Conversations about structural racism and implicit bias can be uncomfortable for clinicians, but they are necessary to improve patient care, says Margaret Larkins-Pettigrew, M.D., senior vice president/chief clinical diversity, equity and inclusion officer at Highmark Health in Pittsburgh.
“Training about structural racism can’t be a one-off,” she said. Educational efforts have to allow physicians and nurses to be in a space where they can think about themselves — not with blame or shame, but just so the health system can move forward. “Those conversations are intense,” she admits, “but everybody has to take the journey.” Larkins-Pettigrew was speaking Feb. 8 at the Healthcare Innovation Mid-Atlantic Summit in Philadelphia about her own unique journey from coal miner’s daughter to nurse to physician to becoming one of the first chief clinical diversity, equity and inclusion officers in the country.
Larkins-Pettigrew joined Highmark, which includes Allegheny Health Network (AHN), in 2020 from University Hospitals/Case Western Reserve University School of Medicine in Cleveland, where she served as Professor of Obstetrics and Gynecology, Chair of Clinical Diversity and Inclusion and Assistant Dean of Students. She founded and continues to serve as CEO of the JustWondoor (Women and Neonates, Diversity, Outreach, Opportunity, Research) global health program; and in 2014, she was named the University’s Chair of Clinical Excellence and Diversity, an endowed position established to promote diversity of academic faculty.
As Larkins-Pettigrew shared with the Summit audience, she earned a bachelor’s degree in nursing at the University of Pittsburgh, a master’s degree in education from California State University, a master’s degree in public policy from the University of Pittsburgh and her medical degree from the University of Pittsburgh School of Medicine. She served in the U.S. Navy for 13 years, achieving the rank of lieutenant commander and completing an OBGYN internship at Portsmouth Naval Hospital.
She also completed a residency at Magee Women’s Hospital in Pittsburgh, and practiced at Magee for eight years, while also serving as Magee’s Director of Global Health Programs.
In a discussion with Healthcare Innovation Editor-in-Chief Mark Hagland, Larkins-Pettigrew said that because of Highmark’s reach across payment and clinical settings, she said her work bridges the health plan and health system world. In addition, you also need people from the academic space to look at trends in the data, she said. ‘You can’t do a good job on DEI without data.”
In addressing clinical equity issues, she brings both a physician and nurse lens. She said both the corporate and clinical sides need to understand the role of bias. “Payers have to understand that they have to have cultural humility and speak to people with respect.”
Larkins-Pettigrew said one key to long-term change is to make sure the work is sustainable within the organization. Highmark has created an Enterprise Equitable Health Institute (EEHI), an enterprise-wide effort dedicated to advancing a comprehensive internal and external strategy to promote a culture of equity and inclusion. The EEHI is engaged in the organization’s recruitment, hiring, professional development and workplace culture practices and standards, as well as the quality of care it provides.
Larkins-Pettigrew described how Highmark has organized around what she calls “pillars of organizational equity.” The organization’s website defines those pillars as invigorate, educate, innovate, investigate, advocate, disseminate and communicate. It notes that each pillar is led by an executive sponsor and consists of subcommittees with members who are diverse in race, ethnicity, gender and expertise.
In addressing social determinants of health, she said, Highmark does patient “journey mapping” to understand their needs and which parts of the healthcare and community service environment patients touch. “You are not going to solve all these problems, but you can see how they fit together.” She recommended focusing efforts on one element such as food insecurity or homelessness. “If you do this journey mapping and focus on food insecurity, you will find all the other things and connect people with resources.”
Larkins-Pettigrew was asked how other health systems should begin this work. She said the murder of George Floyd was a tipping point and an opportunity for organizations to move in a different way and to change trajectory. She recommended taking the plunge, and finding someone like her who can take your organization on this journey.