Good ideas don’t create change unless followed by actions. It’s a theory that Anne Arundel Medical Center (AAMC) in Annapolis, Md., took to heart to better serve its community and create a more understanding work environment. The AHA recently recognized AAMC with the 2019 Carolyn Boone Lewis Equity of Care Award for their efforts in providing equitable care and reducing health inequities by developing a better understanding of the community, implementing new policies and creating an open dialogue among staff.
Major changes included diversity training and the addition of interpreter services for 180 different languages, said Maulik Joshi, executive vice president of integrated care delivery and chief operating officer at AAMC. These and other developments originated from the hospital president and board, reaching all the way to frontline team members, before and after the creation of their transformational Board Health Equity Task Force in 2016.
“The charge of the task force was to identify opportunities for improvement and develop a roadmap for action, which included surveying all our employees and medical staff around issues and perceptions of cultural awareness, cultural bias, cultural competency and the language translation services that we provide,” said AAMC Board member and Health Equity Task Force Co-Chair Carlesa Finney.
Using that information and the results of two subsequent health equity reports identifying trends in patient demographics and disparities, hospital leadership focused on areas with the greatest need. For example, AAMC discovered four health disparities that need extra attention: C-section rates, readmission rates, length of stay and patient satisfaction.
“We’re pretty pleased with the fact that they’re digging into the data to figure out what we can learn and what we can address so we can best prioritize those action plans,” said AAMC Director of Diversity and Inclusion Tamiko Stanley. “What are the biggest contributors to some of these disparities, and where should we place our immediate efforts?”
One area of improvement that became visible from staff surveys was unconscious bias. Leadership immediately began training, offered online resources, created spaces for candid conversations and even brought in an interactive theater group to act out scenes for staff discussions. Joshi said they are always looking for different ways to educate and gather feedback.
“The awareness is so important, and that takes a little bit of time, but you can get stuck in that a little bit. Like, OK, yeah we all get it: There’s unconscious bias. But it’s when you actually apply these things [that you see results],” said Joshi.
When the hospital looked at leadership and realized it didn’t match the community’s demographics, Joshi said human resources started recruiting from different places, such as historically black colleges and universities. Since last July, leadership diversity went from 17% to 24%. In addition, a diverse candidate made it to the final pool for each of the 39 open leader positions.
“You hear nationally, not just in health care, ‘Well it’s hard to find qualified, diverse candidates.’ That’s not true at all. You can find individuals. We need to look in a way that allows everyone that opportunity,” Joshi said.
While staffing and leadership changes play a large part in reducing inequities, locating disparities in the community can be tricky. By paying attention to data, the hospital found a group of patients from the same neighborhood regularly using the emergency department for primary care. So, the hospital decided to go to them.
AAMC partnered with a local senior apartment complex and opened a non-traditional primary care clinic within its resident center. Resources from AAMC and other outside groups include a medical assistant to establish appointment goals and a staff physician, both trained in National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, and weekly tobacco cessation counseling services. Since implementation, AAMC observed a 17% reduction in hospital admissions and a 25% drop in readmissions over a four-year period for this group of patients.
“We really wanted to reduce the experience of crisis-driven and fragmented care to one of a more primary care setting,” said Marianthi Hatzigeorgiou, manager of the Rapid Implementation of Strategic Experiments Unit. “They have the same team there pretty regularly, so that way [the patients] get used to seeing the same faces. They feel that they’re coming into a safe place – it feels like family to them.”
Internally, Nia Wright, senior nursing director of surgical services, said that even before the creation of the task force, nurses would get together and discuss topics related to diversity and equity of care.
“There are all kinds of different levels of diversity that we recognized we had to address,” Wright said. “So we started having things like educational programs, lunch-and-learns, those kinds of things where people could come together, get information on how to better take care of the patients and take care of each other.”
Employees have access to various groups catered to different demographics, including a newer group focused around lesbian, gay, bisexual, transgender, questioning and/or queer, intersex and asexual (LGBTQIA) issues that went from seven members to 20 in less than three years. Shirley Knelly, AAMC chief patient safety officer, chief compliance officer and executive sponsor of the LGBTQIA Resource Group, said the Health Equity Task Force is the reason the resource group exists, which offers training and partners with LGBTQIA community groups, including Annapolis Pride.
“I think one of the other special things is that it really drove us not only to change the culture but also the policies in the organization,” Knelly said. “So we revamped our patient rights, our non-discrimination [policy] and our visitation policy to include sexual orientation and gender identity so that we’re sending that message out across the organization.”
AAMC staff say changes are still needed, but awards and recognition give leadership and staff a chance to appraise their achievements.
“I think awards like this are an opportunity to take a second and reflect,” Joshi said, “which I think is always good because you’re always go, go, go, and to just step back and say, ‘here’s what we did well and here’s where we can do better.’”
Tori Bayless, president and CEO, accepted the award for AAMC July 25 at the AHA Leadership Summit in San Diego.