We can’t solve health inequities in a vacuum. To truly eliminate health disparities, it’s crucial to involve patients and the community and co-design solutions with them. We talk to folks who have partnered with community members and patients to tackle inequities linked to race, ethnicity, poverty, and class. Discussing their journey and challenges, these leaders tell care teams the crucial steps they need for success.
We can’t solve health inequities in a vacuum. To truly eliminate health disparities, it’s crucial to involve patients and the community and co-design solutions with them. We talk to folks who have partnered with community members and patients to tackle inequities linked to race, ethnicity, poverty, and class. Discussing their journey and challenges, these leaders tell care teams the crucial steps they need for success.
Here’s where you can learn more about the people, places, and ideas in this episode:
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This is an automated transcript. Please excuse any errors or hilarious mistakes.
Good afternoon. I would like to welcome all of you to our webinar today on addressing health inequities, through patient and community engagement. Um, for those of you who do not know me, I'm Juliane Tomlin, a senior manager and lead of our population health portfolio here at the center for care innovations.
I thrilled to introduce to you our panel for today. Um, our panel discussion will be moderated by Mary [inaudible], who is a senior policy and program specialists at the Institute for patient and family center care. And this amazing panel who's with us today. I feel so grateful that you're all that you've all joined us. So, um, I will start with Libby Hawaii, um, who is the founder and CEO of PFC partners, um, followed by Maria Lemus. Who's the executive director of physio, any come from me. So we've got Kelly Bruno joining us. Who's the president and CEO of the national health foundation. And last, but certainly not least yet. She is farthest away from us as Leticia raised mash. Who's the director of programmatic services and innovation at cook County health in Illinois. So welcome to all of you, so excited to have you and Mary I'm going to, everyone can, can turn on their cameras. Mary, I'm going to hand it over to you to, to get us started.
You bet. Thank you so much Juliane for that introductory comments. And I really appreciate all of you who have joined us today. I want to set the stage using just a couple minutes, so that we're kind of all on a level playing field. Cause I know people are coming from a variety of disciplines and places of employment. So, um, it's really important that we're all kind of on the same page related to patient engagement. And so I want to help you understand the formal definition is that it's all about an active partnership among patients, families, caregivers, healthcare staff, and the community to improve health care. And it can occur on three levels, both at the individual patient level. So those of you that are working in clinics, you can utilize tools as an example, to engage patients using, um, motivational interviewing or shared decision-making or health coaching.
And, um, an example of patient engagement might be that the patient keeps a log of their daily readings, their blood pressure readings, and brings it to a clinic visit. Um, organizational level engagement is equally important. It's where you create structures and structures really drive behavior for gathering patient family feedback that can be surveying patients doing town hall meetings, establishing advisory councils and, and more so patients with the lived experience. And some of our panelists are going to talk about this can help create messages as an example for other patients about the importance of preventative appointments or monitoring hemoglobin A1C, um, and what the health benefits of that are at the policy and community level. We really want to be engaging patients and families and other community partners in collaborating and developing policies that, um, are working in the community and in healthcare organizations that are inclusive and invite everyone in.
So an example of that might be that patients on Medicaid provide feedback about their experiences working with Medicaid care organizations. And it informs legislation, which requires each Medicaid, managed organizations, staff 51% of those receiving those services on any policy setting committees. And these are examples that are really happening all around the nation related to that. And there is a reason for focusing on engagement. The evidence is compelling. It improves quality and safety and outcomes of care. It ensures that patients receive care that fits their preferences. It reduces the use of diagnostics and other care services that don't really add value, which reduces healthcare costs, but it also increases, um, buy-in for prescribed treatments, um, patient experience. And it also returns the joy of working and reduces staff and clinician burnout, which is a really important thing right now. So our focus is on equity and engagement.
And so let's talk about creating partnerships with communities who have been systematically marginalized or devalued. It's going to require a change on all three of those levels that I've just discussed because we've got to create structures that invite the voices of those populations, what their concerns and their values and preferences are so that we can create systems that are going to reduce health disparities rather than maintain them. And it's only by understanding people's experiences and dismantling systems that have been harmful. That lasting change is going to take place. And this starts by listening to their experiences. All of you have set some bold aims and addressing issues of health equity in, um, in your populations that you're serving. And in today's session, we brought together some amazing people who have experienced working at all three levels, building partnerships that will provide ideas. And I believe that when you hear what their experiences are and the wonderful things that they've done in partnership, that you're going to be inspired. And you're going to look to new ways of creating new partnerships that will create a more just healthcare system. So let's meet our panel members. I'm going to ask each panel member to spend about five minutes telling you about the work that they have done and their organizations have done and how they've worked to address health inequities and Libby. I'd like for us to start with you,
It's always a pleasure to speak with you, and I'm just delighted to be here today. My name is Libby OI. I'm the founder and CEO of PFC partners or person family centered care partners. And we're a patient and family driven organization based on my family's experience of raising three sons, living with mitochondrial disease, we acknowledged early on as we were engaged with our families to care and the boys care that we experienced better outcomes by developing a team approach. And so partnership is at the heart of everything that we do. We really believe strongly in, uh, creating a health system that works not only for the patient and the family caregiver and meets the values and priorities of the patient and the family caregivers, but it also meets the needs of the communities and meet the needs of the clinicians and the overall administration. So we really, um, base all of our, our fundamentals in establishing effective and highly valuable and sustainable partnerships.
We do that in a couple of ways. We work with, um, large health systems, rural health systems, um, measure developers, quality improvement organizations, uh, community-based organizations, public health, and anyone else who's interested in partnering, but we work with them to build the infrastructure, to support partnership with their community members, their patients, and their family caregivers. So that there's integrity in that partnership and a common focus simultaneously why we are, excuse me, it's a bad time for that. Honestly, while we are building the infrastructure for meaningful partnership, we're also raising the capacity of patients and families and community members to be active in that part in your partnership, whether, again, that be in their clinical interactions or in a program design and evaluation, um, improvement or policy. And so we do that by, um, engaging with people who are interested in using their lived experience to inform health care.
Um, and that's what we broadly refer to as a patient family advisor, patient partner, lots of names, community members, um, those people, again, with their lived experience, partnering, we raised the PFA network, um, to build a sense of community between advisors as well as build their capacity and understanding for the, uh, core concepts of patient and family centered care and the, um, core competencies of being effective advisors. We provide skills around quality improvement. We provide, um, uh, programs that are very interactive and continuous learning around measurement basics and, um, and other topics. So we seek to be the connector to, um, affective and high value, um, partnerships with regard to the topic for today. I will say that from the inception of POCC partners in 2010, inclusion and diversity have been part of our fundamental values. And, um, what we have come to realize in this year of revelation for 2020, um, is that we weren't living those out nearly the way that we, we needed to be and that we wanted to be.
And what I mean by that is we were always very embracing of anybody who came to our, any of these patient partners that came, um, to our door. We were always inclusive and embracing, but we didn't do enough to create multiple doors for people in underserved communities. And that are typically underrepresented in policy and, and, uh, design rooms. And so we've, um, worked towards really expanding those efforts. And, um, with the under the guidance of a, uh, recently diversified, uh, advisory board and a new diversity equity and inclusion work group from our PFA networks. So I'll stop there, but, um, it's critically important that we're all in this together and, and moving, um, equity more deeply and into our daily, um, sort of interactions. Thank you.
Thank you, Libby. So important to be humble and recognize and reevaluate during this time, even though our intentions were one thing, are we getting the outcomes that we want? And I love the way that you are talking about, we need to open more doors. And so how do we find those doors and how do we, um, invite, um, and, and go through those doors to find people in their own communities. Um, I am going to go to, uh, Kelly next. Kelly, can you tell us a little bit about your organization and the work that you're doing related to health equity, and then afterwards we'll go to Maria.
Absolutely. Thank you very much. I appreciate the opportunity and feel very honored to be amongst a panel of incredibly powerful women. So thank you again for the opportunity. National health foundation is a nonprofit organization that's been in existence for about 50 years and our mission is to improve the health of under-resourced communities. And we do that by taking action on the social determinants of health. The four that we focus on primarily are housing, food insecurity, built environment and education. We're probably most known for our recuperative care efforts, which are for individuals experiencing homelessness that are leaving hospitals. And we currently operate four recuperative care programs in both Los Angeles and Ventura counties equaling about 200 beds. But what we also do, which I think is most important to what we're talking about today is our community initiatives programs. And that is an effort by national health foundation to work within under-resourced communities, to help them identify health disparities in their communities, barriers to being as healthy as they can be, and then come up with solutions to those barriers and then implementing whatever strategies necessary to basically rid themselves of those barriers.
Easier said than done. It sounds very fancy, but what we're very proud of is the fact that we recognize and use the word under resourced on purpose, because we recognize that the communities we serve are no different than the communities with no health disparities, with the exception of the, of resources that they have. And so our job as an organization is to bring those resources into the community, whether those resources be financial, or do they being research, or whether they be just elbow grease necessary to move their, their vision forward. We feel very strongly that these communities should not need to be empowered. They have this, they have the solutions, they have lots of power. They're simply just missing the resources. It's definitely a strategy or a philosophy that is a little bit out of control. It makes you feel out of control a little bit, because you don't necessarily walk in with all the answers because you're letting the community determine what those answers are because you're trusting that they indeed already know those answers.
And I know that the population or the, uh, the group here today in a lot of their projects already have goals and have been set. And I definitely don't want to discourage any of that because I think that those goals and projects definitely create partnerships that will continue in that same elk that I'm discussing. But oftentimes when you give up the power to a community and you let them, um, identify the solutions to the disparities that exist there, sometimes the solutions are not necessarily the ones that you would have come up with, or they wouldn't have been the things that you would have automatically thought of. And so giving that power back to the communities to create their own solutions and really just being the man behind the curtain, if you will, to help them get there is a strategy that we implement and feel very comfortable and confident in, and I'll stop there.
Great. Thank you, Kelly. What I love about what you said is the, um, the openness to really trusting that the individuals that you are encountering and working with so closely, um, have, are already engaged and, um, are, um, and have the knowledge that's going to be able to help create solutions that are going to make a real difference. So thank you for sharing that. Maria, can you share a little bit about your organization and the work that you're doing related to health equity?
I am happy to, my camera is on, but I don't think you can see me, but it's on, on my side. We can see you now. Can you, Oh, good. So, uh, I'm the founder and executive director of the center come from, we are celebrating our 20th anniversary this year, and if it were not for the pandemic, we would be gathering in a thousand. [inaudible] at our annual conference for three days to learn, share, and build community and dance the night away. Um, that's really reflective of who we are. Um, we were founded, uh, 20 years ago with the idea that Ramona thought us, who we define as, um, mostly women in those days, 20 years ago, primarily women and, um, mostly volunteers in the community who were serving, uh, families, communities by linking resources. Um, bringing them back to the community, helping people. It is, it is the individual that we know in our families.
For me, it was my mother. And when I grew up in segregated, uh, San Bernardino as a child, my mom was the one who would go out of Arvada your own. She would bring in resources. She would help people. So I grew, I grew up with that and my grandmother was a [inaudible]. She was the local healer. So I have in my mind, a really clear picture of what that means through the process of the Americanization of us when we come here and I'm born here, but my parents are from Mexico with the, the process of Americanization for the sake of being American is what I say. We lose a lot of those things that are really a strength, strength in our community, from whatever community that we're from. And this person that I talk about that has the spitty docent ratio that has the heart of service is in every community.
They're, they're Jewish, they're African they're, Iranian they're Punjabi. It doesn't really matter. Every community has a person that may be called something else, but they have that. And so what we do when we started coming together, we thought, wow, it would be great for me to know a little bit about what one knows or a little bit of what a JAK one knows. And so we started with a principle that we wanted to know a little bit of a lot so that we could take it back to our community. Well, five go into 10, grew into a hundred, grew from three regions to five regions, to 13 regions across California, with thousands of promo Torres and in other States. And the movement is the moment is growing in recognition of who these experts are. We call them community experts. We know what the issues are, and we know what the solutions are part of it is because we are Spanish speaking and were primarily immigrants as were my parents.
We don't understand the system that we're in now, do we understand the requirements that we're in and nobody really sits down and says, why is it important for you to have a, a mammogram? And why is it important for you to have these tests? When in my home country, I wouldn't have had those tests and I wouldn't have had that, that kind of, uh, medical effort. So the organization grew, um, by leaps and bounds, so that now we're providing, uh, this organizational strategy and community training and capacity building and leadership, not only in California and to Spanish speaking families, but also to our African-American communities, to Asian Pacific Islander communities, to Samoans across the United States in Mexico and in Guatemala and in particular with our indigenous communities that are there or here in the United States. So we're really pleased to bring this resource together, this leadership building, um, and, uh, and the idea that we see that you have the power, you have the knowledge, you have the power, how can we adapt it and how we really leverage it in the United States?
Um, about 10 years ago, we started to develop projects. So this tides, our, our network, we have projects and we started taking them on with the idea that we wanted to show as an organization that put a lot on us, can do almost anything. It's a matter of how you teach it and what support do you give to them? And so we right now run over 30 projects from you, name it, you name it from gambling to diabetes, to crown disease, to it's just every project you can think of. Um, and that really supports what we believe, which is a social economic ecological model that everything impacts a family and, and the most important one is work is employment. We think that a job will change a family, social determinants, more than anything. And so we're very active in the workforce field, really developing the path for a promo thought, a community promo thought if they want to move towards getting hired by an agency and also work with agency so that they can, um, develop systems to embrace the problem with our model, which is slightly different than the community health worker model, which is focused more towards clinics and hospitals and plans.
We think that that agencies and organizations need to look at a partnership with community that going to scale means partnering with community. You're never going to be able to afford enough community health workers. It's just too many of us. I know that I'm overwhelmed by the number of Latinos there are in the United States and I'm a Latina. And so, and then we're just growing and growing and you're never going to be able to afford it. So I think what we believe in is that the expertise and the resources are in the community. So we need to build up their capacity organism, local CBO capacity to engage in this discussion and to really be at the table, not only to discuss what the issues are, but the solutions,
This is wonderful. Maria, and I'm, we're going to follow up with you with some more questions related to that, but, um, I love that that, that you're reaching out to, to communities across the nation and beyond to really build community. It's excellent. Leticia, can you tell us a bit about in just a few moments, minutes, five minutes, actually, what you are doing in the Chicago land area? Great. I want to just thank everyone. I think Juliane and others for having me be part of this panel. I've already been thinking about a lot of things from hearing from the panelists here that are, that's getting me excited about my own work and how I can partner with all of you. So, um, so again, thank you. So I work, my name is Leticia Rayez Nash, and I work for cook County health. Um, we are a large, um, public hospital system. It's our, it's been our mission for 180 years to serve everyone regardless of their ability to pay. We have a large footprint. We have two 15 community
Clinics. Um, we have the third largest, uh, the third busiest trauma center in the country. Um, we serve that. We provide healthcare in the jail and the juvenile detention center. We have a Medicaid managed care plan, and we have, um, uh, um, um, and Medicare plan. So I say all that to tell you, we have a large scope and, and a large reach, um, to make an impact. And really, um, we serve the most vulnerable, um, in cook County, which includes the suburbs and the city of Chicago. And so, um, I feel very privileged to be in this position because I really work across all of those entities to really leverage our power and privilege as a large government institution, um, and, and our role and our responsibility to serve everybody, regardless of their ability to pay, to think about how we address equity, racial and health equity, um, for the communities that we serve.
And so, um, as I've been working at the health system, um, last November, we put together what we call the center for health equity and innovation. And what we did is we took our funding and ideation unit and brought that together with our data and analytics unit to come together and bring in equity and justice promotion, the financial resources and partners, the community voice, um, and, and data and analytics and research all together to bring forth equity, into focus, um, on addressing, um, the equity needs that our health system, we have a portfolio of work that addresses housing insecurity, food insecurity. We work on projects to address the needs of the justice involved and the opioid epidemic. And I was talking earlier today with somebody, and I said, you know, really when you work on the scope and we have maternal child health as well, the scope and where I sit, we're able to see that everything is interconnected.
And I think Mary did a really great job talking about how, um, we need to look at impacting multiple systems. So in the work that we do, we look at how do we do individual interventions, but then what are the systems, even within our own organization that are going to limit the ability from that individual intervention to be effective. And then what are the policies? And the system changes that we have to impact and change in order to be effective. We can't simply do another intervention in a clinic that has the four walls is our limit to be successful. We have to think beyond those four walls. And honestly, COVID, if nothing else, it has taught us that the four walls of a clinic are insufficient to address the needs of our communities. And when I was just listening to Maria talking about though, that, that workforce and that group of women, the thought as the community folks, the people in the community, how do we think about addressing health differently and utilize the assets within our community to help make sure people are healthier. And COVID
Is a great example of the limits of the health system and how we have to partner and go beyond, um, those, those four walls to do the work that we need to do in Georgia to address racial and health equity. Great. Thanks Laticia. Um, we're going to shift now to be doing some follow-up questions, and I'm also going to be watching the chat. What I would first say is that there was so many powerful, wonderful questions that we got from those of you on the call today. And, um, many more than we can answer, but we're going to try to deal with some basics and also help you get some specific and tactical ideas about what you can do in your own environment. Kelly, I'd like to start with you if we can. Um, and I'm going to combine both, um, a question that you've prepared for, but another one that I'm sure is going to be easy for you to respond to, because you've really created a culture of inclusion and partnership with those you've served. So, um, and, and first impressions really make a difference. And so how do you communicate humbly when you're, um, outreaching to a community so that you can start with outreach, but all with, but how do you go from outreach to creating engagement? When does engagement begin and are there some specific things that you did, um, thoughtfully to really communicate that respect and trust that you talked about in your opening statement?
Sure. Thanks for the opportunity. So I don't personally believe that, um, that outreach ever stops. I think you're constantly outreaching, but when it comes to the question at hand about how do you communicate humbly? And I think, but we believe very strongly that actions speak louder than words. And it's, it's not always what you say, but it's, if you follow up with what you do, when we have a community group that, um, that we built around our last recuperative care that we built in Pico union, and that, that community group actually still exists today. And it looks quite different today. I would add then when it did originally, but when we started with that group, we, the first thing we did was listen. And that's it. You have to listen. You can't be like, yeah, but yeah, but you, listen, you listen and you're there and you have to be comfortable in that space and not want to fix everything, but listen to what is being said after you, listen, you need to ask, what can we do?
What do you need from us? What is this, what you need, is this what you're telling us? And then you need to actually do what you say you're going to do. For example, when we opened the Pico union facility and we brought the community together, we had an idea of what we thought the issues were going to be. And obviously there there's, some of those were true. They wanted to know about the homeless population, where they going to be safe, but then other things came up that we didn't think about. For example, parking was a huge issue for them. It was an issue because we were going to take all their spaces. And then where were they going to park? If they had to park farther from their homes, it wasn't going to be safe for them. So what we did was we leased a parking lot next door at the church, and now all of our employees park at that parking lot, as opposed to parking on the street. It's not that big of a deal, I guess, in the scheme of things. But, but it actually is a big deal because it communicated to our community that we understood what they wanted. We asked them what the solution could be. And we actually do what we said we were going to do that makes, uh, that they trust us and we trust them we're neighbors. And so it sounds simple, but it's really important. I mean, it ask and then do what you say you're going to do.
Right. Thanks, Kelly, Libby. I'm, I'm wondering, um, as we think about this at the clinic level, in the work that you're doing, can you think of a time when you witnessed the power of having someone with a lived experience, share an insight that, that the organization listened to that helped them think differently to address something in the clinic environment? Um,
Yeah. I really appreciate the question. And I think, um, you know, we are, we're all sort of starting with listen first and here. And I think the value of having the person who's experiencing your clinic in the room with you, as you're trying, as you're designing and improving your programs. I mean, COVID Holy smokes. How many of you have gone to tele-health late, you know, basically in 30 days. And when was the last time healthcare changed anything in 30 days. So remove the expectation or even the, the, maybe the burden of feeling like you had to get that right on the first try, because that would be really, really difficult. It's unprecedented. And so the value of bringing the patient and family caregiver, voice into your evaluation process of how did you respond? Did you meet the needs of your community? It's essential to have that perspective informing you.
And, um, one example recently I was on a, um, advisory call with, um, with LA County DHS. And, um, the facilitator was speaking to the return to care, right? Everybody's concerned about how do we get people back in for their, um, their, uh, regularly scheduled appointments and things. And I think a quick assumption is that people are afraid, afraid to come back into the clinical environments. And for some that's probably really true, but we're finding there's this whole host of other logistical problems. And so as this conversation evolved, the patient family advisor on the call said, you know, I've been trying to get my, uh, my reassessment or, uh, recheck scheduled for so long and I can't get a call back. I can't get it scheduled. And the facilitator got very frustrated, very much that fix it mode that Kelly was referring to and said, you know, we called you this morning. You didn't pick up. And, and the advisor said, I don't have any missed calls from the health center on my phone. And they said, well, it wouldn't come from the health center because all of our staff is working remotely. It was a phone number. And as an individual, this person didn't answer phone numbers that she didn't recognize. And so that's the value of really understanding from the community person's perspective. Um, what is the problem, because we don't want to put resource towards solving the wrong problem.
That really is so true. Isn't it? Maria, I'm wondering, um, how you think that community-based promo Torres could be helpful in engaging individuals who have diabetes or high blood pressure, because this is certainly something that the individuals on this call are working with. And, um, you spoke so eloquently about how the community, it can be a solution to, uh, challenging health inequities. Well, I I'd love, um, first of all, I'm gonna stay in love with the two, um, previous speaker spoke about really very true. And, um, I think it's important to be at the table, articulating the importance of, of community being there. Um, the first I'm must say that that social determinants affect our health. We know that, and I know the California endowment for instance, has defined it as our zip code can define our health, but there's such a huge impact on, on requiring us to adhere to B to behavior change.
When we have few resources, um, the food desert that's one example, inability to exercise in non-local areas, um, not having any funds to, to really, uh, to eat properly and not understanding the transition of our indigenous foods to healthy foods. And actually we do eat healthy. Um, and so what we've developed in, in, in rezoning come from me. So there's two programs. We were doing a heart study with, uh, national heart and lung Institute. And we developed an exercise program. That's in the community, it's called [inaudible], it's a wellness program. It's not just exercise. It really talks about nutrition and, and, uh, and exercise and family. And it's it's health has a Charla with it, a kind of a support group, but it was a, it's a resource that's developed by community, by the promotoras for them. We train them, we certify them and they give these, uh, groups.
We have about 400 across the state and they give these groups in different locations near where people live, where people live either in resource centers or in garages or the parks, and we cover their insurance. And so they asked us to develop this because they couldn't afford gyms. They didn't, it wasn't a Y w MC why I'm too close to them. They didn't have the resource to, to travel. They, they, they were unhealthy already. So they couldn't really walk a long distance. And so this is an example of how community can develop the resources. They know what the issues are. They just sometimes don't have those things that will move them to the next step. So this is very popular. It's now engaged in mental health and wellness issues as we're into COVID, it's, uh, we're utilizing it as a way to bring people together, to talk about issues, to integrate, um, wellness topics with that.
It's a great way to, and it's my age. So you have the very active young people, and then you have for older adults, you have seniors. And they actually have one group that exercises sitting in chairs, which is, I think, very creative. Um, but I think that this emphasizes to us, that community can develop these, if there's a discussion and there's, they'll think of something. And then we as an agency formalize it and validate it. Now, I want to say that this is not evidence-based. It is community practice. And I think that as practitioners we're stuck on evidence-base, there's many, there's a lot of wonderful interventions that are going on with the community level that organizations develop for their community. That aren't, that we don't have the funds to do evidence-based, but our community practice work and are thriving in our community. So I would ask people to look beyond the, the public health norms above space and look at what's happening in the community, get to know your community, to get to know what agencies are doing. And certainly we're happy to share what we know about that.
Great. Thank you, Maria. Leticia, you work, your work crosses so many dimensions from the clinic level to development of community resources and program, and you have quite a bit of experience co-designing programs and setting structures that build equity. What are the important first steps when you were just getting started?
Yes, I think that, um, one of the, you know, recently, um, we've had to, uh, engage, um, our community co-design process, um, in partnership with our department of public health. And, um, we were able to, um, engage, uh, a variety of stakeholders to get feedback in a quick way to help inform our decision on how to utilize $6 million of funds to help support the community. And we, um, we were able to engage that community co-design process. Now, I think that as you're, you know, as we are now, um, continuing to embark our work, um, at the health system level, um, to develop our, um, racial and health equity initiative, we'd had to talk about how we need to slow down before we can speed up. And we borrowed kind of the co-design process from the department of public health. And now we're working to build that process as we're building our, um, health equity initiative at the health system.
I think we default to wanting to quickly look at the data and say, okay, we know where the inequities are. We know the interventions that work, and we know how to get this done. And we act, we know the partners that can get that done. And I'll be honest with you. That is very much what I've been doing for a very long time, because that's the process of developing programs. Um, but we have now realized are a very significant blind spot. We can't just simply put people on steering committees and expect that that's going to be sufficient to have community voice. And so now we're working through learning from our public health department and others on how to build processes that will engage, um, community at all levels of decision-making. And I think this was talked about before, um, by Kelly A. Little bit about how you have to be more open and be more patient around what the outcome will be. Um, and I think that, um, we're working with the team and our leadership to communicate that and to start, um, with that community co-design process and to, and also with the data, right. Both. Um, but making sure that we don't take off in the wrong direction and then are surprised when our intervention isn't working.
So Latitia when you're, when you're starting that new process. Um, is there one thing that you did with your, um, your stakeholders who were the represented population that you hadn't done before? A very concrete, specific step that you hadn't done in the many years that you'd worked before that you're now doing?
Yes. I mean, I think what we're doing, what we did in particular for, um, the funding is that we, um, we, we asked for specific feedback on what the needs were. And so we went to through the co-design process, we, we had actually data, we took the data from our call centers. We looked at what was being asked by our care coordinating operations. So we're able to assess kind of like what were all the needs that were being identified in what communities was that happening? And we were already deploying resources into the community during COVID, um, you know, food delivery, prescription delivery, all of those things. Um, but then when we were looking at the investments, we wanted to ask, um, the communities most impacted by COVID, you know, what did they need? And so we asked not only the high level stakeholders, we did selected focus groups and we got feedback, and honestly the feedback strengthened the data, but then it also showed us, there was a lot of creativity happening in the community that we would never even thought of, um, around addressing the needs. And some of those partners were not partners that we would naturally be inclined to engage. And so through that process, we were able to write an RFP that was more open and inclusive and, and, and not only did it fortify kind of the needs we anticipated, but then we made room for other needs to be identified. Um, and the other part of this, I think is important. We are a large public health, there are some
Things that we should do, and there's some things that others should do. And I think that, you know, as an entity figuring out, you know, what is your role and what's the right role for you as your organization, where do you need to step up and where do you need to step back? And where do you need to figure out how to share power? I will be honest. We are still in this process. We are still learning and building. Um, I think the most important thing is to be open, um, and know that you're, um, a learner just like everybody else in those partnerships. Great. Thank you, Libby. How do organizations that have had patient and family advisory councils in the past? How do they move to true patient engagement beyond mandatory advisory councils?
That's a great question. And Mary, for those of us, who've been at this for a while and in creating these partnerships, the patient family advisory council was sort of the default mode. And I think in this new era of, of listening and asking and, and then doing, we really need to design other structures that, um, not necessarily take the place of an advisory council, but, but that, um, add to it and add, you know, like I said, those additional doors, um, one example that, that we're trying out right now is to move from, in addition to the advisory councils that we've set up across LA County, uh, department of health services, we're now adding a hub, what we're calling the patient partnership hub. And that's what the goal of, of creating community connections, doing outreach, um, creating partnerships with trusted community-based organizations to really open, um, a space for every community member in LA County who received services through DHS to have a voice.
And so in addition to creating a open, um, weigh in for everyone, we're doing things like partnering with linguistics to ensure that we're providing language services. Um, we're also thinking about what does that partnership look like? So the once a month, patient family advisory committees and councils, those do a tremendous amount of work, but we also know as we've moved advisers into quality improvement projects that has also benefited and increased, um, value. So we're thinking about what does it look like for communities to have voice? Is it, is it through surveys? Is that a starting point? Is it through focus groups? Is that a starting point? Is it through partnerships with Providores programs and, you know, figuring out where can we bring in and what kind of activities and thinking really differently about that? I mean, um, I think to, to Latisha's point the foundation of co-design, if people are going to enter with co-design that fundamentally says, we don't know the solution is at the outset of co-design.
If you've created this partnership and you're committed, then you can't know because you haven't been together yet. So you're committed to designing that solution together. So I think we're thinking really differently, um, in addition to, it's not in place of, but in addition to how do we open more doors? And as we like to think about it, it's not for us to create a table and invite voices to the table. It's our job. And thinking about our role, our role is to bring the wood, the hammer and the nails and the labor and ask, how do we build your table? How do we help you build the table? And you know, what do we need to discuss at that?
Right. Thank you, Maria. I was thinking about your comments about the importance of the promo Torres and, um, the amazing work that's happening in the community that is community practice. And I often think that, uh, evidence-based practice starts with community practice that then gets funded to research that the community practice makes a difference, but I want to get to a different level, which is really, uh, at a, at a really individual patient level. Um, how would you recommend that practices create a sense of trust and engagement within the Latinex community, patient by patient? And I'm remembering a, a quick, um, story you told about your and your family's experience in receiving health care. Can you share that very briefly with us? I will. Um, so I was born in San Bernardino and my dad worked after we moved out of the fields and grape and, and Chuck and Chuck on apricot and oranges.
That's when there was extra agriculture in the inland empire, he got a job at Kaiser steel. And so we, I have been a Kaiser baby since I was three years old. And what I remember about that is, um, that there was a clinic about three blocks from where we lived on the West side of San Bernardino. And I remember the, um, going there. I remember the nurses it's still embedded in my mind, the nurses and the doctors. Hi, Mrs. Memos and hi, um, you know, my Melendez, my family. Hi, Maddie. How are you doing? And the, the relationship that was built with my family, with the nurses and the doctors, they also had, um, Christmas events for the families. Um, we were poured, so they had Christmas events and they would give us gifts. Um, during most of the holidays, they would do that. That's how we learned about Thanksgiving, because, you know, in Mexico, you don't have Thanksgiving.
And so that's part of the celebration. Um, and so I, the memories that I have is of people caring about me. And so when they would call my mom and say, well, Maria, my Nana has to have this, this exam, or she has to come in. My mother already had a relationship with them. And so she trusted that, what they telling her, asking her that she needed to do was, was important because she had that trusting relationship with them, either with the receptionist, with the nurse or with a doctor. And in those days you spent more than 10 minutes with a doctor and you also, um, had one that was continued continuous. And so I think that that's a really important piece as I think about how do you establish relationships with the community? It's it is who do you connect to? Who was the, who was the well-respected person in the agency right now we're calling people and asking them to come in.
Well, you know, cold call is not going to get me in a cold call. I may not even ask her answer. So I needed somebody that I can relate to, that I can feel a relationship with that I can trust that that will say, this is what you need to do. And, and also will be a warm handoff in the community. That's what we've been encouraging for, for plans to do is really work with [inaudible] to be that warm handoff. Then if I'm diagnosed with, with diabetes or hypertension, I have somebody that I can talk to somebody that can refer me to exercises that can go with me to exercise. If somebody that can come and help me cook better so that I'm I'm cooking, but I'm not, um, cooking high salt foods. And we already have really good indigenous foods. We just don't know it.
Like they go, let's see. So find all those we just are, are, are I think, um, enamored by the American system and look at hot dogs and hamburgers and those things. Plus it's also a cost factor. It's more, more effective. But I think that having [inaudible] be part of that system, a warm handoff to the community would get me, for instance, would get me in. And the other thing is if I had high blood pressure and some of the doctors saying this is the clinic that's open and I can't get an appointment for three months and the clinic is far away, I don't have a ride to get there. What if Laura came to me and said, Maria, let us sit down. How's your blood pressure would have, have you been eating? How are you doing? What can I do to help you? Those are the things that are going to change people's minds, because they'll feel that somebody cares about them already stressed out because they're sick and they think they're going to die. How, how can I change that perspective perception that somebody cares about me? I think that's really an important piece. I agree that somebody really cares about me. Kelly, I'm going to shift gears for just a minute and ask you to very quickly, um, tell us a little bit about your Jedi council and those of you that are star Wars fans. She's going to describe it a little differently, but it's important to listen to anyway, Kelly.
Well, thanks for the opportunity. National health foundation has a staff driven run group called Jedi. Um, what stands for justice, equity, diversity, and inclusion. And it is an organizational group. Like I said, made up of our employees with no leadership I should add. And the goal of this, of this staff run program is not only to have a star Wars reference, but, um, but to also make sure that NHS internal processes and practices are created through a Jedi lens. And that's what we call that. So they actually have their own strategic plan, um, for a three-year strategic plan that has been board approved. And it really includes our goals as an organization and how we're going to ensure that our organization falls through with Jedi practices. For example, one of those goals is, is that by the end of 2021, 75% of our vendors will be, um, uh, businesses of black owned businesses or businesses of color or minority owned businesses or women owned businesses.
We actually have by the end of 2021, that our investment committee will be looking at how we invest our endowment and to make sure that they're investing in social justice ventures. So these are some of the things that this committee has put in practice and making sure that our organization does so that diversity equity and inclusion are at the forefront of everything that we do. Also smaller things like the fact that we have 100% medical benefits. That's something that Jeff has done. Um, what are, what are, um, sick policies look like? What even our educational policies look like? Do we have to require a bachelor of degree for every job or even a, even a, a, um, a high school diploma, does this job really need this? And that's what Jeff is doing for us. We're very proud. And we're also very happy that it's something that leadership is not involved in. That's very important. So that staff feel and recognize that they have that power. Again, it's a shift of power and, and we, as leaders have to give that power up.
So, um, we had a question that came in very late and, and I'm opening it up to any of you because we have a couple of minutes before we do our closing question. Um, but what have you found helpful to engage leadership support on health equity initiatives? I know Kelly that you mentioned that that leadership isn't on the council, but I'm guessing that there was some leadership support, um, for their development. But again, I'm not just asking Kelly, I'm asking anyone, um, how do we really engage leadership so that they can support health equity initiatives?
Well, I'll just briefly say very, very briefly because I want to let everyone else speak that as a white woman running an organization that is, um, helping primarily, uh, persons of color, it is incredibly important that I recognize the privilege that I have and the power that I have and be open and willing to give that power up. I cannot express that enough. Um, w no defensiveness, no fragility, just let shift of power and let that, that you lead, make that decision and leave their own health
Equity. I think that is just incredibly important. Great. Well, I've had the proverbial little, um, lambs, uh, mover to suggest that we, um, moved to our very last question because we're running out of time. Um, so this is just a quick 32nd response from all of you. And we'll start with Libby, um, from your perspective, what are the risks? If we don't engage the populations who experience health disparities?
Oh, in 30 seconds to too numerous to count really. Um, I think that we risk a, um, further division, further, um, spread and gap in health and wellness in this country. Um, that's a huge question, but I think that, um, you know, the risks too. I, yeah, I'm Florida. I, it they're too big to account. We just, can't, it's not an option we have to pursue with leadership at, at all levels equity across the board, especially in healthcare,
Leticia in short. Um, I, I think that we, we will deem ourselves irrelevant. And so being irrelevant means that we don't matter and we can't serve. So we have to do this work in order for us to be able to be part of our communities. Maria, I think we will go deeper into what is an apartheid country that we already are. I don't think we use that language, but that is what we are. We're segregated in our schools and our health and our education and our housing and our, you name it. You go to a Vaddio, you go to the other side of the city and we'll already in that situation. I think it will get worse. And this COVID has affected the education of our children, which is going to it's. The implications for generations are huge and the health of our generation. So I think it's got so many layers of, uh, I'm fearful for our children or our next generations.
And I think we have to act immediately on all levels. Kelly, I piggyback on everything. Everyone said, we risk, we risk failure. We risk success. We will not succeed. We will fail. There is, there is no way to address health inequities with the communities we serve without engaging and letting the communities lead. We will fail and look at the number of dollars that have been invested in some of these communities. And yet the disparity still exists. And you look at these projects and you think, why are they not still there? Well, they're not still there because the community wasn't engaged from the beginning. We have white, almost like a white savior as we come in, we think we're going to save the day. If we don't engage the community, we are rural, rural, we are irrelevant, and then we don't exist. Well, that's, uh, that's powerful statements from all of you and, and certainly a call
To action for those of us on this call and working at the clinic level and, and hoping to connect with community and viable ways. And you've given us lots of great ideas about that. I'm going to go ahead and turn it over to Julia or Julianne to, um, to close this out. Do you land,
Thank you so much. I, on behalf of our CCI team, I just want to extend a warm thank you to Mary and Libby and Maria and Kelly and Latricia. This has just been an incredibly valuable hour, and I'm hoping you all felt the same.