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How Northwell Health Created a Staff Structure for Health Equity, DEI

A top-down, bottom-up staff structure help Northwell Health create a lasting model for health equity and DEI work that it says sets it up for upcoming quality measurement changes.

It’s not enough for healthcare organizations to make a diversity, equity, and inclusion (DEI) pledge or say they have been doing DEI since before the pandemic. Healthcare organizations need to walk the walk and build out an intentional, longitudinal health equity plan, complete with funding sources and staff structuring.

That’s at least the lesson learned at Northwell Health, which began its health equity work around 12 years ago as part of its partnership with Hofstra University to create a medical school. In light of value-based care and the clinical quality measures they entail, Northwell Health looked at how it could create a medical school curriculum built for the 21st century—and that means acknowledging social determinants of health and health equity.

Fast forward to 2020, and Northwell Health was well-prepared to respond to the racial health disparities exposed during the pandemic and the unrest the nation felt in the wake of the George Floyd murders. Health systems nationwide were pressed to acknowledge health inequity and pledge to do better.

According to Jennifer Mieres, MD, FACC, MASNC, FAHA, the chief diversity officer at Northwell Health, the organization was already doing better.

“I left NYU to come back to Northwell Health back in 2010 and had the privilege and honor of coming up with a strategy and establishing the first office for diversity inclusion and health literacy because we thought effective communication was critical to healthcare,” Mieres, who is also senior vice president of the Center for Equity of Care, told PatientEngagementHIT.

“Over the years, we evolved and morphed to establish the Center for Equity of Care so that by the time COVID and George Floyd happened, we had already built a foundation system-wide at the medical school for advancing a journey to health equity.”

And now, Northwell is poised again for changes in quality measurement that will emphasize health equity and equitable outcomes. Social determinants of health are now part of the CMS Universal Foundation, while new accountable care organization modes are emphasizing health equity. NCQA has also integrated health equity and SDOH measures.

According to Mieres, Northwell Health’s success has hinged on intentionality and a clear vision that extends from the top down and bottom up. And to get there, it’s required a staff structure that not just empowers patients but also creates employee satisfaction.

That started with getting everyone on the same page about what DEI even really means.

“We define DEI as the mosaic of attributes that everyone brings to the table,” Mieres explained. “We spent time educating people on what diversity means, that it's not just race- or gender-vulnerable or historically marginalized populations—this is work for all of us.”

Northwell Health’s model for DEI work across the health system starts with the C-suite, where leadership has declared that health equity is a priority and put forward the resources to allow the rest of the organization to get to work. These folks also report to the board of trustees, where they make decisions for allocating resources and putting together teams to do the heavy lifting of health equity work.

Overall, the Center for Equity of Care focuses on seven pillars:

  • Leadership commitment
  • Education and development
  • Language access
  • Community partnerships
  • Workforce
  • Supplier diversity
  • Gender disparities & women’s health

Throughout all of that is the concept of allyship, or the idea that an organization needs to engage people at all different levels to become involved in this work, Mieres said. Throughout Northwell Health, different councils, including a formalized physician’s council and a separate group for nurses, PAs, and NPs, focus on various aspects of DEI.

The organization also has a language access group, helping to provide language access and interpreter services to individuals with limited English proficiency (LEP) and to ensure organization initiatives are designed with LEP patients in mind.

“We also had a pillar for community partnership, and we now have a community and population health department that really works closely with the community,” Mieres noted. “We figured out how to bond with our communities to make sure that they see Northwell as being available and a partner for businesses.”

Currently, Northwell Health has community health partnerships with small businesses, women-owned businesses, businesses owned by historically marginalized groups, and LGBTQ-owned businesses.

But according to Mieres, the highest-yield staff group are the Business Employee Resource Groups (BERGs) that focus on staff engagement, talent development, and employee satisfaction.

Northwell Health has employee resource groups that focus on veterans' needs, environment and sustainability, LGBTQ+ representation, cultural diversity, and more. Mieres said the BERGs are the biggest change agents in the organization’s DEI efforts because they represent a grassroots effort to support health equity throughout Northwell.

Underpinning all of this is a deep sense of trust between leadership, organization staff, and the patients who are impacted by DEI efforts. Building that trust had to start small, Mieres said.

“First, it started with our CEO making a commitment to DEI and our CFO giving resources for organized structures,” Mieres explained. “And then initially, it was people who were passionate about it.”

Those small gestures had a ripple effect across the organization, as Northwell proved that it could walk the walk, Mieres said.

“As we progressed, we were doing inventory and surveys along the way. As we implemented DEI strategies and competencies and components into our healthcare delivery remodel, we showed how our patient engagement and patient experience scores started to change, increase moving in the positive direction, really helped,” she stated.

Mieres said this model has set Northwell Health up for success not just for the culture shift that happened in 2020 amid glaring COVID health inequities but also for the quality measurement changes that are down the pike.

“The time has run out for having this as a nice to do or mission-critical thing to really, it'll translate into dollars and cents,” she explained.

“We, as a medical community, are moving to value-based care, and we're going to get paid based on making sure that we have health equity components embedded into our healthcare delivery system. And eventually, they're going to start looking at patient outcomes, readmission, length of stay indicators, that will determine the type of reimbursement you get.”

It's time for healthcare organizations to recognize that getting to those equitable outcomes is a team sport; if one sociodemographic group faces bad outcomes, it harms the entire healthcare ecosystem, Mieres emphasized.

But she fears implementing the DEI work necessary to achieve equity will be difficult in today’s polarized world.

“Given the political climate, everything becomes confusing,” she noted, noting that even the word “diversity” has gotten divisive. “So how do we rebrand DEI to really get people to recognize that regardless of your race, ethnicity or color, whatever, this is not just about vulnerable population, but it's about all of us?”

“This is truly a team sport regardless of your race, your advantage in life, your lived experience,” Mieres concluded. “As we redesign healthcare for this landmark moment in time, that human connection is critical.”

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