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The Next Generation of Work for Diversity in Our Academic Health Centers:. David Acosta, M.D., FAAFP Chief Diversity Officer, Office of the Dean Clinical Professor, Department of Family Medicine University of Washington School of Medicine. Realizing Full Potential. TTUHS-PLFSOM.

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the next generation of work for diversity in our academic health centers

The Next Generation of Work

for Diversity in Our

Academic Health Centers:

David Acosta, M.D., FAAFP

Chief Diversity Officer, Office of the Dean

Clinical Professor, Department of Family Medicine

University of Washington School of Medicine

Realizing Full Potential

slide2

TTUHS-PLFSOM

E X C E L L E N C E

EDUCATION

RESEARCH

CLINICAL

CORE-MISSION

slide3

TTUHS-PLFSOM

E X C E L L E N C E

EDUCATION

RESEARCH

CLINICAL

D I V E R S I T Y

CORE-MISSION

slide4

TTUHS-PLFSOM

E X C E L L E N C E

Infrastructure

Building Capacity

Capital

Culture

EDUCATION

RESEARCH

CLINICAL

D I V E R S I T Y

CORE-MISSION

agenda
Agenda
  • Challenges facing academic health centers (AHCs)
  • “What job did the AHCs hire diversity to do?”
    • Imperatives driving diversity
  • What can academic health centers do?
slide7

“If you’ve seen one academic medical center,

you’ve seen one academic medical center.”

- Darrell Kirch, M.D.

Kirch, D. “Realizing Just How Much We Have in Common”

AAMC Reporter, 2011

challenges facing academic health centers1
Challenges Facing Academic Health Centers
  • Funding our missions in a climate of ongoing fiscal austerity
    • State support for higher education fell
    • States considering major reductions on Medicaid & other health programs
    • 2/3 reduction in Medicare support for GME
    • Research funding – NIH funding cut $320 million over 2010 levels

AAMC Reporter, July 2011

challenges facing academic health centers2
Challenges Facing Academic Health Centers
  • Funding our missions in a climate of ongoing fiscal austerity
    • Sequestration  effective March 1, 2013
      • Cuts $85 billion across government departments, agencies, and programs
      • NIH will lose $1.6 billion of its $30 billion budget1
    • Health literacy  $106-236 billion per year2
    • Medical errors  $19.5 billion (2008)3

1 - Office of Management and Budget, 2013

2 - NIH, 2012

3 - Andel C et al. J Hlth Care Finance, 2012

health care reform law academic medicine
Health Care Reform Law & Academic Medicine

Rasouli T, Crytzer TW. Acad Med, 2011

challenges facing academic health centers3
Challenges Facing Academic Health Centers
  • Defining our role in an evolving health care delivery system
    • What will our role be in designing and implementing new models of health care delivery?
    • Which components of the future health system have our support?
    • AHC are in a unique position to lead the change
      • Intersection between policymakers and the public

AAMC Reporter, July 2011

challenges facing academic health centers4
Challenges Facing Academic Health Centers
  • Preserving public trust & support of our work in the face of changes that will impact the public
    • 32 million will gain access to health insurance
    • Baby Boomers generation ages & enters Medicare in record numbers
    • Nearly 1 in 3 physicians set to retire during the next 10 years
    • Important safety net programs are being threatened due to federal and state budget cuts

AAMC Reporter, July 2011

challenges facing academic health centers5
Challenges Facing Academic Health Centers
  • Educating the physician of the future
    • Integration of quality & patient safety instruction
    • Interprofessional health care teams
    • Competency-based learning
    • Culturally-responsive, patient-centered care
    • Accountability
    • Faculty development

AAMC Reporter, July 2011

slide14

“Being united in facing our common challenges is only a first step. While all sectors of our community share these concerns, it will take a diversity

of perspectives to reach the desired state we all envision…”

Darrell Kirch, M.D.

President, CEO, AAMC

AAMC Reporter, July 2011

slide15

“Innovation provides the seeds for….growth, and for that innovation to happen depends on collective difference as an aggregate ability. If people think alike then no matter how smart they are, they most likely will get stuck at the same locally optimal solutions. Finding new and better solutions, innovating, requires thinking differently. That’s why diversity powers innovation.”

- Scott E. Page, 2007

The Difference: How the Power

of Diversity Creates Better Groups, Firms, Schools and

Societies

Scott E. Page, Professor,

University of Michigan

Author of “The Difference….”

slide16

“Being united in facing our common challenges is only a first step. While all sectors of our community share these concerns, it will take a diversity

of perspectives to reach the desired state we all envision…”

“….need to discuss the business case for equity,

diversity and inclusion.”

- Trevor Wilson, author,

Diversity at Work: The

Business Case for Equity

what others are saying
What others are saying…
  • Association of Academic Health Centers
  • Need a ‘recalibration’ of AHCs 
    • Focus away from the tripartite mission = “functions” = means to improve health & well-beingof the communities they serve
    • AHC & community together must develop a viable partnership that brings direction and value to both

Wartman SA, Acad Med 2010

degree to which various factors influence health
Degree to Which Various FactorsInfluence Health….
  • Traditionally AHCs have focused on the medical care domain
  • AHCs must take a broader view of health

Wartman SA, Acad Med 2010

recalibration of ahcs wartman
Recalibration of AHCs - Wartman

“`Helping to address the social determinants of health is one way AHCs can demonstrate their value and sustainability and stay relevant to the communities they serve.”

  • Steven Wartman, MD, PhD
  • President, CEO, Association of
  • Academic Health Centers

Wartman SA, Acad Med 2010

recalibration of ahcs wartman1
Recalibration of AHCs - Wartman

Wartman SA, Acad Med 2010

recalibration of ahcs wartman2
Recalibration of AHCs - Wartman

Guiding

Principles

  • Alignment of functions
  • Tangible commitment to community partnerships
  • Collaborative
  • engagement with
  • other AHCs

Wartman SA, Acad Med 2010

moral imperatives driving diversity
“Moral” Imperatives driving diversity…
  • Changing demographics
  • Lack of diversity in our health professional workforce
  • Maldistribution of our health professional workforce
  • Rising number of uninsured/underinsured
  • Health and health care disparities
slide26

“What the diversity and inclusion movement needs for the 21st century is to apply rigorous empirical methods to understanding the most effective and efficient interventions to contribute to institutional excellence.”

- Mark Nivet, Ed.D.

AAMC, Chief Diversity Officer

Nivet MA. Acad Med 2012;87:1458-1460

definition of excellence
Definition of Excellence =

Degree a medical school

achieves its stated mission & goals

Amount of resources expended

excellence imperative driving diversity the next generation of work
“Excellence” Imperative Driving Diversity:the next generation of work
  • To make apparent the overlap between diversity and excellence in patient care, research and medical education

Nivet MA. Acad Med 2012;87:1458-1460

excellence imperative driving diversity the next generation of work1
“Excellence” Imperative Driving Diversity:the next generation of work
  • To make apparent the overlap between diversity and excellence in patient care, research and medical education

AAMC, 2010

excellence imperative driving diversity the next generation of work2
“Excellence” Imperative Driving Diversity:the next generation of work
  • To make apparent the overlap between diversity and excellence in patient care, research and medical education

COMMUNITY

excellence imperative driving diversity the next generation of work3
“Excellence” Imperative Driving Diversity:the next generation of work
  • To make apparent the overlap between diversity and excellence in patient care, research and medical education
  • To invest in diversity and inclusion with evidence of their value to organizational performance

Nivet MA. Acad Med 2012;87:1458-1460

survey of health professions school deans
Survey of Health Professions School Deans…

“…nearly all [surveyed institutions] have diversity efforts underway, but fewer institutions have mechanisms to track institutional progress or report on outcomes to leaders. Within health professions’ strategic plans, diversity and cultural competence is often a “core value,” but is not always accompanied by specific goals and objectives, responsible agents, or metrics.”

Association of Public and Land-Grant Universities. Urban Universities:

Developing a Workforce That Meets Community Needs, 2012

excellence imperative driving diversity the next generation of work4
“Excellence” Imperative Driving Diversity:the next generation of work
  • To make apparent the overlap between diversity and excellence in patient care, research and medical education
  • To invest in diversity and inclusion with evidence of their value to organizational performance
  • To apply rigorous empirical methods to understand the most effective and efficient interventions for meeting goals and sustaining outcomes
  • To measure progress toward and attain accountability on diversity efforts

Nivet MA. Acad Med 2012;87:1458-1460

academic medical institutions should strive to become multicultural organizations
Academic medical institutions should strive to become multiculturalorganizations

“Culturally competent organizational community”

Ross HJ, Reinventing Diversity..., 2011

academic medical institutions should strive to become multicultural organizations1
Academic medical institutions should strive to become multiculturalorganizations
  • Has within its mission, goals, values & operating system explicit policies & practices that prohibit anyone from being excluded or unjustly treated because of social identity or status;

Jackson B, Holvino E., 1996

academic medical institutions should strive to become multicultural organizations2
Academic medical institutions should strive to become multiculturalorganizations
  • Has within its mission, goals, values & operating system explicit policies & practices that prohibit anyone from being excluded or unjustly treated because of social identity or status;
  • Creation of an inclusive, oppression-free environment for all identity groups
  • Advocates these values in interactions within the communities we serve;
  • Understands the strengths & advantages that social diversity brings

Jackson B, Holvino E., 1996

slide38

Diversity

Smith D, Diversity’s Promise to Higher Education: Making It Work, 2010

slide39

Integration Model for

Diversity & Inclusion

Across

Health Sciences

Schoo

D e n t i s t r y · M e d i c i n e · N u r s i n g · P h a r m a c y · P u b l i c H e a l t h · S o c i a l W o r k ·

Core

Shared

Values

E Q U I T Y & D I V E R S I T Y & I N C L U S I O N

slide40

Integration Model for

Diversity & Inclusion

Across

Health Sciences

Schoo

D e n t i s t r y · M e d i c i n e · N u r s i n g · P h a r m a c y · P u b l i c H e a l t h · S o c i a l W o r k ·

Core

Shared

Values

E Q U I T Y & D I V E R S I T Y & I N C L U S I O N

Common Mission

Common Vision

Common Guiding Principles

slide41

Integration Model for

Diversity & Inclusion

Across

Health Sciences

Schoo

D e n t i s t r y · M e d i c i n e · N u r s i n g · P h a r m a c y · P u b l i c H e a l t h · S o c i a l W o r k ·

Shared Educational Resources

Core

Shared

Values

E Q U I T Y & D I V E R S I T Y & I N C L U S I O N

Interprofessional OSCEs

Service Learning

Cultural Competency

Training

Professionalism

Health Literacy

SDH

Patient Safety

Facilities, i.e.

Simulation, IT

Standardized Patients

Faculty

slide42

Integration Model for

Diversity & Inclusion

Across

Health Sciences

Schoo

D e n t i s t r y · M e d i c i n e · N u r s i n g · P h a r m a c y · P u b l i c H e a l t h · S o c i a l W o r k ·

Faculty Development

Faculty Recruitment &

Retention

Faculty Mentoring

Faculty Collaborative Teaching Model

Shared Faculty Resources

Shared Educational Resources

Core

Shared

Values

E Q U I T Y & D I V E R S I T Y & I N C L U S I O N

slide43

Integration Model for

Diversity & Inclusion

Across

Health Sciences

Schoo

D e n t i s t r y · M e d i c i n e · N u r s i n g · P h a r m a c y · P u b l i c H e a l t h · S o c i a l W o r k ·

Collaborative Research Addressing :

Health & Health Care Inequities

Health Care Delivery

Diversity Workforce Issues

Impact of PCMH Outcomes

Shared Research Resources

Shared Faculty Resources

Shared Educational Resources

Core

Shared

Values

E Q U I T Y & D I V E R S I T Y & I N C L U S I O N

slide44

Integration Model for

Diversity & Inclusion

Across

Health Sciences

Schoo

D e n t i s t r y · M e d i c i n e · N u r s i n g · P h a r m a c y · P u b l i c H e a l t h · S o c i a l W o r k ·

Shared Research Resources

Shared Faculty Resources

Shared Educational Resources

Core

Shared

Values

E Q U I T Y & D I V E R S I T Y & I N C L U S I O N

what ahc can do
What AHC Can Do….
  • Take Advantage of Funding from ACA
    • Covers 32 million currently uninsured (by 2019)
      • 16 million added to Medicaid
    • Establishes a 5-year, 10% Medicare bonus for PCP & for general surgeons practicing in shortage areas
    • Partnering with community health centers
      • Collaborative care networks for low-income populations
    • Patient-Center Medical Homes
      • Chronically ill Medicaid beneficiaries
what ahc can do1
What AHC Can Do….
  • Take Advantage of Funding from ACA
    • Pediatric ACO
    • School-based clinics
    • Rural clinics
    • Primary care residency training programs in community-health centers
    • State grants for service in MUA
    • State grants for improving universal access to safety-net trauma care

Andrulis DP et al, Health Affairs, 2011

suggested reading
Suggested Reading:
  • Andrulis DP, Siddiqui NJ, Purtle JP, Duchon L., Patient Protection and Affordable Care Act of 2010: Advancing Health Equity for Racially and Ethnically Diverse Populations. Joint Center for Political and Economic Studies, Washington DC, July 2010
what ahc can do2
What AHC Can Do…..
  • Funding
  • Preserving public trust
what ahc can do3
What AHC Can Do…..
  • Funding
  • Preserving public trust
    • “Understanding the past to approach the future…”
what ahc can do4
What AHC Can Do…..
  • Funding
  • Preserving public trust
    • “Understanding the past to approach the future…”
    • Cross-cultural sensitivity/awareness training
    • Interrupting implicit bias training
    • Community-based participatory strategic planning
    • Defining the role of minority faculty as liaisons & “connectors” of the institution to the community
what ahc can do5
What AHC Can Do…..
  • Funding
  • Preserving public trust
  • Defining our role
    • Social accountability of medical schools
      • “The obligation to direct their education, research, and service activities towards addressing the priority health needs of the community, region, and/or nation they have a mandate to serve.”

Rourke J, Acad Med, 2012

key social accountability actions for medical schools
Key Social Accountability Actions for Medical Schools:
  • Select medical students who reflect the demographic & geographic diversity of the region served
  • Provide curriculum that reflects the region’s priority health needs
  • Produce graduates with appropriate knowledge, skills and interest who will practice how and where needed in the region
  • Do ethical research activities that are inspired by and respond to the health needs of the region

Rourke J, Acad Med, 2012

what ahc can do6
What AHC Can Do…..
  • Funding
  • Preserving public trust
  • Defining our role
    • Diversity can be the driver for new research on
      • Health care delivery
      • Health care inequities
      • PCMH outcomes
      • Workforce interventions
    • Community-based participatory approach to research (& curriculum development)
    • Door of opportunity for minority faculty
what ahc can do7
What AHC Can Do….
  • Funding
  • Preserving public trust
  • Defining our role
  • Educating our physicians of the future
    • Culturally-responsive care
    • Patient-centered medical home
what ahc can do8
What AHC Can Do….
  • Funding
  • Preserving public trust
  • Defining our role
  • Educating our physicians of the future
    • Culturally-responsive care (cultural competence aligned with patient-centered care)
    • Patient-centered medical home
    • Social & behavioral determinants of health
    • Health & health care disparities
what ahc can do9
What AHC Can Do….
  • Funding
  • Preserving public trust
  • Defining our role
  • Educating our physicians of the future
    • Culturally-responsive care (cultural competence aligned with patient-centered care)
    • Patient-centered home
    • Social & behavioral determinants of health
    • Health & health care disparities
    • Interprofessional team building
slide58

Core Competencies for Interprofessional

Collaborative Practice (2011)

  • “The goal….is to prepare all health professions students for deliberately working together with the common goal of building a safer and better patient-centered and community/population oriented U.S. health care system.”
  • “Collaborative” competencies = diversity & inclusion

http://www.asph.org/userfiles/CollaborativePractice.pdf

what ahc can do10
What AHC Can Do….

Continuous diversity improvement

what ahc can do11
What AHC Can Do….

Continuous diversity improvement

  • Means for measuring accountability & continuously monitoring progress
    • Performance trend analysis
    • Report results  dashboard  transparency
    • Not static  once excellence is achieved, it must be sustained
diversity inclusion standards
Diversity & Inclusion Standards
  • Departmental Operations
  • Departmental Culture & Climate
  • Faculty Recruitment
  • Faculty Retention - Faculty Development & Support
  • Clinical Practice
  • Education & Training
  • Research
  • Community Outreach
slide64

Strategic Goal

Sets the standard for achieving the overall organizational mission

Intended Impact

What the program’s stated strategic goal(s) should yield and how “success” can be identified.

Specific

Measurable

Actionable

Relevant

Timebound

Metric

Defined, measurable parameters of the desired outcome.

Defense Centers of Excellence…http://www.dcoe.health.mil/

continuous diversity improvement plan example
Continuous Diversity Improvement Plan:Example
  • Goal: Attract & retain diverse faculty
    • Priority 1: Improve recruitment process & practices for UGMBS faculty by utilizing best practices
      • Action Plan: Create a departmental toolkit and workshop trainings re: UGMBS faculty recruiting and workplace diversity, with attention to recruitment strategies, interviewing, orientation, career advancement & succession planning.
      • Persons Responsible: xxxxxx
      • Timeline: xxxx
what ahc can do12
What AHC Can Do….

Continuous diversity improvement

  • Means for measuring accountability & continuously monitoring progress
    • Performance trend analysis
    • Report results  dashboard  transparency
    • Not static  once excellence is achieved, it must be sustained
  • Accountability  Connect to performance evaluation (and possibly compensation [incentives])
slide67

“Caminante, no hay camino….

Se hace el camino al andar.”

- Antonio Muchado Ruiz

slide68

“Traveler, there is no road….

You make the road as you travel.”

slide69

References

  • Kirch D. A Word from the President: Realizing Just How Much We Have in Common, AAMC Reporter, July 2011.
  • Rasouli T, Crytzer TW. AM Last Page: The Health Care Reform Law and Academic Medicine, Acad Med 2010; 85(11): 1810.
  • Wartman SA. Commentary: Academic Health Centers: The Compelling Need for Recalibration, Acad Med 2010; 85(12): 1821-1822.
  • Association of American Medical Colleges (AAMC). Striving Toward Excellence: Faculty Diversity in Medical Education, 2009, Washington DC.
  • Liaison Committee on Medical Education. Standards for accreditation of medical education programs leading to the M.D. degree accessed at http://www.lcme.org/functions2011may.pdf on 9/8/2011.
  • Accreditation Council for Graduate Medical Education. Core competencies accessed at http://www.acgme.org/acwebsite/RRC_280/280_corecomp.asp on 9/8/2011.
slide70

References (continued)

  • U.S. Department of Health and Human Services, Office of Minority Health. National Standards on Culturally and Linguistically Appropriate Services accessed at http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15 on 9/8/2011.
  • Nivet MA. Commentary: Diversity 3.0: A necessary systems upgrade. Acad Med 2011;86: 1487-1489.
  • Nivet MA. Commentary: Diversity and inclusion in the 21st century: Bridging the moral and excellence imperatives. Acad Med 2012;87:1458-1460.
  • Smith DG. Building institutional capacity for diversity and inclusion in academic medicine. Acad Med 2012; 87: 1511-1515.
  • Page SE. The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools, and Societies. Princeton University Press, Princeton, NJ, 2007.
  • Smith DG. Diversity’s Promise to Higher Education: Making It Work. Johns Hopkins University Press, Baltimore, MD, 2009.
  • Ross HJ. Reinventing Diversity: Transforming Organizational Community to Strengthen People, Purpose, and Performace. Rowman & Littlefield Publishers, Inc., Lanham, MD, 2011.
slide71

References (continued)

  • Jackson BW, Holvino E. Developing multicultural organizations. In: Cultural Diversity Sourcebook: Getting Real About Diversity, Abramms B, Simons GF (Eds.), 1996, Amherst, MA.
  • Andrulis DP, Siddiqui NJ, Purtle JP, Duchon L. Patient protection and affordable care act of 2010: Advancing health equity for racially and ethnically diverse populations. Joint Center for Political and Economic Studies, Washington, DC, 2010.
  • Rourke J. AM Last Page: Social accountability of medical schools. Acad Med 2013; 88(3):430.
  • Beach MC, Saha S, et al. The role and relationship of cultural competence and patient-centeredness in health care quality. Commonwealth Fund Pub. No. 960, 2006
  • AAMC. The Interprofessional Education Collaborative, Core Competencies for Interprofessional Practice, Washington DC, 2011.