Category Archives: Welcome

Perks as an Intern: ACA Open Enrollment Call with First Lady Michelle Obama

Written by Kayana Marks
January 30, 2015

Over the past few months I have been granted many opportunities working as the intern for Wilson-Stronks, LLC. Many of these opportunities allow me to learn so much about many aspects of healthcare. When I was asked by Amy to join the call with First Lady Michelle Obama about Open Enrollment during the LGBT Week of Action I was thrilled because I knew I would learn so much more about the Affordable Care Act. Dialing into the call on January 15 I had an open mind and a willingness to learn as much as I possibly could about my future career field.

First Lady Michelle Obama was the opening speaker and she was very grateful for all the work healthcare advocates had done so far. She emphasized that because of the Affordable Care Act (ACA) millions of Americans have healthcare coverage for the first time. In light of the LGBT Week of Action, First Lady Obama mentioned that the ACA bans health insurance companies from charging LGBT persons higher rates. She stressed that now is the time for advocates to reach further back into their communities for Open Enrollment. As advocates for healthcare we are the leaders of our communities and the people trust us. First Lady Obama closed out her segment of the call by reminding us that we are indeed changing lives by making sure that every American has access to healthcare.

Immediately following First Lady Michelle Obama, Sylvia Burwell, the Secretary of Health and Human Services, addressed the audience. Mrs. Burwell wasted no time in reminding everyone that the ACA has assisted many people in experiencing greater equality and greater healthcare coverage. Mrs. Burwell brought this to life by sharing a story of a lesbian woman who once said, “health insurance was always out of reach” for her. Now that she has more options she finds that “the relationship [with her partner] is respected”. Mrs. Burwell also pointed out that healthcare coverage can also be affordable now. Eighty-seven percent of those that have signed up for insurance have financial assistance. The many millions of Americans that the ACA has helped has shown to be the greatest increase in the last four decades. Mrs. Burwell noted that the Affordable Care Act has helped healthcare all around; from quality to equity.

As the call rounded up with questions I realized that we have come a long way, but we still have a long way to go. As an intern in the healthcare field, as a future medical student, and as a future physician I could not help but think of my role in healthcare. I appreciate what I am learning now and I look forward to how I will apply my acquired knowledge to improve healthcare.

*This blog entry ONLY reflects the views and experiences of Kayana Marks.

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.

Welcome to the Blog: Putting Patients Back in Patient Safety

Hi!

Welcome to the Wilson-Stronks blog. I hope to use this tool to share information that is of interest to those who envision a more equitable and patient-centered health care system. I have titled this blog, “Putting Patients Back in Patient Safety” because I firmly believe that our many patient safety systems have neglected to consider the complex backgrounds, characteristics, and needs of patients who are served by our health system. By “Putting Patients Back in Patient Safety” we can help to promote effective safety strategies in a manner that is inclusive of and sensitive to patients from diverse backgrounds.

I am happy to share a link to a story recently published in the periodical Hospitals, and Health Networks titled, “Does Your Patient Really Understand?” http://digital.hhnmag.com/DigitalAnywhere/viewer.aspx?id=29&pageId=37&refid=220409&s=share
This piece is one of several in this month’s issue of H&HN that directly discusses issues related to culturally sensitive patient-centered care. One of the other pieces is an interview with Peter Pronovost, MD about his work to reduce preventable harm. I was thrilled that he mentioned health disparities and patient-centered care as important components of this work.

My pleasure at the mention of health disparities, health literacy, effective communication, and patient-centered care by a publication much read by hospital administrators is tempered by disappointment at the lack of attention to health disparities, health literacy, effective communication, and patient-centered care at a recent conference attended by healthcare quality professionals. We must do a better job to integrate our efforts to promote health equity into our efforts to improve overall quality and safety. I call to my colleagues who are working to eliminate health disparities to get the word out to the “mainstream” quality professionals. There is great work being done to evaluate the effectiveness of interventions and systems to support equitable care, but I would like to see more disparities work highlighted at our quality conferences. On that note, I think I have an abstract to develop.

Health to all!

Amy