Equity in Health Care with Stephen Graves
10/12/2021
āāWhen it comes to ... resistance...These are priorities within priorities...Thereās going to be a lens of diversity, equity and inclusion ... Maybe youāre expanding your practice...Youāve got to have some consideration for...how are we going to make this accessible for a person with disability? How are we going to make sure that language signage is translated in a way that folks who donāt speak English as a first language can understand? These things are going to be embedded.āā
In episode 33 of Nonprofit Mission: Impact, Carol, her cohost, Peter Cruz, and their guest, Stephen Graves discuss diversity equity and inclusion in the health care sector. This episode is a release of a podcast Carol planned to start with her son-in-law and has many transferrable ideas and concepts to the nonprofit sector. We talk about:
Why leadership engagement and support for diversity, equity and inclusion efforts is key regardless of the sector
How data and evidence can inform DEI efforts
Why there is historical mistrust of the medical professional among communities of color
Guest bio: Stephen Graves
Born in South Carolina and raised in the black Baptist church, Stephen had an insatiable curiosity to understand the Southās nuanced history related to race, his place in that story as a black man, and how the Christian faith could be used as a tool to heal or a weapon to hurt. This curiosity set him on a personal exploration, which turned into a professional journey as he pursued and earned a Master in Health Administration from the Medical University of South Carolina. Throughout his career in healthcare and in diversity, equity and inclusion, he has led initiatives centered on addressing health disparities, improving language access, and increasing cultural humility among teams. He has been fortunate to collaborate with healthcare providers, faith leaders, high school and college students, and business leaders in helping them to create welcoming and inclusive cultures where all can thrive.
Resources:
Cultural humility: https://www.youtube.com/watch?v=SaSHLbS1V4w
Tuskegee Study: https://www.socialworker.com/feature-articles/ethics-articles/The_Tuskegee_Syphilis_Study_and_Its_Implications_for_the_21st_Century/
Racial biases about Black people and pain: https://www.aamc.org/news-insights/how-we-fail-black-patients-pain
Guest contact:
Stephen Graves: https://www.linkedin.com/in/sggraves/
All In Consulting: https://www.allinconsulting.co/
Peter Cruz: https://www.linkedin.com/in/peterjcruz/
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Peter Cruz: Hey, everyone. Welcome to culture. Fit the podcast where we do our best to answer your equity inclusion questions. That'll help you navigate the professional landscape, especially when you are not a culture fit. Peter Cruz
Carol Hamilton: and I'm Carol Hamilton. And today on the podcast, we're going to be talking to Steven Graves and looking at diversity equity inclusion in the healthcare practice.
Peter: It's a great conversation and I hope you enjoyed the episode.
Stephen Graves: Hey Carol,
Peter: How are you doing Carol?
Carol: How are you doing Peter?
Peter: I'm doing all right. I had a good night's sleep because it's like 16 degrees over here. And when it's really cold, you just sleep real hard. So I didn't move. Not one time. So I'm well rested and well-prepared for today.
Carol: Today we do have a guest. Our guest is Steven Graves. How are you doing Steven?
Stephen: Good. Glad to be here.
Peter: Could you provide some background information on yourself?
Stephen: Yeah. I'm Stephen Graves. I'm a native of a small town in South Carolina, upstate South Carolina called Greenville. In between Greenville and Columbia I started in the healthcare profession dating back to when I was in college interning at a disabilities and special needs facility. Also pursue my master's at the medical university of South Carolina down in Charleston, South Carolina. So I had to have about a decade of experience in the medical field. And just really glad to be here today and have a conversation with you all
Peter: glad to have you for sure. I mean, you're our inaugural guests, so without you, the show actually wouldn't be possible.
Stephen: Oh, wow. That is a privilege and an honor pressure too.
Carol: No, no pressure at all. And Steven, I think, as you've been in that field, you've also stepped into specializing more closely in diversity, equity and inclusion. Is that correct? Is that right?
Stephen: Yes. Yeah. I've been doing the diversity equity and inclusion work. Like I said for the last 10 years, I really opened my eyes during my time at the medical university of South Carolina working with a limited English professor. In communities trying to make sure that they have access to translators interpreters, and really just making sure that those services meet and exceed their expectations to improve the patient experience. I was really blessed and honored to be around some great folks, great mentors at the MUFC community. And it just really opened my eyes to the disparities that are in healthcare, in the medical community and understanding how we can. Address those to have a more equitable society and make sure that everybody's living to their full potential as far as their physical and mental health is concerned.
Peter: Hmm. Great. And this is coming this first, like my question, like it's coming from a place of ignorance because I don't know anyone else who works in the medical field. Especially in diversity equity inclusion. Is there, what are, where are things that are similar? From the medical field in DEI that are, that exist in nonprofit or corporate spaces. And then if there's anything that's unique to there, can you like to shine some light on those?
Stephen: Yeah, that's a good question. I think the similarities are that in order for shifts to be made in order for real change, transformational change to happen. You've got to have senior leadership commitment. Whoever is at the top of the organization has the most power. They have the most influence. Oftentimes they can control where energy is being in place, where resources are being placed. So the one similarity, the main similarity is really around that senior leadership commitment piece. I think another similarity is also around being. Data and evidence-based driven, right? So a lot of times the mistake that people make in this particular aspect of diversity equity inclusion is because there's such an emotional tie and pull to it with feelings and it can trigger a lot of people. People don't take a logical, maybe rational and evidence-based approach. And I think whether you're in the nonprofit space, whether you're in the corporate America space, whether you're healthcare like myself, You still need to be driven by data, right? Collecting what we call real data, race, ethnicity, and language, data, collecting sexual orientation and gender identity data. So that's another similarity. And in terms of collecting that data, and then a third similarity would be around using that data. To sit and drive real goals in terms of what are going to be some realistic goals that we can measure and they can help us chart our path forward. I would say the main difference in healthcare is that you are literally talking about life and death, right? Yeah. A lot of people in other spaces can say, okay, well, this is nice to have. But if you don't have the right type of language, access programming in place, or an effective language access program, it can literally be a life or death situation. There can be some dire consequences if you're not focusing on equitable outcomes, I would say that would be the biggest difference when it comes to working in this space in healthcare lands versus any other field.
Peter: Thank you. I think that last bit does stand out for me, it being about life or death. I think that probably because my professional experience is all in nonprofit, like youth focused, youth empowerment and because it doesn't have to do with life or death, it provides that opportunity to. Second guests like to prolong and like to require more patients because the senior leaders have the option to just like, maybe test it a little bit, but then if it doesn't feel like it will succeed. And, but does that mean that things, decisions come quicker in, in, in, in the middle of the profession?
Carol: The huge organizations that you're dealing with as well. I mean, huge systems with so many people and that, that, that makes the complexity even, even more so.
Stephen: Exactly right. When you're talking about a large health system, I've worked in health systems ranging from 8,000 employees to 25,000 employees. So it takes a long time to normalize this across the landscape. If you will, when it comes to that large healthcare. There is a higher sense of urgency, I would say right now, based on the events that happened last year, I think America's having a reawakening and that's happening in the medical field as well. Thinking about the COVID disparities related to the pandemic black and brown communities being hit harder than other communities of color and white communities. When you're thinking about that, the sense of urgency has elevated recently, those same barriers when it comes to that bureaucratic nature of the hierarchy is still there. And that's unfortunate, but I think, again, I'm hopeful and optimistic that right now there's going to be a shift that happens as a result of occurrence.
Carol: And I can imagine that that sense of crisis, actually, it could be helpful and it could also be a hindrance of, oh, we've just got to focus on COVID right now. We can't focus on those, those other things going unquote. And I imagine that plays out as well.
Stephen: It does, it does. And, me being able to prioritize the advice that I would give to leaders when it comes to that resistance, right. In terms of saying, okay, we got to put this off because there's other priorities saying, Hey, these are priorities within priorities. Right? So wherever the conversation is, whether it's around COVID, whether it's around your EHR, electronic health care, right. There's going to be a lens of diversity, equity and inclusion within all of those priorities. Maybe you're building and expanding your practices, expanding a wing, getting your hospital. You've got to have some consideration for, okay, how are we going to make this accessible, right, for a person with disability? How are we going to make sure that language signage is translated in a way that folks who don't speak English as a first language can understand? So these things are going to be embedded, right? Any initiative, any project that hospital organizations are going to be working on. And that's the case that I always try to make when it comes to prioritizing this work.
Carol: And you mentioned data and evidence driven. Can you give us an example of how that's been helpful and bringing that perspective or bringing that evidence to the team.
Stephen: Yeah. So a lot of the organizations that I've had the pleasure to work inside of and consult with survey, right? So doing engagement surveys and really asking some core questions around inclusivity and inclusion saying, do you feel respected? In the walls, these hospitals, do you feel there are patients who are racial, racially, diverse, ethnically diverse, linguistically diverse. Do you feel like they're being respected, being treated the same, that data can provide a baseline and it can really be useful and valuable to getting you some really great information that you can build off of. So that's one part of the data collection that I'm referring to. Another aspect is looking at patient experience scores, right? So this is something we all can relate to, whether you're. Inside of the healthcare system, or you are receiving services as a patient, everybody can either deliver, how their experience was, or we're going to hear how the experience was on our end as healthcare providers. That data can be stratified sorted by race, by ethnicity, by language, by age or all of these different demographic factors. And you can realize contrast, and you can see those contrasts and that data. If again, if the organization's willing to make that commitment, to look at their data differently, to see, okay, there's a difference because different, yeah, this exists and that takes a little bit of commitment and it takes a little bit of discomfort to look at that and say, White patients are having a much better experience when they're interacting with their nurse at bedside than a black patient is. So those that, that type of data will really help tell a story and validate for the, the nonbelievers, if you will, this work is so important.
Peter: Speaking of non-believers. One, one question that we were going to ask you is the anti-vaxxer community. How has that, especially over the past year during COVID, how has that impacted I guess the increase of people coming into the hospital. And is there a community that exists within the staff? The medical professionals that are also anti-vaxxers.
Stephen: Yeah. I would say that when it comes to anti-vaxxers and those who may be a little bit reluctant to take the backseat, it depends on the communities that you're talking about. Right. So we're talking about black and brown communities. There is an understandable and rightful way of having a district. Yeah, the medical community, right, because of history and because of what we've seen, not only in the healthcare space, but in all of our institutions across America. So the medical community as providers and professionals who have done significant harm over the last, however, a hundred, many years to validate those concerns and those anti-vaxxers, if you will. Yes, whether it's a staff member of color, whether it's a patient of color, I've seen it on both ends. And what part of the work that the medical community has to do is to regain trust of those communities by engaging more effectively and more creatively to make sure that, Hey, we are here for your best interests at hand and alleviating those concerns. But yes, there's definitely. That reluctance piece when it comes to the backs of nations, whether it's, staff members, black staff members of color, or folks, out in the community. Yeah.
Carol: And can you say more, a little bit more about that history of the, that really drove that distrust?
Stephen: Yeah. So I would say, dating back, you can Google the Tuskegee experiments, right? You can think about how women of color are right. Who were pregnant or how they've been treated. So there's a deep history and examples in terms of that level of distrust. And I would say going back to that language access piece, there are some, really Keystone cases in terms of capstones that this suggests okay. One word was mistranslated, right? One word was misinterpreted and it led to a misdiagnosis. It led to the wrong arm being amputated, the wrong leg being amputated. So there's several and numerous examples of that distrust that has been building over time.
Peter: Yeah. And I would also wonder with being that, I guess the white community is more of an individualistic community and people of color tend to be. You know more of a collective so to speak. And if one, one patient has a negative experience, it will already create the whole narrative for their entire community about whether or not they will even, if I'm not feeling well, whether or not I even go to the hospital because they mistreated my friend, they mistreated my mother, they mistreated whomever. Right. So that's that, yeah, that, that, that data that you mentioned earlier is so much more signal, like as equally as significant as it. About the historical context, I would say as well, right?
Stephen: Yeah. That data is current too. Right. So if you think about as recent as five years ago, I won't say the school, but there was a medical school and the students, the white medical residents actually thought that blue, black people's blood coagulated. And they literally thought that black people's skin was thicker and that led to a misdiagnosis and mismanagement of pain and, and under-valuing pain management and prescribing for pain. So the data most currently, and most recently it provides more than enough evidence to focus on communities of color and ensure they have equitable care. Yeah, that data piece is huge.
Peter: I'm looking, you mentioned this, but looking at the past year what we were, we've spoken a little bit about the experience for the patients or potential patients or the community for the medical professionals. How has that last year been? In regards to DEI being that there was like an increased sense of it.
Stephen: Yeah, depending on the communities, right. That you're speaking of within the medical community. Right? So the black and brown professionals in the medical field who I've had the opportunity and privilege to work around, they're saying, okay, well it's about time, right? It's about time, that we're having these conversations, right. It's long overdue. So that's by and large, the sentiment that I've heard from communities of color, when it comes to the white profession. There are some who they're on board, right? How can I be an ally? How can I do better as a provider to better serve my patient? But then of course you have those who are saying, okay, we're just one race. We're the human race, right. Or I'm colorblind. I don't see color, right. And you're thinking to yourself, okay, that's well intentioned. There's some blind spots there. Right. And then, Very far end of the spectrum. you have those folks who have been in the medical field for years, right? Maybe 30, 40 years. They just were not trained this way. Right. They didn't, they weren't trained to have any sort of cultural humility when thinking about the patients, the diverse patients that they're serving. So they have a mindset in place that they develop over time and then, develop a sense of their training that they really have to think through and say, okay, what, what do I need to uncover? What can I start getting curious about to be a better provider? Yes, definitely a range across the spectrum in terms of the response to the DEI efforts and the need for DEI efforts.
Peter: Hmm. I have just one more question. Really Carol, do you have any other questions right now? Okay, with all you've experienced the past four years, right. With administration, do court like that, connected with the pandemic and how people have interacted with Medicare and the medical systems. Are there things that you are optimistic about with the change of administration in regards to the medical profession? Cause I know that people think it's a very, it's a clean slate. A new president. We're all good. Now we got the right guy in office. It's no worries. Like we're all good. Right? We're all family. I'm colorblind and we love each other now again is that, is there any optimism moving forward? Any like short-term goals or long-term goals?
Stephen: Iām optimistic about, from what I've heard from the new administration that has entered is that they are reliable. They are going back to that data-driven evidence-based piece, or they're not saying things that may not be true or may not be validated with data. So I'm looking forward to hearing facts from scientists. Medical experts. And if they don't know the answer to something, I don't know the answer rather than making something up or forecasting something that's not true. Right. And not to get too much into my learning series, but I'm looking forward to not being told to inject our stills with Clorox or other, you know substances that may not, that would probably be harmful to us. So I'm looking forward to that. I'm also optimistic about the focus on disparities. Right? So I think one of the things that I saw coming out of this new administration is a task force. That's going to be developed for health disparities, health equity, especially, during the as we continue to navigate COVID right. So I'm optimistic that there's going to be a renewed focus on communities of color, of being a black man myself. I think that that's critically important. So there's a lot to be optimistic about and, just on a general level, I mean, I'm just looking forward to not being as exhausted. Right. So, and I think that goes for everybody, right? No matter what party you support, I think, everybody can attest to the last four years that it was just a level of exhaustion, whether you were defending the former administration or whether you were radically opposed to the former administration. Well, we can all agree to his bit. It will just be a lower temperature if you will, when it comes to what's happening in DC and how it's affecting our world.
Peter: Yeah, it is, it is, it is wild to think that facts were political.
Carol: We don't have to defend facts as a partisan issue. Oh my goodness. Yeah. Yeah. But I think, as you said, it's a long overdue this, this reckoning that we're having. And as. as groups come together and start really digging into the data that's there. And many people have already researched these things, but bringing it all together into light and to light to the general public through the press, I think it should hopefully move things along.
Stephen: Yeah, that's that, that, that is, I'm definitely hopeful. again, with the information, I think that, the. No, not having so much misinformation floating around. I think that'll definitely go a long way.
Carol: All right. Well, yeah. Thank you so much.
Stephen: All right. Yeah, thank y'all for having me. And I was glad to chat with you all today.
Peter: Thank you, Stevie. Hopefully we'll have you back at some other point, looking forward
Stephen: to that. Thank you. Yeah, that'd be fun.
Carol: So I was particularly struck by his CA our conversation about the mistrust of the medical profession and, and you named folks anti-vaxxers, which I often think of as, as white people who are afraid of vaccinations for their children, because of conspiracy theories around autism and, and lots of misinformation there. I think that history is something that I think a lot of white people are not aware of. And yeah, it's steep and it's going to take a long time to correct.
Peter: Yeah. And hopefully we're on being that, as we mentioned, that facts are now political. Like, I hope that that starts to deteriorate at some point soon so that this will, less of them are no longer political facts and are no longer political and the appropriate people are vaccinated appropriately, appropriately. I think a part that stood out to me was the idea of, and it's something that's open-ended is how do we regain the trust of those communities that have been negatively impacted? I feel like that exists everywhere in every single organization, nonprofit or corporate. How, how do you make sure that people are open and are receptive. That, that seems to be like an ongoing conversation and ongoing dilemma because of how deeply rooted and systematic our racism is or sexism or homophobia is and how ingrained that is and in our culture. So I feel like we'll, we'll probably touch on that in every single episode.
Carol: Yeah. And I don't think it's even real. Right. It's it's it starts to. Yeah. Trust.
Peter: Yeah. Yeah, absolutely. Well I think that's it for this week's episode. So if you'd like us to attempt to answer one of your diversity equity, inclusion, questions, or scenarios for us and our guests, please feel free to send those to culturefitpod@gmail.com.
Carol: Look forward to seeing those emails. So culturefitpod.gmail.com.
Peter: Yeah. One of those, try them. Try both of them. Somebody. All right, we'll see you next time. All right.
Carol: Thank you so much. See, talk to you soon.
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