Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
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AMA Chief Experience Officer speaks with co-CEO of Kaiser Permanente on how health care leaders can bring diversity, inclusion and equity to their organizations during the COVID-19 pandemic and beyond.
Learn more at the AMA COVID-19 resource center.
- Edward Ellison, MD, co-CEO, The Permanente Federation
Unger: Hello, this is the American Medical Association's COVID-19 update. Today, we're talking to Permanente's Dr. Edward Ellison, who will share how health care leaders can bring diversity, inclusion and equity to their organizations.
Dr. Ellison is a physician executive, leading Permanente Medical Groups in Georgia and Southern California and co-CEO of the Permanente Federation in Pasadena, California. I'm Todd Unger, AMA's chief experience officer in Chicago.
Dr. Ellison, Permanente championed to help equity long before the pandemic. Now, many other organizations are looking to do the same. Where should they begin?
Dr. Ellison: Yeah. Thanks, Todd. It's a great question. Several things come to mind for me. First and foremost, it really starts with leadership. Leaders set the tone and have to declare that this matters and state explicitly why this matters.
The culture is the most powerful force in the organization. And if you move a culture intentionally towards the importance, the essential nature of equity, inclusion and diversity, that's the really first step that you take. And then you build on where you come from, wherever you're starting from, that's not what's important. It's where you intend to end.
Unger: So you've said that organizations need to create an infrastructure really to support that kind of culture change. How has Permanente done that?
Dr. Ellison: Well, we're fortunate, because we just celebrated our 75th anniversary as Kaiser Permanente, and we have a long history, it's in our DNA. We started in the shipyards in World War II, Mr. Kaiser hiring very diverse workforces, working side by side, in building ships for the war effort.
As we moved forward and Dr. Sidney Garfield joined with Mr. Kaiser in this enterprise of Kaiser Permanente, we had hospitals that were integrated and workforces that were integrated. So that's part of who we've always been. We've taken it very seriously, the importance of health equity, that everyone deserves the same health outcome. And yet, we understand that not everyone responds to the same intervention.
So you have to be mindful of what makes a difference for different communities, based on language and culture and race and ethnicity and other socio-economic determinants. So we have population health infrastructures that help us identify those populations, and we measure it, and we hold ourselves accountable to improve it. And so you start with that infrastructure and you build on it.
And most recently in COVID, the same approach. From the beginning, we had dashboards, COVID dashboards, that looked at race and ethnicity as part of understanding testing rates and admission rates to the hospital, and who's going to the ICU, and who's being intubated, and what treatment outcomes. So it's about intentionality. It's about systems and culture and people and measurement.
Unger: I'm curious, especially in the pandemic, when you see data like that, and you're tracking it in real time, how have you made changes to adapt to what you're learning?
Dr. Ellison: Well, that's the beauty of being in a system like ours and having an electronic health record allows us to aggregate data. We have positioned researchers who are working together to understand it and bring that information together. We're all learning from each other. I think that's the other thing the pandemic has taught us is that really, we want all boats to rise.
And so inside the organization, outside the organization, we want everyone to learn what's most impactful, what makes a difference and what's unique to the populations that we serve.
Unger: Dr. Ellison, one important piece of the infrastructure that you referenced before, obviously, is the workforce. How is Permanente recruiting and developing a more diverse physician workforce?
Dr. Ellison: Yeah, that's a great question. And it really, again, starts with intentionality and saying that it matters. We believe that there is tremendous value in having a diverse workforce, for several reasons. First of all, we know that if we have a diverse workforce that feels valued, we get better outcomes. We get better ideas. It creates an environment.
And it's what I like to call a safe, secure, respectful environment. If people feel respected and they know they have a place at the table, and if their ideas are welcomed, then you make better decisions and you create an environment people want to be part of. So it helps you recruit and retain the best and the brightest from everywhere. It helps you do a better job of taking care of diverse populations, and it supports the wellness of physicians.
If you don't feel respected, you don't feel safe in your environment, you can't be well. And so this connectivity between the physician wellness of recruitment and retention of a diverse workforce and the best care for a diverse population, it all ties together. So that intentionality is really important.
And then we are opening in just a few weeks, the Kaiser Permanente School of Medicine. It's a very exciting endeavor for us. We're looking at students who bring diverse, personal attributes and lived experiences, to help us create that diverse workforce of the future. And physicians will truly be change agents for how health care can evolve and should evolve to meet the needs of what we know the clinical medicine can be.
Unger: Well, that's very exciting. Let's talk now a little bit about how embracing diversity and inclusion within your organization helps you on the patient front, into improved health outcomes, particularly in Black and Latinx communities, that have been really hit hard by COVID-19.
Dr. Ellison: Sure. Absolutely. Well, we've long believed in population health, and we've put in systems to help us measure the outcomes for populations for different care categories. And so for example, we have been able to close gaps in health care disparities for the Latinx population in colorectal cancer screening. We've narrowed gaps in hypertension control for African Americans. We've closed gaps in diabetes, hypertension, heart disease for Medicare members from underserved communities and improved compliance rates for HIV patients from underserved community.
But we understand that not one size fits all, but if you measure and understand what are the interventions that make a difference for different populations, then you begin to make a difference across an array of medical conditions. It gets into social determinants of care, it gets into culturally responsive and sensitive care, the language can coordinate.
We're a big believer that you should be able to have a conversation with your physician in the language of your choice. And so we do have interpreter services. We also invest in physicians becoming proficient in second languages. We have physicians who participate in immersion programs, where they go, so they really can become proficient, not just in the language, but the culture. So we really seek to meet the patient where they stand, because that's the best way to engage them in a therapeutic relationship and achieve the best outcomes.
Unger: Have you run into challenges with patients who were either reluctant to see or can't get in to see their physician?
Dr. Ellison: Well, I think one of the things that we really have to work on is trust, particularly in some of our underserved communities. There's fear and there's stigma associated with COVID, there's fear and stigma associated with different concerns about how language is used, right? Language is so powerful. We created an anti-stigma toolkit for COVID-19 that we need to talk about it as a novel coronavirus or as COVID-19.
But not associate it with any particular country, or group, or race, because that creates a stigma. And so we want to make sure that we create an environment that our patients from all different backgrounds can trust in us and trust in the information that we provide and the care that we provide and that people do respect and care and want to create a safe environment for them to receive care.
Unger: I'm curious, what else is in the anti-stigma toolkit that's been most helpful?
Dr. Ellison: Well, a lot of it is about the language and how you communicate and helping people to understand that it's okay if others are fearful, and that we can help them with that. And again, to meet them where they stand.
We also have a resource we call Thrive Local, and what that helps our physicians and staff to do and all of our physicians and staff have access to it, is to look and see what are the community resources that are available to help our patients who are struggling with food insecurity and maybe housing insecurity? So it allows everyone to be an ambassador and a supporter for our patients, and meet them, again, where they stand, and help to meet their needs that go beyond the walls of the organization.
Because increasingly, we know that health care outcomes are so much more than what we do within the walls of medicine.
Unger: Let's talk a little bit more about how Permanente's health care extends beyond the walls of your health care system and increases that connection to communities. Can you talk more about your approach?
Dr. Ellison: Sure. So we have patient advisory councils, and so we've brought in patients to help be part of key initiatives that we're engaging in to say, tell us what it looks like and sounds like to you. Does this language make sense to you? Does this matter to you? I love that question not what's the matter with you, but what matters to you, to help advise.
Our physicians and staff are part of the community. They take part in Martin Luther King Day, a day of service. We encourage that. Kaiser Permanente sponsors a community benefit scholarship program, with fellows going into communities to make a difference in underserved communities.
We take part in the Hippocrates Circle where physicians who are from minority and underserved communities go to middle schools and identify with middle school students from underserved communities who have an interest in health care in their future. And so these physicians from minority backgrounds will say, I was right where you were at one time. I understand the barriers you face. I overcame them. You can too. Let me share with you how you can do that, and also bring them in and tour them in a hospital, show them than an operating room, show them what it's like to be a doctor, inspire them. Help their parents understand what you have to navigate through to support your child who might have an interest in medicine.
And then of course, our medical school, we train residents, and so part of our mission and vision of Kaiser Permanente is to serve our members, and to serve our communities. And so that inspires so much of what we do.
Unger: Well, thinking of your challenges, as you've made this commitment to health equity, what are the biggest obstacles that you've run into and how have you overcome those?
Dr. Ellison: I think one of the biggest obstacles is just, "I don't know what I don't know." I have to come to this from a place of real humility. I think with the events of the last weeks, we've really understood that none of us knew the lived experiences of our Black and our Latinx colleagues and friends. Their stories are powerful.
We held listening sessions and I was so grateful for the courage of my Black and Latinx colleagues who were willing to tell their stories. And it's even to extend each other grace and say, I don't have the right words to say it, but I want you to know I care. This is important to me. This matters to us as an organization. We need your voice. When you're ready to speak, let us know.
I want to listen, but I want to translate that into action, because listening is incredibly important. We continue to do so, but it's also about translating that into action, that's measurable.
Unger: Any final thoughts for other health care organizations looking to make that commitment that you have to equity?
Dr. Ellison: Yes. I think it's just owning that none of us have all of the answers. Come from a place of humility, but a place of firm commitment. Be explicit, be clear that this matters and why it matters, let your people—t's important to Kaiser Permanente, in spite of our history around this, we several weeks ago made a statement, because it's important to us that our physicians, our staff, our patients, our members, our communities know where we stood on this issue.
And then listen. Go from a place of listening intently and humbly, and then start from where you are. It doesn't matter where you start. It matters where you go next. And know that, reach out. It's just a long road, right? But we can get there together. We want to share and learn. We want to stand with others who want to stand for social justice, so reach out. Let's all work together. We can make a difference, we can impact, but just be intentional and start.
Unger: Well, thank you so much, Dr. Ellison. We at the AMA have made our own and very explicit commitment to health equity, and we share your objectives and your ambitions there too. It's been a pleasure having you on our segment today.
That's it for today's COVID-19 update. We'll be back on Monday with another segment. For updated resources on COVID-19, visit ama-assn.org/covid-19. Thanks for joining us today and take care.
Dr. Ellison: Thank you.