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(Jon) Hello. Welcome to a new episode of Take 5 with The Joint Commission.
I'm Jon DePaolis, and I'll be your host for today's program.
Today, we will be discussing The Joint Commission's new activities
concerning diversity and racial equity in healthcare.
This includes the creation of a new diversity and inclusion council.
Here, today, to discuss the council is its leader, Dr. Ana Pujols McKee,
The Joint Commission's Executive Vice President
and Chief Medical Officer.
She was also recently named the Chief Diversity and Inclusion Officer.
We also are joined by Dr. David Baker,
The Joint Commission's Executive Vice President
for Health Care Quality Evaluation.
Dr. McKee, Dr. Baker, thank you both for joining me today
with this important discussion.
- (Dr. Baker) It's our pleasure. - (Dr. McKee) Good to be here.
(Jon) To start things off, Dr. McKee,
what do you believe should be The Joint Commission's role
in the healthcare industry's ongoing evolution
concerning racial inequities in patient care
and the need for more workforce diversity,
both in and out of leadership positions?
(Dr. McKee) The Joint Commission has a leading role in addressing
what is really a patient safety concern.
We have to start thinking
that if someone is not getting the right care at the right time
because of their race, or the language difference,
or religion, or gender identity,
that that's a safety concern.
We have tremendous safety concerns for women bearing children
and the huge disparity that exists today
in women of color having such high infant mortality rates.
It's unacceptable.
This has been the case for many, many years.
And it continues to get studied but not effectively addressed.
The Joint Commission needs to make the case
that this is a safety concern,
and every organization should be trying to identify opportunities
to reduce the inequities in care,
whether it's in mammogram use or vaccination,
but they need to start.
The Joint Commission will be encouraging organizations
to take the first and necessary steps to address this problem.
When it comes to diversity,
diversity in leadership is considered one of the strongest strategies
to address racial inequities.
Organizations should really look at their hiring and recruitment processes
and make sure that they don't have barriers or processes
that discourage minorities from entering in those roles.
There's many things that need to be done.
But improving the diversity among leadership
is another area that The Joint Commission can encourage organizations
to move forward with.
(Jon) Dr. Baker, The Joint Commission's vision
is to bring all people
the most consistent, highest quality in healthcare.
In response to the sweeping demand for racial equality
we experienced in the US this past summer,
what are some ways The Joint Commission
is going to pursue its goal of equity in healthcare moving forward?
(Dr. Baker) The first thing that we need to be able to do
is identify leading practices who are addressing healthcare disparities
and help disseminate those.
Even though we still have tremendous inequity
within the healthcare system,
this is a problem that many organizations have been working on now
for [20 years].
So we need to be able to identify those organizations
that have truly been able to address things--
measurable improvement, feasible interventions.
And we need to be able to share those both through the web
as well as with one of our most effective things
is [perhaps] surveyors--
be able to share those leading practices
during surveys.
I think a lot of organizations, they've got the motivation,
their heart's in the right place, they want to address these issues,
but honestly, they don't know where to begin.
So we need to be able to overcome them.
But that might not be enough.
We need to be able to think about standards
to be able to encourage organizations to begin to address this.
And we're also going to be looking at measurement programs,
and organizations should probably be routinely stratifying their data
when they look at quality measures
to be able to see whether or not they have disparity.
(Jon) Going off of that, Dr. Baker, what standards do we currently have
that address equity and diversity in healthcare,
and is your group conducting additional research
to build off that existing framework?
(Dr. Baker) Funny, these standards have been around so long,
I think people have forgotten
that The Joint Commission really led the way,
going back now, probably, almost 15 years ago,
starting off with a collection of race and ethnicity data,
but also preferred language for a patient,
as well as standards that the organization should be addressing,
literacy barriers, cross-cultural communication,
a number of things.
As well, we've shared leading practices, as I was talking about before.
Many years ago, we came out with a roadmap for organizations
to begin to address disparity.
So this is something that we've been working on
for a long time.
Now, we're looking and saying,
"What can we do to take this to the next level?"
And there may be some specific things,
but we think the most important thing is to be able to get organizations
to think about this at the organizational level
and not one patient at a time.
They need to think about this as a quality and safety issue,
and just like they have plans for addressing,
for example, healthcare-acquired infection,
they need to look at these,
they need to be able to understand their data
and develop plans to address that.
It's probably time for organizations to routinely start looking at
the data for the populations that they serve,
understand their needs, stratify their measures,
to be able to look at where there are differences
in quality and safety,
and take steps to address them.
(Dr. McKee) David, that's exactly correct.
I agree with you 100%.
We're not asking organizations to build another infrastructure
to address this,
but we're asking them
that within their quality and patient safety infrastructure,
to use those resources to begin to address these issues.
(Jon) One of the examples
of the disparities that exist in healthcare
is from April 2020, when CDC case data showed that Black and Latino people
are over-represented in populations of COVID-19 patients.
How do you think we can address these challenges
with regard to our leadership role during the pandemic?
(Dr. McKee) This is a very complicated issue.
It is not that Black and Latino individuals
are more susceptible to the infection,
it is the social conditions that many of them live in:
multi-generational housing and perhaps crowded housing.
Many of them are part of our essential workforce,
many of them work in positions that if they are sick,
they do not get compensated.
So this is a very complicated issue.
We are concerned about vaccination rates being low
among these populations,
and we will be encouraging
especially people of color who have had a historical reason
for not trusting the vaccination and not trusting the medical profession,
but we will be sending out messages and educating regarding the vaccination.
David, your thoughts?
(Dr. Baker) In addition to what you said-- I agree with everything that you said--
I think there are some concrete things that healthcare organizations can do.
One of the problems that some people have identified
is that many of these different communities
have not received the educational messages that they need
about how to protect themselves from COVID.
And that can be a language barrier,
it can be cross-cultural issues.
But it's really important for organizations
to understand their communities
and be able to help get these messages out there
and identify when additional messages need to be developed.
Everything that Dr. McKee was talking about with vaccination
is critically important, both to get those messages out
but also just the process of engagement,
for building trust for organizations to work with community later.
That's essential to be able to get people to understand
as well as actually agree to take the vaccination.
The other thing, though, that has been a problem
in many of these communities is poor access to screening.
That's another place where I think healthcare organizations
that have done more in the past--
when I say screening, I really mean COVID testing,
so this is really more for people who are symptomatic.
For those groups,
they may have had to travel very long distances
to be able to get tested.
And I think healthcare organizations
who are often relying on departments of public health
for providing that testing,
many of those hospitals, for example, weren't getting adequate supplies,
so they had their own challenges.
But I do think that there was more
that healthcare organizations could've done
to overcome some of the access barriers to COVID testing.
(Jon) Dr. McKee, you were recently appointed as The Joint Commission's
Chief Diversity and Inclusion Officer.
You've already served for many years as the enterprise's chief medical officer,
and you were the Chief Medical Officer and Associate Executive Director
at Penn Presbyterian Medical Center, University of Pennsylvania Health System.
I wanted to draw upon that professional experience
for this last question:
Do you have an example you'd be willing to share with us
about how discrimination has led to poor patient care?
(Dr. McKee) Most recently, we were horrified to read
of an incident involving an African American woman physician,
who was hospitalized, I believe, in Ohio, with COVID,
who suffered several days with severe pain.
And her physician, who was white, refused to treat her pain,
and basically told her that she was not eligible
for pain medication.
The pain was limited to the back of her neck,
and after her pleading,
days later, they did a CAT scan to find that she had a mass.
This is the situation that is repeated over and over
where African Americans are not believed.
One of the Williams sisters--
I can't remember if it was Serena or Venus--
had experienced a pulmonary embolus,
and years later, while she was giving birth,
she told the physicians,
"I am having the same symptoms of a pulmonary embolus."
And they did not respond and had to rescue her.
These are examples of not being believed,
not being heard, being ignored.
It's very sad.
And there are too many of these cases that still occur.
Organizations need to begin to listen to these underrepresented groups,
whether it's by having patient and family groups, or interviews,
or looking at their data that can be stratified,
because I'm sure they will have many lessons learned
and opportunities for improvement after they've done so.
(Jon) Dr. McKee, Dr. Baker,
I want to thank you both so much for joining me.
And I appreciate you both for your candid comments here today.
(Dr. McKee) You're welcome. Thank you.
(Dr. Baker) You're very welcome. Thanks for having us.
(Jon) And thank you all for listening.
You can find more episodes of this program
at The Joint Commission's website found at www.jointcommission.org.
This has been Take 5 with The Joint Commission.
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