Highlights | Challenges and rewards of equity work
- The Office of Healthcare Equity formed in July 2020.
- It is an integration of the healthcare equity team focused on the health system and the Center for Equity Diversity and Inclusion (CEDI), which was within the School of Medicine.
- The team began its work focused on the objectives of the healthcare equity blueprint at UW Medicine in 2017.
- Team members’ long commitments to equity and life experiences informed their career choices.
- Some of the team’s current projects include: a Bias Reporting Tool, EDI and anti-racist training, caucuses/affinity groups, COVID-19 testing sites in BIPOC communities and vaccine distribution equity, equity dashboards and an equity impact review tool.
- Self-care and collaborative teamwork are keys to the team’s success and joy in working together.
UW Medicine officially established its Office of Healthcare Equity on July 1, 2020. The office brings together people from different UW Medicine entities who have long worked to make healthcare delivery more equitable.
We talked with the team about how they got into equity work, how the pandemic changed their work and how they practice self-care and stay motivated.
Meet the team
The team at UW Medicine’s Office of Healthcare Equity (OHCE) come from different backgrounds and careers, but they all have one core value in common: A longtime dedication to equity.
Paula Houston, EdD, Chief Equity Officer leading OHCE, held multiple leadership roles that involved leading equity work in nonprofit organizations and at Public Health — Seattle & King County before coming to UW Medicine.
“Focusing on dismantling oppressive institutional structures and providing equitable care to our most marginalized populations is the work that feeds my soul,” she says.
For Bessie Young, MD, MPH, medical director and associate dean for OHCE, her roots in equity work — and at the University of Washington — go deep. She grew up in Tacoma and went to UW for undergraduate and graduate studies plus medical school, also completing her residency and fellowship here.
“As an African American and health disparities researcher, I have always been interested in diversity, equity and inclusion efforts as well as health disparities and how to identify and improve outcomes for marginalized communities,” she says.
Martine Pierre-Louis, MPH, director of Equity, Diversity and Inclusion at Harborview Medical Center and the former director of Interpreter Services, dedicated herself to equity work 30 years prior when she was thrown into a situation she wasn’t prepared for: Acting as an interpreter for a teenage woman who had immigrated from Haiti and was pregnant.
Pierre-Louis was a graduate student at UW at the time, and because she is Haitian American, people assumed she knew Haitian Creole and could interpret for a patient.
“At the patient’s first appointment, she ended up being in labor, and she ended up a high-risk pregnancy. She was monitored with all sorts of high-tech machines and two days into her labor, I just remember her looking at me incredibly frightened. I realized her concept of labor and delivery and the concept for the folks who were working to save her and her child was so totally different, and I was sitting at the intersection of it. That set me on this trajectory to understand and to support more interpreters that are set up as the bridge to these patients,” she says.
For Edwin Lindo, JD, acting assistant professor at the UW School of Medicine, and Jonathan Kanter, PhD, a clinical psychologist and director for UW’s Center for the Science of Social Connection, activism jump-started their equity work.
Lindo was an activist and then a teacher in San Francisco’s Mission District; he brought that work with him to Seattle, where he teaches critical race theory to medical students. Kanter, working with community groups in Milwaukee on police brutality and violence against Black people, began developing psychological science approaches to anti-racism training and culturally responsive mental health treatments. These early efforts are now a part of the trainings he provides for the OHCE.
Family experiences encouraged Keith A. Bussey, MBA, MPH, associate director of operations for OHCE; Leo Morales, MD, director and assistant dean for Quality Improvement/Outcomes Research at the UW School of Medicine; and Callison Hunter, executive assistant for OHCE, on their journeys in equity work.
Bussey grew up in Alabama’s second most impoverished county watching his working-class parents be the pillars of strength and stability, helping extended family and neighbors whenever it was needed. Morales is from an immigrant family, which led him to studying public health in college and becoming a doctor and researcher in order to have a direct impact on the community. Hunter grew up volunteering regularly and spending a lot of time in hospitals — which were always a “safe place” for her, she says — due to recurring family medical issues.
Setbacks, progress and looking to the future
Working remotely because of the pandemic has made some of the team’s work harder and less personal. Anti-racism trainings and important discussions about heavy topics like healthcare disparities, systemic racism and how to make UW Medicine more equitable for everyone, are part of the team’s everyday — and those types of discussions are more conducive to face-to-face meetings.
While there are some benefits to remote work — Pierre-Louis appreciates getting time between Zoom meetings to recharge or, as she puts it, create “islands of calm” during her day — the team also misses seeing each other and community members in person.
“We always got our best work done standing around talking and laughing. I miss that,” Houston says. (Though, admittedly, much laughter still does occur on Zoom calls.)
“Some of the most influential interactions I had were with people privately after trainings,” Kanter agrees.
Working mostly online hasn’t made the team’s to-do list any shorter. Young has been busy working to transform medical student education. With the support of Paul Ramsey, MD, CEO of UW Medicine and community support from Rayburn Lewis, MD, Young has partnered with medical students Jasmine Gault, L’Oreal Kennedy, Eileen Li and Jeremiah Sims, who developed a Black Health Justice Pathway. She also created the new UW Justice, Equity, Diversity and Inclusion Center for Transformational Research (UW JEDI-CTR).
“For the OHCE, healthcare justice and equity are our foundations as we work towards making UW the model for equitable healthcare, building upon the pillars of clinical work, research, education and community engagement,” she says.
Some of the team’s other accomplishments this year include: Holding many race-based virtual caucuses for people to grieve and talk about police killings of Black people; providing countless trainings to groups and units across the UW Medicine system; hiring a new medical director (Young); hosting countless COVID-19 vaccine information sessions for staff in multiple languages; helping take the annual Martin Luther King Jr. Day celebration virtual for the first time; arranging flag raisings and celebrations at the hospitals for Juneteenth; developing a health equity consult service for UW Medicine; launching a new bias reporting tool; compiling an anti-racism resource list for employees; oh, and reorganizing their entire team (bringing UW Medicine’s healthcare equity team, formed in 2018, together with the School of Medicine’s to form OHCE).
“We do an incredible amount of work and we rarely say no to people. We try to respond to every request that we get for our consultation and trainings. I’m grateful for Callie, who has put some hard no times on my calendar,” Houston says. (Hunter corroborates that Houston would have meetings from dawn to dusk if she didn’t step in.)
“Some folks may think the work is not all-encompassing, but the truth is, if we allowed it, we could do this job 24/7,” Lindo agrees.
There are times when demand for their guidance escalates so quickly it becomes overwhelming and creates, as Kanter says, inequitable working conditions for the team — such as after the murder of George Floyd.
Houston recognizes two truths: The team has always been under-resourced (which is something that is recognized by leadership and is being addressed), and they are here to provide leadership and support to people in the organization who know they must bring healthcare equity to the forefront of their work in their departments, labs and classrooms.
And, of course, they have more work to do. Next up is organizing COVID-19 vaccine information sessions for community members outside of UW Medicine and helping to prioritize vaccine sites for BIPOC communities; updating the healthcare equity blueprint; and launching their new, completely renovated website.
During an already stressful and busy time, they have also experienced both professional and personal losses. The team’s beloved friend and colleague, Pat Dawson, MD, passed away in December 2020.
The importance of self-care — and a strong team
For Bussey, one thing the pandemic has done is elevate the importance of setting and maintaining flexible boundaries in order to prevent burnout and allow for periods of de-stressing more proportionate to demands he encounters.
“It motivated me to tame my reflexive people-pleasing strategies, especially during times of uncertainty. Pausing and remembering what I’m specifically trying to achieve better prepared me to use my strengths in effecting constructive change” he says.
Others on the team have different ways of practicing self-care or de-stressing. Morales takes his wire-haired griffon, Wilson, for walks. Houston has let her dog grow accustomed to sleeping on her bed, which she says is a “bad thing” while laughing about it; plus, she got a new puppy. (She also likes to start her mornings with meditative breathing and yoga.) Bussey has a two-hour morning routine that he says grounds him before he starts work. He is also in the process of adopting a Labradoodle puppy, the name of which he has yet to decide.
And every morning before Pierre-Louis begins work, she rings a special bell.
“It reminds me that if I ever close my heart, I should not be here. Every single person has their own story and every person is unique, and I have to be open to each person’s story,” she says.
One other thing the team has in common is their respect for each other, a respect that includes support and friendship as well as being able to call each other out (or in) when they disagree.
Hunter, who has unique perspective as a newer member of the team, says her colleagues have shown her how important it is for a team to get along internally if they are to accomplish anything for the broader community.
“The first time I saw the passion behind this team, it was obvious; I instantly was all about this work. I knew I was before, but it just hit really hard,” she says.
“It’s the first time in my professional career I don’t feel like I have to look over my shoulder because I know everyone on the team is unconditional in their support; they are constantly looking out for me and for each other,” Lindo adds.
Healthcare equity work can be challenging, stressful, frustrating — and extremely rewarding. Motivation to keep doing the work comes from many places, both personal and external.
For Bussey, one thing he always keeps in mind is his gratitude to be where he is personally and professionally, recognizing the sacrifices people before him made in order for him to be here. He describes this as, “not embarrassing my ancestors,” which is a phrase he got from Lindo.
Houston says the team is also motivated by seeing the impact their work has on the community at UW Medicine and in Seattle, serving people the organization (and the healthcare institution in general) traditionally hasn’t served well in the past.
“I know the work is challenging, but I feel so hopeful for what we have the capacity to do,” Pierre-Louis says.
Though the team will continue to hope for and work toward a more equitable now and future, Morales wants to extend an invitation to everyone at UW Medicine to join in however they can.
“This is everyone’s work,” he says.
Photo Caption: The Office of Healthcare Equity team, from left to right: Keith A. Bussey, MBA, MPH; Bessie Young, MD, MPH; Martine Pierre-Louis, MPH; Paula Houston, EdD; Leo Morales, MD; Jonathan Kanter, PhD; and Edwin Lindo, JD. (Team member Callie Hunter is not pictured.)