Speaker 1: Since a modern healthcare's reporter round table, where we take you beyond the violence to better understand the news and how it's reported. I'm Rachel cores, modern healthcare's politics and policy reporter, and I'm here today hosting a special round table episode to discuss modern healthcare's coverage of issues of race and diversity this year with public health reporter, Stephen Ross Johnson. Thanks for coming on today, Stephen, thanks for having me. COVID 19 cropped up early this year, and it was apparent early on that, you know, racial disparities and health outcomes were reflected from kind of what we've seen in the larger healthcare system. But then the late spring, it became clear that one of the big storylines in 2020 is going to be this national grappling with issues of race relations and diversity, and kind of how that manifests in the healthcare system. So I was wondering if you could open up and just explain kind of when you realize that this was going to be one of the biggest stories of 2020,
Speaker 2: You know, it's funny because when I actually started this project, I actually came up with the concept back in last year when, before any of this stuff occurred. And so if something had been in my mind for a while, and I think just kind of the events, you know, 2020 as they unfolded, it became clear to me that this was going to be something that was going to be in the national spotlight for a long time. I think it became really obvious to you right after the death of George Ford in Minneapolis and the speed at which healthcare organizations put out statements saying they stood against systemic racism, which is something that as long as I've been reporting in healthcare is something I'd never heard them say in terms of, they talk about implicit bias, they talk about individual acts of explicit racism, but never from a systemic or structural standpoint. It was very telling to me that this was different from what are those moments that occur? It seems like, you know, like once a year or once every two years where a tragedy occurs, it'll gain national attention sparks discussions on how to fix it, like, you know, gun violence and then slowly fade from public attention without any substantive action being taken.
Speaker 1: I mean, did you feel in your conversations in your reporting that that kind of changing language to acknowledge this larger systemic problem was really meaningful and kind of how actions could be designed around it? Can you explain a little bit more about that, that shift?
Speaker 2: Yeah, it's, it's interesting because in talking with some of the healthcare executives where the story, they have a common theme that they often believe went to was that they'd had these discussions obviously for years within their own organizations. And they noticed the shift in terms of how to do speed discussions evolved from one where they had to actually try to prove that systemic racism was a thing, you know, try to convince others who are not affected by it, that there is such a thing as systemic structural racism to one word. Now the conversation's changed to where, okay, how do we deal with this? You know, we, it's all understood now that systemic racism is act does actually exist, does actually affect outcomes, does actually affect care, quality and access. So Kate, so what are some of the steps that we have to take towards kind of addressing it? So I think in that sense, the, you know, the, the change in the nature of the conversations has helped you move things along in the right direction, but, you know, as they all, you know, as they all tests of the healthcare executive, so tests are still along with that,
Speaker 1: This seems like such a big issue, like even narrowing these discussions of systemic racism down to the healthcare system, it's still a really big topic. Where did you start and kind of, how do you narrow that down to something that you can really grab onto and shape into a story?
Speaker 2: Yeah, that's a good question. I think it's something that every reporter really deals with in terms of trying to tackle a big, broad story is terms of where do I begin? And I think that like with a lot of big broad subjects, it has to start with the single person in the single story to create a, a base narrative to go from there as to, you know, how you, how that directs your, your reporting to the story that you want to convey, how it, how that example helps to reflect the larger, broader issue. So I think it's, for me, it started a lot. In essence, it was just hearing from individual patients and hearing from individual healthcare executives, express their own experiences. What they've, what they've experienced in terms of implicit bias in terms of just outright explicit bias and way took for them to get to where they are now. And some of the challenges that he still experienced when they reached healthcare leadership roles,
Speaker 1: You spoke with healthcare executives about incidents of racism. And some of these stories are really powerful where people are willing to open up to you about these issues.
Speaker 2: Not every person was open to talk about it because, and I totally understand that, you know, some were some had to think about it, whether or not it was a good idea to share their, their stories because they're very personal. And I think that you always have to keep that in mind. I think one thing that I helped me in terms of helping, you know, those who did share a little more comfortable doing so was having, I would go through the entire interview with them because I've not only talk with them about sharing their stories, but also get their thoughts and insights in terms of the issue at hand, go through that entire process. And then after that was done, then after we built up a rapport, then being, they felt, I think a little more comfortable sharing with me, some of their personal story, believe me, I understand where they're coming from in terms of their reluctance to share, because sometimes, you know, some of these stories open up open.
Speaker 1: So was there any specific story that stood out to you or, you know, anything that was personally really memorable?
Speaker 2: Well, a couple of things, one actually it's a story that never actually got published was I wrote an additional story, which was initially going to be the beginning of the entire series intro kind of an introductory feature for the entire series, which was kind of, kind of more focused on the historical aspects of discrimination within the healthcare industry and how that connects with some of the inequities that we see today in the end. I think the decision was made, just not that it just didn't quite work with this theories because it, I think it took a little bit more focus off of what's going on in the here and now. And I think that was the right decision, that story, because it forces you to have to go back and like really look into like what some of these issues have been since the beginning of health of the health system in this country.
Speaker 2: It's a little jarring, well, it's a lot jarring, but also I guess just taking in all those stories from healthcare executives in terms of their experiences and also clinical clinicians and, and all the professionals I've talked to as a whole, how the stories took on a similar and familiar town. It's, you know, it's hard to explain to someone how it can feel being a person of color or a person who belongs to a minority group of any kind within an organization, and it can be lonely. And there there's bounce that you have to strike between speaking up for yourself to a point where you're not seeing as a problem within the organization. And it's a balance it's like a tight rope that every executive, every professional apps to deal with has to walk and all the stories, I think, shared that particular aspect.
Speaker 1: You have a ballpark of like how many interviews you did?
Speaker 2: Oh gosh, I did well over 30 interviews over the course of like maybe three months, probably closer to 40 thinking back, what would the inclusion of the videos
Speaker 1: Pretty remarkable sample size then to see these trends kind of emerge. And, you know, I just wonder going back to that historical aspect that you were talking about, I mean, this conversation about social determinants, at least within the healthcare industry and space, isn't one that's novel or brand new, these conversations about diversity have kind of been simmering for a long time. And I was curious if you could just speak to kind of what you saw as you were kind of looking back, at least in the recent past, you know, have health systems made progress on diversity in representation issues, especially kind of at that at that management level.
Speaker 2: Some have, but as an industry as whole, not much when if you look, there's not one of the problems with this is that there's not a whole lot of good current data on industry-wide as terms of the makeup of healthcare leadership. I think the American hospital association puts out a, like a benchmark survey once every like five years, four or five years or so. I think the last one that they did, which I took, which I used some information from in order to inform me on this project was like 2015. So it's been a while. And, you know, looking back at previous benchmark service that they had done, it looks as if the percentage of people of color can make up health care. Executive leadership positions has stayed pretty steady at around 10 to 11%. So, and then, so modern healthcare did its own survey of just picking out a number of organizations throughout the country, large organizations, and kind of getting a feel for their ethnic makeup. It seems to be within that ballpark of, of, of 11% or so. I mean, some organizations, obviously single organizations have done fantastic in just a short time thinking about places like Novant health. They, you know, I think like 40, nearly 40% or so, or more of their board of their executive C-suite board are people of color.
Speaker 1: Have you heard ideas or like concrete kind of programs or examples of things that some health systems or companies have done that really worked for them?
Speaker 2: Yeah. As simple as it sounds, I think that the most effective strategies that I've heard so far have been from those who have started with just listening to their workforce, listening to getting that feedback from, you know, not just from middle managers now from, you know, executives, not just from, you know, clinicians, even going down the line, trying to get a lot, the widest possible range of voices possible to kind of express give feedback in terms of what AC is the problem then really trying to build upon what you, the feedback that you get from those voices to, to develop and to work on strategy. Moving forward, Jefferson health was one that stood out to me because yeah, they did that. They they're doing that process exactly where they listen, they take what they learned from those, from those listening tours to build upon, to build a strategy that may, that may result in, in positive effect. I don't know it's still in process, but I think it has to start there because if you don't have a clear view as to what the problem is, you can't address it. The programs that are most effective or IDEO are really taking priorities of taking that commitment to this issue are ones that do it internally, take it from the ground up and then put the right people in place to, to run those programs and then develop.
Speaker 1: So how are you, how are you feeling looking forward? Do you think that kind of, this, this conversation in the wake of Juris, voids, death, you know, do you think things will change in the healthcare industry?
Speaker 2: Honestly, I don't know. I really don't. I it's, I wanna, I would love to be positive and say, Oh yeah, this is going to lead to a whole, you know, so, so much change, but it it's so hard to say because you know, there's a very good chance that this issue could end up running the course, like a whole lot of other social issues where you have a public awareness of this, of the problem of like racial injustice and racial health inequity, you get this heightened sense of awareness. And then after a while, after it's been talked about for a long time after it's been discussed after you've seen protests at the protest and all these calls for change, then my fear is that then your awareness suddenly turns to indifference for healthcare organizations that can't afford to do that. I think that they have to take this opportunity now to really start to address these issues, because if they don't, then I don't, I don't know what will change.
Speaker 2: It makes me think about the issue of gun violence. A lot in the sense that when Sandy hook massacre happened seven years ago, people thought that that was, that was a seminal moment where substantive change was going to occur in terms of putting out some substantial laws to curb gun violence. When that didn't occur, you know, people are now throwing up their hands. Like if, if you can't get behind that, then I mean, what, what will it take? And I think now it's the same. I think there's the same kind of moment where you see what's happening and you see everything, you know, and you see how it's affecting, you know, health outcomes among minority communities throughout this country. And, and if you can't get behind it now to take action now, then I don't know what, what it will take.
Speaker 1: Well, thank you so much for sharing your expertise and your insight with us, Stephen, your reporting is so important and we're so lucky to have you on the team. Thank you very much to make sure you're here. Every episode of beyond the byline, you can subscribe on Apple podcast, Spotify, and radio public. And if you value the work that we do, you can subscribe to modern healthcare at the link in the show notes. Thanks for listening.