Video Transcript: How Can You Help Create Health Equity?

Donald Berwick, MD, Senior Fellow and President Emeritus of IHI
David R. Williams, PhD, MPH, Professor of Public Health, Harvard T.H. Chan School of Public Health

WILLIAMS: What advice would you give to people who are in their own health care system thinking they would love to start a conversation about health equity and about racial bias in health care? What advice would you give them as to how to go about this?

BERWICK: Well, I’m not sure. I mean, maybe call you.

But no, I think a good rule, as a rule in general, is you start with yourself. You know, you don’t ask other people to do something you’re not doing for yourself. And I think this point you’ve made so eloquently about becoming self-aware, especially about the unconscious and innate biases that are there that we don’t even realize. And I think that introspection, I guess I think it’s on the critical path.

My friend and mentor Paul Batalden once drew for me a graph of the sequence of events for real change and improvement, and the first box he drew was leadership curiosity, and I believe that. And I think if we want to reverse this injustice, we need leaders to become, I say authentically curious, that we’re not talking about ticking boxes here. It’s a real, maybe it’s a personal transformation on that. That’s a big ask. That’s a big ask, because people are very busy.

I’m a scientist, too, and I think then the question, if one is aware, and one does care, and one has heard the legitimate questions, well, what might work? What could help here? And I think we need to turn to science, and we need to understand what’s been shown, what might work here, and put it to use.

WILLIAMS: Is there another lesson, any final lesson you might want to give us from improvement science, how it might help address health inequities?

BERWICK: Learn from action. We’ve been taught in Western society, that you think and think and think and think, and then act. No. You think, maybe, and then you act, because the action produces knowledge on the basis of which improvement can occur. And I really think getting into change is important. That could be one patient, one person at a time, one person at a time. Discover an episode of racism at work, an episode of inequity. Fix that one. Go at it and say, what could we do with this particular person and learn from that. So I’d say, moving quickly as we can to deeds, which then become informative for the future, is much more important than the next strategy meeting.