HEDTalk – Advancing Healthcare Equity at UW Medicine – Dr. Patricia Dawson


– So welcome again to our Health
Equity and Diversity talk, lovingly known as a HED Talk. And I think you all get
where we get that from. So that was sort of
goodwill stealing, if I can call it that. My name is Paj Nandi, and I’m the Director
of Community Relations and Health Equity with the
Center for Public Affairs. Many of my teammates
are here today. Thank you for being here. For how many of you this
is your first HED Talk? Wow, quite a few folks. So for those of you who are
new to HED Talks, welcome. This is one of our sort of two, we usually do two to
three HED Talks a year. And this is really a platform
to gain better understanding around issues related
to health equity, diversity, and inclusion. And this is a
provocative platform. So this is a platform where
we actually talk about issues that we often don’t
get to discuss in our office
areas, in our work. And we actually name
issues that are sometimes even hard to even bring
up in conversations. So I think this is a very
important time for us to come together as a, sort of as a (voice
muffled) community. And also hear from experts
and leaders in the region who are working to address
disparities and achieve equity. I also wanna just say
that we’re also in a very important time period in the
maturation of this agency. As many of you know we
just recently completed a diversity and
inclusion assessment, which revealed a lot
of recommendations and work ahead of us. And this kind of platform
is part of that journey. It’s a platform for
us to actually have
these conversations, learn about some of the terms that we may not be familiar with and also chart a course forward to how do we actually
work on advancing equity and looking at the
forms of oppression, especially systemic
and institutional forms of oppression and discrimination that persist in our agencies. And what is our
responsibility and role to actually help mitigate that. So with that I’m not
gonna take too much time. I do have a couple of reminders. If you have cellphones
or mobile phones, please put them on mute. We are recording this webinar
for our future viewing, so please be respectful of that. There are some, our
presenter is gonna share some videos which
may have some images that may feel disturbing to you or may be triggering for you, so I just want to
acknowledge that up front. And of course, if you have
questions or concerns about that we’re happy to answer
them at a later time, but just know that there
might be some imagery that might not be as palatable. With that I actually
have the great pleasure of inviting and introducing
Dr. Patricia L. Dawson from the University
of Washington. Dr. Dawson is a
black woman surgeon and the Medical Director
for Healthcare Equity at UW which is an
umbrella structure that encompasses the
eight UW entities. Dr. Dawson uses
education and data to address local
healthcare disparities and improve health outcomes
to make our entities more welcoming places for
patients to receive care and for providers and
staff to deliver care by working to address
institutional racism, sexism, homophobia,
transphobia, and the other isms. Until we bring awareness to and
interrupt unconscious biases and to increase
cultural humility and engage communities
that we serve. Prior to joining UW
Medicine Dr. Dawson was a breast surgeon
and the Medical Director of the Swedish Cancer Institute
Breast Program in Seattle, the Medical Director of the True Family
Women’s Cancer Center and the chief of the
SCI breast surgeons. This brief description
doesn’t do justice to the dearth of information,
wealth, and wisdom that Dr. Dawson brings. So it’s really our
honor and privilege to invite Dr. Dawson. So please welcome,
join me in welcoming Dr. Dawson to our HED Talk. (audience applauding) – Thank you.
– You’re welcome. – So we like to start
all of our presentations by acknowledging that
the land we occupy is the traditional home
of our native tribes. I think here it’s the Nisqually whose land we’re standing on. Without them we
would not have access to this working,
teaching, healing, and learning environment. And we humbly take
the opportunity to thank the original
caretakers of this land, who are still here. Okay. – [Woman] (voice muffled)
and we’ll see if that helps. Folks in the back can’t here. – Okay. I’m gonna try and
get really close. Is that better? All right. So unless you were living
in an altered reality, you probably remember
about a year ago Starbucks had an episode where
two African American men, this is in Philadelphia,
in Center City, two African American men
went into a Starbucks. They didn’t order anything. They were waiting for
a colleague to come. One of the men, I think
asked to use the restroom. The manager there
didn’t feel comfortable, and so she called the police. And they took the men
away in handcuffs. As a result of that, Starbucks
dedicated a half a day. They closed all their shops, and they brought
all their employees in to do training on this. But not just Starbucks, we’ve seen other acts of racism. This is. Okay, next. Oh, so police were
called on a Yale student. A woman who was napping
in her dorm lounge. There were a group
of black women who were playing
golf in Pennsylvania and they had the
police called on them because they were
golfing too slowly. Hard to imagine. There were a pair of
Native American teens on a college tour of
Colorado State University. One of the other
parents on the tour didn’t feel comfortable, so they called the
campus police on them. Next. Keep goin’. A woman, this is in California, a woman saw burglars. They were Airbnb guests. They were some women filmmakers, African American, who were
checking out of their rental. The woman across
the street waved. When they didn’t wave back
she decided they were burglars and she called the police. This is one of our local ones. You may remember in a
Kirkland yogurt shop a young man was doing a
supervised family visit, and he was sitting, the
kid wanted to get yogurt, so the child and the mother
went in to get yogurt. He was sitting at a
table next to them. Didn’t order anything. The staff there didn’t
feel comfortable so they called their manager
and he said call the police, which they did. A Georgia man was babysitting
two white children. He was driving out of, I
think it was a Walmart. A white woman saw him,
followed him in her car, eventually called
the police on ’em. They pulled ’em over, they
pulled the kids out of the car, they pulled him out of
the car to make sure that he was legitimate. Next. And then this is a,
I think in California there was a 12-year-old
boy who was mowing lawns, and there was no demarcation between this lawn
and the next lawn, and so he accidentally mowed
a part of the neighbor’s lawn, and she called
the police on him. His community rallied
around him and bought him all his lawn mowing equipment. He’s going to hae a business
that’s going forever. So this is, when they did this
Starbucks training, this is one of the videos that they used as part
of the training. – Dear Starbucks partners, I’m Stanley Nelson, a
documentary filmmaker. My films are about
race, America, and the decades-long
struggle for all people to be treated as equals
in public spaces, our town squares, our
stores, our fields, our parks, our pools,
our restaurants. I made this film to
help us understand this important
struggle in our country so we can go forward together. – When I go into stores,
sometimes I get followed, which is really annoying,
and it just gives me, like it just makes
me uncomfortable, and sometimes I get
anxiety, so I have to leave. Especially being
a teen of color, they assume that you’re
doing something bad. – I feel like I’m disturbing
people by just being there. Like, people feel
uncomfortable when I walk in. I guess I’ve kind
of become numb to it after so many years. Like, this is just my life,
and it’s just something that I’ve gotten used
to, unfortunately. – I think all of us make
that choice at some point of, am I gonna take the burden of this interaction
being comfortable? Or am I gonna say,
“You take the burden “of this interaction
being comfortable?” Because what I really
want is a sandwich. Do you know what I mean? I don’t wanna fight. I’m hungry, right? I don’t wanna get
into this with you and I’m really not
here to teach you this. But other times, it’s
like, okay, wait a minute, lesson time. (upbeat drum music) – [Narrator] Discrimination
against African Americans in public spaces
has a long history. In the 1960s, black
and white students trying to desegregate
buses were firebombed. Black patrons were
routinely denied service in restaurants and hotels. – I’m sorry, our
management does not allow us to serve
(bleep) in here. (yelling)
– Get out of here! – [Narrator] And
civil rights workers were dragged from
lunch counters, spat upon, and beaten. (intense drum music) – We’re willing to be
beaten for democracy, and you misuse democracy. – [Narrator] The right to be
respected in public spaces was at the heart of the
civil rights movement. ♪ Everybody wants freedom ♪ ♪ Everybody wants freedom ♪ – They keep thinkin’ we
beggin’ them for somethin’. We ain’t beggin’ for nothin’. We tellin’ them what
is ours right now. – [Crowd] Freedom now! Freedom now! – [Narrator] The freedom
movement of the 1950s and 60s insisted that the United States
live up to its Constitution and allow equal access for all. ♪ Freedom ♪
Finally, the Civil Rights Act of 1964 was passed, outlawing discrimination
in public spaces. But changing the law doesn’t
always change reality, and being allowed in doesn’t always mean
being welcomed. To be welcomed as
a customer means that not only do I allow you in, but it means that
I’m glad you’re here. I want to serve you. I want your business, and
I don’t draw distinctions between you and other customers in terms of your value. But it’s time we talk
about what it means to not be welcomed as
an American citizen. – It’s not like I can mute my actual physical
blackness, right? So I just assume that people
see a particular thing when they see the
color of my skin, so everything else
has to be, like, perfect and clean and as
blended in as possible. It’s really just an arsenal
of different masks, you know? And it happens every time I, every time I leave my house. – When I leave my house,
regardless of where I’m going, the, I’m just leaving my house,
just walkin’ out the door. I don’t, I’m not walkin’
out the door thinkin’, what kind of hurdle am I
going to run into today? What kind of way am
I going to be judged? I walk out a free man. I just do my thing. – I have to make sure
that I have given enough space between
myself and another patron or another commuter
on the train, and just ensure that I’m not
making someone uncomfortable. I have to make sure that
my hands are visible when I walk into certain places, so they make sure I
don’t, I’m not stealing. I try to make sure I make
eye contact with people who may or may not be
security or managerial staff, just to ensure that I’m
not here to hide anything. I watch my tone to make sure that I don’t come
across as threatening. Just leaving the house
some days, you know, is sometimes it’ll
just keep you at home and just keep you
away from everything. – [Narrator] For
more than 50 years, equal treatment
has been the law. Yet, as we know from
cellphone videos, the nightly news, and
maybe our won experience, we still have a long way to go. – [Man] Why are
you following me ? – Watch this. (intense music) He think I’m stealin’. – She’s been following me
around the store the whole- there she goes, she
thinks I’m stealing. – Your card is fake. You’re goin’ to jail. That’s what I kept hearing. – Unless you’re spending money, we don’t need
customers like you. – Oh, I’m not spending money? Because I’m black? (screaming)
– Ow, ow! – You’ve been warned.
– Your manager does not like black people, honey, yeah. (screaming)
– Oh my God! – No, this is wrong, oh my God. – Get your hands off of me. – We just need to
recognize that black people are navigating the public space differently than white people, that women are navigating
the public space differently than men, and not use the shortcut that
has been wired into your brain because of the society
that we live in, that tells you when you see
me you should be nervous, or you should be worried. – It brought me such despair to the day I recognized I had
to explain this to my son, that he was gonna, that this muddy river of racism, he was still gonna have
to walk through it. We hadn’t dammed it. We hadn’t dried it up. It was still there
for him to go through, and I’ve got to somewhat
try to tell him, “Okay, off you go.” – The society I
wanna see is I wanna be able to walk out the house just as free feeling
as that white guy who said he didn’t
worry about a thing when he walks out the door. I wanna have that
same expectation. – [Narrator] Today,
discrimination is
against the law. It’s the people and the systems that support our communities
that must follow suit. No one’s gonna do it for us. What can you do to make
our schools, our parks, our stores, our
restaurants as welcoming and as inclusive as they can be? What kind of country
do we want to live in? Who do we wanna be? (gentle calming music) – I think that’s a
pretty powerful film. I’ve seen it hundreds of times
and it always gets to me. And there’s one thing
that they left off when they were talking
about where people are seen, and what did they leave out? They left out healthcare. And we run into
exactly the same issues having to do with healthcare. Next one please. So this is a study from the Kaiser Family Foundation
from a few years ago, and they found that 53% of
Blacks, 36% of Hispanics report that they’ve
experienced unfair treatment in the past 30 days
because of their race. Next. At work, in stores,
in restaurants, with the police, and
while getting healthcare. So this is something
that’s exists currently in our
healthcare system. Next. So I wanted to
take a few minutes to give you time to
process the video. So if you would just
kind of get together in maybe threes or fours
and talk to each other a couple of minutes about
these two questions. Was anything in the
video new to you? And how do you think the video might be relevant to healthcare or the work that the
Department of Health does. And then we’ll have
a couple of people tell us what they were thinking. So I’m gonna give
you four minutes. (audience murmuring)
Okay, let’s come back, and, there’s a lot of
conversation in here, so it sounds like people
are talking about this. Anybody wanna share
what they’ve said? Their thoughts on this? Anybody wanna say anything about either of
these two questions? We have a mic here. (audience murmuring) Is everybody shy? (audience murmuring) – [Man] I thought it
was cool that they had specific examples
from specific people. To see more about
the perspective. You know, people say
like racism sucks, I think it’s good
that they actually say like what specific
that they face each day so we know what to look
for and stuff like that. – Yeah, thank you,
it makes it real. It’s a real person’s experience. How about one more? – [Constance] So, my
name is Constance, and so we discussed
how that, how the, oh I’m sorry. – [Woman] There we go. – [Constance] We discussed
how discrimination for people of color
in everyday lives related to healthcare and
related to health, period. We all live in this world. We all have stresses. We all have our day-to-day
stuff that we deal with, you know, the
washer doesn’t work, and all that day-to-day stuff. But I relate the
disparity in healthcare and the problems with
health of people of color on top of those everyday things
that we have to deal with, we have all this
discrimination to deal with. So yeah, there’s
high blood pressure, there’s all these
stress-related diseases that we are susceptible to, because on top of
just everyday things, we have to deal with double. – Yes, thank you, and there’s
another little short video that I’m gonna show you
that kind of goes into that, into healthcare
more specifically. I saw one more
hand up over here. – [Woman] So my program
works to try to get people from communities of color
and disadvantaged backgrounds to be healthcare professionals, and it’s amazing the challenge
on that side as well, discrimination, doctors,
and other clinicians face when they have a strong accent or when they look very
different from what people’s visualization of
what a doctor is or what a healthcare provider is and what a challenge
that is for them. – Thank you. One of the pieces of work we do, I’m not gonna get into it today, is we look at what we
do with racist patients and how our providers
deal with that. Did you wanna say something? – [Woman] Yes. I was, we didn’t really, I don’t think we really
noticed anything new, but I think one of the
things that I mentioned was the psychological and
the mental health impacts that this has on people of color that is linked back to
health and wellbeing. – Yeah, thank you. – [Woman] Do we have any
thoughts from online? (voice muffled) – So why don’t we
talk about equity? We used to always talk about
equal care, equal rights. But this is the mission
statement of the UW Medicine, to improve the
health of the public, and we don’t wanna improve
the health of only the public that’s got commercial insurance or only the public that speaks
English as a first language or has no visible disabilities. We want to improve the
health of the public. You may have seen
this slide before. We always used to
talk about equality. We’re gonna treat
everybody the same. We’re gonna treat
everybody equally. But we know in
reality people don’t start out in the same place. Some people start out
having more than they need, and we don’t really
have to give them much. Some people have just enough, and they can get a good outcome with what we provide everybody. And then some people
start out in a hole. And if we give them just enough, they’re like this little person. They’re not gonna be able
to get a good outcome. So what we’re really
looking for is equity, where we give people what they
need to get a good outcome, and it’s going to
be individualized. What we’d like to
eventually get to is removing the barriers to care so that everybody can
get a good outcome. And my (voice muffled) partner, when she gives
this presentation, she says she wants to
see two other slides. She wants to see a slide
where they’re all wearing the same suites as the team. There’s one that shows that, but they’re all still
standing back here. But she wants one where
they’re actually in the game, because with them are
all on the same team are working together. We also do this because
it’s the right thing to do. There is a moral
imperative to do this work. How did we get here? This is the other video
I wanted to show you, and this can also be a
little bit triggering. But it’s a really good
synopsis, I think, of how racism has impacted
our medical systems. – [Narrator] At the edge of
Central Park in Manhattan, there’s a bronze statue of a
doctor names James Marion Sims, whose brilliant
achievement carried the fame of American surgery
throughout the entire world. He’s the guy who created
the vaginal speculum, an instrument gynecologists
use for examination. He pioneered the surgical
repair for fistula, a complication from childbirth, and became known as the
father of modern gynecology. But that brilliant achievement was the result of a
series of excruciating experimental surgeries that he
conducted on enslaved women. (intense music) In a lot of ways Sims
epitomizes the story of American medicine
for black women. It’s a system that’s
failing them to this day, from infant mortality
to life expectancy. The racial disparities in
healthcare are staggering. The gulf between black and white might be widest when we
look at maternal mortality, with black women three
to four times more likely to die in connection
with pregnancy or birth than white women. And that divide can be traced
back to doctors like Sims who contributed to a long,
largely overlooked history of institutional
racism in medicine. – Trying to understand
a historical problem without knowing its history is like trying to
treat a patient without eliciting a
thorough medical history, you’re doomed to failure. – [Narrator] That’s Harriet
Washington, a medical ethicist and author who chronicled
the intersection of race and medicine in her book
“Medical Apartheid.” While many of the stark racial
disparities in healthcare can be attributed
to environmental
and economic factors like access to good healthcare, studies show that minority
patients tend to receive a lower quality of care
than non-minorities, even when they have the same
types of health insurance or the same ability
to pay for care. – As African Americans we’ve
been abused for so long, consistently by the system,
why should we trust it? Why should we go to it when ill? And that’s iatrophobia. That’s a fear of the healer. You know, inculcated
by the behaviors of those healers unfortunately. – [Narrator] It
starts with slavery. Doctors relied on slave owners
for financial stability. They accompanied plantation
masters to auctions to verify the fitness of slaves and were called in
to treat sick slaves to protect their
owners’ investments, in 1807 Congress abolished
the importation of slaves, and in turn, pushed black
women to have more children, to essentially breed slaves. Founding father, Thomas
Jefferson, later wrote, “I consider a woman who
brings a child every two years “as more profitable than
the best man on the farm.” Around the 1830s the
abolitionist movement
led to the rise of what was called
negro medicine, or efforts to identify black
inferiority to justify slavery, And there were polygenists
who tried to use both science and the Bible to find
proof that races evolved from different origins. The 1830s also
marked the beginning of recorded experimentation
on black women’s bodies. One doctor performed
experimental
C-sections on slaves. Another one perfected
the dangerous ovariotomy, or removal of an ovary, by testing the procedure
on slave women. In fact, half the
original articles in the 1836 Southern
Medical and Surgical Journal dealt with experiments
on black people. And then, of course, there
was James Marion Sims, whose reputation is
etched in history and on that statue
in Central Park. Between 1845 and 1849
Sims began performing experimental surgeries on a
17-year-old slave named Anarcha. He eventually performed
30 operations on Anarcha, and more surgeries on about
11 other female slaves. When his male colleagues could
no longer bear to assist him in inflicting pain on the women, the slaves took turns
restraining one another. Yet, paintings
depicting Sims, Anarcha, and other slave women presented a subdued version
of his experiments. Even though anesthesia
was introduced in 1846, Sims chose not to use it for his experimentation
with slaves. His practices echoed one
of the most prevalent and dangerous beliefs
in medicine at the time, that black people did
not feel pain or anxiety. This book from 1851 titled “The Natural History of
Human Species,” claimed, “The American dark races
bear with indifference “tortures insupportable
to a white man.” Studies released as
recently as last year demonstrate that black people are less likely to
be treated for pain, particularly in the ER. There is even one from
a children’s hospital that found the same
to be true for kids. And just this year,
Pearson Education, a leading educational publisher, issued an apology and
recalled nursing textbooks that included
racist stereotypes, like this section that said “black people
often report higher “pain intensity than
other cultures.” – Well what does it
mean when you say someone doesn’t feel pain? Among other things you’re
speaking about their humanity. These are all part of
that suite of beliefs emanating from the 19th Century that we still have
not not shaken off, despite all our knowledge
and sophistication. They’re deeply ingrained. – [Narrator] Doctors
like Sims might fit the Dr. Frankenstein stereotype, but they weren’t outliers. Historically, southern
doctors who used black bodies for troubling experiments
were the norm. – It’s a very common question, how can we judge
our forebearers? You know, those guys
in the 18th century who practiced medicine the
way that appalls us today, and we think, how
could you do that? I did not judge the
practitioners based
on our own ethics. I judge them based on
the ethics of their time. It was not acceptable back then, we just did not
hear from the people who protested against it. – [Narrator] After
the Civil War ended the 1900s brought a wave
of immigrants to the U.S. It sparked a race
panic and coincided with the birth of the
American eugenics movement. One of the movements
key objectives was to reduce the
childbearing potential of the poor and disabled. Leaders included
birth control pioneer and Planned Parenthood
founder, Margaret Sanger, who eventually devised the
controversial Negro Project, or family planning
centers that pushed birth control in
the black south. It was a project that
even garnered support from W.E.B. DuBois, a
founder of the NAACP, who wrote that black people bred carelessly
and disastrously. By the mid 1930s more than
half the states passed pro-sterilization laws, and often sterilization
was forced. In 1961 future Civil Rights
leader Fannie Lou Hamer went to the hospital
to have a tumor removed but was subjected to a
hysterectomy without consent. The procedure, which
rendered women infertile without their knowledge,
was so common in the south that Hamer is said
to have dubbed it the “Mississippi appendectomy.” – African American babies were no longer
economically valuable. And African Americans
themselves had gone from being a resource
to a nuisance. – [Narrator] In June
of 1973 the SPLC uncovered 100 to
150,000 cases of women who had been sterilized with
federal funds in Alabama. Half the women were black. In recent decades women of
color continue to be exposed to dubious reproductive
health programs. In December 1990
the FDA approved a contraceptive called Norplant, and it was selectively marketed to black teenagers
in Baltimore schools. – Now one of the current
birth control methods right now in the United
States is Norplant. – [Narrator] Norplant
fans like David Duke, the former KKK grand wizard,
even introduced legislation to give women on welfare
an annual reward of $100 if they agreed to get Norplant. – And it’s time we start to
encourage welfare mothers to be responsible. – That bill never passed. But the implant ignited a debate on whether long-term
contraception, like Norplant that
lasted five years, could be used as a form
of social engineering when pushed to
specific communities. Today, as we continue
to lose black mothers at alarming rates, a deeper look at the
past may be a good step towards creating a more
equitable healthcare system. (light music) Hi guys, thanks for watching. Of course, there’s a
lot more to the history of how the U.S. medical system has mistreated people of color than we could fit in the video, everything from the
Tuskegee Experiments to Jim Crow Laws
segregating hospitals, but we hope it starts
to give some context to the racial disparities
we see in medicine today. ProPublica has been
reporting on the disparities in maternal
mortality in the U.S. And how it’s the most dangerous
industrialized country in which to give birth. Check out that feature
piece in the link below. And we’re seeking your help
in understanding the problem. So if you nearly
died during pregnancy or you know someone who died due to childbirth
related complications, then check out that
link in the description. Thanks again. (light music) – So I think that’s a bit
of sordid medical history that we often don’t learn about, we often are not
taught about this. And that’s only a
snapshot of the things that have happened in our past. So why do we start with race? That’s often a
question in others, there’s lots of other
things out there. But we think that race is
a really complex system that deeply creates disparities
for people of color. And it’s one of the
most difficult topics
to discuss openly and respectfully. Because it’s been used as a
device of issue to keep us from talking to each other. And then there’s the
concept of intersectionality that we’ll go into in a bit, intersectionality
helps us to explain why race is an important thing. But medicine reflects
and perpetuates oppressions that
exist in our society, and racism is one. But there’s all the other isms, the gender discrimination,
sexism, heterosexism, cissexism, agism,
classism, ableism, I mean, we could
go on and on and on about all the other isms. So, we work on all
of them as we can, but we start with race as
the most pervasive one. There’s a couple of key concepts that I think it’s important
to at least understand or at least to hear about. One is implicit bias
or unconscious bias. The other is microaggressions and the other one is
intersectionality. So implicit bias is the
unconscious attribution of particular
qualities to a member of a certain social group. And there’s stereotypes,
we all use stereotypes. We can’t get through life
without stereotyping people. But these are
negative stereotypes that may operate without
conscious intention and there can be, it
was initially described as implicit bias
related to race. But it also includes
gender bias, age bias, and all the other isms. And we also have them
against our own categories. We have internalized biases. Microaggressions, this was a term that
was first coined by Dr. Pierce who
is a psychiatrist, and he used it, again, looking
at racial microaggressions. Brief, commonplace,
daily verbal, behavioral, or
environmental indignities, whether intentional
or unintentional that communicate hostile
derogatory or negative racial slights and insults
towards people of color. Because they’re
often unconscious they can be much harder
to disrupt or address because perpetrators
of microaggressions may not realize the
impact of their actions, and they may talk about
how that wasn’t my intent. So there have been three types of microaggressions described. I just recently read an article
where there was another one, the micro-assault
was transitioning
into a macro-assault, but so micro-assaults
are most common, they’re most closely related
to conventional racism, and they tend to be conscious. And they can be explicit. And it can be
things like serving, preferentially serving one
group over another group. Or deliberately referring to
an Asian person as Oriental. A micro-insult is a more
unconscious communication that demeans a person from a
minority or marginalized group. And that can include on
things like asking question of how did you get your job? With the implication being you couldn’t possibly be
qualified for your job. Or that you’re the recipient of an affirmative
action program. And then micro-invalidations is something that we
see really commonly. It’s minimizing or
disregarding the thoughts, feelings, or experiences
of a person of color. It could be a white person
asserting to a minority that I don’t see color. I wasn’t raised racist,
I don’t see color. If somebody says to
me I don’t see color, they’re basically
saying I don’t see you. I don’t see the accumulation of all your experiences
as a woman of color. Or all lives matter. Yes, all lives do matter,
but there’s a disparity in the way that black
man have been treated by our legal services
and our police forces. So these are just some
everyday microaggressions that describe it in
different categories. It’s like, you don’t seem gay. Or she’s so bi-polar, ha. Or go back to your own country. I mean, there’s really
only one group of people that are allowed to say go back to your own country
in this country. Or I’d rather see a fill
in the blank, white doctor, male doctor, straight doctor. You graduated from Harvard? Did you get in by
affirmative action? You must have taken my place. The one that I think that
I have often overlooked is the presence of things
like confederate statues, like that statue of
Sims that used to be in a prominent location
in Central Park. It’s now been moved to a
less prominent location in Central Park, but building names and
colleges often named after big funders regardless
of what their history was like, colorblindness. So, and then the other concept that
I think is really important is this concept of
intersectionality that was coined by
Kimberle Crenshaw, who is a law professor
at Columbia and UCLA. And she coined this to
recognize the intersection, the interconnected nature
of social categorization such as race and
class and gender. So there’s overlapping
and interdependent systems of discrimination
or disadvantage, so when I was a
surgical resident, I knew that people
treated me differently. I could never really tell if
it was because I was a woman in a field that
was male or if it was because I was
a woman of color, or if it was because I
was a person of color, because all of those
identities are overlapping. So it’s a really useful
framework for thinking about how these problems can
affect multiple categorizes. I’m gonna skip this
because, of course, I put too much in this talk. So we’ll have some time
for questions at the end. I just wanted to tell you
a little bit about the work that we’re doing at UW Medicine. About three years ago a
group of really smart people got together and they were
doing care transformation, and one of the elements
of care transformation was the development of the
healthcare equity group. And they developed this
blueprint for healthcare equity with a vision to
be a national model for healthcare equity and to reduce disparities
in healthcare delivery. Three main strategic goals, one has to do with workforce
and looking at our workforce, understanding who
is in our workforce, increasing the
diversity and increasing the cultural humility
of our workforce in reducing implicit bias. And so the ultimate goals,
as I think about them, are to make our clinics
and our workplaces the best possible places for
everybody to come to work. So people can come and feel like they can be themselves at work. They don’t have to hide
parts of themselves at work. And by extension
that will make them the best places for our patients
to come and receive care. They don’t feel like they
have to hide who they are. Second has to do with
community engagement. UW Medicine has not
typically been known as an institution that
goes out into the community and asks for feedback, so we have held a series
of community conversations, where we’ve put it in
the community center, some place not related to the U. Invited community folks in,
done a little presentation on a health issue that
is relevant to them, and then asked people
three questions basically. What have been your
experiences in healthcare? What have your experiences been specifically
with UW Medicine? And what can we do better? And so collating
that information to see what things
that we can look at. With the other
goal is to develop a community advisory council
so we can actually bring folks into the community,
from the community, in to help us and then for
us to get more involved in the existing
community councils and organizations
that are there. And then the third one has to
do with clinical improvement. We have data about outcomes
that we can look at on the basis of race or gender
or primarily language spoken, and we can look at that
across the UW Medicine system. We can see where the
largest disparities are and then we can do
targeted interventions to try and improve that. So this is our annual
report from 2018. It’s not readable. (laughing) I’m gonna zoom in
on it a little bit. So in 2018 we gave
presentations like this and similar things to
over 2,000 leaders. We have been at our leadership
development programs. And just trying to
increase awareness of what we’re talking
about, what the issues are. A climate survey was completed, which included over
12,000 respondents looking at what’s our
baseline, where are we? And then we’re forming
equity, diversity, and inclusion committees
in all the entities and many of the departments
within the entities. And then the leadership, they
each had an executive leader, and then they have a more
emerging leader on those groups. And then the leadership is
brought together quarterly for a joint meeting where they talk about what they’re doing. We give them a little
presentation on a certain topic. So we’re trying to increase everybody’s knowledge
about things, so we’ll talk about things
like ableism or weight bias, so that everybody gets
some information as well, and then they can share
what they’re doing and what strategies
they’re using. These are the clinical
improvement projects that were launched
as a part of that. The retinopathy
cameras, we could see that one of our
clinics at Harborview. They had a higher success rate in getting diabetic patients
in to get their eye exams, and that was because they had a retinopathy camera
that was there so that patients didn’t have
to come back for another visit. So as a result of that and the
study that ensued from that retinopathy cameras are
being rolled out at all the primary care clinics to make
it more accessible to patients. Working in colorectal screening,
hypertension, diabetes, and I’m gonna tell
you a little bit more about the transgender,
non-binary program, that’s been led by one of
our physicians, Dr. Heinin. They’ve done a number
of staff trainings throughout the entities on working with this
patient population, why pronouns are important,
why names are important, how to put this data into
our electronic health record. They’ve developed a pathway
for gender affirming surgery, and links to behavioral support, and then for primary
care providers who want to be able to
do hormone provision, there’s training
for them as well. And then this has to do with
the looking at the numbers. So we have this disparity index, which is one of the
ways we can look and see where our biggest
disparities are and where we can focus
our interventions on our website we have a
healthcare equity toolkit, which gives our
entities information on how to start a committee. There’s podcasts,
there’s videos, there’s peer reviewed
articles, there’s books. We’re now starting to have
a book club every quarter. We were gonna do it monthly
but that was way too ambitious. Nobody could read
a book every month. So our last one we did “So
You Wanna Talk About Race” for our book club book. This quarter we’re doing “White
Fragility” by Robin DiAngelo for our book club meeting. Last summer we had an MHA
intern working with us who did an assessment of
our interpreter services across the whole
system and found that every part in the entity
had interpreter services and every major institution
did it differently. So there’s opportunities
for standardization there. And a committee is being
convened to look at that. So this is what we like
to leave folks with. Kind of a, you got it, kind of
a charge to action. Your role in advancing equity. Identify implicit
bias, microaggressions,
discrimination, and opportunities to
intervene on those. Understand the history,
how we got here. That understand that’s
what is important is the impact, rather the
intent of microaggressions, and the benefits to
diversity and inclusion. When we do, we really love
doing three-hour presentations, ’cause then we can dive
into each of these things much more deeply. And then disrupt racism,
bias, and oppression and the status quo
and the initials, as has already been
noticed, spell out IUD. ‘Cause we figure that’s
an easy way for things to, for people to remember. And what we suggest
for next steps is to find a colleague
to be your partner, practice this, make
a leadership plan because everybody’s a leader that incorporates
these learnings, and consider the equity
impact of all decisions. I feel like if we can
just get this incorporated into everybody’s work so
that it’s not an add on. Every time someone makes a
decision they think about what’s the equity
impact of this? Who will be impacted negatively? Who will be impacted positively? And can we live with that? And let’s be
transparent about it. And then hold each
other accountable. And then let us know
how we can help. This is our team. There’s two and a half of us. I’m the half person in the team. And we have about 30,000 people that we work with
at UW Medicine. So I think we have, we do have a few minutes for
questions or comments. – [Woman] Don’t everybody
raise your hand at once. Yeah. – [Audience Member]
In your assessment of interpreter services, did they also look
at the financial
assistance departments? – They did not. I mean, theoretically
it is the responsibility of the institutions to provide
professional interpretation for patients and so
that has to happen in every part of UW Medicine. They did not look at the
financial impact of it because that’s led up to the
leadership in that entity to figure out how to pay for it. – [Audience Member] Oh
no, I meant one big report that came out from
Columbia Legal Services a couple years ago found
that if someone called a financial, like the
billing department, to ask about their bill
and they spoke Spanish they would get hung
up on frequently. Or if they didn’t ask
questions in English, and they were
looking at a lot of our hospitals across the state, and so I just sort of keep
an eye on that access issue ’cause if you don’t– – I’d have to look
specifically at that, but I think that all of
the departments like that have access to the language line so that they can find
out what the language the patient is speaking in and
just call the language line and get an interpreter online. I can’t tell you 100% that
that’s actually working, but I think that’s
one of the things that the group we’re convening
will be trying to clarify. It’s a good point. We’ve had an interesting thing, when we did one of our
community conversations we had a table full of people
from the deaf community, and one of the
things they told us was that they were really
unhappy with the quality of the ASL interpretation. And so that’s another thing. They have to figure
out how to get better ASL interpretation. There’s a real shortage
of ASL interpreters. So that doesn’t help. Other comments or questions? – [Man] Thanks so
much for being here, and I guess my question
is as you’ve incorporated health equity into UW Medical, what would have been your
biggest surprise challenges? And how did you kind
of work through those? – Well I wouldn’t say
we’ve incorporated it. I would say it’s a
work in progress. What I’ve actually
been surprised at is how excited
people are about it, how willing people are
to actually look at this and how we can integrate this
into the work that they do. So every time we give a
presentation somewhere we end up being
asked to give three or four more presentations
to different departments as a huge willingness,
which is really exciting. I think the challenge, the other challenge
that we’re working on is making sure that this work
is strategically situated within the organization, and so that’s another
thing we’re looking at. We really think that
we should be sitting on all the major committees
that are making major decisions. And there is a willingness
for that to happen, and so we’re just working
through the process for that. Yeah. There was a question up here. – [Audience Member] Hi, so I
was listening to you saying that you’re doing
this with leadership. So, how is that trickling down
actually to the student body? – It’s complicated
at UW Medicine because there’s us, there’s
my three and a half person, two and a half person
team and then in the School of Medicine they have a Chief Diversity Officer
there, Dr. Morales, who is in charge of
the School of Medicine. We work together
collaboratively, but we don’t have direct
responsibility for the students. I will say that
we are not exactly overstepping our
reach a little bit, but we’re getting more
involved in committees that look at curriculum and
look at student complaints and how do we improve the
environment for the students. So we are working on that. – [Audience Member] Yeah,
’cause I was thinking mentorship like that is a
great opportunity, because a lot of
them have to shadow, if we’re talking about medical
students, for instance, they have to shadow
real professionals. So I was thinking that
is a great opportunity to kinda bring those mentors
and teach those students, because I had a personal
experience (laughing), that left me with a
bad taste in my mouth. They were trying their best, but there were a few things that they could
have done better. And I am so sorry that
I didn’t mention to them and caught them right off guard, but yeah, I think that is
a great opportunity there. – Yeah, I agree with you. And it’s never too late. I mean, if you have,
you have a story that you wanna tell, a
situation you wanna report back, we always love to hear
people’s experiences. – [Audience Member] Okay. (speaker speaking
too far from mic) – Okay. – [Man] Are there
efforts happening to incorporate
implicit bias training into the medical school
training programs at UW? – There are efforts
to incorporate
implicit bias training in a variety of levels. So now what happens
in the medical school, each time there’s
a position open, there’s a hiring committee. The hiring committee is required to take implicit bias training. Students certainly know
about implicit bias training. They often come in knowing
more than their faculty do. And then we do more specific
training around implicit bias. So we’ve had a number of
different events and programs about implicit bias. Anybody else? Who wants to be last? Okay, well thank you,
thank you very much. (audience applauding) – Thank you, Dr. Dawson. Thank you, Dr.
Dawson for, again, a very inspiring and
provocative talk. I think often after these HED
Talks we sort of need space to actually digest
what we just heard, so it’s okay that you
don’t have questions. And you may have
a lot of questions even actually later on today or as you sort of
go through the day and the rest of the week. So, again, on behalf of the
Health Equity Work Group and the Diversity
Inclusion Council, thank you for being here. I also wanna do a
special shout out to Mahi Zeru, from EPR, Emergency Preparedness
and Response, and Cathy Weed from HSQA. Those two individuals
are leaders who put this HED Talk together, so please give them
a round of applause. And Mahi couldn’t be here today ’cause she’s back home in
Ethiopia, I believe, already. So, so she couldn’t
join us today. But again, thank
you for being here, and we look forward to
seeing you next time. (audience applauding)

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