the hospital to help fill those gaps.

REGENIA: To continue, what kind of things have you been seeing in the Northland specifically that suggest we could do a better job of reaching people or bringing people together?

LINDSAY: So, we are very early in our data collection efforts. We've been collecting data for over a year. Some of our historical data is not the most accurate because this wasn't a huge focus many years ago. So, really, this is something that we've started to key in on in the last 12 to 24 months. From that data, we are finding that our Medicaid populations are underinsured and our uninsured populations, specifically those with chronic illness, are readmitted more than any other population. So that means that for some reason, there's some barrier for those patients and some kind of disparity. Is it insurance coverage and the ability to get specialty care? Is it a medication expense? Is it a life issue like transportation or work-related? Location is sometimes an issue. We have patients from very rural areas unable to get back into the city to see those specialty doctors. So, we're digging into those different cases to see what data we can pull from that and how can we bridge some of those gaps for those patients.

REGENIA: So, when you see that type of disparity that you've described, what kind of outcomes do those patients have when they have those issues, whether they're underinsured, uninsured, they can't get to a place because of transportation issues. Do you see a difference in the outcomes that they have as far as their health goes?

LINDSAY: Certainly, we know that when patients with chronic illnesses, such as heart failure, pneumonia or diabetes, even if they're not able to stick with their medical regimen, see their follow-up specialists, see their primary care doctors, that illness is only going to become more chronic. And so, the management of that becomes very difficult. Then their quality of life becomes less, and then they're in the hospital more. And we all know that the more you're in the hospital, you know, that's not where we want everyone to be. We want you to live a very healthy life outside of the hospital. Readmissions are an area where you can see that there's a problem. If someone is readmitted within 30 days of being in the hospital, there's a problem. How can we help prevent that? How can we keep them at home living life and not being in a hospital?

REGENIA: Several years ago, I had a chronic illness that I had been dealing with for ten plus years. And there was an ultimate solution for that. But I was really resistant to that solution. And as a result of my resistance to that, every 18 months to two years, I had to go into the hospital and have surgery done. I had nine of those procedures, just because I was resisting that ultimate outcome. And one day when I went back in for the surgery again, one of the nurses who was doing the readmission, she came in and said, oh, you're back again. And I was just so fragile at that point, because this was an everyday thing for me, every moment of every day. When she said that she didn't mean anything by that other than, oh, I wish you could get better. I know that's what she was thinking, but what I heard was judgmental, attitude and negativity. Once I was able to process through that and get my emotion out of the way, I was able to get to the intent of what she was saying. Which brings me to being hyper aware of the things that I say, especially to our patients because our words carry a lot of weight as healthcare professionals.

If we could just get to the point where we can take any judgmental comments out of the conversation during times of crisis for patients, we could go much further, much quicker. Which brings me back over to you, Tom. When you say that we're trying to work with our staff and make sure that they receive the same treatment across the board, what kind of things are you seeing? Are there things that we do now that maybe we weren't doing previously, or the things that we're doing differently than what others are doing.

THOMAS: One thing that comes to mind is pay equity and how important that is. We’ve really worked as a leadership team to make sure that we're paying our employees consistently within their pay band and years of experience. I know that's something that you and I, Regenia, have worked together with the nursing team to make sure that we're doing the right thing for all of our people in the workforce. The other thing that you've really helped us spearhead and lead is focusing on our culture, which ties back to our people first. And so that piece is just so important. We've spent a lot of time with our leaders over the last year, helping them get comfortable with not only being vulnerable and focusing on safety and culture efforts, but then also being able to bring that to their teams and help them feel comfortable in their work environment, coming to work and taking care of patients every day.

And you mentioned bias earlier. That's something that we've launched training on for all of our employees over the last several years. We actually reeducate on it every year because it's so important, because it helps take out that stigma and it helps us put ourselves in the patient's shoes or as leaders put ourselves in our team members shoes. What are they feeling? And when we know or when we can think about how they're feeling about a situation or what they're thinking right now, it helps us react in a way that's more aligned with what they need from us right now.

REGENIA: I know that you were very instrumental in bringing in a speaker to talk about implicit bias and I know that you were not prepared for me to talk about this at all, but would you mind talking a little bit about that? I learned so much from that training. I think that I am among the most nonjudgmental of people. Of course, I would think that, but during that training, I realized that I have some bias in me. Looking at a situation through the eyes of whether it's a biased or judgmental, that I was actually shocked by. So, can you talk just a little bit about what we learned in that training?

THOMAS: Yeah, we brought that in for the senior leadership team, and then we ended up bringing it back for physicians. It was an add-on from a bias training that we did for all employees. They focused on health equity, too, which was really cool. I think that taught us all it was kind of an eye opener. I think it started with a self-assessment to see if you have bias. And of course, you go into that thinking, no, I don't have any bias. But everyone does. And I think that's foundational knowledge about bias is that everybody has it. You think you don't, but you do. And, just knowing that enables you to think through that differently. And it's okay to have bias. We have it because we are born and raised into a certain environment that's different from other environments and that forms our thoughts. That's how we develop as humans. So, yeah, that bias workshop was really eye-opening, and I think it helped our senior team relate to each other better. It helps our physicians relate to each other and relate to patients better.

REGENIA: Yeah, I would agree with all of that. I grew up in West Virginia in a very tight knit community with one common belief system. And, I may have been called a redneck here and there myself, but I'm from West Virginia, and I'm okay with that. When I married my husband, he was active-duty military, and we went from this tight knit community in West Virginia to the northeast and to the northwest. And it was nothing like West Virginia at all. And the things that I grew up believing I learned within a month that I was all kinds of wrong. And I needed to start relearning some things, and as we moved from place to place, I was amazed at how culturally different, different places in the country are. Boy, I learned so much. I think that really helped me actually to pull myself out of the equation because not one person is right about every situation or even any situation. You know, we have to bring in other opinions and other viewpoints and hearts and feelings into everything that we do, especially in healthcare. So, I know that you have formed a health equity team, and you're doing a lot of work in the community. Can you talk a little bit about that work?

LINDSAY: Sure, we have recently launched quite a few things that we've been working hard to get in place for the last year. We successfully launched our first mobile food pantry in partnership with Harvesters and Redemption, a non-profit organization in Kansas City. We now host a monthly mobile food pantry for the entire community at our location. It was our first event, and we served over 164 families from seven counties. So, it's not just Clay County. We're helping people in the surrounding counties. It was a great, great launch, and we are excited to continue serving the community in this way. We've also done some things for our employees as well. Through CNC produce, we're doing discounted produce for our employees once a month. Over the last two months, we've grown significantly with that.

We are also getting donated boxes to help some of our employees, which has been very successful. We've made hygiene kits for our homeless and displaced patients, and they are amazing. It lets patients who may have come in with nothing leave with the essentials they need to care for themselves. It's been hugely successful. We've had 30 bags go out in the last two months, so there is a need, and it's gone really well. Our next big one is Narcan distribution. We do have a population of patients who are at high risk for overdose, and it doesn't just have to be someone who's a drug user. There's a lot of education out there, but you never know when you're going to come in contact with it. Or you'll be driving down the road and someone's having an emergency. Having Narcan available with instructions is a phenomenal thing to have available in the community, specifically for our high-risk patients who come into the ER or inpatient areas. They can now leave with a kit of emergency medications and resources to get help. So, we're really excited to launch that in the near future.

REGENIA: I love that. I was so excited about the Narcan initiative when I first heard about it. One of the things that I'm passionate about is getting out in the communities and serving people where they are, meeting the needs of the people and not expecting them to come to us all the time. Let us come to you and help meet your needs. And that's exactly what this Narcan distribution will allow us to do. I'm excited about that. So, for both of you, what type of things do you see in future plans? What type of things do you see in the immediate future, as well as five years or even longer down the road?

LINDSAY: Thank you. One thing we know there is a huge need for in Northland, which is not surprising to anyone, is public transportation. We are metropolitan, but we're not. It's a big city with a small-town feel, and that's wonderful. But it also limits some of our community, not just for healthcare purposes but just general daily life. When we talk about health equity, we are also talking about those social determinants that keep people from living a healthy life and getting access to food, transportation and getting to work. All of those things end up resulting in whether they live a healthy life or not. We cannot wait to start partnering with some of our community organizations and public officials to get expanded transportation soon. We've added some things to it, but I would like it to go much bigger. And then, in the long term, I would love to see this area get a shelter or a nonprofit organization that we can partner with to refer patients to and get additional resources. We don't have that in Clay County or the Northland. We have a lot of resources in larger metropolitan areas to which we're referring patients. But to have something close to home for these patients would be phenomenal.

THOMAS: When I think of the next 5 to 10 years, I think of the perception of us as an employer. And how can we continue to evolve that? Driving people to healthcare careers is really important, and Liberty is no exception. We need to continue to bring more and more to our healthcare workforce. We can do that by reaching a diverse workforce and bringing them into healthcare. And one of the things that we do, I think that we've done a nice job over the last few years, is measuring the employee sentiments on how we're doing as an employer through our employee engagement survey, their specific questions that really tie to feeling like you belong here? Is this a good place for everybody? I would love to see over the next several years that we moved the needle and are doing okay. We're right in line with other organizations. At Liberty, I think we like to be better than other organizations. So how can we get to where we're one of the best hospitals in the country for building that diverse workforce where everybody feels like they belong and have a place.

REGENIA: Yeah. I think one of the things that really sets Liberty Hospital apart is that we're not a huge organization, but we're not small either. I mean, we do open heart surgery. We do brain surgery. We deliver babies. We have a level to intermediate nursery. We have a critical care unit. We are not a small-town hospital. It's really important that we take that, but we feel like a community hospital, right? So it's a really unique mix that we're cutting edge with a community feel. And the heart of our organization is our community. And I do think that sets us apart. As we keep that heart for the community, we want to get more and more involved in the community and improve health in a variety of ways. Training our staff to see disparity or to see issues within health or issues that would prevent people from wanting to come into a hospital and meet those needs that they don't even know they have by getting out there and saying, hey, did you know this? Do you know about this? I love that there's such a concerted effort to make those things happen. Is there anything else you guys would like to say about this topic?

LINDSAY: You know, I'm really excited about the future. Health equity and diversity have been highlighted in the last few years. Not just in healthcare but across organizations and businesses. And it's so great that we're making specific efforts to improve this, not just for our patients but for our employees and across the board, just to make a difference. That one patient made a difference. Even if you're touching five patients' lives, five people's lives are better than they were yesterday. And this is such great work and so important. And what better way to partner with your community than to help them?

THOMAS: To echo what Lindsay is saying, it's work. It takes effort, and to see organizations, ours included, that are putting effort towards really mindful approaches to health equity and equity in our workforce is a really important thing for us to be doing. It's really exciting to be a part of it.

REGENIA: So now, for my favorite question, before we close today, I want to ask you to share your favorite story about your career in healthcare that really highlights the topic that we're talking about today. So, Lindsay, let's start with you.

LINDSAY: Mine is really personal, but we were talking about the launch of the mobile food pantry last week. We have put a ton of work into this, lots of time and energy. I was the lead for this team. Two days before this event, I had to back out because I had a family funeral I needed to attend on the same day. As a team lead, I was disappointed not only for myself but also for them because they were going to have to pick up the pieces. As a leader, you hate leaving your people to deal with everything. None of them felt that way. They were like, hey, we got this. You go do what you need to do. Don't worry about a thing. And they were rock stars. They ran it beautifully. There was not one glitch. It was completely seamless, just a wonderful, wonderful event.

Couldn't have said it enough. I had tons of people in the community say it was amazing. I had other employees reach out, saying it was amazing. It was also the fact that during my time of need, they were not only picking up the pieces for me at work but also supporting me. They sent beautiful flowers. They couldn't have been more supportive. That is what I love about Liberty. We're not just team members. It's not just a job. It's not just a coworker. We're truly friends, and we're truly supporting each other. To wake up every day and go to work and do something so meaningful and so impactful to people's lives and get to hear their stories and be part of their stories and also have wonderful teammates that you can call friends. It's priceless. It's unmatchable. And so last week, I had that experience that made me feel very blessed and I'm very blessed to be at Liberty.

THOMAS: I was most nervous about this question, to be honest, because I knew she was going to ask it, and people had good answers to this, but I don't work in traditional healthcare. I work in human resources, supporting the healthcare workforce. And I feel a really deep connection to healthcare for that reason. I worked in a hospital, and I worked in a pharmacy. I consider myself connected to healthcare, but not traditional healthcare either. So, how do you know what's so great about healthcare? And how does that really connect with me? I had to think about this story and remember the details to share with you.

I started working for a pharmacy when I was 16 years old, and I worked there until I came to Liberty about eight years ago. I worked there for a long time. And much like Liberty, there was a lot of great mentorship and development. And so, you know, I was in high school trying to figure out what I was going to do with my life. I had great people around me who helped teach me the benefits of working in healthcare. I remember working for a manager who had a similar path as me. I started working for the same company in high school and stayed afterward. And she was one of the youngest members of leadership in the market and just had a really good, successful career. She said, you know what I thought when I thought about working for a drug store for the rest of my life., I didn't want to sell toilet paper for the rest of my life. But I realized it's about so much more than selling toilet paper. We're here to meet the needs of patients, of people. Whether that's the daily commodities they need to pick up on their way home or the prescriptions they need to pick up after the worst day of their life. That's always helped me feel connected to serving patients and the healthcare community. So that's what keeps me in healthcare.

REGENIA: Don Berwick once said, we have the honor of being present in unwelcome circumstances. And I have loved that quote from the time I heard it because that's what we do every single day. Nobody wants to be in a hospital or even connected to a hospital as a patient. But we in healthcare, regardless of whether we're doing direct patient care or supporting those who provide direct patient care, we get to be present in that unwelcome circumstance. And I truly consider that an honor and I know that both of you consider it the same honor.

What a great conversation about healthcare disparity and equity but unfortunately, I need to bring us to a close. So, thank you, Thomas. Thank you, Lindsay, for coming. This has been a great conversation. Every time I talk to you guys, I learn more about the importance of how we treat our staff, how we train our staff, how we view the care that our patients need, and how we can get back out into the community in a different way.

So, join us next time as we have the opportunity to talk with some newer nurses now at the bedside, providing care for our patients. And we'll get to pick their brain just a little bit and find out what it's like to be on that front line of healthcare.

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