Redesigning Health Care Delivery

Jennifer Mieres, Northwell Health’s SVP, Equity of Care, chief diversity and inclusion officer, offers a look inside a DEI program that has been expanding since 2010.

Two decades ago, Jennifer H. Mieres, MD, FACC, MASCNC, FAHA, had an interaction with a patient that led her to think differently about how healthcare professionals should deliver critical information to the individuals for whom they provide care. “One of my patients was a documentary producer, and she said to me, ‘You guys [healthcare team members] are just preaching to the choir. You publish in your peer-reviewed journals and you speak in parables, but you need to become a storyteller to empower people to be partners and participants in their health,’” says Dr. Mieres, professor of cardiology, senior vice president and chief diversity and inclusion officer for Northwell Health, New York’s largest healthcare provider.

Dr. Mieres took her patient’s storytelling comment to heart. “I believe every situation is one in which you can learn — especially if you spend some time reflecting on it,” she says. Not only did her interaction with the documentary-producing patient start her and colleagues down a path toward becoming an Emmy-nominated documentary producer and bestselling author herself, but it also served as a cornerstone for the wide-ranging healthcare initiatives she led — including Northwell’s formalized, foundational and long-standing diversity, inclusion and health equity program. Here’s what surgical leaders of facilities large and small can learn from Dr. Mieres’ approach to partnering with patients and embracing the potential of diversity and inclusion in health care.

13 years and counting

Today, many facilities — particularly larger health systems — have some type of diversity, equity and inclusion (DEI) program in place, with the majority in the early phases of implementation. What sets Northwell apart from the pack is the formalized, quantitative nature of its program’s many initiatives, as well as its longevity. The health system formalized its approach to DEI in 2010 — well before many of the most progressive organizations even had DEI on their radar.

In the same year that Northwell launched its program, Dr. Mieres rejoined the health system — after serving as director of nuclear cardiology at NYU-Langone Medical Center — as its first chief diversity and inclusion officer, with the primary objective of identifying gaps that stemmed from healthcare disparities and devising practical strategies to eliminate them. She has looked at equity in health care from the big-picture, 30,000-foot vantage point as well as from the most granular levels of operational minutia, and she’s learned that how leaders frame the introduction of a DEI program ultimately dictates how well it will do with staff.

“I feel like diversity by itself is a word that can be polarizing,” she says. “One can’t just say, ‘OK, we’re jumping into diversity, here’s what you need to do.’ You need to show evidence, you need to include storytelling, you need to communicate and educate all the time. We all need to understand the ‘why.’ Integrating the tenets of diversity is essential for an expanded healthcare delivery model to improve health outcomes for chronic diseases — and improving health care is critical for the needs of 21st century medicine.”

To give her own team the ‘why’ behind Northwell’s foundation-shifting diversity initiative, Dr. Mieres says they launched an entire humanism in medicine campaign around its efforts, with Northwell team members spelling out exactly why diversity is such an important part of what they do. Once teams understood what Northwell wanted to accomplish on the foundational level, it was that much easier to roll out its many additional initiatives.

A Deeper Look

The Book on Northwell Health’s DEI Efforts

For a more in-depth look at the blueprint Northwell Health followed in tackling DEI in health care for the past decade, Jennifer H. Mieres, MD, FACC, MASCNC, FAHA; Elizabeth McCulloch, PhD; and Michael Wright, EdD, all from Northwell Health, teamed up to write the “Reigniting the Human Connection: A Pathway to Diversity, Inclusion, and Health Equity.” You can read a free sample chapter of the book here: pathwaytohealthequity.com/book/

 

Sustainable support from the top

Leadership buy-in. Like any effective, organization-wide initiative, diversity programs can only succeed with the full support of those at the top. “Leadership commitment is key,” says Dr. Mieres. “You need a true leadership commitment to embed all of the DEI tenets into your strategic plan and your dashboard — and one must organize that leadership commitment in a way that is sustainable.”

A strategic Chief Diversity Officer. Every organization needs a point person who’s willing to take ownership for the successes and accountability for the misses of any DEI initiatives. Enter the rapidly expanding title of Chief Diversity Officer (CDO). While many progressive healthcare organizations and more than half of Fortune 500 companies now have a CDO in place, there is a certain level of mystery about what that role actually entails. Dr. Mieres sees the CDO position in health care as someone whose prime objection is to really link health outcomes and quality with the components of diversity and health equity. “I would say the most important role of the chief diversity and inclusion officer in health care is to make the case that integrating the tenets of diversity into the healthcare delivery model is essential to addressing healthcare delivery disparities, improving health outcomes and achieving health equity,” she says.

One can’t just say, ‘OK, we’re jumping into diversity, here’s what you need to do.’ You need to show evidence, you need to include storytelling, you need to communicate and educate all the time.
Jennifer H. Mieres, MD, FACC, MASCNC, FAHA

Universal involvement. If a DEI program begins with leadership buy-in alone, it ultimately lives and dies with team member participation. “It must link to the mission of your organization, and everybody must be involved,” says Dr. Mieres. “You need to customize and make the case that DEI is critical to every single team member.” She points to Northwell’s Business Employee Resource Groups (BERGs) as playing a critical role in the success of its program. “For us, our employee resource groups were the catalyst for our program blossoming into what it is today,” she says. “We have eight of them now, and each has been instrumental in helping us embed all of the DEI components and linking them to everything we do at Northwell.”

Moving forward, Northwell is establishing DEI committees in each clinical department, gathering data on race, ethnicity, gender, sexual orientation and preferred language to determine how well it is delivering care to vulnerable patient populations based on race, ethnicity and gender as well as those who speak primary languages other than English. According to Dr. Mieres, the committees have already been set up in the cardiology and psychology departments, with surgery next in line.

Continuous, multifaceted education. As mentioned earlier, Dr. Mieres is a big believer in the power of continuous education that comes in a variety of formats and mediums. “Continuous education must go beyond the stereotypical view of what diversity is,” she says. “I am a believer that linking equity to quality of care is critical in solving healthcare delivery disparities, and I feel you must find ways to link diversity to health equity.” In addition to a traditional data-driven approach, Dr. Mieres leans heavily on storytelling through multimedia formats (video, written messages, arts, etc.).

The big picture

For Dr. Mieres and the team at Northwell, diversity is ultimately about improving health care for everybody. It’s about bringing together our collective differences — age, race, gender, ethnicity, language, geography, sexual orientation, disabilities, lifestyle choices — and factoring them into the healthcare delivery model. “All of these components matter,” says Dr. Mieres. “I think of DEI as redesigning or expanding healthcare delivery to see all patients as partners. All of these components — the social determinants of health, the tenets of diversity — they are all parts of a healthcare redesign aimed at solving healthcare delivery disparities and achieving equity of care for all.” OSM