Photo by Zac Durant | Unsplash
In the midst of the pandemic shining a spotlight on both new and historically known health inequities, social unrest, and increased discussion of systemic racism, many health systems appointed leaders to focus on equity. Some health systems have even incorporated health equity into their mission statements. While these can be hopeful signs of change, personnel appointments and using the right words are not enough to make and sustain system-wide improvement.
Camille Burnett and Ron Wyatt are two people who understand this better than many. Camille Burnett, PhD, MPA, RN, is the Institute for Healthcare Improvement (IHI) Vice President, Health Equity and faculty for the IHI Leadership for Health Equity Professional Development Program. Ronald Wyatt, MD, MHA, is the Vice President and Patient Safety Officer at MCIC Vermont and an IHI Senior Fellow. IHI recently conducted separate interviews with each to discuss some of the best ways to support health equity leaders to ensure their success is not left up to chance.
On the importance of adequate resources
Camille Burnett: There has been a shift toward the inclusion of a health equity orientation in intersecting areas of health systems ranging from research to accreditation standards. Many health systems have also incorporated equity into their data procedures and quality improvement strategies. Given all this, health equity officers need adequate resources to deliver at the scope and scale required to achieve the changes they are trying to make. You shouldn’t have short-term funding for a long-term need. Also, health equity officers cannot do the work alone. To have bandwidth to do the work without worrying about where the next dollar is going to come from, they need a committed, core-funded team. They need sufficient money, people, and time to do the work and do it well. Chief health equity officer positions must be valued at the appropriate salary level for the broad-scale work that they’re doing and given true positional decision-making authority. It should be a full-time position comparable with the benefits of any other high-level executive.
Ron Wyatt: I currently mentor or coach between 12 to 14 leaders in health equity in systems across the United States. Here's what they all have in common: a deep commitment to the work. The other thing they have in common is limited resources with, in some cases, unrealistic expectations of them. They have the position, but do they have power? Do they have authority? How do things get done? How are they resourced? What does the team look like? Committed resources need to go into this role.
On knowing who will support you when times get tough
Ron Wyatt: When I talk to people who are relatively new to their role as a health equity leader, I ask them a question: Who has your back? Who is going to back you up when you are going to inevitably have difficult conversations? The answer should be the board. It should be the system chief executive officer.
Camille Burnett: One of the reasons I’m excited about the IHI Leadership for Health Equity Professional Development Program is because health equity officers are often navigating similar challenges with limited support. They are frequently the first health equity officer in their organization. This often means they have to establish their health equity portfolio while they are overseeing it. Being able to share experiences, challenges, and solutions together will be helpful for participants. Having a shared understanding of the work, guidance on common competencies, and a tailored framework will be helpful as they start to navigate in these new and evolving spaces. It’s important to have people you can call and say, “Hey, what worked for you when you tackled this issue in your community?”
On the importance of building relationships
Camille Burnett: One of the most important things health equity leaders need to be successful is the ability to start, build, and sustain relationships. It’s often invisible work, but you need protected time to do that. This work does not necessarily mean producing a document or some other concrete deliverable. This kind of work needs to be prioritized, celebrated, and supported by an organization.
Ron Wyatt: One example of a key partner [for health equity leaders] is the chief financial officer. You must understand your system's finances. This means, if we have racial disparities, then we need to know the costs of that to the system. It’s important to have those quantitative money conversations with the chief financial officer and have regular conversations with the finance team to maintain [what Deming called] constancy of purpose for equity work.
On a key piece of advice for equity leaders
Ron Wyatt: Understand that, when we engage with people inside of our system or in the community, there are structures [they have been working and living in] that have been there for decades or centuries. Everyone we engage with in equity work is bringing their social, economic, and political trauma with them. We have to humbly understand that.
Camille Burnett: Remember why you are doing this work. It’s easy to get bogged down by the enormity of the mission. You have to keep the bigger picture in mind, but you don’t want to get too daunted by it. When that happens, all you have to do is look at the very next step, the very next right thing, and take it incrementally, and just put one foot in front of the other.
Editor’s note: These interviews have been edited for length and clarity.
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