Equity of Care Award Winner Robert Wood Johnson University Hospital: Pathways to Health Equity

00:00:00:27 - 00:00:39:21
Tom Haederle
Advancing health equity by expanding and improving access to care is a top priority for caregivers of every shape and size. No two paths on the journey are identical. But broad outlines have emerged pointing to some of the most effective ways hospitals and health systems can achieve progress. Please join us for today's podcast and hear from a health organization whose outstanding work in the health equity space has earned national recognition.

00:00:39:24 - 00:01:07:17
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Robert Wood Johnson University Hospital has been honored by AHA with the 2023 Carolyn Boone Lewis Equity of Care Award. The award recognizes outstanding efforts among hospitals and health systems to advance equity of care to all patients and to spread lessons learned and progress towards diversity, inclusion and health equity.

00:01:07:19 - 00:01:26:20
Tom Haederle
In this discussion, hosted by Dr. Leon Caldwell, senior director of Health Equity Strategies and Innovation for AHA’s Institute for Diversity in Health Equity, we learned how Robert Wood Johnson University Hospital took big steps forward towards dismantling structural barriers in its care delivery system and the community it serves.

00:01:26:22 - 00:01:55:20
Leon Caldwell
Good afternoon, everyone. I'm Dr. Leon Caldwell, senior director for Health Equity Strategies and Innovation at the American Hospital Association's Institute for Diversity in Health Equity. I am pleased to be joined by the Emerging Equity of Care Award winner, the Robert Wood Johnson University Hospital's Franck Nelson, the assistant vice president for equity or of equity, I should say.

00:01:55:23 - 00:02:24:20
Leon Caldwell
So, Franck, welcome. This is a big day for many of us as it culminates a process we go through to award this Carolyn Boone Equity of Care Award. I'll say this is the inaugural year of the three categories that we have for the award and the Robert Wood Johnson Foundation Hospital, University Hospital, was awarded the emerging category, if you will.

00:02:24:22 - 00:02:46:16
Leon Caldwell
And that emerging category recognizes a hospital that is leveraging the health equity roadmap - resources to dismantle structural barriers in their care delivery system and the communities they serve. So this is a great award to have. We're honored to have you representing your hospital and want to say again, welcome.

00:02:46:18 - 00:03:07:23
Franck Nelson
Great. Thanks so much, Leon. I truly am honored and quite delighted to have the opportunity to be here this evening. On behalf of our hospital, we are all thrilled. We have an incredible leadership team, starting with Bill Arnold, who is our CEO, along with Alan Lee, who's our president, and a number of incredible senior leaders who are truly committed to this work.

00:03:07:28 - 00:03:32:21
Franck Nelson
And we have team members of the corporate level, Dr. Alexander. We have our Angel Thomas, a number of many incredible team members who all take part of the work that we do each and every day. And I would certainly be remiss if I did not acknowledge Melissa Hernandez, along with Stephanie Soule, who are both here today. We have Angela as well as Ed House, who are all incredible team members, part of our team.

00:03:32:21 - 00:03:56:13
Franck Nelson
So truly it takes a village, as we all say, and we have worked on putting together a great infrastructure to really drive the work, build a strategy, work with other colleagues, and ensuring the full optimization of this work. And as we all know, it's a journey and we're absolutely thrilled that we have been selected as one of the winners this year.

00:03:56:13 - 00:04:03:05
Franck Nelson
And we understand that this is just part of the journey. We're certainly not where we want to be. But we were very, very thrilled that we're here today.

00:04:03:12 - 00:04:24:12
Leon Caldwell
Yeah, you know, we don't take it lightly that the way we design the redesign, the award, is to recognize the journeys that many of our hospitals are on. Some are have been doing this for a while and they still know there's more work to do. Some are just starting and they know there's work to do. But the important part for us is that we're all in this journey together.

00:04:24:15 - 00:04:47:04
Leon Caldwell
One thing I would say is that being on the journey, there's different kind of waypoints and stops, and we wanted to make sure that this award recognizes those who are in the journey and really leading a light during the journeys process. Right. So thank you for all your work in this. What's also really important that we recognize is . . . IFDHE . . .

00:04:47:09 - 00:05:12:04
Leon Caldwell
one of our indicators that this work is really taking hold. People are in the journey. They're okay to make mistakes. They're also taking a pause to celebrate because one thing that we want to make sure we recognize is that institutions, hospitals, health systems, in order to sustain this work, the infrastructure has to be in place, right? And that infrastructures with policies and practices.

00:05:12:07 - 00:05:40:24
Leon Caldwell
And we really want to make sure that there's a dismantling of those structural barriers before we can overlay what we call health equity or advancing health equity. And that's a really important piece. In Robert Wood Johnson Foundation here is the hospital has taken that on, right? And so I want you to tell me about, one, your health equity department, the work that it's been doing, and then what are some things you want us to know about that's really crystallize your award winning season, I should say?

00:05:40:26 - 00:06:11:07
Franck Nelson
Sure. I appreciate that. I'll make one quick distinction between our Robert Wood Johnson University Hospital, which is one of the main hospitals that are UJA Barnabas Health in New Jersey, and differentiating that from the RWJ Foundation. They're both in New Jersey, but they're not the same organization. I just want to quickly outline that. But for us, I think starting out with the infrastructure, one of the things that has been quite significant really begins with leadership by-in. We have a very committed leadership team

00:06:11:07 - 00:06:33:22
Franck Nelson
as I mentioned earlier, Bill Arnold, when he first started, Robert Wood Johnson University Hospital, made a commitment to the board to ensure that we were looking at how we can improve the care through the communities that we're serving, how can we be very well connected with our community, understanding that there's a lot of great work that was happening in our community from our director of community health and outreach.

00:06:33:25 - 00:06:51:16
Franck Nelson
But we also wanted to make sure that the access to care piece was fully embedded within what was happening. So I came on board. I had a corporate role as a health equity manager, and I had an opportunity to be now responsible for the one site and got an opportunity to work in my current role two years ago.

00:06:51:18 - 00:07:18:07
Franck Nelson
And my first responsibility was really to conduct an assessment to understand where we were as a team, what opportunities we had as a team, and how do we build a team that can help drive towards that journey. And of course, being the first person at the local level, meaning at RWJ University Hospital, my responsibility was to look at a strategic framework in which we could leverage workforce equity, which is diversity, equity and inclusion.

00:07:18:09 - 00:07:41:24
Franck Nelson
Identifying the health equity space as we traditionally know it and also looking at the community health and outreach piece. So the current framework is ultimately divided in those three areas. We had to look at how we can recruit all directors and all of those roles and make sure that those directors could fully operationalize the work and implement these initiatives.

00:07:41:27 - 00:08:17:07
Franck Nelson
The other piece that was particularly impactful for us was working in leveraging a navigation model. Historically, at Robert Wood Johnson University Hospital, we had a Chinese medical program which was developed in Monmouth County with one of our senior leaders, Shirley Wong, who did that work. So for us, what we wanted to do is make sure that as we're thinking about equity, as we thinking about health equity, in looking at access, we wanted to create a similar model and make sure that we're increasing navigation and we're connecting patients directly to our services and the care that was needed for our community.

00:08:17:10 - 00:08:44:17
Franck Nelson
As part of that, under the health equity framework, we looked at two processes and I'll make it very, very clear. The first one was improving the operational efficiencies within how we're collecting data, how we're analyzing data and some of the projects that were being implemented within the hospital. So operationally, we had to ensure that equity was fully embedded within the operational workflow.

00:08:44:20 - 00:09:12:05
Franck Nelson
Additionally, as we're doing that, the other part was making sure that patients were being connected with the right services. So we rolled out an African-American medical program. We rolled out of course, the Chinese medical program was already intact, in addition to a Souza blood medical program which focused on the Hispanic community. So in all, we had a robust and comprehensive community medical program, which really provided the framework to connect directly with the communities that we're serving.

00:09:12:08 - 00:09:39:26
Franck Nelson
Beyond that, we had the Access to Care initiative, which is ultimately a program that allows for anyone who does not have a primary care provider. For us, in collaboration with the Federally Qualified Health Center chamber, which is an entity of our partner Rutgers University. We wanted to make sure that those patients automatically had a referral to a primary care provider. That did two things. The first thing is,it allowed for the community

00:09:39:27 - 00:10:02:03
Franck Nelson
ultimately to be connected to a primary care provider, which in a sense helps the community become healthier in the long term. And the second aspect of that, it reduced emergency department readmissions. Because ultimately our community did not have to use the ED for primary care services. In a nutshell, there's been a number of other initiatives that took place.

00:10:02:03 - 00:10:38:22
Franck Nelson
So we have a number of navigators who are working directly. We have a breast care initiative which connects patients for early screening to make sure that we could identify early detection in the communities that we're serving. So if we think about the overall model, it really begins with, as I mentioned earlier, leadership engagement. And by end of the additional layer would be having the directors really owning each of their workflow and thirdly, having the frontline staff members who are working very closely with the patients as well as the communities that we're serving and connecting those with the care that was needed.

0:10:38:28 - 00:11:14:22
Leon Caldwell
Yeah, that's a great example of the equity roadmap and some of our six levers of transformation. I can see about three levers being leveraged there. One of the great things about this as well is if you listen to you in the way you all think about or have practiced equity, right, particularly cultural equity. And for those who may get that confused with equality, it sounds as if what you did was meet people where they needed and gave each cultural group what they needed, not give them all the same thing.

00:11:14:24 - 00:11:44:10
Leon Caldwell
And while for some that may sound like a bit of segregation, if you will, it's the necessity of being able to identify with language differences or cultural nuances. What are those things that this particular community needs to get access to care in a way that you actually define it? This is a great example of that work. The other piece to that I wanted to make sure we highlighted is that you're for hospitals work, right, and investment in equity policies and practices.

00:11:44:12 - 00:11:52:27
Leon Caldwell
It sounds like it actually avoided cost of ER visits, right? So there is a return, if you will, on your equity approach.

00:11:53:00 - 00:12:13:24
Franck Nelson
Most certainly. I can so appreciate your assertion here, particularly about the inclusion of the work itself. As we think about the community medical program, the practice behind that is to make sure that our communities that were face of it were serving particularly those that are of diverse backgrounds and those who may be underserved, that those patients were connected with the right services.

00:12:13:24 - 00:12:35:15
Franck Nelson
So I can totally appreciate your point about how that may be perceived by some. But ultimately, when we think about the level of the work, there is no one that's ever turned away from care. The goal is that we want to make sure that if someone has a language barrier, that they have access. If someone may have a lack of trust, that they're able to build trust with a navigator.

00:12:35:17 - 00:12:59:16
Franck Nelson
If someone has a particular issue that they're able to have someone directly that can help them with that. So absolutely, having community medical programs with navigation certainly has been really, really a winner for us. But the other point that you made about the investment or return on your investment, we also have a gender center that is focused on the LGBT plus community and providing care and services and navigation in that community as well.

00:12:59:19 - 00:13:22:19
Franck Nelson
And as we're thinking overall, when it comes to all of our community members and ensuring that communities remaining healthier, we know that all hospitals, for the most part, are facing all challenges as it relates to their emergency department. At our hospital in particular, at any given day we're really running at over 100% capacity and there's certainly a demand for our full volume and demand for space.

00:13:22:22 - 00:13:53:07
Franck Nelson
And more importantly, we just want to ensure that we are fully functioning as a quaternary place, such that the patients that could be seen by a primary care provider there, in fact, they have that opportunity. And so to your point, when you when we look at essentially how do we have a win-win model where the patients primarily is benefiting and two, we're also creating additional space such that the patients that really need the quaternary services and those that need the surgery, that need the bed, they can actually have that.

00:13:53:10 - 00:14:08:07
Franck Nelson
So ultimately, we're increasing capacity for others who are in fact in greater need of that care because of their acuity, if you will. So that's what that does for us by connecting those patients with the primary care. So I think you hit that right on the nail there.

00:14:08:07 - 00:14:25:24
Leon Caldwell
Awesome. And so, okay, we're here at the Leadership Summit. We're enjoying what this summit has to offer, learning from each other and having a kind of an experience, if you will, with many of our colleagues. Tell me why this equity work is important to you personally.

00:14:25:26 - 00:14:59:07
Franck Nelson
Yeah, that's a great question, Leon. I'll tell you that for me personally, I started in this work about ten years ago. In fact, I'm a nurse by training, and so I have been in different countries. I grew up in Haiti where lack of care and limited access was definitely a major barrier. So when I came here to the United States, having been exposed to various communities, having seen the difference in terms of those who could potentially be seen at the primary care level, and essentially they do not have the trust and they do not have any type of rapport with their providers.

00:14:59:10 - 00:15:19:24
Franck Nelson
And normally it's not until it's almost too late that those patients are really going for their services as others can attest, in different communities. So for me, it was really about having an opportunity to are really making make care accessible. I've had family members who are affected, whether it's from limited access to care or those who may...I had a sister

00:15:19:24 - 00:15:53:21
Franck Nelson
in fact, when I was younger who passed away from typhoid, malaria. And so to me, I've always made that a mission for me to really have purpose in the work that I do. And I found purpose in connecting patients and providing access and increasing access and really ensuring that we're creating healthier communities. So that really has been the driver for me and seeing...I can recall one time where we certainly in fact, this past October we had a screening event for men of color. Men in general, but particularly we know that there was a gap for men in color in terms of getting properly screening and getting a PSA to be able to get

00:15:53:21 - 00:16:14:27
Franck Nelson
their PSA lab values. So what we conducted was we had a Sunday football event at the hospital. We opened it up for the entire community to be a part of that. And just seeing the outcome, seeing the number of people that came to that and just how it was well-received by the community. To me, that that really was one of the things that really was significant.

00:16:15:00 - 00:16:36:02
Franck Nelson
And that's why it's all about. Making sure that the community understands health care as a necessity and understanding that there can be a mistrust. I can understand that. But we have to ensure that there is a level of familiarity, there's a level of comfort, and that we're building that trust with our communities because ultimately that's what we're here to do, essentially to serve those that are part of our community.

00:16:36:09 - 00:16:46:18
Leon Caldwell
Yeah, I'm pretty sure that the men's group...one way you built trust was to make sure that the Eagles game was playing.

00:16:46:21 - 00:16:51:10
Franck Nelson
We actually had the Giants versus the Jets playing.

00:16:51:12 - 00:17:14:21
Leon Caldwell
So thank you so much, Franck. It's been a pleasure. Its great to meet you hear about your awesome work before the fall your incredible career ahead of you. So on behalf of AHA, thank you for your organization, your leadership, your efforts to be in the journey with us. And for those who are listening, we welcome you to visit equity.aha.org

00:17:14:23 - 00:17:26:16
Leon Caldwell
Join Franck and many others around the country who are engaged with the health equity roadmap. So thank you so much and really do appreciate you being here and all you offer us.

0:17:26:17 - 00:17:46:04
Franck Nelson
Thank you. Thank you so much, Leon. I have to tell you that we could not be any more grateful for really the structure that the AHA has put together. When we think about that road map and how we've leverage every aspect of that, truly has been remarkable. So I'd like to commend you for your leadership, your team as well, and of course, as the president of AHA and along with all the members.

00:17:46:06 - 00:18:03:03
Franck Nelson
It's really significant work and we understand that the journey...it takes a village. And it begins with leadership, the structure and obviously all the hospitals essentially embarking upon that journey. So we're really excited and thank AHA for the selection and we're truly excited about celebrating for the next year or so.

00:18:03:05 - 00:18:08:24
Leon Caldwell
Yeah, I'm sure your community is going to be ready for you to bring home that award and you'll share it with your navigators.

00:18:08:24 - 00:18:21:27
Franck Nelson
Absolutely. Thank you so much, Leon. I greatly appreciate it.