 Good morning everybody. I am Donna Prosser. I am the Chief Clinical Officer here at the Patient Safety Movement Foundation. Again, my apologies for us getting started late. This actually is part two of our Social Disparities webinar that we did back in June and at that time what we were focusing on was the effective COVID-19 on disparate populations very specifically in Chicago, Illinois. If you haven't seen that and you are and you'd like to go back and view that you can see that on our YouTube channel. I've got the long link here but you can access it easily through the webinar page on the Patient Safety Movement website. But just to reiterate what the key points were in this last webinar that we did we talked a lot about how structural racism has significantly impacted communities of color and looking at this list of inadequate poverty, poor nutrition, inadequate education, significantly lower life expectancies and a much much higher prevalence of comorbidities I'm sure that that's not surprising that this created the conditions for the severe level of illness and deaths from COVID that we saw in these populations early in the pandemic and still now. You know Pat, Mary Weather, one of our panelists brought up that the elderly are another disparate population often forgotten in nursing homes and rehabilitation centers and also disproportionately affected by COVID. We also spoke about the safety net hospitals that serve these communities who didn't receive much of the CARES Act funding and sustained some pretty significant financial losses because of COVID. The message last time that I heard loud and clear was that achieving health equity is going to be very hard work but it has to be done and we unfortunately had run out of time last time to talk much about what we need to do about this. This is not an easy solution so we have our panelists back today to talk about what we need to do to improve this. So our same panelists from last time are here joining us so we've got Dr. Ron Wyatt, Dr. Marcus Robinson, Dr. Daria Terrell and Pat Mary Weather and I'd love for I'm gonna stop sharing my screen and and for the remainder of this conversation we're just gonna have a panel discussion so I'd love for our panelists to introduce themselves and I'd like to start with Ron Wyatt. Dr. Wyatt tell us a little bit about your background. Yeah hi good morning everyone good to see you again and thank you Donna and Kaylee and patient safety movement. So about training I'm an internist practiced for about 25 years mostly in St. Louis and here in North Alabama where I am this morning grew up in the Alabama black belt small town born in Selma and I would say that the work of disparities has been a lifelong journey for me it's the reason I went into health care in the first place and that journey continues so thank you. I muted myself by it okay and Marcus please tell us a little bit about yourself. Hi I'm Marcus Robinson psychologist by training and I've been working in the community development field for over 30 years and I've been served on the boards of Spectrum Health Lakeland Health Unity out of Michigan Unity Health in New York and currently here in my neighborhood in Inglewood Chicago the patient advisory board at Sabrinoc hospital. Wonderful thank you so much for joining us again and Pat good morning tell us a bit about yourself. Good morning everyone and I'm Pam air weather Argus and I'm with project patient care prior to project patient care and it is an advocacy organization for patients families caregivers in bringing the voice of the patient and resident to the forefront but prior to the act I worked for the Illinois Hospital Association and also the quality improvement organization both organizations working on not only the equity issue but also across the continuum of care because that's oftentimes we focus on hospitals but as we know care has shifted to the community level to the outpatient level and I also serve on a number of hospital boards including one in Marcus's neighborhood in Inglewood at Sabrinoc hospital. Wonderful welcome again to everyone I know that Dr. Daria Terrell is working on getting on so Kaylee just if you just let us know when she's able to join and then we will hear from her as well. So let's go ahead and get started we have lots of questions for you all today and I'd love to start first with Ron Ron since our last webinar you had a personal experience that illustrated exactly what we're talking about here today and why this is so important. I'd love for you to share that story with us and some insights that you've learned. Sure and thanks for asking a question I'll add on some to some developments from that story as I go and I'll try to be as concise as possible about two and a half months ago my brother was diagnosed with a significant medical illness that will require radiation treatment chemotherapy and a bone marrow transplant after a couple days of not feeling well his wife who had had a ruptured cerebral aneurysm about two years ago this decided to take him to a hospital there in northern Virginia and he was admitted with septic shock and put in ICU. Now I'm gonna back up and tell you a bit about my brother who's a couple years older he is a lifelong public servant veteran of the Vietnam era he is a managing supervisor for a large federal government agency that I think most of us know and fear so but about him he is a consummate professional person impeccable in his dress down to the point that if he gets a nick on a pair of shoes he won't wear me anymore so I get these really nice shoes that he decides not to wear he sends his shirts and blue jeans even to get him starched so after a day in the ICU when he was on liver fed which people that don't know it was there to keep his blood pressure up apparently he had gone into acute renal failure I talked with the care team on two days back to back the conversations were mostly demeaning to me and the data that I was given was totally misleading so for example the hospitalist told me that his renal function had improved and I asked for his creatinine and it was actually higher than it was the day before so when I said well how could this be an improvement when it's worse than the day before and he went into an explanation of how that was better and finally you know he gave up on that and I said well that there's nothing about this is better the next day a nurse practitioner talk with me who I would say had better grasp of the data but still what I experienced was a disconnect between the medical interventions and the person that was in the bed with a very low blood pressure and acute renal failure who have been told that he would probably face temporary dialysis about three days later he was to me inexplicably transferred to a medical surgical unit I made sure that his wife knew that he needed to speak with pharmacy social services care coordination care management all of the things that he would need to know before he was discharged home now again this is a person who's never been in a hospital overnight as a patient in his life the next day he was discharged home when my sister-in-law picked him up from the hospital and understand the midst of COVID she could not visit him as an inpatient he was brought to the reception area to be picked up by her and wheelchair when she picked him up he broke down in tears she described him as quote-unquote filthy and this again a person who prided himself in his appearance during that hospitalization again nor he or the family met with any of the teams that I just described they did not do any type of home assessment they didn't know anything about her functional inabilities or that he had to climb both of them had to climb to flights of stairs he worked primarily at world level at home but his the bedroom was two flights of stairs up there was no inquire about what kind of home setting are you going into so about a week after I filed a concern complaint and grievance with a hospital I was able to speak to the head of hospital medicine and I went through this same story that that I shared with you but he started out with a statement that I think demonstrates what happened to my brother and what happened to him was that his dignity was taken he was not shown compassion he was not respected and back to your your point Donna this is this is hard work but this is hard work and he did not receive the hard work that and the hard work doesn't hard work doesn't substitute for hard work so when I when I talked with the hospitalist this is how he started the statement well you know when these folks come in and I said wait a second what do you mean by these folks and he said well you know what I mean you're internist I said no I don't but I know is you had a human being that happened to be my brother in septic shock and I went through this the same series of events so I said so we need to back up and we're not going to talk about any human being as as these folks whoever these folks are and and through the conversation he began after some of the defensiveness began to fade not all of it he said well I'm learning from this as I talk to you and you know he could have learned from my brother and my sister-in-law when he was there if they had met with them you know I spent the next week gone over what a renal diet was because they didn't go over renal diet for a person was facing temporary dialysis so so she was she took him home and was giving him the same foods that he had been taking before high potassium foods and a person who's in acute renal failure no one talked to her about diet when I talked to the hospitalist chief hospital medicine he even said to me well you know we have a dietitian but we don't have a nutritionist so I said well you know you're you're in a very large health care system one of the more large health care system in this country you gonna tell me that you have people in acute renal failure that don't have access to a nutritionist that he had a reaction to a biologic and no one discussed with him the dosage or what that biologic was doing to him none of that took place he never met with the pharmacist or a care team so I'm gonna pause there because I think in many ways it does demonstrate the disparity or as WEB dwells talked about this passive indifference to people and it doesn't matter in his case he has he has not one but two master's degrees you know a professional person so that doesn't matter and the data says for for black indigenous and people of color it doesn't matter what your your educational background is it doesn't matter what your income is there's something different about that those interactions that impact care what my what my brother said and I shared this with the hospitalist is when he left and tears his wife said I might as well be dead because the way he was treated when he was in the hospital and and again this is something I know directly about because it's my brother and I experienced it but this happens every day and this happened every day for decades and generations and we're to this inflection point where we what we talk about today we've got to say we have to stop this we have to do hard work we have to respect people we have to show compassion we have to be empathetic we cannot rip a person's dignity from them because then they they're left feeling with this internalized idea that I might as well be dead so I'll stop there wow Ron thank you so much for sharing that very powerful story and you know sets the tone for exactly why we're having this conversation today so thank you very much we we have been able to get Dr. Daria Terrell on with us on the panel so good morning Daria so so sorry for the the the technical difficulties we're still getting texts that zoom is having all kinds of issues so my apologies there no if you yeah if you would would you introduce yourself for for the audience please good morning everyone sorry for the delay and joining you as Donna said tech issues got the best of me this morning but I am Dr. Daria Brooks Terrell I'm an orthopedic surgeon and I am the medical director of clinical programming and health outcomes at St. Bernard Hospital which is a safety net hospital in Chicago Illinois and I'm very happy to be here in a part of this discussion this very important discussion this morning thanks for joining us well my first question is on Ron in our last webinar we ended the webinar where you spoke about the three things that we have to do to achieve health equity rectifying historical injustices valuing everyone equally and reallocating resources based upon need could you just briefly review those and and where you think that we we need to so I'm gonna say first and foremost if I look at those three all are critical the most important one is we have to value people that's most important doesn't matter how old you are where you live your education your skin color we have to value people that black indigenous and people of color populations LBGTQ populations that elderly this the disabled have been devalued and in some cases have been dehumanized and as the example I gave then people become and they internalize this devaluation of them as a person and then we have this way of feeling comfortable by ourselves by saying well that person was non-adherent or they were non-compliant or they were combative or they were difficult or even the family doesn't care why should I that's that's the realness that goes on so we have to learn that every human being has innate value and if we can start there and see the humanity in the people that come to us seeking to trust us and that gets into the historical injustice there has been so much trust in black indigenous and people color population that have been taken away and and in health care I think we gotta understand a part of racial healing is we're gonna have to go back through some pain and wounds have to be cleaned out and sanitized and and allow to heal an environment where healing is the top priority so so that trust started I'm gonna say in 1619 or before so so so pandemics for for our populations started then the disparity started then the disparity started on slave ships and on plantations it started when when a black slave that ran away was labeled a dreptomaniac because you had to be crazy to try to run away from being a slave it started with Marion Sims who who was the father of gynecology that operated on black women some of whom he owned without anesthesia and became the father of modern gynecology we can talk about the birth control contraceptive experiments that happened in Puerto Rico with with almost no informed consent we all know the story of Henry the lax and the healer sales here in Alabama why am the Tuskegee syphilis experiments all of these things begin to line up for people to say why should I trust you and as we move through a pandemic and the urgency of a vaccine that's a question that we need to start answering why are these populations gonna trust a vaccine when I don't even trust you to treat a sinus infection so so we got to understand that it's historical injustice and restore it to people the next and a very difficult part of this is we have to take resources that we have that there's not many new resources it's almost a zero-sum game but if but leadership at the executive board level you got to say we're gonna look at our resources and we're gonna reallocate resources and that's scary for people because they hear redistribution of wealth well you know yes we're gonna have to redistribute wealth and we need to redistribute resources where they are most needed not where they're most wanted or where they are most needed and this is for both nonprofit or for systems for profit systems government federal health care systems leadership has got to say we have to put the resources where they're needed there's no excuse for eight zip codes in New York City to not have no PPE in rich health care systems there's no excuse that decisions have to be made about who gets put on a ventilator that nurses and health care providers have to wear trash bags to protect themselves in systems that have millions of dollars in resources that they distribute in an unequal way so we need to understand who our populations are that are truly at risk and decide where those resources need to go understand who the people even that work for us that that have to catch a train and a bus or walk or ride a bike that that are making less than a living wage in our health care systems and take care of them that's a leadership commitment that is the hard work so we have to value people as human beings we got to understand the historical injustices that that existed and frankly still exist and then we got to make a commitment that we're going to put the resources where they are most needed and don't apologize for these are human beings and we're in a in a life-saving industry and I would say bluntly to people that don't get this you're doing more harm than good find something else to do for a living because you're only hurting people and that's not what we're going to do from this point forward we must not do it we must commit to these three areas invest in them incentivize them and pay attention to them so I'll pause there because I get carried away with it so I love your passion Ron thank you thank you so much well my next question is for Marcus you know Ron articulated very well what hospitals and health care systems need to focus on you know from a leadership standpoint but you know we also know that in those in those organizations there's a culture that's made up of individuals and folks from the community what can the average person do the average individual and the communities do to help support hospitals in this endeavor well I think first of all thank you Ron for sharing your personal story and and given context for this this conversation and and the passion that you bring to the very important ideas you just shared about the path forward for us and Donna thanks for such a wonderful complex question you're welcome I knew you can handle it thank you so so I'm gonna I'm gonna start at the macro and see if I can't get down to something that makes some sense so ultimately we just simply have to come to a group the fact that oppressions drive the disparities and social determinants are all man-made they're within our full control to address you know we can deal with these underlying issues that that Ron is pointing out and and for the one we also need to understand that we are all complicit in that system that Ron is pointing out that would have that kind of outcome happen for that would rob the dignity of a human from a human being in that way and that we all live at the effect of that system that oppression and nobody gets a buy you know black brown blue white yellow doesn't matter who you are we're all negatively affected by it so we all have to do our own work to help rectify these injustices and the work breaks down for me in three stages really some sort of first stage I heard Ron kind of allude to it we simply have to tell the truth to ourselves about the way things are and the way they have been so that we can see the evidences of the disparities and other underlying drivers of these disparities so that we've got evidence with which data with which to get some real work done and so so the truth-telling piece of it was super important so that we could understand how these oppressions racism sexism genderism you name it is out there and this all you know having an impact on us and once we find so you have your own homework on that regard then there's the reconciliation piece I think Ron spoke a little bit to this too there's some making right that has to get done and right now that means that might mean reprioritizing our how we use dollars in health care writ large and then expanding the health care team getting out of our silos kind of thing you know hospitals are in a silo public health people are in a silo unaffiliated practitioners are in their own you know little foxholes kind of thing we all have to you know kind of do our own work and so reconciliation is a big piece of that work and and we have to repair the breach and keep in mind that this is a cultural journey this is a journey towards cultural understanding and belonging it's not a destination or a time point so it's you don't without the worry about trying to get someplace by a certain period of time we just have to get on the way of speaking truth about the issues gathering the data and then making the reconciliations and the repatriations and the repayments and whatever we have to do to reorganize in order to get this thing done in your wherever you're at because everybody's in a different lane you know so not everybody can do the top-level work but there is work we could do at the level of of an intake at the at the level of I'm coming to check your vitals this hour I could do more of this if we check off the numbers I can actually have a human interaction with you that says I see you I value you and I'm on this healing journey with you so that folks can you know you know recover themselves in that way and it's only when we do the truth-telling and reconciliation that we can get on to healing and I'm gonna use healing at the most broad sense of the word I'm gonna use trauma in a broad sense of the word because the oppressions that Rod is speaking to are traumas and then when he talks about the historical patterns of how these things have come from 1690 right through the 1800s right into the day these these become epigenetic traumas that we actually experience in our bodies to experience in it as much as I have skin color I have encoded trauma of my ancestors as well and it's genealogical because it means that you know this this stuff comes down we all get told how to do this the kid at kindergarten is getting the same getting white kids black kids brown kids white people black people brown people business people we all get the same lessons about oppression we're told where our place is in the thing and these are like family known family traditions regional customs cultural norms they even have legal components I mean there are laws that need to be addressed administrative rules that need to be reviewed organizational policies that need to be examined and changed and we have to develop professionally developed so leader preference as as as Ron was pointing out leaders in charge of large institutions change themselves so that they could be the vanguard and and the standard bearer for the change that needs to happen in the in the organizations so just remember the three big things I've kind of point out here and that is truth reconciliation and healing is the pathway to get into where Ron wants to be where we can all value each and every human being that comes into our presence no matter who they are from what's they come or whether they have money or not full stop very well said I really yeah truth reconciliation and healing I'm writing that down for our notes for that thank you and Daria the last time that we when we joined together you talked about your safety net hospital and the strut the financial struggles that safety net hospitals who serve communities of color are facing generally in general but specifically in this COVID situation how did those hospitals who are already struggling how did they improve access to resources for for our desperate pop so thank you for the question Donna again a little complex you know by nature the fact that safety net hospitals strive to deliver care to those who are challenged by low income and lack of insurance sort of makes us almost at a disadvantage in trying to render care but despite those challenges there I think there are ways both on large scale and smaller scales that we can still try to provide the health care resources that patients need the first thing that I will say is and it's almost non-medical but I feel like the less financial resources you have as an institution the more you have to use your voice and the more almost politically active you have to be so I say that meaning that our hospital leaders have to continue to be vocal about resources and the needs and why we need those resources you know the the whole discussion of COVID brought out a lot of talk about disparity so when we if you think about the fact that in some instances we're starting with sometimes sicker patients it would seem almost intuitive that we should have these resources but that's not always the case so being vocal on is one one answer the next thing I would say is as institutions we have to be able to meet people where they are so the challenges of COVID-19 have made certain barriers to access and so we have to be equipped to transition to telephonic medicine and try to encourage our patients to come along in that journey with us some go a little bit more readily than others but also in that we have to also realize that everyone may not have internet access and so just being able to render care as to the best of your ability within certain circumstances being able to have a telephone conversation if that's what it takes to at least establish some kind of contact and prevent things from just going haywire or really getting out of out of control until they can be in person also you know messaging is very important I think at this time so I I'm a big advocate of people using social media responsibly almost all institutions now have Facebook pages some have Instagram LinkedIn etc so using those platforms which speak to a lot of people now dinosaurs like me have to accept that you have to get on the social media bandwagon or you'll you'll kind of be you'd be dragging behind but we can use those tools to help us communicate with patients so I think one of the big things that we need to do right now is let our patients know that it's okay to come back to the doctor let us let them know that we're available for them let them know that this is the time that you want to maintain your follow-up visits you want to maintain your screening for things like diabetes for colon cancer for breast cancer those things that we put on hold in the midst of our crises we can't we can't lose sight of those now because then we might be putting ourselves at risk I want to share a really really quick story that exemplifies this I during the heart of all of this I want to say back in April I got a call from the emergency room for a woman who had come in she had had a small wound February January February got worse was referred to a consultant which by the time she got the appointment we were in the heart of the COVID and that camp that appointment was canceled so she stayed at home the leg got worse more pain wound got worse so this poor woman decided not to eat because she thought if she didn't eat she wouldn't have to get up to go to the bathroom so then she wouldn't incur more pressure on her leg and that and she stayed at home in that state not eating not drinking for days until things just couldn't go anymore so by the time she actually presented to the emergency room she had a leg that needed to be amputated and she was maybe 80 pounds so I share that story because on one hand we want to sometimes we we're right now we're so focused on trying to keep ourselves safe from COVID that we are not doing what we need to do in terms of keeping ourselves safe the other thing I would say they're even small things so for example in our institution where patients can't get to the hospital or to the medical center for more complex care such as surgeries or diagnostic testing we're doing what we can to help them with those transportation needs also the CDC has talked about the importance of getting flu shots this year more than ever because we all want to avoid the synergistic phenomenon of the flu and COVID so we're doing things to make getting flu shots and pneumonia vaccines more accessible to our patients and our patients in particular some of whom are still dealing with the devastation of looting and their local pharmacies that they've come to depend on still haven't reopened from some of the civil unrest and looting and lastly I would say one of the more powerful things that I think we as institutions can do is celebrate engage and educate August's civil health month and for those of you who don't know and as providers we're encouraging our patients to register to vote one way or the other your health care is dependent on the political regime no matter which side of the aisle and which philosophy you partake in health care is a part of what happens in politics and so we are actually encouraging and also trying to help our patients register to vote sometimes just in discussions as they occur in history taking sometimes we're doing it as a part of our social history and then we are actively assisting patients we've had in-person groups come in to help patients register to vote while they're waiting for their appointments or while they're waiting to be registered I'm a little technologically challenged so I'll put this up just as a demonstration this is an organization vote ER but I'm putting it up just for the symbolism so that you can see this is a wonderful organization that was started by Dr. Alistair Williams and Mass at Mass General and basically it provides a QR code that patients can just scan and that shoots them directly to a mechanism where they can register to vote you we have to vote like our health depends on it because it does and I'll leave it at that wow I had no idea that that it was civil health month in this month so thank you so much we will be sure to share that on our social media as well thank you Pat a question for you we have several patient advocates that are on in our network and also on the line today I wonder if you can share with us what can patient advocates do to help improve health care equity I think that's a great issue and I really have to applaud the prior speakers for their informative discussion as well as their powerful messages so so thank you in terms of patient advocates I'd like to propose something a little bit different is we all need to be patient advocates if we're if we're in a setting or we need to have caregivers that are our advocates so so again patient advocates doesn't mean just a formal organization it's everyone can be an advocate for themselves and oftentimes they need to be and certainly that's where caregivers also are of great assistance and then there's the formal ones that sometimes can work on behalf of patients and they're the sometimes now for-profit organizations or for-profit organizations where you have to pay a fee to to get some advocacy and then there's the focus area ones whether it's disease-based or location-based there are many different organizations out there and I just want to talk about two streams because if you're in immediate jeopardy what we call immediate jeopardy or immediate harm you take different actions than you will for something that may be longer term and when I say immediate that means that you're in the hospital or you're in the nursing home or you have a loved one and they need some change to occur well first you want to try and speak to the caregivers have somebody speak to the caregivers see if you can change their mind if not you want to go to the hospital patient representative or you want to go in a nursing home to the ombudsman which is located outside of that nursing home and is supposed to work on behalf of the resident and then if you don't get anywhere there if you're a Medicare beneficiary you can contact the the BFCC the beneficiary and family-centered care quality improvement organization and they actually respond they respond well and they will advocate for you whether it's hospital or nursing home or outside of those settings as well and then you can also contact public health but oftentimes you may get not immediate assistance depending upon the state you're in they all work function differently and then the other option is if you're not getting satisfaction along those ways take to social media because it really does have an impact so those are for the immediate issues and I'll tell you right now during this COVID-19 time people are taking to media they are trying to find solutions because again care in some settings is not the best and if we hit disparities before they're only being accentuated by by what's going on right now with COVID-19 so again the disparities are just widening they're not closing they're in they're in full blown view of everyone for a longer term approach I would say you know you can get involved with the patient family advisory council within a hospital setting that's an opportunity to voice your issues and concerns you can also get involved in a nursing home resident council or family council and everyone has to have a resident or resident family council now sometimes they're not open you know in terms of their discussions but some are so again you have to at least try that route community leaders people in the community you know if there's disparities occurring and you're being treated in justly then you need to also look at are there community organizations that are also rallying behind that issue and we see that in Chicago oftentimes you can also join with some of the organizations that are out there whether it's a disease-based or even the patient safety movement foundation there's many organizations the other thing is approach elected officials and sometimes it's not so much the official you can write a letter there it may be their staff and raise the issues because elected officials and their staff actually do respond and you have to be very you know share your story and be willing to share it otherwise the other route is journalists I just picked up an article somebody sent it to me and it's the most insightful article on what went on at the Kirkland nursing home and and the harm and from a resident perspective a caregiver perspective clinician perspective just the the chaos that was going on and how people were calling out for help and then of course you know it's you can go to your state public health but right now they seem to be overwhelmed with everything going on so again I would try the other avenues first and but the idea is not just to let it occur but to be proactive and know it's okay I think we all as I hate the word patience because it implies you're supposed to be patient not do anything we'll take care of you you don't have to voice your concerns and we need to change that around so they have people all feel they have a voice and they should have their voice respected and we have to address the health and equity issues because they are really driving up the cost of care because we're not providing the proper care at the beginning so with that again I hope I encouraged everyone to be a patient or caregiver advocate because that's the only way and not give up when you the door closes on you but just find another door to go through thank you wow yes very well said that we are we all do have to be our own patient advocate and I great suggestions for all of us thank you so much Ron question actually from the audience for you someone who commented that they were very sorry to hear about your brother's experience and but curious to know about the social history assessment that was done when he was admitted to the hospital you know very often that's the one and only time that we gather the kind of information that you were saying that people didn't know about your brother can you just talk about about that process and what what happens with your brother there and what can organizations do better in their social assessments sure so and I thank you for the question and I alluded to that a bit there was very little known about him as a person that inquiry wasn't made and I think what's really important in healthcare whether it's inpatient or outpatient whether it's face-to-face or or telemedicine that it is a person who has a life has a family and is a part of this society so that there was little or no evidence that any of that took place person comes into an ICU with septic shock and they get IV fluids and leave a fed and all those things but there's a person there so no those aspects about his his social background and that's why I brought some of that in the kind of person that he is uh is important and that's for for anyone who comes into healthcare and is looking for empathy and looking to trust what's about to happen to them I think a big part of what healthcare can can do is not it's just not complicated calculus and you know I go to Dr. Venable who was just this wonderful person that I met years ago when I was leaving training in St. Louis Dr. Venable was over 90 years old and still practice medicine in St. Louis and he gave me a few lessons about this I still think applied to all of us whether you're physician nurse or advocate whoever it is he said when a person comes to see you keep your mouth shut and listen and they're going to tell you who they are they're going to tell you what's important to them they're going to tell you what matters to them and he said over nine percent of time they're going to tell you what's wrong with them and then all you need to do is come up with some of those big medical words that you learned in medical school and repeat them back and he said first they're going to thank you the smartest doctor ever met so they're going to go tell the whole community you know that's a smart doctor he knew exactly what was wrong with me but it came down to just humility and somewhere we've lost humility in health care delivery in patient outpatient again I go back you got to have humility on a telemedicine visit so we have to practice humility structural humility culture humility listen listen to people ask questions ask their permission to enter into their lives tell me about your life and this is not something new for me even when I was in academic medicine teaching medical students when they want to say well this is a 58 year old black female yada yada yada I abolished using 58 year old black female over 20 years ago I would say to medical student resident tell me about the person in the room and it was one in some case it was a simple question give me three things that are sitting on their nightstand in that hospital room tell me that there's some sign of life is are there paintings from grandkids or family members or friends are there flowers what is in that room that tells you this is a person in front of you that has a life outside of these four walls and if there is nothing if there are no flowers if there are no signs if there is no get well soon grandma that's still telling you something that there's something there that you need to understand this person may be lacking social support what what is going on in the other dynamic that we need to know about so you know I just say empathy love compassion respect humility you know and I always use the term from Chen Waqibi who wrote things fall apart and and I paraphrase it you can't come to into my house through your gate you have to come through my gate I need to tell you about my gate and my yard and my house and what it means to me and then I'll give you permission and we can sit at my table and we can have a conversation and we can get to know each other and we can co-produce your health care and you can own it take away this paternalistic approach that that hit me in the face with my brother when that physician said you know these folk come in he's already made a decision about people whatever that meant so that's we got a back away from that and enter to a different kind of partnership where where people take control of of their health care people understand the resource available is their patient family advisory council you know I have the right to ask for pharmacists to to to talk to me about my medications inpatient outpatient about my diet about me get to know me and then we can get healthier together and and and that's I think the things that we need to go to before we can get to then clinical decisions and the bias and violent clinical decisions and you know we can talk about that if we have time but those are the basics of it that we need to we need to understand and get back to and admit that in large part inpatient outpatient um we have lost if we ever had it so we need to focus on regaining what's been lost absolutely well and and it sounds like it sounds like what you're suggesting is that we go back to the way we used to think about assessments before they became checkboxes and an ahr so um and thank you so much for reminding us that humility and health care is is a key in order for us to understand others um Marcus I wonder if you could um and and and I just wanted to note to everyone we are about six minutes away from the hour but because we did get started late um if if anybody has to jump off I completely understand but if if we could kind of go until 10 after the hour to get everybody the full one hour of contact hour credit that we that we are offering today that would be fabulous um Marcus um can you you know both Pat and Daria talked about the importance of getting involved talking with politicians voting um and and and such what what how do we incentivize local governments to uh to better improve health care access again with those modestly beautiful complex questions oh thank you so much Donna you must think a lot of me I'll take I'll take that as a as a as I'll take that absolutely I do okay so so so it was so I'm gonna follow uh Ron's uh uh I'm gonna follow everybody because they're sleeping with souls the size of in their answers so I'm just to get right to it in Western society specifically the United States of America no matter what town you're in is incentive it's all about the money it's all about the money and here's where I come at that oppression costs way too much with little or no actual ROI for the oppression I mean it's just not a good deal uh there is a business case for resolving these oppressions of racism sexism classism other isms however you define them there is a business case for solving that uh when when communities and government lower the overall uh cost of effective efficient governance we all win financially you know we all win by paying less tax lower issuance premiums better outcomes oh my goodness what could be better than that you know uh so solving the oppression riddle that drives disparity actually reduces taxes increases societal uh uh level engagement productivity you know if we're healthier we perform better and so we could earn more I mean it's it's uh it's in a balanced scorecard kind of way uh we could do a lot better job for ourselves and that's the rule incentive so getting smarter about the economic equations that drive what I would call human capital value add so like it's not just so that human being has a life and has family and people or no life from family and people there is a capacity for economic value add sitting right there there is a human capital ROI that can be established for non-profit and for-profit agencies organizations that that will drive their efforts to reduce the impact of their touch on the oppression will so figure oppression is like a huge societal boulder that all of us have our hands on and we're all pushing it one way or the other if we could just get one hand off the boulder that means it pushes a little little you know it rolls over fewer people we can get both hands off it might even stop kind of thing so getting smart about these uh uh occasions uh can be a bit about about the human piece of it the money piece of it will lead to better outcomes across the board in the human endeavor so here's a here's a quick story about this so when I first came to Chicago six years ago I decided I was going to come be a part of the the solution around the gun violence inside did my own little research on that thing my little back of the napkin calculation and what does this thing cost the Illinois Cook County city of Chicago and all told that the way I rolled it up it was about three three and a half billion dollars a year for gun violence alone three and a half billion dollars a year now if you and I got together with all of my institutions and all of the you know all of our partners and and uh and you know the public health departments and all of their partners in housing economic development all these other things that drive at the underlying stressors that are that are the source of the uh the disparities and if we and if we only did a what I would call excuse my name a half-ass job that means it would go down by 50 percent right well what is a 50 percent reduction in that well that's a 1.5 billion dollar savings year on year for a Cook County for city of Chicago and uh the state of Michigan I'm sorry state of Illinois and guess what if if those were sustainable uh cost savings with responsible leadership that would be passed on as lower tax burden to you and me it's all about the money and if we could see the business case for eradicating racism the business case for eradicating genderism the you know for sexism we all be wealthier and healthier because we did full stop thank you Marcus I knew you were the right person to ask that question of as complex as it was that's a perfect answer thank you um um Daria I there's we got about 10 minutes left I have about three more questions I'd like to get to so um so I'll ask you another complex question but ask you if you could keep it brief for me you know kind of playing on what what Marcus just said we we really need data to be able to establish a business case for this so what role uh what role um it does data play in health care organizations and how can they better use the data that they have to address disparity so I'm going to try to keep this brief but I'd like to answer your question about using data uh with one of my favorite quotes um that I don't think people apply to health care but Dr Martin Luther King said nothing in the world is more dangerous than sincere ignorance and conscientious stupidity and I that is my driving force and how I practice medicine how I interpret that is as a as a clinician if we don't understand that or we we're not aware of the increased incidences of maternal mortality in Chicago for example that Chicago actually has the highest rate of of deaths related to uh childbirth if I don't understand the side effects that certain african-american patients have with certain anti-hypertensive drugs that's sincere ignorance if I don't understand that racial and ethnic minority females are more likely than white women to present with uh breast cancer at later stages that's sincere ignorance if I have the data I have to have the data first and I have to I have to familiarize myself with it and once we have the data and all these discussions of COVID has brought out you know all these discussions about health disparities and how people of color are affected now if we don't use the data correctly that's the conscientious stupidity if uh Ron gave us examples uh countless examples so I won't I won't I won't dwell on that but if we if we don't look at our diabetic patients for example and we chastise them why aren't you why aren't you uh checking your sugars but we're not paying attention to the fact that they were sent lancids but their insurance companies have not given them a glucose meter or they've called five times trying to get a glucose meter or if I'm talking to them about their diet and why aren't you eating a healthy diet but I don't appreciate that they have food insecurity then that's conscientious stupidity I'm practicing medicine without as Ron told us thinking about them as a person so what I would I would recommend or how I see this uh we have to do some basic things I'm not going to go into how we need to listen to our patients because I think Ron has driven that point home that's like the assist from magic johnson and now that you know we've got the slam dunk I would say we have to as entities we need to use social workers and community health workers to help us gauge what patients need things and and and use those individuals to help us try to link them to the resources that we need we have to look at this uh healthcare disparities within the context of social determinants of health so we as an institution need to play a part in trying to solve burdens of food insecurity we're when we do contact tracing we're asking patients okay we told you to shelter in place do you have meals and so if we if they don't have meals we partnered with some local community partners in the food depository to bring them meals so that they can safely eat and shelter in place we need to look at health literacy I think that's a huge huge vacuum and where a lot more attention is needed because if we expect patients to be partners we also have to be partners in helping them navigate the medical system we need to have robust comprehensive programming that includes looking at social disparities and things that have been identified including mental health and lastly I would say we need to again listen to the community listen to our patients we we conduct community needs assessments here at our hospital every three years and we look at that data and use that data along with all that we know about specific comorbidities to gauge programming to to help guide us to know which programs do we need to implement comprehensive diabetes do we need to implement ice screening do we need to implement std programming so we use the community needs assessment as well as the data from entities such as the cdc and and other medical entities to help guide our programming if we don't use the data we're practicing dangerous medicine in my opinion as Dr. King warmed us against doing wow this has been such a fabulous fabulous panel discussion I do I do have a quick question for pat you know Daria mentioned the importance of health literacy you know we also have language barriers in our communities what can be done to improve this so that so that hospitals can do a better job first of all there's a study that came out from cms and asked the health care providers how many of their patients have difficulty with language or literacy and they said 60 of all the patients so again we're talking about almost everyone has it as a barrier when it comes to language health care providers are required to provide a language line if the patient expresses and they have to ask the question what is your preferred language because many people are bilingual but they tend to prefer one language over another so they have to ask that question and then second they have to provide them with access to if it's a different language than what the provider speaks they have to provide that service either within the if it's in a hospital or a nursing home or they've got to use the language line because again that that has to be offered they have to be it's a requirements it and if they don't you can always contact within each region around the united states there's the department of health and human services office of civil rights and you can file a complaint and they do follow up this is a very serious violation by a provider so that's language now you come to health literacy and and it's not just literacy it's health literacy and that's where many people don't understand their condition or it's not explained to them and and that's where the opportunities to improve care occur is when you when a patient is asked if they understand this and not in a threatening way or a demeaning way because we've got to get away from the demeaning of patients and ask them if they understand and and also is Ron was saying listen to the patients I always you know we hear about teach back having the patients say what they thought they heard were the instructions for care but it's also I call it bi-directional are we listening to the patient really listening to them and and just to give you an idea health literacy changes and I have a I have a very close friend that is a well-known physician top of the line international researcher and lecturer and he for kidney disease but he now has a new disease he's got a esophageal cancer and he knew nothing about it and so he's had to listen to the others and learn from them and he even though he was an expert in his field he did not understand his his needs as well as the treatment and options that he has available so we all even if you're the most prolific you know a physician around you need assistance in understanding your condition and it's it's very common when somebody has a chronic disease their disease may progress and so their needs for more information different information occurs but we always need to be asking at the beginning of a session do you understand do you it's called the confidence tool do you understand your condition are we explaining it so that you can understand it and then at the end asking those same questions because the conversation may have changed and again it's it's a way of really doing fast track improvement is just by listening to the patient and asking them questions in a non-threatening way making them feel comfortable that they can say I really don't understand so so health literacy goes a long way in improving outcomes keeping the patient safe because they understand their their course of treatment and then language is just essential to care I mean there's no other way around it's essential care absolutely thank you Ron last question is to you I wonder if you could wrap up this session by addressing a question that somebody had from the audience about how to define disparities in patient safety and and commented that this is the first time this person who works in patient safety has heard this term so I wonder if you could end the session just by commenting on that and your thoughts about what patient safety professionals need to know and and and how do we help it help people for this not to be their first time hearing it yeah so so you know I summarize patient safety as no one should be hurt or harmed in the process of receiving health and health care that's what patient safety is so if we just go to the to the inpatient side of it then that means we have to look at things like hospital acquired pressure ulcer falls with injury surgical site infections we have to look at things like readmission race and why people readmitted so on the hospital side you can begin to look at those and that's the data part of it because all of those are harms on the outpatient side of it that the whole access issue but it's more than access is what happens once I gain access at the at the reception desk if I don't speak English as the first language is there a person there that speaks my language that's a patient safety issue right because what we found when I was at the general commission and still at the state is one of the biggest root causes of failure is failures in communication so so if you are working in a community where you know that the the first language of most of the people in that community is not English but if when they walk in no one speaks that language that's a major patient safety failure when that person's calls in for an appointment likewise that's a major patient safety failure when a person sits in front of a clinician or decisions are being made is the is the clinician listening or they spend most of the time in front of the computer typing in some words that's that's where failures and communication and clinical decisions are made that hurt people so it's inpatient and outpatient so look what but look what the data is telling you is your race and ethnicity and language data accurate valid robust measurable and actionable when you look at the outcomes of what your care are you measuring them do you know that for every person that comes in that evidence-based best practice is being implemented and and and you can measure that and so look at those things are you incentivizing reductions in in harm are you looking at and I think probably top patient safety issue and inpatient outpatient settings are medication errors so so look at the medication error rate these are valid numbers and they'll tell you something about where those errors are being made and you dig underneath that to say how can we make our system safer just around medication error so those are just some examples but I'll sum it up again by saying no one should be hurt and that's preventable in the process of receiving health and health care that is patient safety that is zero harm there's no substitute for it there's no compromise about it there's no negotiating it and I think at every level of health care we have to say to people that that aim the goal is zero harm wow absolutely thank you so much Ron Marcus Pat Daria this has been a phenomenal discussion we've got lots of comments from the audience about about how much they really appreciate everything that you've spoken about today this is of course being recorded as are all of our our sessions and we are providing continuing education credit for physicians nurses and pharmacists so there we also have a question from the audience about contact information to our panelists if oh perfect excellent so Ron has already answered that question if anybody else has a has contact information to share if you would share it in the chat so that folks can reach out and ask questions then that is wonderful well this again this is part two but definitely not the end of this conversation I am sure so I appreciate your time and you all so very much and I hope you have a wonderful rest of your day