Last year. Rani Morrison moved from the position of senior director, care continuum, to the newly created position of chief diversity and community health equity officer at the University of Illinois Hospital and Clinics (UI Health) in Chicago. She recently spoke to Healthcare Innovation about patient engagement and data gathering efforts under way.
I asked Morrison why UI Health created the new position. She responded that a lot of things on the hospital and outpatient side that would directly address health equity, such as housing and transportation programs, had been put under her areas of responsibility in social work and case management. “The new role was created so that we can really sharpen our focus on community health equity,” she said. “We are working with community-based partners to develop and increase what we do in the health equity space. And at the same time, this role is also responsible for improving and addressing our diversity and inclusion initiative, with our personnel and our staff.”
Morrison reports directly to UI Health CEO Michael Zenn, and works very closely with C-suite peers and clinical leaders. “I work closely with our chief human resources officer and our chief ambulatory medical officer, addressing what we need to do with our patients in the outpatient space,” she said, adding that even though social work no longer reports to her, she works closely with the director of social work because they work most closely with patients to address social needs. “I am working really closely with our physicians, our ED physicians, our family medicine physicians and our primary care clinics,” Morrison said. “Even as we deal with the impacts of COVID, which, of course, exacerbated every disparity we've ever experienced in the healthcare space, we also are dealing with how to translate lessons learned into better health equity in our system and in our community.”
UI Health has undertaken some initiatives to leverage technology around targeted patient engagement. Like other health systems, when COVID hit, they moved a lot of appointments to telehealth platforms. A wide deployment of donated iPads allowed patients in the hospital to stay connected to families and caregivers at home.
In addition, UI Health has been doing post-discharge calls using a platform from CipherHealth. Patients are given an automated call two days after they are discharged from the hospital to ask them a series of questions to make sure that they've had a good discharge. Did they receive their medications yet? Did they understand their discharge instructions? Do they feel better or worse than when they left the hospital? Their responses to those automated questions can trigger a call with a nurse, who will follow up with them within a couple of hours to resolve any problems that may have been identified. “That's been a real satisfier for our patients, and allowed us to really address more patients,” Morrison said. “We have been able to reach about 70 percent of our patients who are discharged that way compared to a much lower reach rate when we were doing it manually.”
Health systems are starting to gather and be transparent with data about disparities in health outcomes, and then working to close those gaps. I asked Morrison if UI Health is planning something similar.
“Absolutely,” she said. “The first step we had to take is make sure we're getting clean data. In the last couple of months, we've actually reconfigured our race and ethnicity data collection. We recently switched to a new EHR in 2020, and with that, we brought over some artifact data that we realized wasn't the best data. There's some cleanup required in order to get our data to where we can really have clean measurements. We haven't necessarily been measuring our disease burden and outcomes by race and ethnicity, partly because we are a majority-minority-serving institution. But we do have to start getting more granular about the data, so we can be knowledgeable about how our patients break down for different disorders and diseases. We need to start knowing our patients specifically, and the only way that we can do that is by having that data and breaking it out. That's what we're moving towards, and the first thing we had to do is start cleaning up the data that's in our system. We've actually retrained our front-end staff on how to capture that race and ethnicity data as well as preferred language and also gender identity.”
Morrison believes the pandemic has been a catalyst for change on equity issues. “We've had to change in ways we didn't think we would have to,” she said. “We are an academic medical center, so I'm the first one to say that traditionally we moved extraordinarily slowly. Everything requires three committees. But COVID meant we couldn't take that time. We had to put the patients’ needs first. I would say that it's proven that we can make decisions more quickly, and that we've been able to do it when it counts.”
In 2022, UI Health is expanding its efforts to celebrate employee culture, such as Black History Month and Women's History Month. On the social determinants front, it is exploring some new transportation and food insecurity offerings. “We're positioning ourselves to start asking more regularly and consistently about the social determinants of health of our patients,” she said. “We haven't been consistently asking our patients, and it's something that is in our strategic goals to do starting this year, so that we can consistently capture that information, and really understand what our patients’ needs are.”
I asked Morrison what advice she would give to people considering taking a chief health equity officer position in a large health system. She said her number one thing would be thinking about the reporting structure and reporting to the CEO, if possible. “Everyone wants to know who you report to because you have to make sure that the position has the right gravitas. Sometimes these roles are put in different areas, and it doesn't mean it's any less important, but you want the role to have the right influence. Otherwise, you're not going to be able to get things done.”
Secondly, she said, make sure that you resource the role. “I've taken some time. "I haven't fully hired my team yet because I really wanted to create my plan first,” Morrison said. “My plan is now done, and I am ready to start hiring. But another question I get asked a lot is whether I have resources and a team. Because a lot of times people are put in these roles, and they're an army of one. You cannot get anything done if you don't have a team. Otherwise, it's all just lip service. Our CEO is completely behind this and everything that I want to do, and the institution is really behind it. There's a lot of energy behind being more intentional about both our diversity efforts and our health equity efforts. We're in a good position, and I'm really excited about the next year.”
