Learning to Apologize and Other Surprising Leadership Lessons

Main Line Health CEO Jack Lynch, FACHE, has said that his health system is “working to create a future state where — without question or exception — every single patient receives the same level of safe, high-quality care.” In the following interview, Lynch describes how Main Line Health, a five-hospital health system in the western suburbs of Philadelphia, plans to make safety and quality outcomes “a direct reflection of equitable care delivery” in every patient encounter. Main Line Health is one of eight health care organizations taking part in IHI’s Pursuing Equity initiative.

What made Main Line Health (MLH) decide to make pursuing health equity a priority?

• It’s about safety and quality. You can’t have a culture of safety if you don’t have a culture committed to the elimination of disparities.
• It’s the right thing to do. You can’t rationalize why everyone shouldn’t be treated equitably.
• It’s a business decision. From a business standpoint, it’s an opportunity to connect with those we are not currently reaching.

What are the keys to your organization’s approach to addressing health inequities?

We at MLH are always learning from others, and three approaches have been critical to our pledge to achieve equity:

• A focus on the STEEEP principles established by the Institute of Medicine (now the National Academy of Medicine) to deliver care that is safe, timely, efficient, effective, equitable, and patient centered;
• Robust cultural competence education for health care teams; and
• An organizational culture that rewards those who speak up for safety.

Our ultimate vision is to create a STEEEP experience, everywhere, every time, for everyone, across our system.

How do you communicate about prioritizing health equity to your organization?

When I first arrived at MLH, we talked in terms of diversity. Later, in my role at the AHA’s Institute for Diversity and Health Equity, I learned more about disparities in care. That helped me understand that this is about ensuring that we deliver a safe and high-quality experience for all those we serve.

At Main Line Health, we have embedded a focus on equitable care delivery into an organizational initiative called Performance Excellence 2020, which has four pathways to success:

• Eliminate harm
• Achieve top decile performance in all quality metrics
• Eliminate disparities in care
• Break even with Medicare

These four pathways provide aspirational goals and direction. Progress that we can make in all four areas are better for our patients, community, organization, and better for the health care industry.

What is one of the biggest challenges in dealing with health disparities?

Lots of literature suggests that health care administrators often feel health disparities are not an issue at their institutions. Most CEOs can’t imagine it’s going on in their hospitals, but I assure you, it’s happening. Since most disparities are because of unconscious bias, you need to look for it to understand that it’s a problem.

One of the ways MLH looks for health disparities is through our annual Health Care Disparities Colloquium. We ask our clinical investigators to look for the presence of a range of disparities, including potential inequities related to race, ethnicity, gender, sexual orientation, and physical challenges in various elements of health care practices across our system. We just finished our 6^th annual colloquium, with 17 case studies investigating a range of topics, including Integrating Nutrition and Care; Diversity, Respect & Inclusion training; Behavioral Health Resources for the Underserved; Identifying Human Trafficking in the Emergency Department; Disparities in Women’s Health and Trauma Treatment; and the growth of MLH’s Health Career Academy.

One example of how we use this learning started in the first year of the colloquium. We studied compliance with mammography guidelines in our clinic practice patients versus private practice. We determined that both practices had a lower compliance rate than the 68 percent national average, but the clinic practice had a lower compliance than the private practice for reasons including difficulty contacting patients, patients who did not follow-up or did not feel screening mammograms were important, and insurance issues. We addressed these barriers by connecting these patients with our Healthy Women Program, which provides free mammograms, and the numbers have improved.

What have you learned on your personal journey as a white man working to advance equity? 

• You will say things you must apologize for. For instance, several years ago, in a letter I sent to our team early in our Diversity, Respect and Inclusion initiative, I used the term “sexual preference” when talking about the many types of diversity that comprise our organization. One of our employees — who fortunately felt safe enough to speak up — emailed me and explained “orientation” is the appropriate word to use and implying that being gay is a choice is offensive. I apologized to this employee and thanked her for having my back. I won’t make the same mistake again.
• As an industry, inequities are more complex and institutionalized than I initially realized.
• If I don’t take the lead in my health system and speak about equity, no one else will.
• Employees want you to do the right thing and patients deserve it. Doing the right thing includes supporting our staff against discrimination. For example, many years ago, if a patient requested a new caregiver because of race, we may have accommodated their request. This is unacceptable and a contradiction of our organizational values. When I arrived at MLH 12 years ago we instituted a policy that prohibits this practice.

What difference has it made to your organization to be part of IHI’s Pursuing Equity initiative?

We are sharing our success and failures with others and we are learning along the way. Being a part of Pursuing Equity has underscored the successful frameworks we have put in place, but has also provided us with practical ways to embed the work in and out of clinical settings to create an equitable environment for all.

Editor’s note: This interview has been edited for length and clarity.

You may also be interested in:

IHI white paper - Achieving Health Equity: A Guide for Health Care Organizations