Health Care Diversity

It’s in the DNA of Emergency Medicine

Discussions about diversity and inclusion in health care are more than buzzwords at ApolloMD.

They’re tangible, operational tenets, powered by the key leadership commitments and everyday health practices, including:

•   The importance of hiring and promoting an emergency medicine workforce whose make-up, experiences, and expectations reflect the communities and patients they serve.

•  The embrace of a broad, people-driven definition of diversity to include racial and cultural backgrounds, training, experiences lived, family influences, exploration of internal and external biases, and a focus on everyone working together to make sure patients receive the top-notch medical care.

Two ApolloMD executives recently discussed key issues surrounding the everyday meaning, presence, and impact of diversity in health care.

“A hospital’s Emergency Department is the front door and safety net for the vast majority of patients across the country who access the health care system,” says Richard T. Benson II, MD, FACEP, a board-certified, practicing emergency medicine physician and Regional Vice President for ApolloMD. “The Emergency Department is a 24/7/365 one-stop shop for all patients, regardless of age, gender, nationality, ethnicity, religious background, primary language, insurance status, or ability to pay.

“Yet despite the significant advancements in improving the access to prompt and high-quality medical care, health inequities continue in the United States, leading to disparities in several key indicators of health outcomes,” he points out.

“Interestingly, an article published in the American Journal of Preventive Medicine, and later validated by other studies, showed that clinical care impacts only about 20% of health outcomes, while social determinants of health affect as much as 50% of outcomes — a statistic that, in turn, addresses diversity on a large scale. This is why diversity matters.”

Self-awareness, learning from data

Relying on data and patient experience scores is one way of monitoring the success of clinician-patient interactions and outcomes, points out Michael Lipscomb, MD, FACEP, a board-certified, emergency medicine specialist who serves as ApolloMD’s Chief Quality and Patient Safety Officer, and as a Regional Vice President.

He recalls being concerned when his patient experience scores dropped among Black patients, for several months.

“It bothered me,” he says. “What those scores told me was that I needed to consciously connect with these patients and monitor my own approach to care. Maybe I wasn’t making eye contact. Maybe I was talking too much and not listening enough. Maybe I wasn’t communicating effectively or giving clear instructions. Was I neglecting patients somehow?”

Within three months of a more deliberate, conscious approach to patient care, communication skills, and personal interactions, his scores improved.

“What I learned is that you have to come back to the basics by re-visiting, evaluating, and improving your interactions,” Dr. Lipscomb says. “Once you do it, it becomes hard-wired into your practice of emergency medicine.”

Doing so, notes Dr. Benson, supports an important underlying concept of health care: trust.

Sharing personal stories

“Beyond our duty to stabilize, diagnose, and treat – we are responsible for effectively communicating and educating our patients to guide them in making the best decisions about their care,” Dr. Benson emphasizes. “To do this, our patients must trust us. Embedded within the complexities of diversity is an appreciation for our uniqueness, which enables us to develop the trust within the clinician-patient relationship that is vital to good health outcomes. As a group, it’s important for us to reflect the communities we serve.

ApolloMD’s operating philosophy incorporates a commitment to serve all patients and all communities, agrees Dr. Lipscomb.

“As an Emergency Department team, we serve everyone,” says Dr. Lipscomb. “It’s always been at the forefront at ApolloMD that all patients receive equal treatment. There’s no prejudice or preconceptions. We see everyone. It’s in our DNA as emergency medicine specialists.”

ApolloMD’s commitment to diversity took root several years ago and assumed greater importance during and after the challenges of the COVID-19 pandemic, says Dr. Lipscomb, when emergency departments were overwhelmed with new patients of all ages, races, ethnic backgrounds, health care experiences, and expectations.

“Based on personal experiences at our hospitals, some of us decided we would share our stories with our colleagues at other hospitals, and instead of sharing through news articles or emails, we felt that hearing directly from our colleagues was most impactful,” he explains.

At one partner hospital’s lunch-and-learn event focusing on shared personal experiences, an administrator set the stage with a simple statement, along the lines of: “I just want to start this meeting by telling everyone that I will not tolerate discrimination of any kind. I don’t endorse it, even passively, in any shape or form. If I hear it or see it, I will stop it.”

Those words, Dr. Lipscomb recalls, brought one employee to tears, a Black colleague who said: “I have never heard a leader say that before in such a way that I felt it.”

Ongoing sessions provide opportunities for ApolloMD colleagues and coworkers to share personal stories of experiencing, facing, and overcoming prejudices or biases.

“These are not faceless events,” says Dr. Lipscomb. “These are ongoing staff gatherings featuring our coworkers and friends whose lives have been shaped by specific, impactful experiences. Unlike meetings featuring generalities or statistics, these are meaningful meetings among colleagues who share their stories. Hearing from your colleagues what they’ve experienced is powerful, and their stories and experiences provide great opportunities for learning, growth, and change.”

Dr. Benson agrees: “It’s important to talk about diversity as a group. We want to optimize everyone on the team, and when you have diversity – particularly of thoughts and ideas – you strengthen everyone individually and you strengthen the group.”

Tangible evidence of health care diversity and its impact

Dr. Benson looks to his own family’s experiences for the value of paying attention to issues of diversity, equity, quality, and treatment in health care.

In 2014 during residency at the University of Chicago, he donated one of his kidneys to his teen-age brother, whose trip to the local emergency room resulted in a diagnosis of kidney failure. Organ transplantation, he points out, is one specialty that has only recently begun to address racial disparities in eligibility for donated organs. In 2018, he notes, 77% of all kidney transplant recipients in the U.S. were White, while 10% were Black and 10% were Hispanic. Yet, Black and Hispanics patients are diagnosed with kidney failure at a rate almost four times that of White patients.

In 2021, Boston researchers discovered that the estimated glomerular filtration rate (eGFR) used to determine eligibility for kidney transplants included a non-biologic racial coefficient that erroneously calculated the eGFR in Black and Hispanic patients, thus denying them a life-saving organ transplant. In the last two years, a new race-free equation has been validated and has begun to correct this long-held bias.

“That’s one pretty direct way that diversity has impacted health care and health outcomes for a specific population,” Dr. Benson points out.

A conscious commitment to health care diversity

Diversity is just one of numerous factors that come into play in ApolloMD’s approach to recruitment and hiring, says Dr. Lipscomb. The employee-owned, physician-led firm seeks emergency medicine colleagues who are committed to excellent, patient-centered care.

“When we bring on people, we keep diversity in mind,” he says. “As we partner with new hospitals, we choose leaders whose skills match the needs of that community. We know that if we consciously seek out the best candidates with diversity in mind, we will find highly qualified candidates who will be great leaders.”

Adds Dr. Benson: “What is really helpful is understanding who we are. I can look at our executive team and tell you what the diversity breakdown is, but what’s really important is knowing what the communities that we serve look like, and then asking: does our entire group of 1,500 clinicians match the communities we serve? It’s important for us to ensure that everyone is being included, and that everyone is at the table driving decisions.”

To learn more about ApolloMD’s commitment to diversity and inclusion, click here

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