"This Is Sacred Work": The 2024 Carolyn Boone Lewis Equity of Care Award Winners

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Tom Haederle
Hospitals and health systems across the nation are working hard to advance equity of care to all patients and to spread lessons learned and progress towards diversity, inclusion and health equity. The American Hospital Association's Carolyn Boone Lewis Equity of Care Award was created to honor the most outstanding examples of such work. The 2024 award was split among three health systems who are helping to chart the path forward for everyone.

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Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In today's podcast, Jackie Hunter, vice president of Health Equity Strategies with the AHA explores the winning strategies of this year's three Carolyn Boone Lewis Equity of Care Award honorees. Their discussion was recorded at the AHA's Leadership Summit in San Diego. Her guests are Dr. Clint Merritt, chief physician executive with Augusta Health,

00:01:04:26 - 00:01:32:09
Tom Haederle
recognized for its progress in dismantling structural barriers in their care delivery system and the communities they serve. Rosangely Cruz-Rojas, vice president and chief diversity and equity officer for Mainline Health, honored for creating strategies to influence equity in the surrounding community ecosystem. And Juana Slade, chief diversity officer with AnMed, distinguished for demonstrated excellence in advancing health equity in rural or small communities.

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Jacqueline Hunter
Congratulations again on being recognized as the 2024 Equity of Care Award winners. This is a huge honor, and I am sure that comes with a lot of excitement for your organization and community. Clint, can you share with me what it means for your organization to win this award in your respective category?

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Clint Merritt, M.D.
Sure. Thank you for being here. We feel incredibly honored. Augusta Health is a community, nonprofit health system in the Shenandoah Valley in Virginia. We earned the emerging category in the Carolyn Boone Lewis Equity Care Award, and that fits that we're on a journey. We've had many different projects that fit into the health equity body of work, which means we've engaged a lot of people in the organization and a lot of community partners.

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Clint Merritt, M.D.
And so winning this award, it tells us that we're on the right track. It gives us a lot of energy. So we're incredibly honored.

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Jacqueline Hunter
Great. Thank you. And I ask the same question to Rosangely, what about you?

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Rosangely Cruz-Rojas
This is extremely exciting for us. We've been working on issues of health equity for about 13 years now, and it has been a period of going through a lot of learning, you know, doing the steps that you have to do in order to be able to understand what you need to do in terms of your work clinically, internally and some of the work we do in the community.

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Rosangely Cruz-Rojas
And so going through that whole health equity transformation assessment, the HETA, two years ago, getting some of the information back, help us really organize some of the efforts. And we went into putting the application as a way to show and demonstrate the efforts we found in so many areas, and it was just simply amazing to get the reward back of being awarded the winners.

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Rosangely Cruz-Rojas
We are in the category of transforming, which is for health care systems.

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Jacqueline Hunter
Great. Thank you. And Juana, what about you?

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Juana Slade
We're just incredibly proud. It's a long time coming. We've been at the work since 2001, and I think that this was an opportunity for us during that time to take a pause and establish the infrastructure that many systems around the country are really struggling now to try to get into place.

00:03:39:03 - 00:04:03:13
Juana Slade
But we had the time and the opportunity to engage internally across our system, but we also had the opportunity to establish relationships which are paying back benefits tenfold, because we have the trust of the community to be involved in the work. And that's not to mean that we're perfect, but we certainly don't have an issue with looking for our imperfections and then addressing them.

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Juana Slade
And we've got both clinical and non-clinical partners leading the work. And it's just not only personally rewarding and gratifying, but it's gratifying for those individuals who've been working for so long.

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Jacqueline Hunter
Great. Thank you. And Julie, you had referenced the Health Equity Roadmap. How was your experience with the Health Equity Roadmap thus far, and how does align with your organization's current strategic plan?

00:04:27:03 - 00:04:53:19 Rosangely Cruz-Rojas
So, and I said two years, I think it was really three, because we were part of the first wave of early adopters. That was 2021. We initially did it as a way to understand the different areas or pockets or levers where we needed to invest efforts and do work and help us really identify where we have opportunities, where we were more mature, what areas we needed to do better or integrate better with the rest of the work we were doing.

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Rosangely Cruz-Rojas
It really ultimately became a way of us developing our own internal maturity model. In fact, we were just finishing our strategic plan for DREI. We call it DREI because we add respect, and in doing so, we went through the health equity transformation assessment, identify where we had priorities and prioritize in our strategic plan, those areas where we wanted to do additional efforts to continue to move to the next level.

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Rosangely Cruz-Rojas
So it has become part of our maturity model, alongside with our community needs assessment and some other factors that we use.

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Jacqueline Hunter
Great. Juana, how have your organization incorporated the HETA within your strategic plan?

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Juana Slade
Absolutely. We, of course, completed the HETA as we had to do and as we were required to do as a part of the process. But actually, for us, it began about 15 years ago as a part of some work within the South Carolina Hospital Association under what we call the Health Coordinating Council.

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Juana Slade
So the terminology was somewhat different, but the objective was quite the same. We wanted to identify those individuals, both inside our organizations across South Carolina hospitals, but we also wanted to make sure that those hospitals were identifying community partners, public health partners, business partners, and then bringing all of those resources to the table and then looking for ways to improve health outcomes for everyone.

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Juana Slade
In 2017 AnMed replicated that approach for ourselves. So internally, we tried to do what we were helping the state to do. We came together. We brought individuals from across disciplines, from across the community, from our governance leaders. We wanted to make sure that everybody who could impact health being provided through AnMed was at the table to look for some solutions, and we took action.

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Juana Slade
Dr. Michael Seemuller is our chief quality officer and he makes it his responsibility to make sure that we are re-stratifying quality measures across the organization. We have a director of patient care quality who was has the responsibility to do that at the bedside. And then of course, my primary responsibility is to make sure that we've got the cultural and linguistic competence inside the organization to do what's necessary.

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Juana Slade
So, as I said, it's been a part of our character, the culture of the organization for a very long time. I know that for me, the most important part - we were talking about this the other day - the most important thing is to have this work embedded in our strategic plan. Because it doesn't matter if I think it's important,

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Juana Slade
what matters is our governance leaders, our administrative leaders, operational leaders are holding themselves and us accountable for patient outcomes.

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Jacqueline Hunter
And Clint, what is your experience been with the Health Equity Roadmap thus far?

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Clint Merritt, M.D.
Yeah, we completed the health equity roadmap in 2022, and it came at a really good time for us because through Covid we had built a lot of community programing very organically, not only around Covid safety and vaccines, but a lot of work with housing and homelessness and food insecurity work with the Latino community. And we realized in completing the health equity roadmap, we engaged many of the leaders across the organization and the clinical teams to do the assessment.

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Clint Merritt, M.D.
How are we doing? And we found there are some things we were strong at. Our community partners were incredibly strong, and our data and analytics were also quite strong. But then we had a lot of work to do, and it's very helpful to see sort of a structured framework to recognize we need a continuous building curriculum for team members to understand how they engage in reducing health disparities and care for the community.

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Clint Merritt, M.D.
We need a governance structure engagement that defines how each of our committees and our boards have a role in advancing health equity for the community, and this helped us craft all that structure. And we put it together in a strategic plan in 2023, using a lot of the ideas and framework that came out of the roadmap. We also recast the organization's mission, which we had not done in a couple decades, and it was a mission statement that really leaned into inclusivity and diversity.

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Clint Merritt, M.D.
to strengthen in the health and well-being of all people in our communities, it's been very meaningful.

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Jacqueline Hunter
Great. And some of you have hit on this as well... but Clint, if you can elaborate on anything that you may not have referenced in regards to innovative strategies, that kind of came from the implementation of the HETA - Health Equity Roadmap.

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Clint Merritt, M.D.
Yeah, we've been using data at the neighborhood level to understand where our opportunities lie, who we're not reaching. The health equity roadmap is also about those partnerships and listening well. So we are taking neighborhood level data on mental health, on addiction, on diabetes, and then meeting with neighborhood partners to share "here's what we're seeing." And then lead with listening at that point.

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Clint Merritt, M.D.
And it's helping us craft tailored interventions for particular pockets in our community with engaged partners and that kind of approach of very tailored care for health equity seems to come through the Health Equity Roadmap. It's a philosophy that you see in that framework.

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Jacqueline Hunter
Anyone else want to add anything additional in regards to any innovative strategies that you have implemented? Juana or Rosangely?

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Rosangely Cruz-Rojas
One thing we, because of having the roadmap and understanding the areas where we have opportunities that we've been trying to communicate more clearly is what I call the 3P's of DREA. And the 3P's meaning people, patients, population, population as code for community. And we have a lot of work in all these different areas that until recently were reporting or being developed through different areas of the organization.

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Rosangely Cruz-Rojas
So now with all of us being combined, we have an opportunity to say if an ERG employee resource group, or a DEI council is working on a particular area we can tie that back better to our community space and the more we want to do with our community partners. But also in any health equity initiative that we have been working through.

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Rosangely Cruz-Rojas
An example just recently, our African-American and black African-American ERG was consulted for some issues and questions we have around providing palliative care consults for the African-American population. And they were able to not only give us recommendations, but also tell us where to go to get additional information and additional feedback on our processes internally. So we are seeing now this combined effort of the 3P's of the work we do in it internally to really accelerate the work we are doing in the health equity space.

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Jacqueline Hunter
Great. Thank you Juana, anything to add?

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Juana Slade
Well, character, this is sacred work. And that work has been embedded in our organization. And because of our long standing character, we've been able to provide the backbone for our Anderson County Safety Net Council. And one of the tenants is about making sure that we're looking for partners beyond the four walls of our systems.

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Juana Slade
We are a founding member of a group in South Carolina that I mentioned earlier, called the Alliance for a Healthier South Carolina and our intent is to bring together people around the state who have similar purpose, whose missions are similar, but to convene those conversations to be at the table for those conversations certainly does take character, and one that I'm particularly proud of -

00:12:30:23 - 00:12:54:28
Juana Slade
we're in a partnership with the Urban League of the Upstate of South Carolina to co-host the Black Men in White Coats Youth Summit to provide outreach, education and field exploration for underrepresented populations. That had not been done in our state. And it certainly had not been done in Anderson County. So we're really proud of that. And then we look for opportunities to bring local dollars together.

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Juana Slade
So our foundation, in partnership with the United Way of Anderson County is conducting, for the last few years, a joint fundraising effort to make sure that we're looking at people who are food insecure and those individuals who have opportunities for not only to receive or take a handout of food, but to understand how to prepare that food, and better yet, perhaps how to grow their own.

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Juana Slade
So we think that because of the character, the longstanding character of our work, our voice is a trusted voice. We are not new to the conversation of DEI.

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Jacqueline Hunter
So as we get ready to wrap it with our last question for you, if you can maybe name one thing and how does your organization, as we look ahead, how does your organization plan to continue to use AHA’s Health Equity Roadmap and advancing its mission of promoting health equity in your respective communities?

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Jacqueline Hunter
So I will start with Juana.

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Juana Slade
This is one of the levers is about community engagement and thinking organically, thinking outside of the box. Well, in 2020, at the height of Covid 19, the credibility of our organization allowed us to come together with several individuals, leaders from across the community and launch a program that replicates the work of the Equal Justice Initiative in Alabama.

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Juana Slade
And we identified the five known victims of racial terror lynching. Now, what does that have to do with the work that we are doing as it relates to health equity? Well, it helps to know how we got here. And so understanding that there are reasons that people are reluctant to engage and to seek counsel and support from health systems, and why people may be reluctant to seek care from individuals who may not look like them or live like them.

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Juana Slade
This kind of bold conversation in a community like Anderson has allowed us to expand the meaning of beloved community. And quite honestly, we think that having this conversation, acknowledging that there are founded reasons and the reluctance is going to eventually allow us to provide better care.

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Jacqueline Hunter
Great. And Rosangely what about at Mainline Health?

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Rosangely Cruz-Rojas
So we plan to continue using the framework both as part of our maturity model, but also as a way to measure our progress to many of the strategic initiatives that we have in place. I come from measurement. I used to direct the Department of Analytics and Process Improvement on the quality, safety and equity before. I'm very strong and really ensuring that over time, the only way you know that you're moving forward is by measuring.

00:15:28:20 - 00:15:59:01
Rosangely Cruz-Rojas
And so using a model like this help us understand where we still have gaps, where we have opportunities to continue to grow. Part of what I've been able to benefit as I examine that framework is that you see in the roadmap, if you were to mature and do more work in your community collaborations or, you know, engage your employee base resources, you have clear steps that some other organizations have done, and they are now documented that you could use that information to grow. For us,

00:15:59:02 - 00:16:23:09
Rosangely Cruz-Rojas
one opportunity that is in the horizon and we're going to be working on this year, is to continue to capacitate, provide capacity for our ERGs and the councils to do work that moves the bar around the strategic imperatives, particularly around these issues of health equity. I hear from some of the members of our organization and that they would like to be part of the solutions, work with us.

00:16:23:09 - 00:16:33:29
Rosangely Cruz-Rojas
So, while providing capacity and getting, you know, training for them to do process improvement, to be part of the initiatives, we probably will be able to scale up more of the work we are doing.

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Jacqueline Hunter
Great. And Clint, will you bring us home, what's happening at Augusta Health?

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Clint Merritt, M.D.
Thank you. As I think about the next few years in health equity work at Augusta Health, there's a few challenge areas that I think the roadmap gives us some guidance for. One is in the work with community partners who are really the experts on social drivers of health. How do we share data? How do we measure our impact in a way that helps all of our organizations set goals and move forward?

00:17:02:11 - 00:17:23:27
Clint Merritt, M.D.
I see a lot of meetings that focus around that, and that's sort of fits within the roadmap nicely. Related to that, showing impact, is making sure we continue to draw the connections of health equity work to value-based care models so that we have growing funding behind this work. And that looks so many creative ways right now

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Clint Merritt, M.D.
so it's an exciting space. And then last at Augusta Health, we're continuing to lean into teaching the next generation of health care workers. We do a lot of education in nursing and pharmacy and therapy, and we just launched our first internal medicine residency program, first GME work three weeks ago. And these young folks coming out, they are very drawn to health equity work.

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Clint Merritt, M.D.
It is in their passion. It's wonderful. And I believe they're going to help us be even better at that work with time and that's an exciting part of the work for the next few years for us.

00:17:54:10 - 00:18:13:29
Jacqueline Hunter
Great. Thank you. So thank you all for your time today and for sharing with us innovative, impactful initiatives your team has implemented to advance health equity. We appreciate your dedication to this vital work, and we look forward to seeing you continue the positive impact of your leadership. Thank you so much. As I close, thank you all for listening.

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Jacqueline Hunter
For additional information from the Institute of Diversity and Health Equity, please visit our website at IFDHE.aha.org. Thank you very much.

00:18:25:18 - 00:18:33:22
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.