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Diversity, Equity and Inclusion: Global Perspective

In the wake of the pandemic and recent social justice movements, more and more health care leaders are addressing issues of racism and bias. Highly motivated health systems are using disaggregated data to identify opportunities for improving care and find trends and common denominators among certain populations. Dr. Mary “Toni” Flowers, Chief Diversity And Social Responsibility Officer at LCMC Health and subject matter expert featured in SHSMD’s Futurescan 2023-2028 Health Care Trends & Implications publication, discusses how it is important to study all data sets so that everyone gets great care. She elaborates on the difference between health disparity and health care disparity and how collaboration is critical to addressing health disparities. Fostering diversity and inclusion is becoming part of the overall strategic plan for health systems, and that makes it within everyone’s scope of responsibility.
Diversity, Equity and Inclusion: Global Perspective
Featured Speaker:
Mary "Toni" Flowers, PhD, DHI, MBA
Mary "Toni" Flowers, PhD, DHI, MBA is a subject matter expert on the topics of diversity, strategy and action planning, health care equity, health, and health care disparities, community health, cultural competency, executive coaching, customer/patient experience, and social marketing. 

Learn morer about Mary "Toni" Flowers, PhD, DHI, MBA
Transcription:
Diversity, Equity and Inclusion: Global Perspective

Intro: The following SHSMD Podcast is a production of DoctorPodcasting.com.

Bill Klaproth (host): On this edition of the SHSMD Podcast, we get a global perspective on diversity, equity and inclusion, and a preview of an upcoming article in Futurescan 2023 to 2028 Healthcare Trends and Implications. So let's talk with one of the coauthors of the article, Dr. Mary "Toni" Flowers, right now.

This is the SHSMD Podcast, rapid insights for healthcare strategy professionals in planning, business development, marketing, communications, and public relations. I'm your host, Bill Klaproth.

In this episode, we talk with Dr. Toni Flowers, Chief Diversity and Social Responsibility Officer at LCMC Health and its member hospitals. Dr. Flowers is the coauthor for the latest Futurescan 2023 to 2028 Healthcare Trends and Implications.

Bill Klaproth: And Dr. Flowers will also kick off the shish. Ahmed connections, virtual conference on October 12th as the opening keynote. Don't miss out on her session and a variety of new webinars plus access to all the in-person breakout session recordings included in the virtual conference. Visit. med.org to register today.

Those who attend the in-person conference September 11th through the 14th. Hope to see you there. We'll also have an opportunity to get virtual conference access at a discounted rate.

Bill Klaproth (host): Dr. Flowers, welcome to the SHSMD podcast. As you know, we start every episode of the SHSMD Podcast with rapid insights. One quick tip someone can use to make their marketing communications better today. Dr. Flowers, give us your rapid insight.

Dr. Toni Flowers: My rapid insight would be to always remember to stay curious. You don't know what you don't know. And as we're dealing with diverse cultures and ways of thinking and ways of doing things, always ask questions.

Bill Klaproth (host): And that is your rapid insight. Always stay curious. You don't know what you don't know. Dr. Flowers, thank you so much for being here. We appreciate it. And we're looking forward to reading your article that you co-authored in the latest Futurescan 2023 to 2028 Healthcare Trends and Implications. It's a global perspective on diversity, equity and inclusion, such an important topic. And one of the key challenges facing the healthcare industry is that and health inequity. And as we start out this discussion, can you please explain to us what does health inequity actually mean?

Dr. Toni Flowers: Sure. When we talk about healthcare inequity, it is recognizing that equality means, providing the same thing for everybody. But equity really is a step deeper where we're looking to provide what is needed for each person to have the same experience. There's an image that you may have seen before. And it shows a series of people that are given a bicycle. But one person is too tall, one person is too short, one person is in a wheelchair. So they all can't have the same experience, although they all have the same bicycle. What we want them to do is to create the bicycle that meets each person's needs. So the person that was too tall, we have a bicycle that's bigger. The person that was too short, we have a smaller bicycle. The person that was in a wheelchair, maybe they're in what we call a recumbent bike. So we're providing the same experience, which is bicycle riding, but we're providing it in a way that meets the specific need of each person.

Bill Klaproth (host): Well, that is a great analogy. Thinking about that bicycle really makes it easy for us to understand when you picture that. So when it comes to health inequity, what are the factors that are contributing to this?

Dr. Toni Flowers: Well, there was several contributing factors. And I would say some push and pull factors. One thing is the demographics of our country have changed over the years so much. I remember a time in healthcare where we can say that we interact with people from all over the country. Well, now we interact with people from all over the world and recognizing that people bring their culture with them to the hospital, they bring their lifeways with them to the hospital and they bring how they want to be cared for to the hospital as well. And so it's important for us to recognize that those factors will influence how they receive healthcare, how they seek healthcare and how they will engage in the treatment plans that we provide for them. And that may be based on cultural racial issues, or it also may be based on financial or socioeconomic issues, how they're able to engage with the services that they may need to help them in their healing process after they leave the hospital. So it is socioeconomic factors. We know that as demographics have changed and once people immigrate to the United States over time, their health status may change. And that may be influenced by the kind of lifestyle that they're leading, so if they came from an area where they had more physical activity in the need of maybe walking, they didn't have the same level of transportation or conveniences. But when they get to the United States, because we have a more sedentary lifestyle, what we find is usually within a year or so of them immigrating to this country, that their health begins to go down because we have a more sedentary lifestyle. We have more fast food, less healthy nutritional options. And so, that is a factor. The socioeconomic issues of being able to provide for themselves, whether they have insurance or not, whether they are able to have food insecurities, housing insecurities, all these things add to the kind of experiences that they will have as they engage with healthcare organizations.

Bill Klaproth (host): And then Dr. Flowers, you've got a quote that says health follows wealth. And I know that ties into this and is a big factor. Can you explain that to us?

Dr. Toni Flowers: Absolutely. Well, you know, I remember years ago when I was first entering healthcare, there were lots of slogans and taglines that we use. And there was one that was stated, "Know your numbers." And that meant know your blood pressure, know your blood sugar, know your BMI, know your weight. Well, now, when we say know your numbers, the most important number is your ZIP code, because where you live impacts how you live. So when I say health follows wealth, we know that certainly socioeconomic factors impact an individual's ability to access healthcare, to live in neighborhoods where they have clean air, where they have open access to places to exercise, where they may not have access to transportation, where they may have issues with housing insecurity and food insecurity. So we know that as people have more access to wealth, then they have better options for health. So health does follow wealth.

Bill Klaproth (host): Yeah, that really makes sense when you talk about that. And yeah, know your number, sure, we've heard of that. But as you said, that important number for a lot of people is the ZIP code that they live in.

Dr. Toni Flowers: When we look at ZIP-code level data and we're even now looking at data, not just by the ZIP code, but even by the block. We know that life expectancy can change even within one mile, ZIP codes that are one mile apart, that the life expectancy can go down as many as 25 years or more, again, based on what there is access to within that ZIP code. So that certainly speaks to longevity and it speaks to health outcomes.

Bill Klaproth (host): Right. And our goal is to try to get that bicycle to fit every community, so everyone has the same level of healthcare, right?

Dr. Toni Flowers: Absolutely. So when we talk about the social determinants of health, what happens to a person's health that is influenced by health, healthcare facilities, hospitals and such is really only about 20% of what happens with health overall. That other 80% happens outside the hospital, in the neighborhoods where people live. And so when we talk about the social determinants of health, they're things like education, access to healthy foods and those other things that I mentioned, but those social determinants of health really do influence the situations that cause people to come and require healthcare, and it also influences, once they're discharged from the facilities, how they're able to heal and how they're able to access those additional services that they need to help them on their healing process.

Bill Klaproth (host): Right. And when it comes to social determinants of health, let me ask you this, what is the difference then between health disparity and healthcare disparity?

Dr. Toni Flowers: Oh, that's a great question. And I think often people use those terms interchangeably and they are very different. So when we talk about health disparity, an example would be the incidence of disease within a population. So for example, a few years ago, we used to be able to say based on the data that our Caucasian women would have more incidence of breast cancer than African-American women. So that's a difference of a disease within populations. So it's a disparity, a difference. And that's no longer true, actually, African-American women are having breast cancer at the same rate and sometimes even higher than our Caucasian sisters.

So when we talk about healthcare disparities, that's really speaking to the quality or the standard of care that's provided by health providers to populations. So an example of that would be the fact that the data tells us that often, when communities of color present with the same health issue, the same insurance, the same pathophysiology of their disease, that they tend to get a lower quality of care delivered to them by healthcare professionals than do our Caucasian counterparts. And so we see that in things like long bone fractures, like if you fracture your leg, which is an incidence that would certainly cause you a high level of pain, that they are given a lower pain medication than our Caucasian counterparts are. So that is a difference in the care that's being delivered to populations.

And this is something that there are lots of research to back this up. I will tell you that the Institute of Medicine produced book which is just loaded with research that proves that these inequities or disparities in care actually exist. And the name of that book was called Unequal Treatment, and it just really brought to light lots of research to prove that this does happen. So what happens in the minds of healthcare providers could it be unconscious bias or it could be implicit or explicit bias. And so that it may be decisions that are made at an unconscious level or it could be that there is racism and stereotyping that happens and discrimination that happens in healthcare and both are true. And so our task is to help bring these incidence to light to help our healthcare professionals to recognize that we all have biases and biases of themselves are not bad, they just are. Everybody has preferences. Some people like hot coffee in the morning, that's their caffeine. And some people like a diet Coke in the morning, that's their caffeine. So they have a preference or a bias for a beverage.

Well, we all have biases. And biases in and of themselves are not bad, they just are. And they're based on our background and our preferences. But what's important is, in healthcare, what we do with those biases. Do we then now take our thoughts and change them into behaviors that create a situation where a patient is treated differently and treated in a way that provides a lower quality or standard of care for them.

Bill Klaproth (host): Right. So unconscious bias is something that we have to make people aware of and shed light on and even implicit bias as well.

Dr. Toni Flowers: Absolutely. And I would tell you that often people might say, "Well, this is unconscious. How can I change it?" Well, we take it from being unconscious to raising your awareness that it exists. And then as you become aware of your preferences, then you have to then police your own line and police your own behavior and decide, "Have I treated one patient differently than another patient in a way that is a lower quality or lower standard of care?" And so if we can say yes to that, then we can then decide that's the place where we need to change our behavior and that's the place where we have opportunity for improvement.

Bill Klaproth (host): And is that why then it's really important that diversity, equity and inclusion be a part of the overall strategic plan for healthcare systems?

Dr. Toni Flowers: Absolutely. And I think the word that you use is so important, strategic. It has to be intentional and strategic to recognize that we live in a time that we have more access to a greater diverse population of patients, a more diverse population of employees. And we live in a time where we have five generations in the workforce, which means you can have someone 18 working next to someone who's 80. And we know that they will bring to the workplace different mindsets and different thought patterns and different gifts that they can provide as employees. Well, it's the same thing with our patients, that we have a greatly diverse patient population with expectations and desires of how they want to be cared for that we need to be aware of and then able to meet. We have to be strategic and intentional and recognize that there are so many benefits.

And I think often that the healthcare industry often lags behind other industries like maybe hospitality or even the auto industry and understanding the importance of customer satisfaction. We know that those other industries recognize that if we don't do a good job with our customers, they're going to choose to go someplace else for the services and the goods they're looking for. Well, I think with healthcare, we've been a little bit arrogant in the sense that we're healers and people should be privileged to come to us. Well, it's actually the other way around. We should be privileged when patients drive past facilities and choose to come to us and come to us during a time when they are so vulnerable and in such need of care. And so when patients choose us, we should be prepared to provide the best quality of care for them and to assist them in their healing journey. So as we focus on diversity, equity and inclusion, we're creating environments where people feel they belong, not only our patients, but also our employees, that we value the gifts that they bring to us every day. And that as a result of that, we create environments where everyone is represented and patients see themselves reflected in our staff and our administration and our leadership and all the way up to our board.

Bill Klaproth (host): And that quality of care should be for everyone. It doesn't matter who you are or the color of your skin, right? It should be that same exact quality of care.

Dr. Toni Flowers: I believe the reason that we have this differences is because we're humans and we're not machines. You know, if we were dealing with a robot, we could standardize everything and know that it would work the same way every time with good maintenance, right? Well, for us because human beings, we have so many variables and so many things that can cause us to have different responses. So it's important for us, and that's why I say to be intentional that we recognize. I think I'm a little bit, extreme in the sense that I believe that working. Not just as a healthcare provider, but I consider us healers, that we are working to create an environment where people can heal. And it is an honor to be a part of their healing process. So it should be expected that they would have the best quality of care. No one goes to nursing school or medical school to provide poor here. Everyone wants, I believe, to provide the best care possible and we have to make sure that we keep that front of mind.

Bill Klaproth (host): So now that we understand what the issues are at hand, what are some of the action steps for our healthcare leaders at this point?

Dr. Toni Flowers: Well, I would say the first step is to begin to explore and examine where you are today. What's your baseline. Look at your data. We need to recognize that it's important to have data, but not just have data, have disaggregated data. Have our data where we can not just say, "This is how we're doing overall," but disaggregate that data by diversity metrics. Look at age, look at race, look at gender, gender identity, sexual orientation. Look at how are we providing care and our patient satisfaction scores for all of our patients. Look at our employee engagement scores to see in every area up and down the food chain, is everyone having the kind of experience we want them to have. Get a baseline to understand exactly where you are today.

And then, have a multi-disciplinary team, not just leaders by title, but leaders by actions, that come together and say, "Well this is where we are today. Who do we want to be in five years, in ten years? And what is the journey that we need to identify to get there?" And also include in that your community that you serve so that they can give you honest feedback around what their experiences have been with your facility and therefore, you have internal stakeholders and external stakeholders that are giving honest opinions and views on how we can begin to create that journey of belonging for all of our patients and for our teammates as well, so that we have the diversity, equity and inclusion, so that everyone feels like they belong and that they are privileged to be a part of the team and that we are privileged when patients choose us for their healthcare

Bill Klaproth (host): So make sure you have a baseline of where you're at and then focus on that multi-disciplinary team are some of the first action steps to take. So of course, there's a lot more in the article and I urge all of you to read it. Let me ask you this, what are then some of the key takeaways from this article that you've coauthored in Futurescan?

Dr. Toni Flowers: I think one of the takeaways is to remember the world has changed. And as healthcare providers, as healthcare facilities, we have to continue to change with that world. Our insurers, our payers are focusing more on diversity, equity and inclusion. They're identifying requirements of ways that we can encourage patients to have the best experience possible and have the best health outcomes. So by incorporating intentional strategies to create environments of belonging for our patients and our teammates, then we're in great place to meet those goals of diversity, equity and inclusion.

Bill Klaproth (host): That is very well said. The world has changed and we need to change with it. And I love how you said this is part of an intentional strategy, so being more intentional can really help us with this mission to further our diversity, equity and inclusion. Well, this is a great article. Thank you for co-authoring it. And thank you for all of your insight and your wisdom on this podcast. Dr. Flowers, thank you so much for your time. We appreciate it.

Dr. Toni Flowers: Oh, it's been my absolute pleasure. Thank you for having me.

Bill Klaproth (host): And once again, that's Dr. Toni Flowers, the coauthor for the latest Futurescan 2023 to 2028 Healthcare Trends and Implications out in November. Please visit SHSMD, that's SHSMD.org/futurescan, to learn more. And if you found this podcast helpful and, again, how could you not? Please share it on all of your social channels and please hit the subscriber follow button to get every episode. This has been a production of DoctorPodcasting. I'm Bill Klaproth. Say yah!