Healthcare companies promoting diversity, equity and inclusion face the twin challenges of persuading veteran clinicians to change their practices and training emerging providers to make tackling disparities an integral part of what they do.
Increasingly, health systems are turning to leaders with feet in both the corporate and academic worlds to tackle this joint mission.
Executives with dual appointments in academia have identified a streamlined approach to tackling these issues through medical education. For example, medical schools are updating curricula to eliminate race-based teachings and many have implemented bias and diversity training to provide aspiring physicians with foundational knowledge about health disparities and how to solve them.
"Our medical students today very much want to make sure that they're going to be working within health systems that really are focused around DEI and health equity, especially those medical students who are underrepresented in medicine," said Shiva Bidar-Sielaff, vice president of diversity, equity and inclusion for Madison, Wisconsin-based UW Health and associate dean for diversity and equity transformation at the University of Wisconsin-Madison School of Medicine.
Decades of research has made plain that patients from marginalized groups, including Black and LGBTQ+ people, experience worse health outcomes that often arise from outdated clinical practices, some rooted in debunked racial science, that persist throughout the healthcare system. DEI leaders confront persistent challenges such as patient distrust, medical devices that produce biased results and racism embedded in electronic health records.
Medical education programs historically neglected DEI principles, leaving most of the current physician workforce unexposed to information about health disparities and inequity. For providers engaged in pushing DEI in healthcare, convincing doctors to apply those lessons and mitigate disparities remains a work in progress.
But Dr. Joyce Sackey, chief equity, diversity and inclusion officer at Stanford Medicine, perceives altruism and a commitment to equitable patient care among current medical students, which she sees as promising. "They are really taking us to the next level," she said.
"I am optimistic that—assuming that we equip them with the tools they need to be champions of equity and inclusivity—we're going to have a profession that is transformed," Sackey said. "But first, we don't want to get them jaded. We must nurture that idealism."
The Stanford, California-based health system, comprising a medical school and two hospitals, hired Sackey last year to be the first executive overseeing its entire DEI portfolio. The internal medicine physician advocates for health equity to be integrated into the school curriculum, including subjects such as implicit bias and health disparities. Sackey also ;works with faculty to diversify clinical research with the goal that emerging treatments benefit all types of patients.
Sackey's responsibilities extend to Stanford Medicine hospitals, where she simultaneously focuses on addressing inequity among today's doctors and patients through activities such as DEI discussions with teams and individuals and joining doctors, residents and students on grand rounds.
At UW Health, the DEI team is embedded across health system projects. They bring fresh perspectives and highlight equity issues that might otherwise be overlooked, Bidar-Sielaff said. These teams provide prompt sheets to encourage clinicians to consider new perspectives and potential impacts.
For example, the UW Health DEI office reviews clinical algorithms, policies and patient safety protocols to address disparities based on race, ethnicity and language. The health system offers comprehensive DEI training programs that last up to two years and feature short videos, learning roadmaps and facilitated discussions. The health system has conducted training for more than 130 departments, Bidar-Sielaff said.
At the University of Wisconsin-Madison School of Medicine, Bidar-Sielaff participates in projects such as addressing the distinction between race-based medicine and race-conscious medicine and emphasizing the importance of aligning education with systemic change in the healthcare system, she said.
"We're teaching you these things in medical school, and we're doing that work in the health system to change the systems that would then support you to be able to deliver care in the way that we're teaching you," Bidar-Sielaff said.