Achieving Authentic Equity in Healthcare: Impact4Health’s Bold Mission

Aug. 21, 2021
María Hernandez, Ph.D., president and COO of Impact4Health, a not-for-profit organization dedicated to helping patient care organization leaders achieve accountability for health equity efforts, shares her perspectives on the work ahead

While the COVID-19 pandemic has had a devastating impact on the healthcare industry along numerous dimensions, it has ended up highlighting inequity in healthcare, and the need for the leaders of patient care organizations to address equity and diversity issues both internally and externally, as they attempt to do better by the communities of color that have so long been marginalized both by the broader society and by problematic processes within the healthcare industry.

One organization whose bedrock mission has been focused on making important changes in that regard is the Oakland, California based Impact4Health, a consulting and education firm dedicated to addressing unconscious bias in healthcare delivery and operations.

As the organization’s website explains, “Population Health strategies cannot succeed without understanding the diverse needs of the patients being served or the unique conditions in which they live and work. Impact4Health is a multidisciplinary team of psychologists, public health researchers, physicians and health educators working together to advance health equity using innovative solutions that leverage emerging and known best practices in the field of population health, community health, organizational strategy, and social justice. We partner with hospitals, public health departments, and health insurers with training in inclusive leadership, reducing bias in medicine, cross cultural effectiveness, and implementing the Inclusion Scorecard for Population Health™. We work with senior executives and Boards of Directors and Trustees to support improved governance and organizational alignment to integrate equity into overall organizational strategy.”

The website further notes that “We work with those who share our mission to foster health equity by providing the necessary training to become culturally competent healthcare teams, engage with diverse patient populations and better serve their communities.”

And, the website notes, Impact4Health has created its own “Inclusion SCORECARD for Population Health™,” which is “an interactive on-line dashboard of best practices that health systems can use to address health care inequities, organized into four distinct focus areas.”

Those four areas are:

> Tracking key metrics about the population served and the overall diversity

>   Building a culture of inclusion throughout the health system

>   Creating greater accountability among leaders to address health disparities

>   Developing higher engagement with diverse community stakeholders

The website further notes that “The Scorecard inspires greater coordinated and systematic approaches to address patients in diverse communities. It includes key data to collect about patients and the communities where they live and work. It identifies strategies to engage community partners in healthcare coordination, upstream social determinants of health or health education. As more health systems adopt new reimbursement models and strive for value based care, a significant paradigm shift in healthcare must take place. The Scorecard plays an integral role in a site’s effort to achieve the Quadruple Aim: better care, better patient experience, lowered costs and improved provider experience. Healthcare is no longer solely about what happens inside a facility—health outcomes are inextricably linked to the social determinants of health, culturally effective care, patient engagement and community resiliency.”

Recently, María Hernandez, Ph.D., the president and COO of Impact4Health, spoke with Healthcare Innovation Editor-in-Chief Mark Hagland regarding the work that Impact4Health has been doing in hospitals and health systems nationwide, and the organization’s strategies for the future. Below are excerpts from that interview.

Tell me about how you see the current landscape around moving forward on health equity issues, through the lens of Impact4Health?

The pandemic and the George Floyd murder galvanized everyone around the concept of equity—that we can’t ignore health inequities and other inequities. We’ve known about health inequities for over 100 years. Now is the time to act.

How does your personal-professional background fit into this work?

I’ve been a consultant and entrepreneur for over 20 years; I started in the corporate sector, and 10 years ago, I wanted to revisit my original career path.

How was Impact4Health created, with its sole focus on the healthcare industry?

Impact4Health is a subsidiary of InclusionINC, which is based in Minneapolis. That company has done broad corporate work around diversity, inclusion, equity. I was working with Campbells Soup, Microsoft, Michelin, a lot of the Fortune 100 companies. And I’d like to share a personal story here that illustrates my sense of purpose in this work. Ten years ago, my dad had his first battle with cancer. And our family were wishing him well as he was being wheeled into surgery, and he said, “Stop speaking Spanish! They’ll think I’m stupid, and they won’t help me.” And that’s anticipatory bias—the fear that your background might impact your care. People are trying to minimize their identities. At the time, I was in career transition; and Shirley Engelmeier, the CEO and founder of InclusionINC, said, “I know this is your passion; focus on healthcare.” So Impact4Health started in 2015. Our biggest product right now is the Inclusion SCORECARD for Population Health™. It’s a fabulous tool. It’s online, so a hospital can look at all those best practices. We give it away for free. People can ask us to create one for them. We use a software system that’s pretty readily available to everyone. And people begin to look at the magnitude of work that has to be done. Over 80 percent of the folks for whom we do an evaluation, ask us to work with them extensively.

And we were looking at myriad reports from the AMA [American Medical Association], Institute for Healthcare Improvement, and others; there are a lot of groups out there that have published around health equity. It’s hard: often, the chief health equity officer in an organization is often one person. And to find the best practices is a heavy lift. So we feel really proud that we’ve identified those. And we’ve

I was also a trustee for Alameda Health System, so I had a front-row seat for watching healthcare reform. And many hospitals were talking about value-based healthcare when the ACA passed. And we were talking about how we needed to be prepared for new ways to pay for healthcare. And population health was often being presented in purely financial terms. And I thought that was horrible. And I said, patients with different zip codes present different problems. When you don’t have food security or housing security; if you’re living in an area we now call “pharmacy-poor,” where you can’t fill a prescription—you won’t be successful in complying with directions.

The concept of SDOH—the social determinants of health—has really caught fire lately among leaders in the healthcare industry.

Yes. And it’s an old discussion. When you can’t get food or can’t get transportation to a clinic, that will affect everything. And I tell people, when I present a scorecard, please don’t try to solve these issues from inside your four walls. Yes, you need to be culturally fluent, and yes, you need to examine unconscious bias; but a lot of non-governmental entities and agencies are already working with these issues, so partner with them: do the hard work of finding these partner organizations. But it involves hard work.

What do you see as the biggest challenges in moving forward in all this?

With regard to the pandemic, it’s been very difficult to pull people into any kind of training, particularly frontline workers; it’s very hard. But also, many hospitals just did not have that infrastructure around cultural competency or health equity, to mobilize and do this work quickly. It took forever for some hospitals to reach out into the community—some of the FQHCs [federally qualified health centers] were natural partners. But to formulate those partnerships, to create that kind of training, and to develop the internal political will, those are the big challenges. You still have physicians in class who will say, “Hey, I treat everybody the same!” And I’ll say, “Whose ‘same’ are you talking about? If you’re treating an educated, upper-middle-class white male, that’s one thing; but treating an immigrant of color who’s not comfortable with English or with how the healthcare system works, that won’t work out as well.

So quite frankly, that’s the wake-up call. Some frontline folks want to deny that it’s a problem. But once you look at the data, you’ve got to scratch your head and ask what’s going on. And the best example of that is the maternal mortality in the United States; another is pain medication. Studies have shown that you won’t get the same amount of pain medication if you’re Black or Latino; or that Black or Latino people are drug-seeking.

The senior executive management in most health systems in this country is still overwhelmingly upper-middle-class white male, and non-immigrant. Do you still have problems enlightening them?

Well, ten years ago, I think that a lot of people were saying, just go away. And I think white men have gone from being clueless to being afraid to be found out. And that’s a terrible headspace. So I have to become the white male whisperer and present myself as non-threatening, so that I can help them see things. And it’s extremely painful to admit that you don’t everything. So early on, it was an issue of denial; but now, given all the data, and the issue of unrest around the country, I think they know they have to do something. But, per political will, it’s amazing how much you see them drag their feet about this, when they know they have to take action. But they’re immobilized, and the fear has got them going in circles.

So our tool is purposely non-threatening. You can go through the list of elements around health equity. And now you can actually look at this and say, wait a minute, we don’t have anything like this in the system. So where are we going to put this, and who will do it? So you look at three things: do you have this particular practice as a goal or stated objective somewhere in your system? Do you have resources aligned to support this? And last, is this in your strategy? Do you talk about this?

And how do you achieve accountability in these processes?

Yes, that’s one of the questions in our executive scorecard: is every executive leader held to a standard for leadership? And held accountable for achieving health equity? You’re correct, historically, we’ve said we just need to hire Jane or Joe; but that’s not enough. And you have to bake the ethics around diversity, inclusion and equity, into your core culture. Weirdly enough, the corporate world is ahead. And that’s because this didn’t get into the healthcare cultural environment as quickly. In the corporate world, there was this realization that your customers were changing and your people internally were changing. There was some hubris in healthcare.

Microsoft, Michelin, Google—when you can go into those kinds of organizations and see what a diversity, inclusion, and equity philosophy looks like when it’s embedded into their processes—how we source you, how we onboard you, how we mentor you—managed and advance them. There are some pretty sophisticated processes in place in the corporate world, but healthcare is behind. We’re not just focused on how you treat diverse patients, but also, in terms of engaging around staff; if your staff represents the communities you care for, you’re going to do better.

How do you feel about the future, as your work goes forward?

I’m actually really optimistic about it, because I’m seeing so much change taking place. I’m seeing systems that are coming out of denial, and they’re bringing people in to create and support programs. I’m working with a health system that’s been in its community for over 100 years, and they’re hiring their first diversity officer ever. And fortunately, that person recognizes that this is not a one-person job. And the field of diversity and equity training is growing and expanding. I’m very encouraged by that. I’m very concerned by how polarized we are as a country. But I would share with you that the younger generations, the GenXers and millennials, are pretty outspoken about this. My son is 27; he doesn’t work in healthcare. But I’m just seeing a very different constellation of concerns over this among younger people. And I’m outspoken, because I have to be in my work.

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