A Checklist for Prescribing Change

This feature was written by Studio MSP writers. While some of our advertisers were sourced, no advertiser paid to be included.

If we’ve taken anything away from the mercurial 2020s, it’s that two things can be true at once: remote work, our new default, offers flexibility and convenience while also blurring the lines between work and personal life. Scientific theories can coexist even when they seem contradictory. Vaccines are effective, and yet new variants of viruses will always turn up and evolve.

And while our home state is known for its constellation of high-quality health care institutions, racial and socioeconomic disparities remain deeply and stubbornly entrenched in the system, disproportionately impacting communities of color and marginalized populations. Reversing centuries of racial injustice doesn’t happen in isolation—it happens in community. “There’s a long history of mistrust in health care and we’re committed to this work,” says Dr. Yeng Yang, regional director of primary care at HealthPartners. “We’re making incremental gains in closing health care disparity gaps and diversifying our workforce, but we haven’t closed them completely … so, the work continues.”

Ahead, a handful of our local health care systems, hospitals, and clinics share the policies and practices they’ve instituted to make health care delivery a coordinated team sport—and a little more human.

Tapping into an Underutilized Talent Pool

Celebrating differences has always been the hallmark of care at Gillette Children’s. The health care professionals, quite literally, structure their care model around every child’s unique needs and individual nature. So taking part in Project SEARCH, an evidence-based, one-year internship that combines hands-on training with classroom instruction and career exploration through workplace rotations for students with cognitive or intellectual disabilities, felt like a natural click. “The students work alongside our employees, rotating through three internships during the school years, and I’ve really seen this break down stereotypes,” says Kit Brady, vice president of human resources. “This has been a great program for us, and we’ve even hired students at the end of the school year.” According to the U.S. Department of Labor, 36 percent of adults with disabilities in their prime working age are employed compared with 74 percent of all prime working-age adults. Since 2017, Project SEARCH has graduated more than 40 students. “The internship provides students with the opportunity to practice a variety of employment skills in a professional environment and learn what it means to be a valued member of the workforce,” says Brady.

From Inspire to Hire

Hennepin Healthcare has made a point to introduce and usher in the next generation of historically-excluded youth to careers in health care, thanks to its multidimensional Talent Garden program. Since late 2021, the health care giant has held 10 youth summits for young people ages 12 to 18, a series of events where youth have the opportunity to participate in panel discussions with health care professionals and engage in simulated activities using stethoscopes and real medical equipment for blood draws, baby delivery, dermatology, and more. “Four youth summits were held during 2023, attended by 300 youth, and in February, we held our first Asian Youth with Stethoscopes summit with 106 youth attendees,” says Dr. Nneka Sederstrom, chief health equity officer. Hennepin Healthcare is on pace to do four youth summits per school year.

In its second consecutive summer, the program saw 21 students undergo a paid six-week internship where they observed physicians, nurses, and advanced practice providers, and completed 256 shadowing assignments over 12 days in areas like hyperbaric medicine, clinical ethics, and anesthesia. “The data has shown us that the quickest way to decrease health disparities in Black and Brown populations is to have a clinician that has the same racial concordance as the patient,” says Sederstrom.

As part of their training, interns passed the Emergency Medical Responder (EMR) certification exam after receiving 55 hours of Emergency Medical Services (EMS) training. Minnesota’s EMS workforce exhibits a significant racial disparity, with 70 percent being white while Asians, Hispanics, Blacks, and American Indians or Alaska Natives collectively represent only 8.6 percent.

Sederstrom and the Health Equity department, a team that she spearheaded and currently oversees, aren’t waiting for change to happen—they’re driving it. Another recruiting strategy yielding positive returns for Hennepin Healthcare is its namesake Expanding Diversity Career Fair, which saw more than 130 attendees and opportunities to engage with more than a dozen departments at each event. “Of the 2,035 employees hired in 2023, 49 percent identified themselves as diverse hires. Hennepin Healthcare achieved a 40 percent representation ratio last year,” says Sederstrom.

Leadership at Allina Health says they’re bucketing DEI&B efforts into five critical categories: workforce development, purchasing practices, health care provision, investment decisions, and community engagement. Last year, the organization increased its supplier diversity spend and set an even higher goal for 2024. “As a purchaser of goods and services, we are committed to promoting the inclusion of vendors and suppliers from our local community, especially those owned by women, BIPOC, people with disabilities, veterans, and people who identify as LGBTQ+,” says Tom Lubotsky, vice president of supply chain at Allina Health. “By shifting more spending for supplies and services to diverse local businesses, we are working to fuel job growth and create an economically sustainable ecosystem that’s good for the health and well-being of our patients, too.”

In 2023, Allina Health partnered with Vizient, a company that provides contracting services to more than half the nation’s health care providers, to create a first-of-its kind regional collective that directly supports diverse businesses with a local or regional footprint by creating visibility among area health care providers and community-based organizations such as universities, colleges, and other large employers in Minnesota. “By investing purchasing dollars and directing resources to local, diverse suppliers, Allina Health is supporting area growth and development, positioning itself to hire from its local community which, in turn, addresses social determinants of health,” says Shaleta Dunn, vice president of supplier diversity and social investment impact of Vizient, in a press release. The program seeks diverse suppliers of more than 40 products and services.

“[We’re] expanding population health equity initiatives, starting with a Native health equity initiative that aims to build trust and relationships with Native communities.”

–Diane Tran, System Executive Director of Community Health Equity and Engagement; M Health fairview

Nourishing Community

Our neighborhoods bear the scars of past and present-day discriminatory practices—just look up redlining and blockbusting to learn about the lasting impacts of structural racism. (The homeownership gap between Black and white households in Minnesota is among the largest in the nation.) That’s why community outreach isn’t just an act of service; for many, it’s a literal lifeline. Studies have shown that people who live in communities rife with unmet health and social needs experience markedly poorer outcomes for well-being and life expectancy. Addressing social determinants of health (what WHO refers to as “nonmedical factors”)—the conditions in which people are born, live, learn, work, and worship—can shape health inequities and improve public health.

The Fairview Community Health and Wellness Hub, a first-of-its-kind campus located in downtown St. Paul, was born out of M Health Fairview’s pursuit to transform internal structures to create an anti-racist and inclusive environment. It’s a gathering space for community partners to address the socioeconomic factors that affect health, including food access and affordable health care services.

“We know that 80 percent of overall health is influenced by factors outside of hospital and clinical care, like food insecurity, race, income, housing and more,” says Dr. Taj Mustapha, chief equity strategy officer for M Health Fairview. “Our system has taken bold steps to uplift historically marginalized voices, enhance workforce diversity, reduce patient care disparities, and integrate equity into all operational processes, creating upstream solutions and breaking down barriers to health care through our food access, housing, and community care programs.”

Since its 2022 inception, the hub has provided thousands of families with access to primary and behavioral health appointments, and referrals to local resources such as transportation assistance and food support. “Ebenezer Senior Services opened DayBreak, an adult day program that offers high-quality care and companionship for seniors while their caregivers are at work,” says Diane Tran, system executive director of community health equity and engagement for M Health Fairview. “The mental health and addiction services [at M Health Fairview] provided outpatient care within the hub, and cared for patients in more than 9,000 visits in the first half of 2023.”

Because access to nutritious food is a critical social determinant of health (and a human right), Tran adds that nearly 100,000 pounds of food are processed through the hub each week between M Health Fairview, The Sanneh Foundation, and Second Harvest Heartland. The Sanneh Foundation and Second Harvest Heartland operate food storage, distribution, and pop-up food shelves. “Food is sourced from partnerships with small, local BIPOC farms,” she says, “and a youth workforce development program offers paid work experience to 20–25 youth per week.”

The success of the hub led to the rise of the M Health Fairview Center for Community Health Equity, located within the hub, where community partners and a diverse array of health equity programming can share a physical space and work side by side. The center has held more than 100 events and community partner meetings, building on its emphasis on three social determinants of health initiatives: Food is Medicine, Housing is Health, and Connection is Cure. “The center is expanding population health equity initiatives, starting with a Native health equity initiative that aims to build trust and relationships with Native communities,” says Tran. “This includes clinical services at local powwows, an open house for Native communities, and collaboration with the Minnesota Indian Affairs Council.”

Closing the Birth Outcomes Gap

Childbirth for Black mothers is a lethal crisis—the CDC reports that Black mothers die at three to four times the rate of white mothers. And the mortality rate of Black infants is higher than any other ethnic group in the U.S. In 2021, HealthPartners got together with an agency called Heart of the Customer to improve outcomes for Black patients. “The goal was to build empathy, undermine systemic racism, and improve outcomes,” says Dr. Yeng Yang, regional director of primary care at HealthPartners. They followed and documented pregnancy experiences, from the time a patient discovered ›they were expecting through delivery and postpartum. Yang says this effort resulted in two new virtual group classes focused on supporting Black patients through their prenatal and postpartum journeys. “In 2023, 66 pregnant or postpartum women participated in 22 Community Circles group sessions,” she says. “Feedback from past participants has included that their experiences and personhood were validated, the space reduced feelings of isolation, and that social support complements clinical care.”

No Discomfort, No Revolution

Patient-centered care isn’t limited to the clinical experience; it’s about acknowledging and addressing patients’ unique needs, backgrounds, and circumstances, something that’s central to the ethos of DEI. And if your DEI efforts make people uncomfortable, that means it’s working. The organizations that will be successful in bridging the gaps in health care will be the ones that understand that education grounded in action is an ongoing process—not a one-time or once-a-quarter event.

Yang of HealthPartners cites a recent initiative that’s seen major results—using clinical simulation to train health care workers to build an anti-racism culture. She says this training model helps colleagues learn how to be better allies to each other by better preparing for racist care delivery encounters and implementing anti-racism interventions as part of their daily work. “It’s about cultural change and making colleagues not just see the importance of our equity, inclusion, and anti-racism work, but also giving them tools to feel empowered to do something about racism when they hear and see it,” says Yang.

She adds that 881 clinicians completed pre- and post-training surveys, indicating positive increases in five key measures that show demonstrable understanding in: how unconscious thinking systems work; why unconscious biases can be different from our genuine conscious beliefs; evidence-based strategies that prevent unintended biases from affecting patient care; and more.

Last year, the Health Equity department at Hennepin Healthcare brought on DEI coaches, cultural navigators, health equity educators, and DEI clinical consultants. The team of DEI coaches operate with the goal of supporting Hennepin Healthcare’s mission to become an anti-racist institution, organizing events like healing retreats and healing spaces. Each retreat includes art and communal, spiritual, and physical healing components.

Sederstrom says DEI coaching is now available to all employees, “normalizing the idea that everyone can become more equitable and inclusive, and that asking for help is okay.” In addition to face-to-face chats, DEI coaches conduct program assessments. In 2023, the DEI coaching team coached 142 unique clients from 61 departments, providing 386 coaching sessions to Hennepin Healthcare employees.

Health equity educators manage the Compass Program, a one-year long health equity training for all staff, where they’re provided the opportunity to learn more about the history of racism in the U.S., how different racial groups have faced racism in the U.S., and how systemic racism contributes to health disparities. The goal is for staff to be equipped with the skills to navigate systemic forms of racism and interpersonal microaggressions. One team member says that “having the support and motivation through this program to sit in discomfort, unpack my biases, and come to a complete understanding of history has been incredible.” To date, more than 130 senior leaders completed the Compass Program and 50 percent of staff is enrolled in the program.

“The data has shown us that the quickest way to decrease health disparities in Black and Brown populations is to have a clinician that has the same racial concordance as the patient.”

–Dr. Nneka Sederstrom, Chief Health Equity Officer; Hennepin Healthcare

Undoing the Financial Strain for First-Gen Students

In 2020, CARE Counseling launched CAREMore, a nonprofit community initiative intended to create systemic change within the mental health community. Only one in three Black or African American adults who need mental health care receive it, according to the website—and reluctance to enlist the aid of a mental health professional can lead to a lack of representation. In Minnesota, 95 percent of mental health professionals are white while just over 2 percent are Black. CAREMore is on a mission to draw more BIPOC students into the therapy field. “Essentially, this is a foundation that serves to help bridge financial constraints that can serve as barriers for marginalized communities entering the field,” says Molly Jockheck mental health therapist, clinical supervisor, and DEI specialist. “We offer book scholarships through the foundations for clinicians entering the field at University of St. Thomas through their psychology programs.” CAREMore recently donated $50,000 to St. Thomas to fund the cost of textbooks for BIPOC students pursuing masters and doctoral programs in the psychology department. 

This article originally appeared in the May 2024 issue of Mpls.St.Paul Magazine.

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Hennepin Healthcare, multiple locations, hennepinhealthcare.org

PrairieCare, multiple locations, prairie-care.com

University of Minnesota Foundation, Mpls., give.umn.edu