Structural Racism in Healthcare with Dr. Ronald Wyatt

Lit Health

In today’s episode, Tracy is joined by Dr. Ronald Wyatt, a global healthcare patient safety and quality improvement expert, and well known health and healthcare disparity and equity champion. Dr. Wyatt is also a Senior Fellow at the Institute for Healthcare Improvement, former co-chair of the IHI equity advisory board, and currently serves as faculty for the IHI Pursuing Equity Initiative and facilitator for the ACGME Equity Matters collaborative. During his illustrious career, he has held the position of Chief Quality and Patient Safety Officer at Cook County Health in Chicago, and was the first Patient Safety Officer at the Joint Commission, as well as the first African American Chief Medical Resident in 1987-88.

The episode starts with Dr. Wyatt’s story of his experience with racism during an encounter with police in 1970s Alabama, a subject on which he wrote a paper describing the event. He talks about how that experience has stayed with him and how it relates to current issues around inequity, disparity, and structural racism, particularly regarding trust. He quotes surveys that demonstrate the low levels of trust the Black communities have in healthcare systems, and suggests that the disrespect experienced by these communities within the healthcare system prevents trust. Moving on, Dr. Wyatt addresses the challenges involved in getting those in leadership positions to acknowledge and address issues of structural racism and how, while there is still a long way to go, some progress is being made by medical institutions and governing bodies. He mentions initiatives that are attempting to educate the healthcare world on these issues and suggests that a major part of getting people’s attention is to make addressing inequity and disparity a prerequisite of accreditation. Dr. Wyatt points out the low representation of Black physicians and how that plays into disparities in healthcare quality. Finally, on a positive note, Tracy and Dr. Wyatt discuss one of the initiatives he’s involved with that is making significant progress in this area and how important it is to keep fighting and to believe that change is coming.

Highlights:

- The Kaiser Foundation’s “Undefeated” survey demonstrating the low level of trust Black and Latinx communities have for institutions such as the police and hospitals.

- Another survey showed that younger Black people, in particular, tend to have much lower levels of trust in health and healthcare.

- Dr. Wyatt’s biggest challenges in his career have been around getting people in leadership roles to accept and address the problem of systemic racism.

- Governing bodies, including CMS and the NCQA, are beginning to take steps to address racism, and Dr. Wyatt is hopeful this will lead to a national patient safety goal.

- Dr. Wyatt participates as a facilitator at the Accreditation Council for Graduate Medical Education in Chicago and sits on an Equity Matters collaborative there, supported by insurers Blue Cross and Blue Shield of Illinois.

- This initiative aims to educate healthcare workers about topics including inequity, disparity, racism, allyship, and the impact trauma has on inequity. It also focuses on how graduate medical education can evolve to address issues of structural racism.

- Dr. Wyatt points out that attaching financial penalties to ignoring inequity and disparity is the most effective way to get people’s attention.

- When Dr. Wyatt was at the Joint Commission, he witnessed care teams reporting incidents of racism because they felt they had nowhere else to go.

- The number of Black physicians in the US is ~5%, with the total number practicing medicine at 3%—the same number it was in the late 1800s, however the number of black medical students is increasing.

- Dr. Wyatt states that the ability to sit with people who don’t look like them and come to a proper care management decision should be a clinical competency for any clinician.

- By January, Dr. Wyatt hopes to publish a document he co-authored about the role of trust and addressing inequity and racism.

Quotes:

“I had this odd sensation, and I slowly turned to my right. And when I turned, I saw that the other policeman had his handgun pulled, he was actually leaning through the window with his handgun pointed at my head.”

“To this day—and this happened in the mid-70s—whenever I meet a police car, or a police car pulls up behind me when I’m driving down a street, road, highway, interstate, I do experience some visceral anxiety about that police car in my rearview mirror or approaching me.”

“Here’s a guy who says, ‘I’m trying to do the right things. I’m trying to eat right. I tell my friends, you shouldn’t smoke, but then I go on for health care, and I feel disrespected.’”

“Not just the flavor of the month, but sustainable change, so that when we look back a decade from now, we will say that was a moment that became a movement that truly did lead to lasting change.”

“People are being asked to get results on a system of inequity, a system of disparity, a system of structural and institutional racism when even the leadership doesn’t understand how it works as a system, yet they’re saying, give us some results.”

“If we say, as a part of your accreditation, as a condition of participating in CMS, that you must address these issues, then I think we will continue to move it forward.”

“We know that the hospitals and healthcare systems in lower-income communities are lower quality, they have fewer resources, less capacity, are understaffed, don’t have the supplies and equipment that are needed to provide quality care in these communities. We know that there are pharmacy deserts, and they’ve been mapped out right there in Chicago. So those are the structural things that communities are challenged with.”

“This is about going from strategy to organizing to action. And part of action is to hold people, organizations, institutions accountable.”

“So there’s a lot of movement that gives me nothing but hope and more optimism than I’ve had on these topics in over a decade. But that said, we have to continue to fight, push, struggle, and I always go back to the business of medicine, where they typically say, ‘If there is no margin, there’s no mission.’ That, I totally reject. This is what I say about that: if there is no mission, there is no margin. If there is no mission, there is no soul.”

“Those of us who are involved with this work begin to understand that it’s going to seem slow, it’s going to seem tiring, it’s going to be frustrating, there will be setbacks. But, you know, honestly, as the Old Testament says, ‘Wait on it, wait on it, because it’s going to come.’”

Show Links:

Dr. Wyatt’s LinkedIn Page