Building a Culture of Health in Health Care and our Community

From the August 4, 2023 issue of the Transformational Times

 

Building a Culture of Health in Health Care and our Community 

Kajua Lor, PharmD, BCACP 

 

We as healthcare professionals and leaders need to recognize that to build a culture of health, we must take off our white coats and meet the community… The neighborhoods we live in, the places we work and play, impact the health of our community…

George Floyd. A Black man who died on May 25, 2020, as a white police officer in Minneapolis knelt on his neck for nearly nine minutes. A name that goes does down in history as a flashpoint of inequities faced by people of color and vulnerable communities. A death captured by a bystander on a video that went viral and sparked one of the largest protest movements in U.S. history, as well as a movement within health care.   

Together, George Floyd and the COVID-19 pandemic revealed the true colors of our broken healthcare systems and the inequities faced by people of color and people disadvantaged by the system.   

 

 

My experience as a Hmong American refugee 

 

As a Hmong American refugee growing up here in Wisconsin, I was oftentimes the only person of color in the room, the only woman in the room, the only pharmacist in the room. I struggled with my identities and many times would feel like I was “lucky,” and I was the “underdog” in many of the spaces that I was in personally and professionally. 

 

Being the “first” and or the “only” person made me question if I could be my own authentic self in the spaces that I was in. Early on in my professional career, I would hide myself and my identities as I felt that showing any vulnerability would mean that I may not be good enough.  

 

Since the COVID-19 pandemic, I’ve learned that life is so precious, that there are so many things to be grateful for, that I can show up as my own authentic self and that I need to know my allies, people who support and are able to create positive influences around me.    

 

When I saw the video of George Floyd’s death, I was shocked, angry and, then, sad. I felt disappointed in humanity. How can I influence change? Where is the love for humankind? What can I do to make things better where I live, work, and play? 

 

I remember a white coworker who said to me, “I don’t understand why those Black people are so angry.” And I thought about my own privilege as an Asian American. Why did they feel comfortable speaking with me? Was it because I was Asian American?

 

I remember being part of a virtual listening circle to create safe spaces to hear from others from the MCW community after the death of George Floyd. I volunteered to participate as a note taker for the circle. I appreciated being a part of this circle as I learned from others in the room about their stories. As the only person of color, I realized that this was a safe space with many allies, raised my “virtual” hand, and said, “As an Asian American woman and leader, I experience microaggressions almost every day at MCW. There hasn’t been one week that I have not had a microaggression.”  

 

Microaggressions happen and are real. Psychologist Derald Wing Sue, who has written two books on microaggressions, defines the term: "The everyday slights, indignities, put-downs, and insults that people of color, women, LGBT populations, or those who are marginalized experience in their day-to-day interactions with people.” 

 

Research has shown that microaggressions, although seemingly small and sometimes innocent offenses, can take a real psychological toll on the mental health of their recipients. This toll can lead to anger and depression and can even lower work productivity and problem-solving abilities. 

 

Some microaggressions I have experienced:  

 

• Patients asking me “Where are you from?”  
• Direct reports seeking recognition from male leadership as my recognition as a woman leader was not “good enough.” 
• After returning from maternity leave, a coworker stated, “hope you had a nice vacation.” 
• A staff member referring to Asian Americans as “Oriental.”  
• After sharing that I was attending a blessing ceremony over the weekend, a colleague saying, “Oooooo! Spooky”  
• A staff member’s written comment about a candidate that they “didn’t speak English good enough.” 

 

Mountain or mole hill? I’ve learned to pick my battles. Will I be working with them in the long term? Is it worth it to say anything?  

 

I learned that one of the officers in the video who was a bystander, watching the death of George Floyd, was Hmong. I remember the hatred toward the Hmong community for letting George Floyd’s death happen. Many Hmong were targeted with death threats. It seemed that there was a perception the inaction by one member of the Hmong community reflected the entire Hmong community. 

 

How do we create change with people who “don’t see color?” How do we change when there are differences in opinion on the approach to building inclusion and belonging? How do we learn from one another and embrace our differences? How can we move forward when we remain behind in the work that we do? 

 

Race was created as a social construct, not a biological construct. 

 

We as healthcare professionals and leaders need to recognize that to build a culture of health, we must take off our white coats and meet the community. 

 

According to the Robert Wood Johnson Foundation, “Building a Culture of Health means working together to dismantle structural racism and other barriers so that everyone has the chance to live the healthiest life possible.” 

 

The neighborhoods we live in, the places we work and play, impact the health of our community.  

 

I’ve learned over the years, working with community, that I can be my own authentic self in the spaces that I’m in and that I need to show up when times get tough as an ally for others. 

 

Each of us has a different story and a different walk of life. We need to embrace each other as humans to be able to “see” one another and develop a deeper understanding -- to learn from one another to be able to move forward.  

 

 

Take action: Practice inclusive leadership  

 

Has the needle moved? Progress has been made; however, the journey has just begun and will continue to be a long one. Many hospitals and healthcare systems have expanded positions and resources to support health equity efforts. Many organizations have provided more budgetary resources and infrastructure in efforts to build health equity.   

 

At MCW, the Office of Diversity and Inclusion developed the Inclusive Excellence Framework. This framework showcases how we all can create communities of safe spaces for others to ensure all feel they belong.   

 

We must develop inclusive leadership skills. Inclusive leadership is defined as “leadership that assures that all community members feel they are treated respectfully and fairly, are valued and sense that they belong, and are confident and inspired.” (“Workplace Inclusion Network – Reflections from our Virtual Roundtables ...”) 

 

Strategies to practice inclusive leadership:  

• Take time to make a personal connection with your team and your patients (if applicable). 
• Develop topic discussions with your team that incorporate inclusive leadership principles. 
• Describe resources for health and well-being. 
• Address fears – listen with empathy. 
• Cultivate compassion for yourself and others.  

 

Spend some time to reflect on equity, diversity, and inclusion:  

• What does diversity mean to me?  
• "When have I or someone else been treated equally, but should have been treated equitably?" (“Discussion Guide DEI: The Basics – Part 1”)  
• Think of a time when you felt excluded. What were your feelings? How did they impact you?  
• Think of a time when you felt included. What were your feelings? How did they impact you?  
• How can I help others to be/feel included? Valued? 

 

Take action:  

In the next month, what one action will I commit to that promotes diversity, equity, and/or inclusion? (i.e., “I will engage in a conversation with someone whose opinions differ from my own.”) (“Discussion Guide DEI: The Basics – Part 1”)  

 

For further exploration: 

 

• This Day in History: George Floyd is Killed by a Police Officer
• Robert Wood Johnson Foundation: Why Build a Culture of Health?

Resources from the MCW Office of Diversity and Inclusion: 

• MCW Office of Community Engagement Introduction and "Quick Links"
• Inclusive Excellence Resources
• Resources to Read and Watch
• MCW Anti-Racism, Equity, Diversity, & Inclusion Glossary

Videos: 

• Reggie Jackson: A History of Race 

Kajua Lor, PharmD, BCACP, is Founding Chair/Associate Professor in the Department of Clinical Sciences at MCW School of Pharmacy. She is a clinical pharmacist at Sixteenth Street Clinic, a federally qualified healthcare center serving Spanish-speaking communities one day per week. Dr. Lor was a fellow of the Robert Wood Johnson Foundation Clinical Scholars Program from 2017 – 2020, a leadership program to build healthier and equitable communities. She is a community-engaged researcher building a culture of health with Hmong refugees.  

 

 

 

 

 

Implicit Bias and the Motherhood Penalty – Opting Out vs. Helping Out

From the March 31, 2023 issue of the Transformational TImes - Women's History Month

Implicit Bias and the Motherhood Penalty – Opting Out vs. Helping Out 

 

 

Elizabeth “Libby” Ellinas, MD, and Adina Kalet, MD, MPH  

 

In this Director’s Corner, Drs. Libby Ellinas and Adina Kalet call for ongoing, proactive attention to the subtle and mostly unconscious gender bias in the workplace that lowers career expectations for women and parental engagement for men and deprives all of us a more equitable world. If you would like to explore ways to mitigate gender stereotypes and second-generation gender bias, please consider making an IWill Pledge... 

 

Dr. Kalet’s story (1993):  

When I gave birth to our first child in 1992, my husband and I had parallel jobs -- same hours, same salary, same responsibilities, and we even had offices side by side. Except for the fact our colleagues, students, and staff acted as if my door was “always open” and his was “always closed,” we pretty much had the same daily routines. I took a six-month, mostly unpaid leave, because there were no formal maternity leave benefits at the time. He took two weeks paternity leave and returned to paid work. 

As the end of my leave approached, we discussed each returning to work four days a week so we could have a family life that included each of us having a full weekday with our child and -- along with a creative mixture of other childcare arrangements -- two meaningful work lives. When I went to my boss to discuss this, he said, “Sounds exactly right; we will support you in being ‘part-time.’” When my husband went to his boss, he said, “Don’t do it! You will ruin your career!”  

 

Two facts about this experience perplexed me. First, neither of us requested part-time work, given the demands of our clinical schedules, which included mandatory evening clinical hours. We proposed more than full-time hours, confined to four weekdays.  

Second, we worked for the same man.  

Dr. Ellinas’s story (circa 2003): 

As a young faculty member, and then as program director for the Obstetric Anesthesiology Fellowship, I had many opportunities to discuss fellowship opportunities with anesthesiology residents. 

When I spoke to women residents, I would sometimes encounter “interest if...” This would occur when someone was a great practitioner, and expressed interest in perhaps pursuing a fellowship “if…” That would be followed by a statement indicating she was putting her career second; usually second to her partner’s career: I will consider a fellowship if my partner gets his fellowship where there happens to also be space for me. Many were also feeling the time pressure to have children. I have not had that same conversation with a man.  

Maybe the woman’s answer was just a polite way of saying she really was not that interested in the fellowship. If not, I wondered whether a prioritization of the husband’s career would extend beyond the fellowship. Those fellowships would benefit both their careers and were open to both equally. What pressure was there – and coming from what direction – that resulted in the husband’s fellowship being prioritized over the wife’s fellowship? 

Now (2023) 

Second-generation gender bias refers to practices that may appear neutral or even favorable to women, but that discriminate against a gender because they reflect hidden, subtle, or silent bias.

The motherhood penalty is part of that bias: 

Mothers suffer a penalty relative to non-mothers and men in the form of lower perceived competence and commitment, higher professional expectations, lower likelihood of hiring and promotion, and lower recommended salaries.” (“Mothers suffer a penalty relative to non-mothers and men in the form ...”) This evidence implies that being a mother leads to discrimination in the workplace.

For men, on the other hand, having a child benefits their careers. They are seen as more stable, worthy of higher salary and more competent. So, when it comes to the differences between mothers and fathers at work, “the disparity is not because mothers… become less productive employees and fathers work harder when they become parents — but because employers expect them to.” 

Dr. Kalet and her husband’s boss had two children. He regularly talked about his home life as a means of relating to the women who worked for him, although he did not do this with the men. It was obvious he viewed himself as a feminist and a great supporter of women in medicine.

However, his own wife did not work outside the home, and took care of almost all the daily needs of making a home and caring for the family. This probably contributed to his blindness or insensitivity to the challenges of being a working parent in a dual-career family. This manifested as having unrealistic expectations of his team for time flexibility in clinical coverage, calling last-minute, early morning or late afternoon meetings, and expecting writing tasks to be done evenings and weekends.  

Because he himself was not forced to be organized and planful when opportunities arose, he waited until the last minute to recruit help from more junior members of the faculty so that only those with few responsibilities, other than work, could take advantage. Parents who might have been interested would have needed more notice to engage in the work. In these ways, he created inequities for leadership and academic opportunities. Had our institution had policies and incentives for him to be a more equitable leader, he would have embraced them readily.  

If we want to help women be successful in the workplace -- and reach what they perceive as their full potential -- we need to be aware of subtle (and not so subtle) biases that persist in the ways we work and think about our workplace and ourselves.  

 

The authors encourage everyone to: 

• Educate ourselves about second-generation gender bias and maternal bias. Both are often implicit, so we will not know about them unless we look for them.
• Encourage everyone to take full parental leave. Make it both straightforward and possible for the birthing parent.  
• Encourage fathers to take full leave. Discourage work productivity during this time to incentivize parent-child bonding and build other skills critical to equality in the home sphere. 

We encourage MCW to: 

• Continue to support salary equity efforts.  
• Address known and emerging second-generation gender bias in hiring and salary equity.  
• Consider more generous paid leave policies for parents.  
• Consider creative scheduling options for parent flexibility as the needs of families rapidly evolve. 
• Support lactation spaces and develop a culture that assists lactating persons toward success.
• Continue to offer equal parental leave, regardless of gender.  

See Info scope for details about MCW’s parental leave for faculty and staff. 

 

Dr. Kalet’s status update:  

My husband continues to have his “Daddy Day” long after our children have left home, his colleagues have adjusted to the fact he doesn’t attend routine meetings or teach on Fridays. As a result, as the needs of the family evolved, he was able to “protect” time for other work and personal pursuits. In fact, we both have had long satisfying careers, albeit with many difficult bumps along the way. Being a “good worker” has required remaining sensitive and responsible to institutional needs, learning to advocate for ourselves and others effectively when needed, and a willingness to compromise. All of this has been a continual negotiation and renegotiation around our work and with our bosses and supervisors, each other, and our kids.  

 

No careers have been ruined. 

 

Libby Ellinas, MD, is Director, Center for Advancement of Women in Science and Medicine and Associate Dean, Women's Leadership, Professor, Anesthesiology and a member of the Medical Education Data Science Laboratory at the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education at the Medical College of Wisconsin. 

 

Adina Kalet, MD, MPH, is Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.