Article by: Aisling Carroll
For health care systems that rigorously apply themselves to the essential and dense work of health equity, there can be some learning curves.
“If you throw out terms like DEI, implicit bias, and racial equity, a lot of people on our (Riverside University Health System [RUHS]) campus probably don’t know what they mean,” said Sabreen White, program director at RUHS and leading member of its multidisciplinary Equity and Diversity Advocacy Taskforce. (DEI stands for diversity, equity, and inclusion.) “So, when we started our taskforce, we agreed that education was going to be a top priority.”
Specifically, highly specialized education and training that can help dismantle racism and develop staff grounded in the principles and practices of diversity, equity, inclusion, and belonging. Having trained 150+ staff on implicit bias, RUHS is currently deliberating on how best to expand this learning to its entire 8,000-strong team across hundreds of locations. The hospital system is one of Riverside County’s largest employers.
“There’s so much information out there, it’s very difficult to decipher what will work for our organization,” said White. “And as a county hospital, it’s nice to look at other county hospitals to see, ‘What are you doing up north?’ Or, ‘What are you doing in San Diego?’ And we can piggyback and learn off of each other.”
White turns to 70 safety net peers – and they to her – for guidance and support on uprooting structures that drive devastating health inequities as a member of the Racial Equity Community of Practice (CoP).
“If you hear that one group can do it, and they’re your peers, and they have the same challenges that you do, then you’re thinking, ‘You know, we should be able to do that too.’”
– Geoffrey Leung
Comprising 12 of California’s public health care systems, CoP was formed in early 2022 by the Safety Net Institute (SNI) as an 18-month learning and problem-solving collaborative funded by the California Health Care Foundation. CoP members meet in person and virtually to thoughtfully accelerate their equity work to better the lives of patients, staff, and those in their communities. These systems primarily serve communities of color and historically marginalized groups.
Peers inform and inspire
During a recent CoP session, White was impressed when UCLA Health shared that it educated and trained more than 27,000 staff members on equity, diversity, and inclusion within eight months.
UCLA Health broke down how they did it, supplying the other systems with training modules, resources, and links.
Dr. Geoffrey Leung, public health officer for Riverside County, co-chair of RUHS’ equity taskforce, and CoP member, found this peer-to-peer learning experience inspiring. “If you hear that one group can do it, and they’re your peers, and they have the same challenges that you do, then you’re thinking, ‘You know, we should be able to do that too.’”
Such system-to-system exchanges of reliable information and lessons learned on the road to health equity, whether about DEI training modules or race and ethnicity data collection, can help in numerous ways. Systems can move more quickly with intention, use fewer resources, and build greater confidence in the process and results.
“If another county agency has already figured certain areas of DEI out, or has the outcomes that we’re looking for, then there’s no need for us to recreate that on our own,” said Brandon Jacobs, deputy director for quality management in behavioral health at RUHS and member of its equity taskforce and CoP.
Considering CoP system members collectively serve millions of underserved Californians, any progress in reducing disparities more quickly may have an outsize impact in providing patients with increased timely access to trusted care and services.
RUHS’ grand rounds on diversity, equity, and inclusion
At the same time RUHS was learning from its peers, White said, “Our peers wanted to learn from us.” After presenting at a CoP meeting on RUHS’ DEI grand rounds program, she immediately received three emails from separate hospital systems wanting more information.
Some systems were interested in the program because it appeared effective at educating many while relatively easy to put together. Its shorter turnaround time, sometimes just a few weeks from planning to implementation, also appealed, said White.
Each RUHS DEI grand rounds is a one-hour online forum where experts from the health system and the wider community drill into data around a range of disparities, wade into learnings from DEI-related efforts, and highlight potential improvements. Topics have included the human tragedy of health inequities and a three-prong approach to tackling them.
White and her colleagues then walked new attendees through how they designed and executed their DEI grand rounds program, including choosing speakers, deciding on topics, and promoting the event.
Aimed at educating staff and leadership (members of RUHS’ C-suite have attended), the DEI grand rounds have also “served to foster collaboration and partnership opportunities,” said Dr. Vikram Kumar, chief health information officer at RUHS, co-chair of its equity taskforce, and CoP member. Kumar spearheaded the grand rounds program, which 400 people have attended to date and is ongoing.
How did RUHS attract large numbers of non-physician staff to attend its grand rounds? After White’s presentation, that was a question on the mind of Dr. Minako Watabe, chief medical officer at Ventura County Medical Center and Santa Paula Hospital, co-director of its Diversity, Equity, and Inclusion Advisory Group, and member of CoP.
Watabe leads Ventura’s health equity grand rounds and is eager for more nurses, registration staff, technicians, transport staff, residents, nutritionists, and others to engage in these forums.
“From the time a patient walks in until the time they are discharged, it’s important for everyone to understand what the history of racism in health care looks like and focus on health equity when interacting with patients,” said Watabe.
Reflecting the inclusive and supportive nature of the RUHS team, White invited Watabe, Arrowhead Regional Medical Center, San Mateo Medical Center, and others who had emailed her to an internal equity taskforce’s weekly meeting. White and her colleagues then walked new attendees through how they designed and executed their DEI grand rounds program, including choosing speakers, deciding on topics, and promoting the event.
Targeted universalism and traction
Since its founding in 1893, RUHS has championed health equity.
“By our very identity as part of the safety net, we have been working on disparities and caring for the most vulnerable populations and complex individuals, those who are uninsured or underinsured or cannot get care elsewhere, since we’ve existed,” said Leung.
RUHS cares for a diverse, low-income patient population at high risk for health disparities and poor health incomes in this medically underserved area with one of the fastest-growing populations in the state.
“Once we complete an equity event, we’re working on the next one. As long as we keep this momentum going, I think we can definitely make a difference.”
– Sabreen White
After decades of taking aim at disparities and structures that impede equity, RUHS members recently learned of a new approach to thinking and strategizing about this work at a CoP session. They were intrigued by what they heard, repeatedly using the words “eye-opening” to describe the novel framework called targeted universalism. SNI’s equity expert, the National Equity Project, led the presentation.
Currently, most equity work employs targeted policies or interventions aimed at one group, often excluding others. In recent years, this has been favored over the universal approach, which sets a universal goal for all groups but ignores critical disparities between them.
The targeted universalism approach marries the positive attributes of both. It sets a universal goal for everyone and uses targeted strategies for each group based upon their needs and circumstances to meet that goal. By supporting all groups, targeted universalism hopes to create greater belonging and buy-in.
Shortly after the CoP meeting, Jacobs was excited to implement the concept when he sent out department-wide emails and workflows about policy and procedure changes. Instead of framing these communications as “we’re doing this to address this one population or this one problem,” Jacobs said he now writes, “Let me tell you how this is going to benefit everyone.” He believes “there’s a lot of good that can come out of this [targeted universalism].”
Callisha Mays, director of ambulatory quality at RUHS and member of its equity taskforce and CoP, also values this approach. “If you really have concern for humankind, then this equity work is important, and we don’t want to leave anyone behind.”
As RUHS applies a health equity lens to more and more structures and practices, it is exploring how targeted universalism might help increase the likelihood of achieving equity. The health care system has ramped up its disparities and DEI activity in the last few years to reach that goal. Some examples include disparity reduction programs around blood pressure, cancer screenings, and opioid abuse; the launch of HeRCARe, which helps those experiencing high-risk pregnancies; the establishment of an inaugural disparities workshop and retreat; and the publication of a disparities-themed internal magazine.
White appreciates that RUHS’ executive team is “100 percent” supportive and encouraging of the equity taskforce’s work. “Once we complete an equity event, we’re working on the next one,” she said. “As long as we keep this momentum going, I think we can definitely make a difference.”
The Community of Practice is funded by the California Health Care Foundation.