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Agenda

Welcome/Framing 9:00-10:00
Vision and Strategy Activity 10:00-12:00

15 min break built within

60 min lunch
Asset Mapping 1:00-2:15

15 min break

Learning and Leading Together 2:30-3:45

Wrap Up and Next Steps 3:45-4:00

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Framing Our Conversation with Deborah & Simbo

Construy

Deborah Bae Simbo Ige

Interim Managing Director Managing Director

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Introduce yourself (name, story of your name, location)

What excites about this work?

A key insight?
A question you’re leaning into?
What do you need to feel like this was a really good use of your time?

Introductions and Reflection

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A Blessing for One who Holds Power

May the gift of leadership awaken in you as a vocation Keep you mindful of the providence that calls you to serve.. As high over the mountains the eagle spreads its wings,

May your perspective be larger than the view from the foothills. When the way is flat and dull in times of grey endurance,

May your imagination continue to evoke horizons. When thirst burns in times of drought,

May you be blessed to find the wells. May you have the wisdom to read time clearly

And know when the seed of change will flourish. In your heart may there be a sanctuary

For the stillness where clarity is born. May your work be infused with passion and creativity

And have the wisdom to balance compassion and challenge. May your soul find the graciousness

To rise above the fester of small mediocrities. May your power never become a shell

Wherein your heart would silently atrophy. May you welcome your own vulnerability

As the ground where healing and truth join. May integrity of soul be your first ideal,

The source that will guide and bless your work.

John O’Donohue

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Touchstones - Which touchstone resonates with you today?

Be present as fully as possible. Speak our truth from our hearts and minds.
Listen generously to our own, and each other’s truths. Trust that we all hold a piece of the puzzle and we need each other’s pieces to understand the whole picture.
Embrace differences and be open to learning from each other.
When the going gets rough, practice deep respect, honor dignity, suspend judgment and get curious. Be quick to forgive and ask open questions to understand each other as individuals, in relationship.
Honor each other’s learning and resourcefulness. Trust we each will learn and contribute in our own way, that there is no need to “fix” each other.
Make space to pause and reflect to deepen our thinking.
Be willing to have meaningful conflict to create unprecedented goals and solutions. When needed, seek counsel for help with conflicts.

Allow our ideas to be developed further by others.
Seek common ground aligned with our goals and principles, not the lowest common denominator. When we can’t fully agree, we commit to a unified decision and to see what happens from a humble posture of learning. If we have made the wrong turn, we will discover it together and turn the right way together.
Accept that we will sometimes fail, but will learn together and move forward.
Help each other to have the confidence to spread our wings, be creative, and take on new roles.
Balance our yearning for change with patience for the process of change and growth.
Make the way we work together an example of what’s possible.
Embrace cultural humility
What is said here in confidentially, stays here
What is learned and decided here, leaves here

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A racially just and equitable health system grounded in love and belonging that treats people with dignity, provides culturally excellent high quality care, and enhances the well being and quality of life for all people.

What would it take to dismantle structural racism in health and health care in order to advance health equity?

The Vision that Emerged

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Recommended Strategic Structural Shifts

Pulling Levers To Unlock On-Ramps for Systemic Change in U.S. Healthcare

Addressing Structural Racism in Health Professional Education

Integrate training that provides a structural diagnosis and structural solutions into all new and existing leadership training programs with a focus on administrative and clinical leaders of all disciplines. To build that structural solution we must increase…

Change how and what we measure to advance racial justice and equity

Racism’s Role in Outcomes Not Being Measured

Engage specialties and laboratories to change racist bases embedded in diagnostics, starting with racism in kidney transplantation

The Capitalist Basis of Health Systems

Shift the narrative that health care is a business first

Demonstrate strategies to realign the business and financing of medicine to create health and well-being

Burden on BIPOC Leaders

At time, efforts to address racial justice can impose a “minority tax,” on minority faculty and staff.

Lack of Accounting for Racist Past

How past and present legacies perpetuate health inequities

Certain Bodies

Cherished More

How the practice of medicine and diagnostics embed racism beliefs

Racism’s Role in Diagnostics

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The 14 Structural Shifts 1/3

Shift	Current State	Future State
Capitalist Basis of Health System	Much of the U.S. health system is increasingly driven by capitalist mentality and values, prioritizing profit maximization over its social purpose, benefiting economically from chronic illness, especially among BIPOC people.	We have effectively disconnected the U.S. health system from the capitalist economic system and grounded it in a social purpose of health and well-being for all.
Treatment-�focused Payment Models	Payment models and systems incentivize efficient delivery of high volumes of services that favor treating disease over nurturing wellness.	We have structured all major payment programs to center disease prevention and well-being and incentivise equitable outcomes around race.
Undermined Public Health System	The U.S. public health system is underfunded and under threat.	We have an effective, well-funded public health system across the country that’s led by public health professionals and grounded in equity.
Certain Bodies Cherished More	White, male, cisgendered, and nondisabled health and wellbeing are consistently valued over the lives of BIPOC, women, transgender, and disabled people.	We have a shared culture of health in which all lives are valued equally.
Integrating Structural Racism into Health Professional Education	Health professionals lack understanding of the structural and racial determinants of health, and they in fact gain racial and gender bias during their training.	The awareness and behaviors of all new clinicians, researchers, and health professionals are aligned with racial justice.

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The 14 Structural Shifts 2/3

Shift	Current State	Future State
BIPOC Health System Workforce Inclusion, Agency & Power	BIPOC are largely excluded in health system leadership and clinical positions and BIPOC across all health system positions are poorly supported and experience their voices being silenced, neglected, or discarded in our healthcare system.	BIPOC are included across all levels and functions, particularly senior leadership and clinical care, and experience a culture of belonging that lends agency and power to their work.
Accountability to Communities	The U.S. healthcare system is increasingly centralized and consolidated, separating it further from community focus and accountability.	Our health system is organized around the needs and priorities of communities, especially those most underserved, with clear accountability to, and shared governance with, those communities.
Racism’s Role in Outcomes Not Being Measured	A majority of the U.S. health system is unable to identify the role that racism plays in patient and community health outcomes.	The use of disaggregated data to close race-based gaps in health outcomes is standard practice across the health system.
Racism and Racial Bias in Research & Diagnostics	Unfounded race-based (and sex-based) distinctions are endemic in medical research, diagnostic standards, and testing technologies.	We have eliminated unfounded race and sex-based distinctions in research, diagnostic standards and testing technologies.
BIPOC Patient Voices Discarded	BIPOC patients are not listened to and are treated as people without agency or a say in their own health decisions.	The goals, aspirations, and priorities of BIPOC patients are centered in decisions about their treatment and care.

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The 14 Structural Shifts 3/3

Shift	Current State	Future State
Complete Health and Wellness	The U.S. health system is fragmented and heavily focused on the treatment of illness and symptoms of disease.	Our health system is employing a proactive, holistic, and culturally-excellent approach to health and well-being.
Burden on BIPOC Leaders	Anti-racism healthcare leaders experience racial battle fatigue, are often marginalized to the fringes of the health system, and their recommendations are mediated by white cultural norms.	BIPOC leading systemic changes to dismantle structural racism in healthcare are fully supported in their well-being, resilience, and capacity and their work is valued and centered within the health system. White co-conspirators step up with a spirit of co-design and shared leadership, seeing that this is everyone’s work.
Lack of Accounting for Racist Past	We have not reconciled the deep history of racism that is still embedded in today’s health system.	Key institutions across the health system are actively engaged in a meaningful process of truth and reconciliation around past and present racism in their systems.
Cross-System Approach to Structural Drivers of Health	Our health system heavily focuses resources, expertise, and capacity on treating downstream outcomes to the neglect of shifting the upstream, structural drivers of health.	Leaders across the health system actively partner with leaders from other sectors to change culture, policies, and investments to build new equitable systems (e.g. housing, community safety, policing, education.)

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72 participants responded to the prompt, “Which of these [14] shifts do you believe are most critical to focus on to achieve our goal?” The poll allowed respondents to choose and rank up to 5 shifts. A score of 3 means that the shift was ranked 3 times higher than a score of 1.

Capitalist Basis of Healthcare (3.21)
Undermined Public Health System (1.53)
Payment Models Favor Disease (1.50)
White Bodies Cherished More (1.43)
Racial Bias in Medical Training (1.10)
Community-Driven Health (1.00)
Lack of BIPOC Health Professionals (0.96)

Ranking of Shifts by Consultation Session Participants

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KILE ADUMENE

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Robert Sanchez was sent to various specialists for both kidney failure and cancer. Often being misdiagnosed or over treated. The siloed health system resulted in limited lines of communication between hus specialists and his needs were dealt with episodically rather than holistically and preventatively. Robert’s whole person (social and physical barriers) were not addressed as he slipped into deeper depression which exacerbated his physical illness.

During kidney failure, Robert asked why this was happening to him? The nephrologist stated that it was just “the luck of the draw”. Again, the lack of accountability towards communities is manifested by the physician statement. Robert is three times more likely to need a kidney transplant than his white counterpart. It is not bad luck, it iia system that has a lack of black and brown kidney donors, plus a poor algorithm that historically blocked kidney transplants to black patients

Robert’s kidney failure was only one of his concerns in life. Often providers ignore or are unaware of the environmental barriers we face when diagnosing and treating illness. Robert has faced decades of environmental barriers including;

Two very traumatic life experiences before he was 5 years old
15 consecutive years of incarceration ending with a rough reentry process
Employment insecurity as he had no transferable skills
Residing in same neighborhood where he was arrested and had the adverse childhood experiences

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