Penn Seeking ‘Bold Solutions’ to Dismantle Racism in Healthcare
Health services researchers from across University of Pennsylvania schools and centers are coming together to explore and implement solutions to entrenched racial inequities in the U.S. healthcare system.
The initiative is called “Bold Solutions: Dismantle Racism. Advance Health.” Every Bold Solutions project will aim to have a Black co-lead and will partner with Black faculty, staff, and students, and with Black businesses when feasible. It will also include community organizations and groups in meaningful ways in all projects.
Initial areas of focus will be healthcare, payment models, neighborhoods and built environments, economic opportunities, and financial health.
"This is a big initiative that is thinking in the long-term about developing, implementing, and disseminating a national model for addressing interpersonal, institutional, and structural racism within health care," said Raina Merchant, M.D., M.S., an associate vice president at Penn Medicine and an associate professor of emergency medicine and one of the Bold Solutions organizers.
The Leonard Davis Institute of Health Economics (LDI) has issued a request for proposals to its hundreds of senior and associate fellows across the Penn campus, and will fund a program of pilot grants to start the first round of Bold Solutions research projects.
LDI is prioritizing research proposals that accelerate the science of structural, institutional, and interpersonal racism and align with Bold Solutions’ focus. We are interested in research proposals that apply rigorous and solution-oriented science to dismantle racism and achieve health equity rather than documenting disparities, including (but not limited to) the following:
• How racism translates into poor health and healthcare
• How structural, institutional, and interpersonal racism can be dismantled
• How to foster antiracism in individuals and institutions in healthcare
• How systems and policies outside of healthcare impact the health of Black communities
• How to change healthcare systems to address racism
• How to influence national and local health policies that currently disadvantage Black and other minority populations
• How to recruit, train, and retain a diverse and antiracist healthcare workforce, including building a pipeline of minority students and increasing representation of Black faculty, staff, and administration at all levels of leadership
• How to design healthcare financing systems to eliminate segregation of clinical care and restrictions on access
LDI will also consider proposals related to other important emerging issues in population health, healthcare delivery and health policy. Funded proposals usually align with at least one of LDI’s priority areas: Access and Coverage for Healthcare, Care for Vulnerable Populations, Improving Care for Older Adults, and Opioid Epidemic.
“Funded science is serious science,” said LDI Executive Director Rachel Werner, M.D., Ph.D., in a statement. “LDI's investment in this initiative signals that we really mean business and intend to make a difference. We want to overcome inertia and resistance to make bold, necessary, and essential change that addresses the effects of racism on health.”
The eight Bold Solutions team members are all leaders in healthcare-related research centers at Penn and highly respected experts in their diverse fields. They are:
• Raina Merchant, M.D., M.S.H.P., director of the Penn Medicine Center for Digital Health
David Asch, M.D., M.B.A., executive director of the Penn Medicine Center for Health Care Innovation
•Alison Buttenheim, Ph.D., M.B.A., associate director of the Penn Center for Health Incentives and Behavioral Economics and director of engagement at the Leonard Davis Institute of Health Economics
• Carolyn Cannuscio, Sc.D., director of research at the Penn Center for Public Health Initiatives
• Eugenia South, M.D., M.S.H.P., director of the Penn Urban Health Lab
• Atheendar Venkataramani, Ph.D., M.D., director of the Penn Opportunity for Health Lab
• Kevin Volpp, M.D., Ph.D., director of the Penn Center for Health Incentives and Behavioral Economics
• Rachel Werner, M.D., Ph.D., executive director of the Leonard Davis Institute of Health Economics
Earlier this year, Healthcare Innovation interviewed Jaya Aysola, M.D., chair of Penn Medicine’s Health Equity Alliance and executive director for the Penn Medicine Center for Health Advancement within the Office of the Chief Medical Officer, where she leads the charge to improve equity and inclusion within the health system and affiliated health science schools.
Initially she was asked to help resident physicians and physicians in training receive some training around equity and inclusion. “It quickly became clear to me upon taking the job that this was going to have to be a health system endeavor as well,” she explains. “If we were going to focus only on educating the physicians in training and residents on principles of equity, it wouldn’t work if we did it in a vacuum and didn’t change the system of how we are delivering care. We had to do provider education and system-level change.”
Aysola says she began by standing up a Penn Medicine Health Equity Task Force and creating a blueprint for Penn Medicine to achieve health equity and inclusion. She and others founded the Center for Health Equity Advancement, which sits in the Office of the CMO at Penn Medicine. “Rather than naming a chief equity officer, we felt that this needed to be a centralized team that has a seat at the table for all CMO and CNO discussions,” she says. “The vision is that equity is not a siloed activity, but rather an integral and necessary part of daily operations — whether it is how we deliver care on the front lines or how we recruit and retain our work force. Those two things are intertwined.”
At the provider level, you can have unconscious bias and stereotypes, Aysola notes. “As clinicians, we have been trained in the same way with a knowledge base developed with a single cultural perspective. So oftentimes, we talk about diversifying the front lines, with the front-line workers in mind, but we also have to diversity those who are generating the science of tomorrow and have a seat at the table in the C-suite designing the models of delivering care. That will shift us toward a more equitable state.”
Aysola’s team is doing research on health equity efforts as well. “We think of our health system as the research laboratory but also as a key place to operationalize these truths with real-time data and discussions with CMOs,” she says. “For instance, like some other health systems we found a wait time disparity in patients admitted to a hospital through the emergency department. We took the extra step with signals we got in our health system to work with CMOs to do a deeper dive on why that is happening.”
