Equity of Care Awards Case Study: Monument Health Rapid City Hospital
2023 Equity of Care Awards Winner (Small/Rural Hospital Excellence)
Overview
Monument Health Rapid City Hospital’s excellence in using quantitative and qualitative data to address disparities and improve patient health quality resulted in the organization winning AHA’s 2023 Carolyn Boone Lewis Equity of Care Award in the Small/Rural Hospital Excellence category. The Equity of Care Award, named after Carolyn Boone Lewis, the first African American chair of the AHA board, is an annual recognition of efforts among hospitals and health systems that demonstrate high levels of success in advancing equitable care, diversity and inclusion through data, leadership, governance, cultural humility and community partnerships.
Rapid City Hospital is one of five hospitals that are members of Monument Health, a system which is headquartered within the Black Hills in western South Dakota. According to the U.S. Census Bureau, 9.3% of Rapid City’s population are of American Indian and Alaskan Native descent, but Monument Health notes that American Indians make up approximately 25% of patients at Rapid City Hospital. The area is native to the Lakota tribe and caregivers are educated on Lakota culture.
Monument Health’s equity agenda is driven from the board level, which is done by design. Sandra Ogunremi, DHA, is Monument Health’s vice president of diversity, inclusion and belonging, and reports directly to the health system’s Corporate Responsibility Committee. The committee handles all compliance, regulatory and compensation matters for the organization.
Monument Health signed the AHA’s #123forEquity pledge in 2015 and has consistently captured race, ethnicity and language (REaL) data at a capture rate above 98%. Since 2015, the health system has created several initiatives and projects to further advance equity within Rapid City Hospital and throughout the Rapid City community
Impact
Monument Health’s health equity efforts are anchored by its data collection efforts. It has a health equity council, which includes board members, C-suite executives, physicians and nurses; the council uses data and reports to inform their discussions on initiatives to reduce health care disparities. One example of this was the use of data indicating that patients aged 18-49 with no identified support person had higher admission rates than other groups. Patients with multiple visits in this age range were more likely to have chronic conditions, including substance abuse, mental health disorders, diabetes and chronic kidney disease. Analyzing the data allowed the team to develop a care plan that included additional monitoring and an increased frequency of discharge phone calls.
Monument Health also uses data to analyze the conditions of people living in different zip codes. When this initiative began, Monument Health leaders discovered that patients in certain areas suffered from particular conditions and had higher admission rates than others, consistent with the socioeconomic status of those areas, which were low-income. Monument Health caregivers identified Native American patients in the area notably suffering from congestive heart failure, congenital syphilis, peripheral artery disease and diabetes. From there, a plan was developed that involves community health workers visiting recently discharged congestive heart failure patients in their homes, where they make sure those patients have sufficient food resources and medication, and ensure that any future doctors’ appointments are scheduled. To help congenital syphilis patients, the health system has partnered with other organizations including a local health center for Native Americans to provide education about the condition and help with testing and treatment for syphilis.
One of the first initiatives Monument Health created since signing the AHA’s equity pledge in 2015 was an educational campaign on cultural humility to address latent racial tensions within western South Dakota communities.
“We began to have education to help our caregivers increase cultural awareness. The importance of cultural awareness cannot be overstated because when people are aware of what they say and what they do and the effects it has on others, they can adjust it.” said Ogunremi.
To do so, Monument Health provided cultural awareness training and other educational sessions. Caregivers must complete cultural awareness training as part of their orientation. Cultural awareness seminars have also been held since 2016 to help understand and address health disparities that affect Native Americans. The seminar, which Monument Health President and CEO Paulette Davidson, FACHE, calls a “moving classroom,” is a four-day trip covering more than 500 miles. Participants visit the Pine Ridge Indian Reservation and significant sites across the Black Hills to learn about housing, education system, long-term care, health care accessibility and more. Seminar participants also learn about the history of the communities and trauma that historical events have created that are still felt today.
“We also talk about stereotypes and how we educate around them,” Davidson said. “For example, we don’t refer to people living in a Native American reservation as ‘on’ or ‘off the reservation.’ The appropriate teaching is they live in the reservation.” Davidson said through inviting community partners to join the educational seminar the organization has helped educate police officers, city officials, business leaders and other community partners.
To help embrace Native American culture, Rapid City Hospital completed a $1 million construction of a culturally appropriate prayer room in 2020. The room, called “Wicozani Otipi,” means healing room. The circular room is designed with artifacts that have significant meanings to the Native community. In addition to that space, Rapid City Hospital also has a chapel, where priests and ministers are brought in from across the community to support the spiritual needs of patients and families.
In 2021, Monument Health launched an unconscious bias educational series for caregivers and providers that included 30 online sessions. A health equity seminar was added in 2022, in which physicians presented data and clinical findings on medical conditions impacting Native American communities, such as peripheral artery disease, congenital syphilis and cancer.
Lessons Learned
Ogunremi and Davidson have worked together at Monument Health for eight years. One of the biggest lessons they’ve learned along the way is that support from the health system’s board of directors is critical. Davidson pushed for this structure and said that the board is very engaged with the organization’s Diversity, Inclusion and Belonging (DIB) work, which has resulted in many successes.
“They see the path we’re on and they’re fueling us with their support and guidance,” Davidson said. “It’s a bit different, but it’s purposeful that her role reports to a board committee.”
The other critical piece to Monument Health’s success in its DIB initiatives has been its work in data collection. Simply collecting isn’t as important as the analysis and interpretation of it for your specific community, according to Davidson.
Future Goals
Following its current efforts, Monument Health is looking to tackle other societal factors of health. Shelter and food security are areas the health system is trying to address next. The organization is working with city and county leaders to help address those issues.
For more information and to follow Monument Health’s equity efforts, visit their website. Learn more about the AHA Equity of Care Awards here.
