Boston Medical Center: Leading the Way Towards Health Equity and Justice

00:00:00:18 - 00:00:21:24
Tom Haederle
In 2020, Boston Medical Center took a hard look at the data and was forced to conclude that its best efforts to close disparities in health outcomes among its patient population were not really making a difference. So, BMC went back to the drawing board, conducting a long and thorough review across all its systems of why such gaps remained and how they could be addressed.

00:00:21:27 - 00:00:41:12
Tom Haederle
The result was a new approach that not only helped close disparities among different groups, but has also been recognized with one of the most prestigious awards in the health care field.

00:00:41:14 - 00:01:18:22
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Boston Medical Center is the winner of the AHA's 2024 Foster G. McGaw Prize, which recognizes hospital efforts to improve the health and well-being of everyone in their communities. In this podcast hosted by Nancy Meyers, AHA's vice president for Leadership and System Innovation, we hear from Dr. Thea James, vice president of mission with Boston Medical Center, about how BMC's creation of the Health Equity Accelerator helped lead the way to achieving health justice in the communities it serves.

00:01:18:25 - 00:01:27:05
Tom Haederle
This podcast was recorded in San Diego at the American Hospital Association's annual Leadership Summit. Now let's join Nancy.

00:01:27:08 - 00:01:52:08
Nancy Foster
So, Dr. James, the Foster McGaw committee members were really impressed with BMC’s approach to addressing disparities in health and health care, not just as a separate thing, but as a foundation to the overall strategy of BMC in general. So talk about how the organization has made that shift to really incorporating equity as the foundation of everything that you do.

00:01:52:10 - 00:02:39:21
Thea James, M.D.
Thank you for that question, Nancy. I think what happened is, you know, we serve a population that disparities are front and center all day, every day. And we also have for decades created lots of different programs to address some of the challenges that our patients have. But I think in 2020, when so many things sort of emerged and people became more aware of - and you remember, there were so many people across all sectors who were coming out with commitments to equity statements. And honestly, to our credit and to our CEO and our executive vice president at that time -

00:02:39:23 - 00:03:08:14
Thea James, M.D.
to their credit, they said we're not gonna do that. We're absolutely not going to do that. And I think they said that because they were reflecting on all the work we had done, all the programs we've created to address the challenges of our patients, many that have been even disseminated across the country. When they looked at clinical outcomes data for Boston from a demographic perspective, none of which was surprising

00:03:08:14 - 00:03:29:20
Thea James, M.D.
if you really think about it. I mean, you really think about it, it doesn't matter what you measure. You already know who's going to do worse if you look at it from a demographic perspective. And I think that fact and all the work that we've been doing for so many decades and all the work we've been doing, was having no impact on that data.

00:03:29:22 - 00:04:08:19
Thea James, M.D.
I think that made them say, we're missing something. And so what they decided to do instead of coming up with an equity statement, was to look inside our own house and look across the entire enterprise, looking at clinical work, inpatient, outpatient, education, research, human resources, even public safety, and look for disparities with an intentionality to interrogate the disparities back to the root cause, and also to use the subjects of the data to help us interpret it and to help us with implementing approaches to close the data.

00:04:08:21 - 00:04:33:01
Thea James, M.D.
You know, many people study disparities, but never with any intentionality to close the data and close the gaps in the disparities. And so that's what they did. And we did that. We looked at more than 100 analyzes because, you know, we collect data anyway. We have a data warehouse. They broke us up into four work groups, six work groups covering those areas

00:04:33:01 - 00:05:04:01
Thea James, M.D.
I named in the beginning. There was a great deal of accountability involved. Each work group was led by an executive sponsor. We met about 3 or 4 times a week and once a month at a two-hour round table, and everyone had to report out on their work. And what we did was to identify which disparities we were going to work on, closing over the next 12 to 24 months, using that model that actually had been established by some work done by ObGyn.

00:05:04:04 - 00:05:09:13
Thea James, M.D.
And that's how we got to here. And they've turned out to be proofs of concept. They're working.

00:05:09:16 - 00:05:33:03
Nancy Foster
You know, and it strikes me you talked about doing it in 2020, which was post the murder of George Floyd, which spurred many folks to relook at how they were addressing equity. And it also happened to be in the middle of a pandemic. Exactly. How did that shape the work that you did, or did it kind of shape the or give impetus to the work as well?

00:05:33:09 - 00:05:57:23
Thea James, M.D.
Well, the pandemic was so revealing. It was really revealing. I mean, it revealed things to people that people don't question. People acknowledge - well, they don't acknowledge it, but they accept it as a natural order of things. And it really isn't. They don't question it. In fact, if anyone suggests addressing it, people will say things quickly like, you can't boil the ocean.

00:05:57:26 - 00:06:00:24
Thea James, M.D.
And we just decided not to accept that.

00:06:00:27 - 00:06:29:09
Nancy Foster
Yeah, it's hard when you're feeling so overwhelmed to take on something that feels new or goes deeper. So it's very impressive that you had leadership that made that decision to go that way. And so that's led to the creation of what you refer to as your Health Equity Accelerator. Yes. Which is kind of the organizing unit or part of BMC that has come out of this work.

00:06:29:10 - 00:06:37:08
Nancy Foster
So talk a little bit about what is that and how is it organized and how does it fuel the focus at BMC.

00:06:37:10 - 00:07:07:07
Thea James, M.D.
So, you know, once we identified all those disparities, and deciding that we wanted to address these with intentionality to close the gaps. The first thing we did was to set a principles of engagement. They said that nothing that already exists is immune to being questioned. They said we were all going to be on our own journeys, but that we would hold each other accountable and where mistakes were made and that we would look for opportunities to learn.

00:07:07:10 - 00:07:30:25
Thea James, M.D.
And once we decided all of these things, we had to figure out a way of operationalizing this work. And the first thing it did, they put us in a room for a couple of days with a facilitator. That's how we came up with the name Health Equity Accelerator. And it's all about health justice. And it operates a bit like a hub and spoke, but it has different sort of components to it.

00:07:30:26 - 00:08:00:02
Thea James, M.D.
You know there's research. We also have fellows, health equity fellows because once we identified, the first thing we did also was to identify the highest clinical areas, the clinical areas that had the highest levels of disparities. And, you know, interrogating and back to the inequities that were leading to disparities. We involve the patients to help us choose which order we would launch each of those vertical clinical areas.

00:08:00:04 - 00:08:24:12
Thea James, M.D.
Another thing we did, not only having them interpret the data, but also help us to identify what's most pressing and choosing them in that order. So the first thing we did was maternal health. As I said, ObGyn did that really identifying a root cause of a disparity in how quickly doctors were taking pregnant women to C-section who had hypertension in pregnancy.

00:08:24:15 - 00:08:50:21
Thea James, M.D.
And what they found was remarkable and literally the way that we supported them was through project managers and that type thing, because it required the support that they would need is through project management and a really robust analytics team, data analytics team that has been incredible. And also doing this work quickly, which is where the word accelerator came from.

00:08:50:21 - 00:09:17:04
Thea James, M.D.
We didn't want to study and restudy and restudy over years. We wanted to quickly get to the root cause of things. And I think the efficiency we found in interrogating back to root cause, having the subjects of the data interpret what the data meant, and also using them to implement ways to address what we saw, just got us to an answer and outcomes very, very quickly.

00:09:17:04 - 00:09:44:10
Thea James, M.D.
When I say outcomes, I'm talking about closing these gaps. And then we use the same approach with diabetes because that was the next pillar. And actually our community patient advisors chose that as the next vertical. And we use continuous glucose monitors. We used people who are like navigators and also did testing on people in terms of depression scores.

00:09:44:17 - 00:10:10:09
Thea James, M.D.
Depression scores were really high, and mainly because people were depressed over not being able to manage their diabetes, but through the interventions that we used, 39% of the people in that cohort reduced their A1Cs in just six months. And again, just attacking this and addressing this with intentionality, you design it to do what you want to know, what you want to learn.

00:10:10:09 - 00:10:21:21
Thea James, M.D.
And when you do that, it actually happens. It happens not only quickly, but also you're more likely to get it right the first time around based upon what they tell you. What the people, the patients in the cohort tell you.

00:10:21:24 - 00:10:54:25
Nancy Foster
Yeah. So I want to ask a little bit more about that, because I think what we recognized in the committee as we were doing the site visit at Boston Medical Center, is the relationship that you have with your patients, with your community is quite unique, and I think that a lot of folks are understanding and wanting to draw patients, family members, community into that strategic process at earlier points and have them be at the table throughout the entire process, but are maybe wondering how to do that.

00:10:54:26 - 00:11:10:26
Nancy Foster
So if you were talking to folks across the country at other hospitals or health systems, what are some practical tips that you would suggest that they think about as they're trying to bring those folks that they are serving to the table to help design the programs?

00:11:10:27 - 00:11:30:24
Thea James, M.D.
Sure. So, number one, I think you have to give up power. I hate to call it power, but that's essentially what it is. And that's the way you're taught in medical education. I mean, you just have to relinquish that and not be paternalistic, like we can be. Not think we know why these things aren't working for people and allow them to lead us.

00:11:30:27 - 00:11:59:18
Thea James, M.D.
The second thing I would say is, you know, we had Petrina Martin Cherry, our vice president of community engagement and external affairs, who has a very, very unique way of connecting people, bringing people together. She did a lot of work like that during the pandemic, connecting our leaders in the hospital, including like our operations people, strategy, people with leaders in the community to identify new sites for vaccinations, for example.

00:11:59:21 - 00:12:30:12
Thea James, M.D.
But she just does this job in a very, very different way. Like what she will always say is that many hospitals support communities by checking boxes, writing checks. And this type thing depends on what you're writing for, of course. But what we do is engage with the community and work with them as equal partners in this space. And people learn to trust you when you're asking them, you know, to lead the way, lead the process, and be a partner with you at the table.

00:12:30:18 - 00:12:32:02
Thea James, M.D.
That makes a difference.

00:12:32:04 - 00:12:42:14
Nancy Foster
And you do a great job of trusting the community to lead you in the direction that also makes sense for the organization. I think that's where folks are a little concerned.

00:12:42:18 - 00:13:06:19
Thea James, M.D.
Allowing people to have agency. Yeah, it's unique, but I will also say that Boston Medical Center has always been a place that does things in a very different way. You know, they're generally bold in how we make moves, and a lot of that has to do with being an essential hospital. You know, you are often working under the same pressures that our patients work under. Particularly, the ways in which we are reimbursed.

00:13:06:20 - 00:13:30:09
Thea James, M.D.
Similarly, we have cliff effects similarly, and it's a bit of what happens when you have a population like that, that you decide that you want to work with and want to take care of, and so you actually have some of the same challenges that they have. But we don't accept them as they are. We really, again, just reject this whole notion of you can't boil the ocean.

00:13:30:11 - 00:13:45:20
Nancy Foster
Well, we want to thank you again on behalf of AHA. Thanks to BMC for the work that you do every day, and also for the example that you provide to other health system leaders across the country. And congratulations again on winning this year's Foster McGaw Prize.

00:13:45:20 - 00:14:03:04
Thea James, M.D.
Thank you so much. Can I say one last thing? You may. In order for you to be able to do anything like that, it has to come from the top. It has to be a commitment coming from the top. And that is what's enabled us to do this as well. Thank you so much. We appreciate it.

00:14:03:07 - 00:14:11:17
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.