While each organization charts its own unique DEI path, being able to track effectiveness is a key component to providing safe and equitable care. In this "Safety Speaks" conversation, Hackensack Meridian Health's Avonia Richardson-Miller, senior vice president and chief diversity officer, and Rajan Gurunathan, M.D., vice president, discuss their organization's DEI efforts, assistance from AHA's Health Equity Roadmap, and how advanced metric dashboards has played a pivotal role in success.

To learn more about AHA's Patient Safety Initiative, please visit https://www.aha.org/aha-patient-safety-initiative

Tom Haederle

During the past several years, a growing number of hospitals and health systems have ramped up their diversity, equity, and inclusion efforts with focus and intentionality. While each organization charts its own unique DEI path, most of them, like New Jersey's Hackensack Meridian Health, have found that being able to track their effectiveness at the intersection of quality, patient safety, and health equity with measurable, reliable data is making a big difference.

Tom Haederle

Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Hackensack Meridian Health's DEI effort has made good use of several important tools, including guidance provided by the AHA's Health Equity Roadmap. It's also developed advanced metric dashboards that allow it to precisely gauge what's working and what can be improved. We learn more in today's podcast hosted by Joy Lewis, senior vice president of health equity strategies and executive director of Institute for Diversity and Health Equity.

Tom Haederle

Joy is joined by two experts from Hackensack Meridian Health. Avonia Richardson Miller is senior vice president and chief diversity officer and Dr. Rajan Gurunathan is a vice president.

Joy Lewis

Why don't we talk about how you got started? How did your organization begin its health equity journey? Essentially with a leaning towards what prompted you to even want to launch this work, and maybe a little bit in your response about how you initially identified where there were gaps, where those inequities existed across patient populations in your system?

Avonia Richardson-Miller

Hello, Joy, and thank you so much for this opportunity.

Avonia Richardson-Miller

First, let me say that I am so proud of the strides that Hackensack Meridian Health has made through years to address health equity. I want to say we've been on this journey for some time. We continue to build on the great work that has happened historically across our organization. But what has changed is our degree of strategic focus and intentionality around this work.

Avonia Richardson-Miller

Avonia Richardson-Miller

Avonia Richardson-Miller

So all of this really resonated with our leadership, strengthening our commitment to make a difference and address health equity through living our mission. Our mission is to transform health care and be a leader of positive change. So here's just a few of the actions that was taken. One of the first things is that our CEO, Robert Garrett, signed the CEO Action Pledge.

Avonia Richardson-Miller

He joined over 2,500 CEOs across the nation. It's the largest business initiative that's focusing on advancing DEI. And then within HMH created the role of the chief diversity officer and elevated that reporting structure to be a direct report to himself, the CEO. So I'm proud to be the first to serve in that capacity. We were formerly diversity and inclusion.

Avonia Richardson-Miller

So our scope also expanded with that to include equity. And so we would then have leadership and oversight to drive a network level health equity strategy, which I will add was an area of opportunity that had been identified in the most recent AHA survey. With that we created first thing, an effective DEI governance structure with stakeholders from all across the organization.

Avonia Richardson-Miller

That included a committee that was focused on health equity and our collaboration with our quality team, which Dr. Gurunathan leads a great deal of that work. AHA at the time also launched the Equity Roadmap, and we had the privilege to collaborate with you to actually pilot the health equity transformation assessment. And we partnered through our flagship hospital, Hackensack University Medical Center.

Avonia Richardson-Miller

At that time, we were able to recognize the great value that that tool provides.

Joy Lewis

Avonia Richardson-Miller

Yes.

Joy Lewis

this work is right. Absolutely. And having the sponsorship from the highest levels within your health system that it's really that trifecta.

Joy Lewis

The combination of all of that that has probably been really instrumental. And then having the support from the association.

Avonia Richardson-Miller

Yeah.

Joy Lewis

With the development, I mean, you got in on the ground floor helping us to actually craft that assessment to benefit the field. So thanks again for that. But it sounds like it's really this multi-factor...you know,

Avonia Richardson-Miller

It is.

Avonia Richardson-Miller

Let me just say that it started even at the highest level of our organization at the level of our board. That's critical. So that is really where it starts. And then our CEO.. and really do believe that it has to be top down and bottom up, inclusive of everyone.

Joy Lewis

So Dr. Gurunathan, I guess I would ask, how has the strategy that Avonia just walked us through

Joy Lewis

How is that evolved over time? And maybe since quality is a key area, a cornerstone, and we are often talking about the intersection of quality, patient safety and health equity. How do you leverage data? I know our point of view at the AHA is that data is an important starting point. You need to know your organizational story as it pertains to the data.

Rajan Gurunathan, M.D.

Yeah, I think data has been a central issue for us for a couple of different reasons, right? So number one really is understanding that in this context of the DEI quality landscape, you need a lot of context. And so just one set of numbers without any context can really actually be off-putting in some ways. Right. And throw people sort of that general track.

Rajan Gurunathan, M.D.

Right. So one thing we accepted very early on from a data perspective is we needed some sort of governance and quality mechanism in the beginning to make sure that data was collected in a reasonable and appropriate way. And there was training and competency around some of the things that we wanted to capture. And then we also wanted to make sure that once that information came in, that we were able to use it, first off, to understand our populations, like you said, because many of our interventions are really organized around the needs of our sites and their communities.

Rajan Gurunathan, M.D.

So they're heavily influenced by demographics and they're heavily influenced by the community needs assessment framework of the social determinants of health. And so once we established let's get good data, right, then it was what type of data? And that data again started with just understanding who we're serving. And that really helped frame out a lot of our efforts because we realized, you know, as a network we're over 50% women in terms of patient mix.

Rajan Gurunathan, M.D.

We have several sites that are highly geriatric, and we have several pockets of real diverse language levels, and we have several pockets which are much more homogeneous, but means that it's even more critical that data framework of understanding who we are was really important. And the last piece I think that really helps make it actionable is to make it as self-service as possible.

Rajan Gurunathan, M.D.

And so we really were very intentional, as Avonia said, about figuring out how we could make our data platforms, which are cloud platforms, be able to stratify all of our information. So anything we want to be able to look at, we should be able to look at with this particular type of lens. And so as we build out our data platform, having that in there and having it self-service where any leader in their department could be able to click through their quality metrics and goals and be able to stratify them immediately and see their population.

Rajan Gurunathan, M.D.

That's been very powerful and helping promote what we want to work on, how you can follow it, and tools to do it.

Joy Lewis

No that makes sense. I think the ability to self-interrogate and slice and dice your data across what you just described gender, age, language preferences, race and ethnicity and all of those dimensions of diversity. And also looking at the social drivers of health. That's exactly the direction that we've got to take this work. You mentioned that you've made it self-service.

Joy Lewis

So does this mean you've created dashboards or some way to track and monitor the progress?

Rajan Gurunathan, M.D.

Yeah, absolutely. So we've created a series of dashboards actually. And so some of them are large scale dashboards which again let us look at the whole network, right. Demographics of the network, right. Race, ethnicity payer etc.. And then there's some specific ones that relate to cultural competence, right? To be able to look at that. And so how often are we properly documenting preferred language,

Rajan Gurunathan, M.D.

For example? How often are we offering interpreter services, documenting interpreter services in the right fashion, and how often are we providing discharge instructions, for example, or other materials in preferred language? So there's a set of cultural competence dashboards that are also very relevant. And lastly, I think, you know, the idea that we look at this as a care for all kind of initiative, right?

Rajan Gurunathan, M.D.

But at the same time, you can't ignore the fact that there are certain populations which in the literature are full of disparities. And so for us to have eyes on those populations of maternal health, behavioral health, pediatrics and cancer. And for those, I think it's looking at the process of care as well as the outcome.

Avonia Richardson-Miller

Dr. Gurunathan, maybe speak a little bit about the one link dashboard too, because that was a major advancement with us too, looking at health equity.

Rajan Gurunathan, M.D.

100%. And that was really driven by Avonia and several other high level leaders in our organization to be able to start bringing equity and safety into the same conversation. In terms of our event reporting system, we should be able to have the same visibility and the same lenses on those events, just as we do on other types of outcomes and goals.

Rajan Gurunathan, M.D.

And so again, we can now stratify our event reporting system with similar fashion. And so there's a lot of power in that, you know, both on the front end and the back end, right. So bringing all those data points together helps round out our view on where we need to improve and where are the gaps, as you were describing.

Joy Lewis

And creating that larger context. As you mentioned earlier.

Chris DeRienzo, M.D.

Thank you for tuning in to this episode of Safety Speaks, the podcast series dedicated to patient safety, brought to you by the American Hospital Association. I'm Dr. Chris DeRienzo, AHA’s chief physician executive and a champion of the AHA Patient Safety Initiative. AHA's Patient Safety Initiative is a collaborative, data driven effort that lifts up the voices of individual hospitals and health systems into the national patient safety conversation.

Chris DeRienzo, M.D.

We strive to catalyze and connect health care professionals like you across America in your efforts to innovate and improve, and to bolster public trust in hospitals and health systems by helping you share your successes. For more information and to join the 1,500 other hospitals already involved, visit aha.org/patientsafety or click on the link in the podcast description. Stay tuned to hear more about the incredible work of members of the AHA's Patient Safety Initiative.

Chris DeRienzo, M.D.

Remember - together, we can make health care safer for everyone.

Joy Lewis

Before I move back, Avonia, are you reporting out these data and your progress to internal stakeholders? How does it bubble up to the board level at the board table? And have you gone as far as sharing any of these data with your community partners as well? Just curious about that.

Avonia Richardson-Miller

Absolutely. It does get shared with the board

Avonia Richardson-Miller

and actually Dr. Gurunathan coordinates presents to the quality committee. And then we also have an executive DEI council that's chaired by our CEO has many stakeholders across the organization a part of that. So it's regularly reported out there as well. And then whenever we're speaking we may reference some of it not, you know, not our whole dashboard report, but certain things that we're speaking to.

Avonia Richardson-Miller

We may speak to some of that data there.

Joy Lewis

What a strong signal of support, though, to have your CEO as the chair of your DEI council.

Avonia Richardson-Miller

Absolutely. He is our biggest champion.

Joy Lewis

Yes. This is what you need. Okay. Over to you, Dr. Gurunathan.

Rajan Gurunathan, M.D.

No, I completely agree. And I think having that level of leadership, acceptance and accountability and the empowerment of the rest of us to operationalize that strategy has really allowed the organization, I think, to take this battleship in an ocean kind of issue. I think, you know, really with a lot of steam. So I think, to the point that Avonia was making about all the way, you know, the governance structure and the data, certainly it goes all the way to the board.

Rajan Gurunathan, M.D.

And what I especially like is that we've been able to align all of it, right? And so it's not just random data at random meetings. It's information about the same kinds of things. It's information about the same kinds of populations that we're interested in. Information about the same processes of care around cultural competence and communication with patients in the same way.

Rajan Gurunathan, M.D.

So I think what's been especially valuable for me in this is, is seeing how when you stack all those things together, that you can actually move the needle, and it doesn't seem so much like a series of one-offs.

Avonia Richardson-Miller

I think to what Dr. Gurunathan was saying, what the beauty of it is it's not the check the box of the extra thing that we need to do to say that we're doing health equity, right. Our aim is that it's the lens by which we approach all things. And also the fact that it's everybody's work and everybody has accountability for this.

Avonia Richardson-Miller

Whatever role you have in an organization, whatever department, there is a DEI lens on it, too.

Joy Lewis

Sounds consistent with the way we think about it at the AHA both on the clinical side and the operational side.

Avonia Richardson-Miller

Absolutely.

Joy Lewis

Because to your point, everyone should begin to see him or herself as an equity influencer from wherever they sit.

Avonia Richardson-Miller

Absolutely.

Joy Lewis

Inspire others to take action and to really coalesce around that, that North Star, which is equitable care, safe care for all.

Joy Lewis

We didn't talk much about the role of community and how you're collaborating with your community partners to ensure that whatever the solutions are that you're developing are being done in a collaborative, very intentional way. I think that's amiss, Dr. Gurunathan, when you said the secret sauce, you know, you just described, I think another component of that secret sauce is the collaboration with the community.

Avonia Richardson-Miller

Absolutely. And so we have defined at the highest level four pillars to drive our efforts for DEI and health equity. Number one: being focus on patient care and outcomes. Number two: on community. Number three: on our workforce, right? We want to make sure representation matters. And then supplier diversity is a fourth one. And that one because that drives jobs.

Avonia Richardson-Miller

That drives wealth. That drives sustainable communities. And that's just the four high level buckets. We are doing some work in the space of community and for example, our community health needs assessment. The most recent one that was done has been done completely through the lens of health equity. And then our social determinants of health space, where Dr. Nicole Harris-Hollingsworth leads this area -

Avonia Richardson-Miller

over 4 million screenings have been conducted. Five million referrals. And what has been incorporated now is the closed loop reporting for that system. And so those are referrals that are going out to agencies that are aligned with the type of work that we do. And that's driving where some of our focus is around those community collaborations.

Rajan Gurunathan, M.D.

I would look at those community aspects again with two sort of buckets. Right? I think certainly the community needs assessment helps frame out our data context in a particular way, right. Because it establishes links between the services and the services provided and needed. And I think also we've got a robust network of community health workers that actually partner with us, who are actively out in the community and engaged not only with our patients, but with, you know, patients that don't even follow with us.

Joy Lewis

That's right. We're learning more and more about the value of the role of the community health worker as a real, integral part of the care team. Are there any final thoughts you want to leave with our audience today? Because I've been inspired by the good work that you're leading on the ground there in New Jersey.

Avonia Richardson-Miller

I think it's important to just know that you have to start the work and you start wherever you are.

Avonia Richardson-Miller

Avonia Richardson-Miller

But in the short amount of time, Dr. Gurunathan has really described where we've come along that continuum with data, because I believe in our baseline assessments of the HETA we were exploring, we fell in the category of exploring consistent with where most of our hospitals are. So yeah, you're not alone. But now we are far beyond that to get mission accreditation in a very short time.

Joy Lewis

Yes. So it's doable.

Avonia Richardson-Miller

And that's due to partnership with our IT department.

Joy Lewis

Great. And you Dr. Gurunathan.

Rajan Gurunathan, M.D.

Yeah, I think Avonia said it very well. I think you know my three words or three lines of advice - hashtags would be, you know, just start for sure. I think that's just, you know, the number one. I think the idea of being collaborative, as Avonia mentioned, because it affects all aspects of the organization. And then lastly, be intentional because you don't have to cut it off all at once.

Rajan Gurunathan, M.D.

And then I think, just figure out what's important to you and the people you serve. And there's clearly room for gains.

Joy Lewis

Excellent. So thank you, thank you, thank you for being here.

Avonia Richardson-Miller

Joy, can I add one more thing?

Joy Lewis

Sure.

Avonia Richardson-Miller

Don't think that you have to reinvent the wheel. Use the resources that are out there. Yes. And I'm talking about the Equity Roadmap. And then all of the resources that Joint Commission has also identified.

Joy Lewis

I think you're spot on. That's one of our key lessons that we want to leave with our audience is you don't have to feel like you're alone in this.

Joy Lewis

There are others who you can beg, borrow and steal from. The AHA has done a lot of the heavy lifting for you, so please, this is a member benefit, frankly. So why not lean into the Health Equity Roadmap and other tools and resources that might be there at your disposal from, as you mentioned, Avonia to the Joint Commission and other spaces.

Joy Lewis

So thank you again and keep up the good work.

Avonia Richardson-Miller

Thank you. And you too, because we are, as you say, borrow, steal. We're doing that from AHA.

Joy Lewis

We're in this together.

Avonia Richardson-Miller

Thank you.

Rajan Gurunathan, M.D.

Thank you.

Joy Lewis

Take care.

Tom Haederle

Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.