LEDI 91 | Healthcare System

 

Every health system leader has unprecedented executive management challenges facing their organization in the wake of the pandemic. Sometimes people start feeling overwhelmed by our capitalistic healthcare system. As sad as it sounds, having access to healthcare is now more of a privilege than a right. In this episode, we have catalysts of change KaiLonnie Dunsmore and Duane Reynolds to talk about our healthcare system and why it is important to start changing it. Duane and KaiLonnie share the vision we should have for the health industry: transforming healthcare into a human-centered system! It is high time to stop tolerating the special treatment of the higher class, the shutdowns of hospitals serving the underserved market, and the capitalistic priorities of the system. It is the time for change. Join us in this revolutionary conversation!

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Duane Reynolds And KaiLonnie Dunsmore

We’ve got a great conversation, don’t we, Ben Sawyer? Do you remember Ben, my trusted co-host from Bald Healthcare?

I’m looking forward to this very important conversation, Roger. Great to have KaiLonnie and Duane on.

It is. We’ve got two wonderful guests on this episode and let me briefly introduce our guests and the topic we’re going to be talking about. This is a very important topic for all of you who are in healthcare leadership now. This is something that’s probably not new to you but you are looking for some fresh ideas. That’s our hope that we’re going to give you some fresh ideas and some hope in terms of how to thread this needle and how to take care of this very important new standard.

It’s not a new standard but it’s a way for us to ensure that there’s equity in our organizations. We’re going to talk about how mission-driven organizations can improve equity and boost access to health. In order to help us have this meaningful conversation, Ben and I have called upon our good friend, Dr. KaiLonnie Dunsmore. KaiLonnie is the Director of Community Initiatives at the Baldridge Foundation now among other things but she works with the Communities of Excellence.

I’m sure many of you have heard about Communities of Excellence and the initiative that the Baldridge Foundation has been hosting. She’s got such a great resume and great background. KaiLonnie, as I said, is a friend of ours. We’ve been able to work on some projects together. Her PhD is from Michigan State University. She focused on literacy, disability and professional learning and practice.

She’s been a Principal Research Scientist at the University of Chicago. She’s involved in a lot of projects and is a great resource. She brought to us our new friend, Duane Reynolds. Duane is the President of the Chartis Just Health Collective. He is the Founder of the Just Health Collective and has become part of Chartis recently. He was also a consulting leader at the advisory board company. He also worked for the American hospital association’s Institute for Diversity and Health as its President and CEO. As I said, we couldn’t find two better people to help us discuss this topic. KaiLonnie, welcome. It’s great to see you and have you be a part of our conversation.

Thank you. I’m excited to talk about this issue and to talk with Dr. Reynolds.

Duane, thank you so much for being here. I’ve had the opportunity to listen to a couple of your excellent podcasts and you have such a wonderful and fresh approach to this topic. We’re looking forward to sharing that information with our readers. I’d say let’s get at it. Duane, you can talk a little bit about the journey that you’ve had in terms of how you are helping health systems approach in an appropriate way, this whole issue of diversity and health equity.

Roger and Ben, thank you so much for having me and KaiLonnie on to talk about this very important issue. This evergreen issue has now come into focus for healthcare. I’ll give you a little bit about my background, which spans many years in healthcare. I started my career in organizational development in a large healthcare system, then moved into operations for academic medical centers.

For about ten years, I was running faculty practices for academic medical centers, which, in my perspective, gave me an understanding of the business of healthcare, what drove healthcare, and also what some of the challenges were for healthcare as it came to marginalized, disadvantaged communities and for anyone that was interacting with the system. From there, I went into management consulting in the space of health systems and medical groups. I helped them figure out how to gain synergy and align around different objectives.

I became a subject matter expert in the area of access, which is a very critical component of the health equity conversation as we talk about individuals in their ability to receive the right type of service at the right time with the right provider. Again, I spent a good majority of my career inside of provider organizations which ultimately gave me this perspective that we needed to do something different to create a healthcare system that functioned better for everyone that was now interacting with it.

LEDI 91 | Healthcare System
Healthcare System: The area of access is a very critical part of the health equity conversation as we talk about the right kind of service with the right provider at the right time for the right person.

 

When I think about everyone, I think about the myriad of diverse demographics and characteristics that all of us show up with as we encounter this healthcare system. Understanding that the system itself was not constructed in a way that was meant to address all of the diversity dimensions that we now serve. Understanding that I dove into this work when I was at the advisory board company. I started off leading internal diversity, equity and inclusion for our consulting firm but wanted to marry my passion for healthcare, my career, and my professional experience in healthcare administration with this concept of diversity, equity and inclusion.

What that translated to was the establishment of a health equity consulting product. From there, I was able to begin to think about what was ultimately coming around the corner, which is where we are now. What was coming around the corner was this need to focus on how we constructed a system that created equity and justice and allowed individuals to show up as who they are inside of the healthcare system, which ultimately, advances concepts of equity, both for employees and for patients in the community. That’s a little bit about where I came from that has led me to this point in my career journey.

What a great start and wonderful experience you’ve had in working inside the consulting field and health systems. That’s great. We’re so glad to have your insights. KaiLonnie, maybe you could share with our audience a little bit about what you’ve been doing, particularly about the work that you’re doing for the Baldridge Foundation with Communities of Excellence.

The reason I’m pretty excited about this topic and having Duane on is when we think about Communities of Excellence, that’s the new congressionally approved funded category in terms of award category within Baldridge. The Communities of Excellence bring a lens of thinking about solving problems and challenges in a collaborative way in a community-based way. Whether it’s thinking about food insecurity, early literacy or early childhood outcomes, it’s recognizing that in order to tackle some of these problems, we need to do so from a perspective that looks at the community, not at individual organizations.

Baldridge, historically, funded awards in categories in healthcare. We think of it in education and manufacturing but the award category within Communities of Excellence says that we want to recognize and award communities that take on these challenges in a collaborative way. I’d like to use that lens to shift back to Duane and talk about this issue when we think about equity.

Your work has been within working with healthcare systems and hospital systems but I know you’ve also talked about the need to move beyond the four walls to tackle this. What I’d like you to think about and talk about with us is how, as we think about equity, it requires hospital systems to do this well. Not just to think about what they’re trying to do with their services but maybe a new way of sharing data, data transparency or working with new kinds of partners. Give us some expertise and insight from your lens on how people can approach that while knowing they have a bottom line in their own institution to address.

Thank you for bringing up that very important point. I’ll set the context of the framework that we, at Chartis, use to look at this, which is three prompts. The first is thinking about the inside of the organization. That could be a hospital, health plan and health tech company. It’s the myriad of organizations that are collectively working on this issue that will help to solve it. As we think about the inside of the organization, we’re driving toward diversity, equity and inclusion, and that is for our employees and for the patients that we serve.

As we shift to the outside of the organization, we’re talking about the community and how we partner with organizations in the community to ultimately advance goals toward equity. The reality is healthcare organizations alone cannot solve this issue. They’re in a great position to be able to influence because patients are coming to them. Most people have to interact with the system at some point but they should not be the sole bearers of solving for social, environmental and political determinants of health, which are the drivers of inequitable health.

As we think about that, we have to be thinking about the entities within the communities and particularly those individuals who are marginalized and on the receiving end of poor health as a result of some of these social drivers of health. What we’re seeing across the country is that there are communities now that are coming together in a collective way. That might be organizations developing a 501(c)(3) in which multiple stakeholders such as community-based organizations, corporate organizations, healthcare organizations, philanthropic organizations and government entitie, all come together to ultimately create a vision and design a path for solving some of these social drivers of health.

What we know is that that type of work takes coordination, multiple perspectives, and coming to the table as there’s a shared power that each organization must come to the table ready to give up some of the power that they might possess by virtue of the size and scale of their organization understanding that, again, to drive towards true community change. We have to center those who are in the community who are most marginalized and most vulnerable. If we can think about that perspective as we go about solving some of these broader societal issues, then what happens inside of healthcare will reinforce the ability to solve those issues.

Duane, I want to make sure I close the loop. You mentioned there are three prompts. You talked about the inside and I love that you mentioned employees because some of the studies I’ve looked at suggest when we’re started tackling these issues of equity, we look at the patients. Some of the surveys done of employees within find that they’re not experiencing through their own healthcare plans provided by the employer. They’re experiencing the inequities that the organization is trying to solve with patients.

That’s right. The reality is employees are also likely patients of the organization and you have to get your own house in order before you go out trying to sweep up and fix someone else’s.

I’m intrigued by this. I was explaining to Duane and KaiLonnie before we started, this is for the readers, that we had Dr. John Chessare, who is the President and CEO of GBMC in Baltimore in 2022. He was talking about this very thing of marginalized populations and the social drivers of health and making sure that health systems are aligned around this. One of the things that we got into was the logistics of it as well as the principles of it.

In other words, if you don’t have the capacity and an easy way to essentially help those who need the care to gain access to those who provide care faster and efficiently, it compromises the ability to effectuate this admission. It’s interesting for us and ABOUT Healthcare because our vision is ubiquitous to whoever is asking.

The goal is to help those who need care and get to those who provide care faster. Have you seen, Duane, where there are operational obstacles and impediments that keep organizations from being able to do this effectively, or is it more slanted toward their awareness and understanding of these marginalized populations and the underlying social drivers? Is it both end or how do that work?

I would consider it to be both end. One thing I do want to clarify is that when we talk about health equity, we’re talking about everyone. Health equity is a concern of individuals who are in rural communities and who have shorter lifespans because of the challenges of primary care providers and of internet access. All of the things that ultimately keep them from attaining the same level of lifespan.

We’re talking about White males who suffered disproportionately from the opioid epidemic but we also understand that there are these social drivers that have kept certain communities and demographics from achieving optimal health for centuries. Our ability to solve this is one of looking at internal processes, procedures, and policies inside of organizations but also understanding that there’s a larger structural problem here.

If we think about healthcare and how it has been traditionally financed under a fee-for-service environment, we understand that volume is what drives the profit of a healthcare organization. If we’re focused on volume, then at the expense of those marginalized communities, we may not be creating health for the CEO that you mentioned. To his point, our system has not been about creating health.

When I talk to executive leaders across the country, what we’re getting into discussions about first is understanding concepts like bias, systemic racism, and structural racism and looking at that from an individual level and understanding your own contributions to that system. Bringing awareness to your own contributions to a system that is at play that has harmed individuals.

We have to move into thinking about how you as a leader have an opportunity to make change. That opportunity is 1) What you do inside of your organization, but 2) Understanding that there are these factors at play that we have to grapple with at a larger societal level, which is why the work that KaiLonnie is influencing is about the broader community picture.

We have to grapple with the fact that our healthcare system is a capitalist healthcare system. By virtue of that, we are going to have winners and losers. We cannot divorce ourselves from decisions that we have made, for instance, about where to locate a clinic or a hospital, when understanding that we typically are going to make those decisions based on business criteria. Where is the most growth in a particular area? Where are the best payers based off of who has insurance coverage?

We have to grapple with the fact that our healthcare system is a capitalist healthcare system. By virtue of that, we are going to have winners, and we are going to have losers. Share on X

With that, we make rational business decisions in order to feed our capitalist healthcare system. When we do that, we also then are making decisions not to place clinics in communities where the need is greatest, where we have comorbid conditions, individuals who don’t have access, and individuals who have transportation issues and food insecurity issues.

What I’m trying to help folks understand is within your sphere of influence inside of an organization, there are things that you can do but you as a leader also have to begin to challenge a system that is not working for any of us when we ultimately think about it. That system has to be deconstructed based on thinking about who is harmed in the system and who ultimately needs to benefit if we’re going to bring health to the masses in a way that is equitable and just.

Duane, we have these things in place, community health needs assessments that are intended to address some of those things you mentioned. We also have our calculation of community benefit and those things are, in some communities, wonderful. They’re helpful and in some places, it’s checking the box. You clearly know because of your scan across the country in your past and your present roles. There are people who are hitting it out of the park in terms of not just the capitalist agenda that you talked about earlier but creating health.

I’m curious to know what is the tipping point. What sets apart those communities and those systems that have gotten ahold of this, they understand it and they are A-plus, at the top of your list in terms of examples of what can be done. What is possible? What’s the tipping point? Is it an enlightened CEO that’s deeply committed to this? Is it some program? What is it, Duane? Help us out.

From what I’ve observed in some of the organizations that I’ve been in that are getting this right, it is an enlightened CEO. It’s also an enlightened board and an aligned leadership team that understands we are functioning in a system that is in some ways perverse in terms of not driving toward optimal health. It’s driving towards volume but understanding we have to still be able to keep the lights on, make decisions that we make from a business perspective but also begin to question the system itself and to advocate for new policies at a local level, a state level, a federal level that is going to lead us down a different path.

LEDI 91 | Healthcare System
Healthcare System: We have to still be able to keep the lights on, make decisions from a business perspective, but also begin to question the system itself and to advocate for new policies at a local level, at a state level, at a federal level, that are going to lead us down a different path.

 

I’ve encountered CEOs that see this as instrumental to who they are as an organization and what transformation they are trying to make ultimately. They’re leaning into value-based care and being very intentional about how they set up different contracts. Those contracts drive towards health equity, going at risk for achieving success and then starting to create a system that allows them to be successful in that endeavor.

That system takes a lot of effort. It takes retooling and helping people understand the priority is not how many people we’re seeing but how well we are treating those individuals. The costs that we are driving down. The experience and outcomes that we are improving and there’s a lot of work that goes into that but it starts at the top with the vision and strategy from the CEO, the board and the aligned C-suite team.

Duane, I want to talk more about that because this is where I start getting passionate about making sure that I talk about who’s at the table. I’ve worked in communities or with health systems and in partnerships where it’s someone who has this title. In a minute, we want to talk a little bit about the health equity requirements and the data pieces but it can be someone who’s off to the side. Their offices literally off to the side. You get people who are passionate about the subject but they are not at the table in the leadership decisions in their organizations. I talk about it as having line authority and making sure that who’s at the table are the people who are in decision-making roles.

Maybe you can talk a little bit about this in terms of the requirements. Hospital healthcare systems look at data and think about equity and are gathering equity data, which is the requirement from the joint commission. To me, this seems like an opportunity but there are ways of implementing it that could be about changing how we work as an opportunity. There are ways of implementing it that are very much compliance oriented. If you could talk a little bit about how the current maybe requirements can be an opportunity but some of these pieces we want to get in place.

The who’s at the table is a very important piece of the puzzle. This is why diversity, equity and inclusion inside the organization matter. You want people who have had a lived experience in the communities that you’re serving in positions of power and influence, where decisions are being made about resources and investments that the organization is going to make.

We still are woefully behind when we look at the leadership of healthcare C-suites. We still have not achieved what I would say is an optimal reflection of the diversity of our country or our communities. Every organization should be striving to reflect and mirror the community demographics that they serve. Also, realizing that even if we achieve parody with C-Suite representation, being in the C-suite is a privilege in and of itself.

There are folks from the community who have very different lived experiences or socioeconomic experiences that can still add value based on the experience that they have. How do you begin to invite those types of voices to the table to allow them to provide information relative to their lived experience and what they think is ultimately going to help solve the healthcare challenges and issues in their communities?

All in all, it is about diversifying the people who are a part of the conversation that makes this change possible, which is why, again, the work you’re influencing in communities is one of the major keys to solving these challenges. Now, the joint commission and other regulatory bodies are starting to put out requirements. Some of which started on January 1st, 2023. It’s exciting, for me, as a person that has been doing this work to see it come into regulatory compliance.

What that means is some people are going to come on board but they’re going to come on board and meet the letter of the law. They’re going to check the box and they’re going to assume that that is solving the issues when in reality, it is a baseline. It is the minimum thing that you can do to, for instance, collect race and ethnicity language data because that is information you have to have in order to be able to solve disparities to identify them to do performance improvement.

The reality is we still have to grapple and operate in a system that is not one in which we’re set up to solve for health. We’re set up for volume still. We’re moving towards value but we’re still in a predominantly fee-for-service environment. We have to have individuals who understand a broader picture who are concerned about not just the healthcare organization that they operate but the broader societal challenges and issues that we know are in front of us that require us to do something different.

To say, “It is not acceptable that we close hospitals in large cities that are serving an underserved community and we leave a major gap,” then expect the safety net system takes care of that. That’s not acceptable. It should not be acceptable if we truly are talking about having a human-centered approach to health. Hopefully, that clarifies my perspective on that. It is wonderful that we have these compliance components coming along. They will help us keep focus but they will not solve the major issues that we have at play.

It is not acceptable that we close hospitals helping underserved communities. This leaves a major gap, and we can’t expect the safety net system to take care of that. This should not be acceptable if we truly are to take a human-centered approach to… Share on X

Folks, unfortunately, we are a couple of minutes from our time allotted for this episode. I think that this is something that we’re going to have to maybe do part two. There are a couple of things I wanted to get into, Duane. We’ll give you the last word in a minute here or maybe KaiLonnie has one last question.

One of your guests on your podcast talked about collaboration between health systems. You talked about how we’re adding cost in one area but at the same time, the environment is we’re trying to reduce cost everywhere we can. Maybe there’s not enough time but in the future, how do we show that this can add value and revenue if you do it right? It’s not just a cost. There is revenue attached to doing this right.

KaiLonnie talked to me before we had a chance to meet about your vision for the future and what’s possible versus shame and blame for our past actions unless KaiLonnie has a question related to that. We’ll give you the last word, Duane, before we say goodbye to our audience and maybe we’ll pick this up again another time.

What we’re trying to get at is there are risks to not approaching this. There are also benefits and there’s the humanistic piece you talked about. There’s the financial piece but we want to get a vision of what’s possible and why we want to approach this in the best interest of a community, an organization, and individuals.

Ultimately, this work from my perspective is about being human-centered and about understanding that we all are connected. Our connectedness means that we will also win and lose together. When we have communities and demographics that are suffering, that will impact us in some way, shape, or form, whether it’s directly in front of us or not. Indirectly, it will impact how we live our lives. It will impact our ability as a country to ensure that we have the most educated populace and the healthiest communities out there.

All that matters in the context of our ability to thrive as human beings and as people living in the United States. Having said that, as we think about benefits that accrue, there are certainly financial things that we can point to that, for instance, if you close a gap in diabetes, disparities between African-American men and White men. You will likely see a reduction in ED visits and readmissions.

Those things allow us to avoid certain costs in the system. We know that. We’re already proving that with value-based care. What we have to do is define it by the stratification of different demographic characteristics because by doing so, we allow ourselves to think about new and innovative interventions that are going to close these disparities and reduce costs. From my perspective, this should not be about the financial benefit that we accrue.

Again, we’re thinking about that mentality is in the vein of a capitalist mentality. Part of the challenge that we have is balancing and trying to sustain an organization financially and trying to do what’s right. What we have to do is speak truth to ourselves and understand that the system has failed people for many years. Is it fair for those individuals who the system has failed for them to have to prove why there’s a financial benefit to fixing a system that has failed them? That’s a fundamental question that we have to ask of ourselves.

LEDI 91 | Healthcare System
Healthcare System: We have to speak truth to ourselves and understand that the system has failed people for many, many years.

 

That’s great a close to this fascinating discussion. As I said, we’ve just begun to scratch the surface of it and our readers will want to hear more. Your point about we’re all in this, we’re all connected, we win together or we lose together. It’s a great admonition and inside there, there’s hope. Thank you, Duane, for giving us that hope that regardless of the past, we can do better in the future. Indeed, we must do better in the future and you’re helping us do that.

On behalf of our readers, thank you so much, Duane Reynolds and KaiLonnie Dunsmore, for being with us and being a part of this important conversation. We will look to connecting with you in the future. You, to our reading audience, please let us know your concerns, your questions and what issues you’d like us to address. Again, I have a feeling you’re going to want to hear more from these two fascinating individuals. Thanks so much for being with us. Thank you, Ben. We will look forward to seeing you on the next episode. Thank you.

 

Important Links

 

About KaiLonnie Dunsmore

LEDI 91 | Healthcare SystemLiteracy Improvement & Systems Change Consultant.

 

 

 

 

About Duane Reynolds

LEDI 91 | Healthcare SystemMr. Reynolds is a frequent keynote speaker at board and leadership retreats and industry conferences. In addition to dozens of podcasts and numerous television appearances, he has presented at national conferences and symposiums including the Patient Experience Symposium, The College for Behavioral Health Leadership, HLTH, HIMSS, and The Black Enterprise Magazine Wellness Summit. He also authored numerous articles for the Journal of Healthcare Management, NPR, Modern Healthcare, HIMSS Medium, LinkedIn, Healthcare News, Saporta Report, The GA Voice, and Indeed.com.

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