Tag Archives: 2014

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.

GLMA 2014 Annual Conference and Nursing Summit

Posted by Amy Wilson-Stronks

GLMA Conference September 10-13
The 2014 GLMA: Health Professionals Advancing LGBT Equality Conference and will take place September 10-13 in Baltimore, Maryland. Amy Wilson-Stronks is concluding her board term as Vice President of Education at the conference, but will remain active in GLMA as a member of the new Nursing Section and continue as a member of the Education Committee. GLMA has an increasingly strong interest in facilitating mentoring opportunities for students and young professionals in the health professions, and will be hosting a mentoring event to allow students as well as young and seasoned professionals to network and learn from each other. For more information, please visit the GLMA website at www.glma.org.

GLMA Nursing Summit September 10th
The second annual GLMA Nursing Summit will precede the GLMA conference and take place on September 10, 2014. The nursing summit focuses on LGBT issues in the nursing field and provides LGBT allies and supporters with the tools they need to improve LGBT healthcare. A table topic will be facilitated on the organizational climate around LGBT health and nursing. The conference is highly anticipated after the interest and strong turnout generated in 2013.