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Are Love and Empathy the Keys to Health Equity?

By Julie Oehlert | Tuesday, June 12, 2018
Are Love and Empathy the Keys to Health Equity

Vidant Health Chief Experience Officer Julie Kennedy Oehlert has described her organization’s work on equity as “some of the most wonderful, rewarding work I’ve ever done.” But she’s the first person to admit that it hasn’t been easy. In the following interview, Oehlert describes how Vidant Health — a health system in eastern North Carolina that serves a third of the state — is focusing on increasing the equity of their workforce to help attain health equity for their community. Vidant Health is one of eight health care organizations taking part in IHI’s Pursuing Equity initiative.

Why did Vidant Health join the Pursuing Equity initiative?

Vidant Health is a health care system in eastern North Carolina, and equity issues go deep in the 29 counties we serve. We wanted to do better than we were doing, and we thought that by joining the Institute for Healthcare Improvement’s Pursuing Equity cohort we would have colleagues, and support to do the work.

Why is Vidant focusing your efforts on workforce equity?

Our flagship hospital in Greenville, North Carolina is a 900-bed academic medical center in a city of 90,000. If you live in eastern North Carolina, there’s a good chance you work at Vidant Health. For the most part, our team members and our patients and their families are the same people. We realized that, if we focused on health equity within our own organization — what we call work force equity with our team members — we would impact health equity in our region.

A part of work force equity is having a diverse workforce.  We truly believe that our workforce should represent the population we serve. If our workforce doesn’t represent our population, and isn’t focused on their own diverse health needs, it won’t translate to the patients, and we won’t impact health equity in our region.

How are you improving the equity of your workforce?

One of the first things that we thought about was pay equity. We decided it would be important for our starting wage to be higher than other employers in town. We do not want to just be the biggest employer, but the employer of choice. We raised our minimum wage to be the highest in the city to show that we’re serious about not only working on health equity, but on making our communities better.

We also reviewed our job requirements. Job requirements can be biased. For example, why should the minimum requirement for our entry-level jobs be a high school diploma? We have the resources to help people get their GEDs. We have the resources to help people go back to school. So, why did we have minimum job requirements that prevented some of the people who most needed work from even being considered? Until we looked more closely, we didn’t realize there were biases built into our processes.

How did you engage your leadership in your equity work?

We started with our system’s CEO and our boards. Both were very supportive. When we joined Pursuing Equity, we put equity and inclusion in our strategic plan and in our strategic framework because, if it’s in the strategic imperative, then it has support, visibility, and funding. It has presence. It will have goals for success. We started there, and we were stubborn about staying there until we got that done and equity and inclusion became part of our strategic framework.

We have also been very thoughtful about showing executive presence in this work. We did not pass it off to others in the form of projects. We keep it where it belongs, which is front and center as a strategic imperative for Vidant Health. We talk about all of this to our boards, and we also talk at the executive and corporate level with a lot of intention and direction. Many of our executives, myself included, champion this work. Our Chief Human Resource Officer is also part of the Pursuing Equity initiative. Our Chief Quality Officer provides resources associated with this work. Our Vice President of Organization Development designs education around equity and inclusion.

How do you communicate about this initiative to your staff and your clinicians?

We started at the top. We spent time educating our boards and our senior leaders. Then, this past fall, we started talking about equity and inclusion at our team member town halls. All the presidents and our CEO, across the system, talked about our IHI Pursuing Equity initiative. After those town halls, so many people came to us and said, “I’m so glad you’re doing this work. How can I help?” Now we have a groundswell of people, from across the system, who are ready to help do the work that we need to get done.

What kind of language do you use to communicate about your equity work?

At Vidant Health, we believe that the human capacity for love and empathy deeply outweighs other factors. When we talk about equity and inclusion, we connect it to our mission and our values as a rural health care system, and we talk about it in the context of love. Love for humanity. We approach this work as an effort of community love.

Organizationally, we agree that we are all in this together. We aren’t blaming people. We aren’t creating divisions. We are creating inclusion, and demonstrating our love for our patients and our communities. We have stood very firm on that platform, which is why I think we’ve been successful.

Eastern North Carolina has a long history of structural racism. But we are not going to be able to go back and undo that history. We can move forward with love and compassion.

Why did you choose the words “love” and “empathy” to talk about your equity work?

We chose a platform of love and empathy knowing that the human capacity for those things outweighs other fears, and maybe even outweighs our own history. When we talk to our board and our staff, we talk about why this makes a difference to our team members. Why does equity and inclusion make a difference to our community? Why does this make a difference to someone who doesn’t have a car in one of our rural areas? We come at it in a very human way.

Health care is a tough job and it is very fractured. We want our equity work to be something positive, and it has been. The groundswell of people who want to be engaged in this work, from all walks of life, has been surprising and joyful for me.

You mentioned that you’re at the beginning of this work, but are there lessons you’ve learned so far that you think others could apply?

First, this work needs to be a strategic priority. It needs to have funding. It needs to be front and center. It needs to be part of policy and procedure. It needs to be part of operations. It needs to be deeply embedded in Human Resources and Talent Acquisition. There need to be metrics that measure success.

Second, decide what approach works for your organization. The approach we take is that we are an inclusive organization, and we will move forward in love for our communities and for our team members. We knew that this work could be stonewalled unless we were thoughtful about our approaches, how we use our metrics, and how we put the work in the context of our values and our mission as a health care system.

Equity is not a comfortable topic for people, especially for people who are privileged. At Vidant Health, we talk about institutional racism. We talk about unintentional bias. We talk about straight up racism. We talk about it all. 

As an organization, you also have to be prepared if people don’t want to do this work with you. If they don’t, you can help them leave your organization. No harm, no foul. We are clear that if this isn’t your work, you can’t be a leader here, you will not be happy working here. We’ve been intentional about that as well.

It’s also important to remember to tie this work to other desired outcomes. When we think about health disparities — about the groups of people who get readmitted to our emergency room, or the populations who have uncontrolled diabetes, for example — it’s easy to see that those outcomes are tied to equity. If you bother to look, you will find the root cause of those disparities. If your organization is going to work on population health, you can’t do it successfully without working on equity.

What story can you share that helps illustrate why equity work is so important?

One day, my daughter and I were getting manicures. The young woman doing my nails asked where I worked. I told her and she said, “I would love to work at Vidant Health.” I asked her what she did, and she said, “I’m a nursing assistant.” I thought about how we need about 60 nursing assistants, and asked, “Why are you working in a nail salon?”

What she told me opened my eyes. She told me that her dream is to be a nurse. She worked part-time at a geriatric center. She told me beautiful patient stories about how much she loves the patients. She had applied for a job at our organization — the only hospital in town — but she couldn’t get a job with us because she doesn’t have a nursing assistant II certificate. She was working at the nail salon because she couldn’t get a job with us, and we needed her. We could help her go back to school and be a nurse. We needed each other!

Hearing those stories motivated me to talk to people about focusing on health equity by focusing on work equity

Talking to people also helped me understand that there are problems that you will not see if you do not want to see them or you do not take the time to listen. For example, we started working with one of our community organizations, and I love the leader of this community organization. He said, “We don’t want your money. We want your presence. We want you in this community. Come and visit us.” So, we started to visit. And we learned that the things we were providing and the programs we were invested in were not always things they really needed.

Now we spend more time in our communities learning from people — why they can’t get to their doctor's appointments or why they can’t take their medicine. You can’t address equity without going into communities and letting them lead you.

I’ve been a nurse for 35 years. My clinical practice was as an ER trauma nurse. I’m now a Chief Experience Officer. Working on equity has been some of the most wonderful, rewarding work I’ve ever done. And I would say that every one of our executives involved in Pursuing Equity would agree.

Editor’s note: This interview has been edited for length and clarity.

You may also be interested in:

Achieving Health Equity: A Guide for Health Care Organizations

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