Why It Matters
In the first of a two-part interview, Ronald L. Copeland, MD, FACS, Kaiser Permanente’s Chief Equity, Diversity, and Inclusion Officer and Senior Vice President of National Diversity and Inclusion Strategy and Policy, described what it takes to address longstanding health care inequities. In the second and final part of the interview, Dr. Copeland places health care quality improvement in the context of the current activism, protests, and organizing against racism.
What does the recent increase in mainstream focus on racism in the US mean for those dedicated to health care improvement?
The mainstream focus on racism stems from the evidence-based conclusion that systemic racism and discriminatory practices exist in various systems (criminal justice, housing, education, and employment). In health care, systemic racism can serve as one root cause of health inequities. Across the industry, health care organizations are pledging to address systemic racism by reexamining their policies, practices, culture, and outcomes.
Kaiser Permanente has a longstanding history of supporting social justice issues and a rich tradition of equity, inclusion, and diversity. We stand against racism, discrimination, oppression, and social injustice. We have long been focused on addressing health disparities to ensure greater health equity across all the communities we serve. Our evolution includes culturally responsive care and the work in the communities we serve to address social needs — whether it’s food insecurity, homelessness, or lack of economic opportunity. Now, we’ve formally expanded our focus to include racism as a determinant of health.
What kinds of results has Kaiser Permanente achieved by removing barriers to health equity?
We’ve developed a holistic approach to removing barriers in pursuit of health equity based on the lessons we’ve learned over the years. The collaboration across several functions allows us to integrate and collaborate to address social needs, quality outcomes and measurements, care delivery (doctors and nurses), and address culture.
Our comprehensive model includes:
- Making health equity a strategic priority
- Integrating our quality improvement, community health, care delivery, and equity, inclusion, and diversity frameworks
- Leveraging technology solutions to enable operational efficiency and effectiveness for stakeholders
- Creating communities of practice to enable shared learning and innovative breakthroughs
- The establishment of performance goals
- Creating and implementing an institutional approach to inclusion and equity
Our integrated model, our systematic approach, our scale and data allowed us to identify and close gaps in clinical outcomes. The results include:
- Eliminating racial/ethnic disparities in colon cancer survival rates among patients, despite well-documented health disparities in colon cancer incidence and mortality in the United States
- Eliminating disparities in mortality and medication adherence rates among HIV-positive Black/African American and Latinx patients
- Nearly eliminating disparities for cardiac risks and diabetes markers between Blacks/African American and white senior citizen members in the western United States
Other improvements include increases in patient trust, patient cooperation, effective doctor-to-patient communications, and equitable outcomes.
In conjunction with the foundational work we’ve done towards achieving health equity, we are expanding and leveraging our community health strategic investments to help address health and economic inequities in the communities we serve. We have developed and are implementing strategies for equitable pandemic response and are working to advance community conversations on social justice. Additionally, we are deepening our efforts, including grants and investments to get at the heart of inequities: we are addressing systemic racism, breaking cycles of trauma, and creating economic opportunities for community advancement.
How has Kaiser Permanente’s approach to addressed unconscious bias training changed over time?
Kaiser Permanente’s evolution toward providing optimal care includes tackling unconscious bias head on. Our evolution had three phases over the decades:
- Provide culturally responsive care. We focused on the role of culture in health care delivery. Providing culturally responsive care aligned with a patient’s culture, values, belief systems, and preferred language helps build trust and gain cooperation.
- Address unconscious bias. We know that the scope of bias within the health care system causes disparate outcomes for individuals. Acknowledging the role of unconscious bias within health care delivery was uncomfortable for some people. After being shown the empirical data, the clinicians understood how unconscious biases impact their patients. This understanding prompted a wave of activities, including mitigating implicit bias through recognition and training. The next phase of this unconscious bias work includes building a scalable model for inclusive culture based on knowledge, engagement, skills, and inclusive leadership behaviors. Our challenge will be embarking on this path in a large and decentralized health system like Kaiser Permanente.
- Understand and address racism. For health care systems to optimize population health goals and mitigate the exponentially growing cost of care, racism must be viewed and intentionally addressed as a determinant of health. At Kaiser Permanente, we’ve broadened our portfolio, and we are developing initiatives to assess and disrupt systemic racism as a barrier to health. We are just getting started and will continue to push for health equity and address factors inside and outside the organization to improve the health of our members and the communities we serve.
How does your organization use data to address both interpersonal and systemic racism?
Kaiser Permanente regularly tracks and monitors outcomes to confirm progress and identify new improvement opportunities. Data and metrics drive our actions. We measure against our own stated goals, and we also benchmark with peers and other industry leaders. Analyzing our data is useful for understanding opportunities to improve systemic practices and identifying the root causes of complex problems.
In terms of what we measure, we have formal workforce reviews and employee engagement surveys as measurements. We perform engagement studies across our workforce to assess whether people’s day-to-day lived experiences are consistent with the goals we’ve set forth. As an organization, we aspire for equity in our workplaces. We want people feeling included at work, feeling psychologically safe in their work environments, feeling heard, and we want to ensure employees are getting fair opportunities to develop their careers.
Editor’s note: This interview has been edited for length and clarity.
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"You Can’t Achieve True Health Equity Without Addressing Racism": Part I
Ingraining Equity into Quality and Safety: A System-Wide Strategy