Category Archives: Updates

Have Soapbox; Will Travel

By Amy Wilson-Stronks

Last month I delivered the keynote address at the American Medical Association’s Fall 2014 Commission to End Health Care Disparities Meeting. I was flattered to be asked to speak to a room of accomplished healthcare professionals who are leading efforts to improve healthcare by addressing healthcare disparities. I envisioned this as an opportunity to share some observations made during the years that I have been working toward the same goal/directing efforts in the same direction.

Specifically, I saw this unassuming audience as an opportunity to get on my soapbox, a position I find myself on with increasing frequency as I continue to work in healthcare. The title of my talk was Putting Patients in Patient Safety: Lessons Learned.

When tasked with delivering the keynote, I was told to “ ‘ignite’ the audience; give them something provocative to consider, something that will keep them awake during this dinner time presentation”. Since the focus of this group is the reduction of health disparities with the ultimate goal of eliminating disparate care, I believed I could deliver.

Why? Because fundamentally, our current systems are so flawed that none of us will EVER be able to eliminate disparities for any vulnerable or underserved group. I envisioned this message: Give up, we are wasting our time!

No, that was not my opening line. But beneath my remarks, that sentiment muttered like a mantra; it was the gist of my talk, whether articulated or not.

Why am I so negative? Several reasons. And, yes, these are points I shared with my esteemed colleagues.

There is no such thing as racism, sexism, (Insert any “ism”) .
“Not in my backyard,” “We treat everybody the same.” It would be short sighted and inaccurate to blame healthcare organizations for racial, ethnic, and other healthcare disparities. However, since health care is received at healthcare organizations, they necessarily are essential to the solution. Yet, many do not believe that they are culpable, nor do they think it is a problem that they need to address as a priority.

If our care organizations are not interested in evaluating the care they provide to various population groups that have been identified at the national level as suffering from health and healthcare disparities, then how will we recognize when we are doing things right? I have found that many healthcare organization leaders are not aware what is happening across their organization during patient-provider interfaces. They may set expectations that all patients are treated with dignity and respect, but they aren’t told, nor do they observe the Emergency Department staff comment, “Oh no! Not another Ebonics. I wish my shift would end already!” They don’t realize how unconscious and conscious bias can create a chasm between providers and patients from different racial and ethnic groups. And the bias isn’t only between providers and patients, but also among employee groups, as one HR professional once confided to me when asked about the lack of racial diversity in his organization,

“You know, the blacks (employees) really need to get over (themselves); Slavery was over a hundred years ago.”

Yeah, I guess we all need to get over it. But that won’t eliminate disparities.

Meaningful Use isn’t Meaningful
Meaningful Use is designed to establish a degree of data accessibility across the healthcare system to support care transitions, improve data access and communication, and improve systems for monitoring and evaluating quality by introducing uniformity and compatibility. This makes sense. And it is necessary for us to really understand how healthcare disparities present, what causes them, what removes/improves them, etc.

Unfortunately, the data necessary for us to address healthcare disparities are rarely captured, and if captured, they are rarely accurate.
“Only Press Ganey Data Matter”
“We have the data field right here.”

We need to incite collective action to incentivize the vendors of Electronic Health/Medical Record (EH/MR) systems to create adaptable programs for the collection of data on patient race, ethnicity, and preferred language. To the AMA, NMA, NHMA, AHA, and all others working to improve healthcare and advance equity– please join us on our soapbox.

If we still can’t get this right after more than 10 years, how are we ever going to effectively collect data on sexual orientation and gender identity?

Our Systems of Care Aren’t Designed by Patients
“If you listen to your patients CAREFULLY they will give you the diagnosis; if you listen a bit longer they will give you the treatment”

“Only physicians are capable of judging what is or is not good medical practice. Patients and hospital personnel may learn to recognize good practice but only the physician can accurately evaluate its quality.”-Explanatory Supplement to the 1965 Joint Commission Hospital Standards.

“Well, when I am in their room and they are all talking in another language I feel uncomfortable. I feel as if they are talking about me. I don’t like that.”

“Although my doctor knew all about me, each encounter with new people—with blood draws, ultrasound, breast x-ray, etc.—had the basic anxiety of the procedure and layered on to that, the possibility of homophobia and having to watch out for myself” ¹

If patients cannot communicate with their caregivers, then caregivers can’t do their job.

Unfortunately, many things complicate communication, such as trust, fear of hospitals, cultural beliefs and practices, conscious and unconscious bias as well as basic human assumptions. Healthcare professionals must involve the patient in every aspect of their care and not make any assumptions.

This drives the work we do at Wilson-Stronks. We want to Improve Healthcare. And we know that the only way to do so is to work collaboratively and act collectively. This collaboration and collective action must involve our patients. We were honored to be asked to share some of our experiences “in the world” with the AMA Commission to End Health Care Disparities.

¹ Margolies L, Scout NFN. LGBT Patient-Centered Outcomes: Cancer Survivors Teach Us How To Improve Care for All. April 2013.

Note: All other quotes are reflections of my thoughts from information that others have shared with me.

Improving Healthcare into the Future: The Wilson-Stronks Internship Program

Posted by Amy Wilson-Stronks

2014 was exciting for Wilson-Stronks as we launched what is proving to be a very successful internship program.  We have been so fortunate to have the interest of very talented, bright, and dedicated individuals to serve as research assistants through our internship program.  Alas, the success is bittersweet as our first intern heads back to school this fall, we welcome our newest intern who will be gearing up during her time at Wilson-Stronks to become the Doctor of the Future.  Read on below…

Katie Singer has worked with Wilson-Stronks since June 2014.  She became interested in the position because it provided a solid comprehensive experience that incorporated learning about health care, advocacy, consulting, and research.  Also, considering that health care is a “hot topic,” Katie knew that working with Wilson-Stronks would be a great opportunity to learn more about the healthcare system and its inner workings.  Additionally, she knew this would satisfy her interest in different cultures, different styles of life, and improving equality.

While working at Wilson-Stronks, Katie has had many note-worthy experiences: attending chamber events, developing a social media platform, and researching language access and faith-based healthcare information.  She most enjoys being able to see the multi-faceted process of this business.  Every part of this business, from the advocacy to the research, has provided her with an impressionable experience that she will be able to use for her future endeavors.

Katie appreciates working with and learning from Amy and Deborah because they provide a great perspective from their experiences with health care and advocacy.  Working at Wilson-Stronks has improved her outlook on healthcare quality, cultural competence and equity.

This fall Katie is returning to Lawrence University in Appleton, Wisconsin as a part of the class of 2017.  We are going to miss her, and we hope she comes back during her breaks to help us improve healthcare!

Wilson-Stronks is excited to welcome the newest member of our team, Kayana Marks!

At the age of two, Kayana decided she wanted to be a doctor. Although she does not yet know what field of medicine she would like to work, she is passionate about caring for others.

Kayana is excited to be a part of the Wilson-Stronks team and learn more about the relationships that exist between patient care and the business side of healthcare. In her past experiences in the healthcare field, Kayana learned that many employees in doctor’s offices do not witness the healthcare side of their business, creating a lack of understanding between the employees and patients. After observing this disparity, she became interested in strengthening the connection between patients and healthcare providers. Similarly, she is interested in using advocacy and consulting as tools to bring awareness of healthcare issues to communities and companies, ultimately decreasing existing inconsistencies in information and knowledge.

Kayana intends to utilize her experience at Wilson-Stronks to better understand the entirety of healthcare in order to better serve her future patients.

Kayana Marks is a 2014 Graduate of Howard University in Washington, DC. She graduated with a Bachelor’s of Science in Biology and a minor in Chemistry. She plans to attend medical school in the fall of 2015.

Please join us in welcoming Kayana! She can be reached at kayana@wilson-stronks.com.

Advocating for Change: Improving Healthcare

Posted by Amy Wilson-Stronks

I am fortunate to have a very wide, robust, multi-disciplinary, diverse network of colleagues and friends with expertise in many areas related directly and indirectly to healthcare. I have had many conversations with my network about our healthcare system, and unashamedly, I find myself frustrated with how healthcare is delivered. I am stunned at the lack of sincere focus on the patient.

Sure, “patient engagement,” “population health,” “patient experience,” and “patient satisfaction” cover the pages of healthcare trade publications. But as I work with healthcare organizations, I see that sincere attention to the needs, beliefs, and expectations of the patients, families, and communities receiving care is relatively rare.

I know that there are many reasons for the lack of awareness, and but the issue does not exist because healthcare providers don’t care about their patients. However, competing priorities, the complexity of payment systems, staffing challenges, and the burden of documentation and electronic record systems limits the time that direct care staff and clinicians have to communicate effectively with patients and family members in order to sincerely understand the patient.

Historically, Wilson-Stronks has engaged clients by collaborating with healthcare organizations to help them create systems that support effective patient-provider communication and understanding. Unfortunately, effective communication is an area of quality and safety improvement and risk reduction that is not always viewed as a priority. We are left to wonder, “Well then, WHAT? What CAN we do to improve healthcare?”

A conversation last summer finally made things click. Ilene Corina, a grass-roots patient safety advocate and trainer, responded to my laments regarding patient provider-communication with this comment,

“That’s why I work with patients. (Decision-makers) don’t really know what is happening at the bedside. They sit behind their desks and hold meetings. And when they are on the units, it’s a show in their honor; unlikely the day-to-day reality faced by most direct care staff, clinicians, and patients.”

Ilene helped me (finally) understand how Wilson-Stronks can have a more meaningful impact: Working to empower the people who are at the patient’s bedside–the family caregiver; the healthcare proxy; the support person. I don’t know why it took me so long to get it, but my conversations with Ilene inspire our launch of the Wilson-Stronks Improving Healthcare Advocacy Program: Putting Patients in Patient Safety.

Many people who read this blog may have had personal experiences that made them aware of the gaps in the healthcare system. Some people may know about the gaps from the experiences of a friend or family member. Others may be familiar with issues because they are among the direct care staff trying to find the time and resources to sincerely understand their patients. Many of you have shared your stories with me, as I have shared my own.

But FINALLY I get it, and now Wilson-Stronks is ready to act: the only way to really improve healthcare is by taking our care into our own hands and educating and empowering those around us who have less medical and health literacy than we do.

I hope I can share some great success stories with you soon. Please know that the power of your stories can have a positive influence, and I thank you all for sharing to help the rest of us better understand what it is like to be in the hospital gown and sitting at the bedside of our loved one.

HHS announces refined survey standards to examine and help eliminate differences in care based on race, ethnicity, sex, primary language, or disability

Today, the US Department of Health and Human Services announced final survey standards for the collection of race, ethnicity, sex, primary language, and disability status for surveys administered by the department. This is a great advance in efforts to better discern health and health care disparities in different populations. Read more at  http://www.hhs.gov/news/press/2011pres/10/20111031b.html

LGBT Webinar Archive Available https://www2.gotomeeting.com/register/728441986

In partnership with the Human Rights Campaign Foundation and Wilson-Stronks, LLC the Hopkins Center for Health Disparities Solutions offered a free webinar tilted, Advancing LGBT Patient-Centered Care: Strategies to Create an Inclusive Environment on October 11, 2011. The archived webinar presents the business case for building an inclusive environment for LGBT patients and families, shares strategies and a framework for action, and provides an overview of the Health Care Equality Index as a useful tool to begin creating an inclusive environment.
To view, please visit https://www2.gotomeeting.com/register/728441986