October 3, 2022
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Racial Equity Plan: Developing Specific Actions for Anti-Racist Health Care

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Consuelo Wilkins and Namita Seth Mohta headshots on purple background.

Namita Seth Mohta, MD, interviews Consuelo H. Wilkins, MD, MSCI, Vice President for Health Equity and Professor of Medicine at Vanderbilt University Medical Center.

Namita Seth Mohta:

This is Namita Seth Mohta for NEJM Catalyst. I am speaking with Dr. Consuelo Wilkins. Dr. Wilkins currently serves as the Chief Equity Officer and Professor of Medicine at Vanderbilt University Medical Center. I won’t name all her remarkable accomplishments and accolades here, but suffice it to say, there are many. Her career has been focused on community engagement, community academic partnerships, and addressing health equities. Today, we will be focusing on her work with the Vanderbilt community on anti-racism. Thank you for joining us.

Consuelo Wilkins:

Thank you for having me.

Mohta:

Let’s start with the basics. Tell us about your chief equity role. What is your purview and responsibilities in this position?

Wilkins:

In my role as Chief Equity Officer, I oversee two offices. One is the Office of Health Equity, and the other is the Office of Diversity and Inclusion. We intentionally keep those separate. Oftentimes, we hear people conflate the two, but for us, we think it’s important to distinguish between health equity, where we’re focusing on health outcomes — making sure that people who are socially disadvantaged have every opportunity for optimal health — and in the Office of Diversity and Inclusion, we’re thinking about the workforce [including students and trainees] and how to make sure that the workforce reflects the broad diversity of the populations we serve, that we’re thinking about how to make sure those people are included and have a sense of belonging in the organization.

Obviously, we know that having a more diverse and inclusive workforce does have some impact on health equity, but they’re actually two separate and distinct concepts, because when you think about what’s necessary to have a diverse workforce, it’s very different than when you think about what’s needed to affect health outcomes.

Mohta:

Can you share with us a little about the specific projects that are going on in each of these two departments to highlight those differences?

Wilkins:

In our Office of Health Equity, that’s where our Community Health Needs Assessment is housed. [That’s] our required, every-3-years-at-least process of engaging the community to identify needs. For us, a big focus is on populations that’ve been minoritized, marginalized, socially disadvantaged. We also have a certificate program that focuses on training individuals to use a health equity lens in examining information, data, [and] developing plans and strategies to improve health outcomes.

Meanwhile, in our Office of Diversity and Inclusion, we have strategies focused on recruiting and retaining individuals from racial and ethnic minorities from groups that’ve been underrepresented and historically excluded.

There, we have our faculty toolkit for advancing inclusive excellence, [where we make] sure we’re emphasizing in that space that diversity is not just for diversity’s sake, but if we actually want to achieve our best excellence or be excellent, then we recognize the value of diversity.

Mohta:

You’ve mentioned Vanderbilt’s commitment to becoming an anti-racist medical center. What does this mean in the context of the larger frame that you mentioned? What are some of the key strategies and tactics that Vanderbilt is using to realize this bold goal?

Wilkins:

When we think about equity and groups that’ve been socially disadvantaged, that can be groups based on race, ethnicity, sexual and gender minority status, socioeconomic status. There are many areas or spaces where people have been socially disadvantaged. For us, when we are focusing on racism and recognizing that as an area that has been challenging for us to address — not just us at Vanderbilt but us broadly in society — we have decided that we want to be intentional in actively addressing and confronting racism. That anti-racist approach means that we have an action plan. We’re developing clear steps with intentionality and thinking about how we will dismantle, confront, reorganize, and transform the organization to address racism.

Mohta:

What does that look like in the day-to-day?

Wilkins:

I’m excited that we just, in [May 2022], have released internally our Racial Equity Plan. It has more than 100 specific actions that we, as an organization, are taking to confront racism. It’s organized in eight thematic areas and starts with, how do we create and ensure that we have the infrastructure that’s needed to do this work?

Across the other thematic areas, we’re focusing on recruiting, including, and promoting racial and ethnic minorities, making sure they have the benefits to achieve equity. There’s a focus on students and trainees. There’s a plan specifically for creating an anti-racist research agenda. We have a focus, as well, on being anti-racist in the clinical setting and providing more equitable care. It’s intended to be a road map in which every single action has a leader who is responsible and accountable for that action.

Mohta:

First of all, congratulations.

Mohta:

I’m looking forward hearing about how that journey goes. In even getting to this point of having this plan, and as you look ahead to activating and implementing it, what have been some of the biggest challenges and barriers? How have you overcome them, or how will you plan on overcoming them?

Wilkins:

We’ve been thinking quite a bit about this. We produced our Racial Equity Plan at the end of December 2021. In the last few months, we’ve been planning for the implementation and thinking through what are going to be the barriers to doing this work?

On the one hand, we have people who are passionate and vocal and ready to do this work. They’re saying, “It’s been months since you all said that you were going to have this plan. Why haven’t we done the work? You’re moving too slow.” And then we have people, on the other hand, who are saying, “This is moving too fast. You’re talking about racism. You’re talking about anti-racism. You’re talking about white supremacy, and this is a lot.”

How do we try and make sure that we are having wins and actions being taken while also preparing [and moving forward] people who are not fully prepared to do this work, or be involved, or even talk about this work? A key piece of our implementation plan is managing the resistance. We’re actively talking about thinking through and asking our leaders to imagine how they might resist the actions in these plans. For some people, that’s challenging to do.

We’re also asking them to think about how individuals who report to them might be resistant to the plan. Sometimes they could come up with those answers a little easier, but we want to make sure that people are thinking about what kinds of resistance they’ll face, so that we can arm them with the tools to address the resistance.

Mohta:

What’s an example of a tool that you might provide one of your clinical leaders to help manage the resistance?

Wilkins:

We are preparing different kinds of anti-racism trainings. Specifically, in the clinical setting, thinking about how to make sure individuals are able to use that health equity lens to identify inequities, so how to disaggregate data by race, ethnicity, gender, social determinants of health. And then we have other areas that we’re focused on that are considering if you’re experiencing racism in the clinical setting as a student or trainee, what kind of upstander training is needed so that we can address it in that moment and be clear on what kind of organization we are and how we’re not going to tolerate discrimination, bias, or racism? Again, thinking through all those kinds of tools that people might need is based on the problems we’ve identified, and the resulting actions that we planned.

Mohta:

You mentioned data earlier. How are you using the data of your patient population, of the employee population to inform these tactics? Just as importantly, how are you going to measure and demonstrate success?

Wilkins:

When we were developing this plan — and the first step to the plan was coming up with a set of recommendations — and when we were developing the recommendations, we went through a lot of data. We were looking at the diversity of the workforce in different roles, in different levels. If you were in a service role, in one of the lower–wage earning roles in the organization, we were looking at whether you contributed to your retirement account at the level for which you would get a match.

We were disaggregating that by race and ethnicity. From that, we learned that Black and Hispanic/Latinx individuals were less likely to be contributing at a level for which they could get a match, and so, one of the actions is to have more culturally relevant information provided to individuals to support their being able to contribute to their retirement.

Access to hardship funds, and making that information around financial literacy available in languages other than English and being delivered by individuals who might be more racially or culturally concordant with that population. That’s one example of, specifically, the data in forming the plans. And then, certainly, we’ve thought quite a bit about how we will evaluate the work and what success looks like.

In addition to an action and an individual who’s responsible and a leader who’s accountable, we have milestones and metrics for each action that’s already in the plan. We expect that those milestones and metrics will evolve over time, and maybe they’ll become more precise, but we’ll have an overarching evaluation plan. We’re hiring a director of evaluation specifically for this work, and that individual will help us refine that conceptual framework and the logic models. Every individual who is responsible for an action will be responsible for communicating progress up to the evaluated level that’s informing our overall tracking.

Mohta:

I’m already looking forward to our part-two conversation, where we talk about the impact of all of this. Let me ask you one last question. Given all the work that you’ve done, given where you are in this journey and the work that is ahead, what advice would you give your colleagues across the country and, quite frankly, across the world, who are committed to building anti-racism cultures in their organizations?

Wilkins:

I would say it’s so important that you have a plan. That’s probably obvious. You should have a plan, and that plan needs to be informed by and developed with a broad group of people. We had more than 100 people on our Racial Equity Taskforce, representing students, faculty, clinicians, people in service roles. We had the chief of campus police. Hospital presidents were all involved in this.

You have to make sure that you have a lot of different lenses and perspectives included in that work. A very important aspect of this is the leadership role. This Racial Equity Plan is not my plan. It’s our plan. Our CEO and dean endorsed, has been involved in, helped to revise the plan. That buy-in at the leadership level is critical because it really needs to be understood and expected that this is a group activity and that we have broad accountability.

That’s why we spent so much time thinking about, who’s going to be responsible and accountable? In that plan, we identified the role so that if an individual leaves or moves or gets promoted, the responsibility of that work stays with the role. That, hopefully, will increase our chances of being successful.

Mohta:

The chances for success already sound pretty high to me, Consuelo. Thank you so much for speaking with NEJM Catalyst today.

Wilkins:

My pleasure. Thanks for having me.



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