THE NEXT GENERATION OF WORK
FOR DIVERSITY IN OUR
ACADEMIC HEALTH CENTERS:
Realizing Full Potential
David Acosta, M.D., FAAFP
Chief Diversity Officer, Office of the Dean
Clinical Professor, Department of Family Medicine
University of Washington School of Medicine
TTUHS-PLFSOM
CORE-MISSION
CLINICAL
RESEARCH
EDUCATION
EXCELLENCE
TTUHS-PLFSOM
DIVERSITY
CORE-MISSION
CLINICAL
RESEARCH
EDUCATION
EXCELLENCE
CORE-MISSION
D I V E R S I T Y
CLINICAL
Culture
Capital
RESEARCH
Building Capacity
Infrastructure
EDUCATION
TTUHS-PLFSOM
EXCELLENCE
AGENDA
 Challenges
facing academic health centers
(AHCs)
 “What
job did the AHCs hire diversity to
do?”

Imperatives driving diversity
 What
can academic health centers do?
CHALLENGES FACING
ACADEMIC HEALTH CENTERS
“If you’ve seen one academic medical center,
you’ve seen one academic medical center.”
- Darrell Kirch, M.D.
Kirch, D. “Realizing Just How Much We Have in Common”
AAMC Reporter, 2011
CHALLENGES FACING
ACADEMIC HEALTH CENTERS
 Funding
our missions in a climate of ongoing
fiscal austerity




State support for higher education fell
States considering major reductions on Medicaid &
other health programs
2/3 reduction in Medicare support for GME
Research funding – NIH funding cut $320 million
over 2010 levels
AAMC Reporter, July 2011
CHALLENGES FACING
ACADEMIC HEALTH CENTERS
 Funding
our missions in a climate of ongoing
fiscal austerity

Sequestration  effective March 1, 2013
 Cuts $85 billion across government departments,
agencies, and programs
 NIH will lose $1.6 billion of its $30 billion
budget1
Health literacy  $106-236 billion per year2
 Medical errors  $19.5 billion (2008)3

1 - Office of Management and Budget, 2013
2 - NIH, 2012
3 - Andel C et al. J Hlth Care Finance, 2012
HEALTH CARE REFORM LAW
& ACADEMIC MEDICINE
Reductions in
Medicare/
Medicaid
DSH
payments
PatientCentered
Medical
Home
ACOs
How will
Expanding
coverage for
the
uninsured
ACA affect
medical
schools and
teaching
hospitals?
No increase
in GME
slots
Decrease in
GME
funding
Rasouli T, Crytzer TW. Acad Med, 2011
Valuebased
payment
CHALLENGES FACING
ACADEMIC HEALTH CENTERS
 Defining
our role in an evolving health care
delivery system



What will our role be in designing and implementing
new models of health care delivery?
Which components of the future health system have
our support?
AHC are in a unique position to lead the change
 Intersection between policymakers and the public
AAMC Reporter, July 2011
CHALLENGES FACING
ACADEMIC HEALTH CENTERS
 Preserving
public trust & support of our
work in the face of changes that will impact
the public




32 million will gain access to health insurance
Baby Boomers generation ages & enters Medicare
in record numbers
Nearly 1 in 3 physicians set to retire during the
next 10 years
Important safety net programs are being
threatened due to federal and state budget cuts
AAMC Reporter, July 2011
CHALLENGES FACING
ACADEMIC HEALTH CENTERS
 Educating
the physician of the future

Integration of quality & patient safety instruction
Interprofessional health care teams
Competency-based learning
Culturally-responsive, patient-centered care
Accountability

Faculty development




AAMC Reporter, July 2011
“Being united in facing our
common challenges is only a
first step. While all sectors of
our community share these
concerns, it will take a diversity
of perspectives to reach the
desired state we all envision…”
AAMC Reporter, July 2011
Darrell Kirch, M.D.
President, CEO, AAMC
“Innovation provides the seeds for….growth, and for
that innovation to happen depends on collective
difference as an aggregate ability. If people think
alike then no matter how smart they are, they most
likely will get stuck at the same locally optimal
solutions. Finding new and better solutions,
innovating, requires thinking differently. That’s why
diversity powers innovation.”
- Scott E. Page, 2007
The Difference: How the Power
of Diversity Creates Better
Groups, Firms, Schools and
Societies
Scott E. Page, Professor,
University of Michigan
Author of “The Difference….”
“Being united in facing our
common challenges is only a
first step. While all sectors of
our community share these
concerns, it will take a diversity
of perspectives to reach the
desired state we all envision…”
“….need to discuss the business case for equity,
diversity and inclusion.”
- Trevor Wilson, author,
Diversity at Work: The
Business Case for Equity
WHAT OTHERS ARE SAYING…
 Association
 Need


of Academic Health Centers
a ‘recalibration’ of AHCs 
Focus away from the tripartite mission =
“functions” = means to improve health & wellbeing of the communities they serve
AHC & community together must develop a
viable partnership that brings direction and
value to both
Wartman SA, Acad Med 2010
DEGREE TO WHICH VARIOUS FACTORS
INFLUENCE HEALTH….


Traditionally AHCs
have focused on the
medical care domain
AHCs must take a
broader view of health
Wartman SA, Acad Med 2010
RECALIBRATION OF AHCS - WARTMAN
“`Helping to address the social determinants
of health is one way AHCs can demonstrate
their value and sustainability and stay
relevant to the communities they serve.”
- Steven Wartman, MD, PhD
President, CEO, Association of
Academic Health Centers
Wartman SA, Acad Med 2010
RECALIBRATION OF AHCS - WARTMAN
Education
Societal &
patient
needs
Research
Healthcare
delivery
Patient
Care
Community
needs
Wartman SA, Acad Med 2010
Health care
disparities
Regional &
Global
needs
RECALIBRATION OF AHCS - WARTMAN
Research
Patient
Care
Societal
needs
Guiding
Principles
Education
Health
• Alignment of functions
• Tangible commitment
to community
partnerships
• Collaborative
engagement with
other
AHCs
Community
Regional
needs
needs
Wartman SA, Acad Med 2010
WHAT JOB DID THE AHCS
HIRE DIVERSITY TO DO?
IMPERATIVES FOR
DIVERSITY
“ACCREDITATION” IMPERATIVES
DRIVING DIVERSITY
LCME
IS-16; MS-8, MS-9, MS-31; ED-22, ED-23
ACGME
Core Competencies #5: Professionalism
Sensitivity and responsiveness to a diverse
patient population, including but not limited to
diversity in gender, age, culture, race, religion,
disabilities and sexual orientation.
JCAHO
14 National Standards for Culturally
Linguistically Appropriate Services in Health:
• Culturally competent care: Standards 1-3
• Language access services: Standards 4-7
• Organizational supports for cultural
competence: Standards 8-14
“MORAL” IMPERATIVES
DRIVING DIVERSITY…
 Changing
demographics
 Lack of diversity in our health professional
workforce
 Maldistribution of our health professional
workforce
 Rising number of uninsured/underinsured
 Health and health care disparities
“What the diversity and inclusion movement needs for
the 21st century is to apply rigorous empirical methods
to understanding the most effective and efficient
interventions
to
contribute
to
institutional
excellence.”
- Mark Nivet, Ed.D.
AAMC, Chief Diversity Officer
Nivet MA. Acad Med 2012;87:1458-1460
DEFINITION OF EXCELLENCE =
Degree a medical school
achieves its stated mission & goals
Amount of resources expended
“EXCELLENCE” IMPERATIVE
DRIVING DIVERSITY:
THE NEXT GENERATION OF WORK

To make apparent the overlap between diversity and
excellence in patient care, research and medical
education
Nivet MA. Acad Med 2012;87:1458-1460
“EXCELLENCE” IMPERATIVE
DRIVING DIVERSITY:
THE NEXT GENERATION OF WORK

To make apparent the overlap between diversity and
excellence in patient care, research and medical
education
AAMC, 2010
“EXCELLENCE” IMPERATIVE
DRIVING DIVERSITY:
THE NEXT GENERATION OF WORK

To make apparent the overlap between diversity and
excellence in patient care, research and medical
education
COMMUNITY
“EXCELLENCE” IMPERATIVE
DRIVING DIVERSITY:
THE NEXT GENERATION OF WORK
To make apparent the overlap between diversity and
excellence in patient care, research and medical
education
 To invest in diversity and inclusion with evidence of
their value to organizational performance

Nivet MA. Acad Med 2012;87:1458-1460
SURVEY OF HEALTH PROFESSIONS
SCHOOL DEANS…
“…nearly all [surveyed institutions] have diversity
efforts underway, but fewer institutions have
mechanisms to track institutional progress or report
on outcomes to leaders. Within health professions’
strategic plans, diversity and cultural competence is
often a “core value,” but is not always accompanied
by specific goals and objectives, responsible agents,
or metrics.”
Association of Public and Land-Grant Universities. Urban Universities:
Developing a Workforce That Meets Community Needs, 2012
“EXCELLENCE” IMPERATIVE
DRIVING DIVERSITY:
THE NEXT GENERATION OF WORK
To make apparent the overlap between diversity and
excellence in patient care, research and medical
education
 To invest in diversity and inclusion with evidence of
their value to organizational performance
 To apply rigorous empirical methods to understand
the most effective and efficient interventions for
meeting goals and sustaining outcomes
 To measure progress toward and attain
accountability on diversity efforts

Nivet MA. Acad Med 2012;87:1458-1460
WHAT CAN
ACADEMIC HEALTH CENTERS
DO TO GET THERE?
ACADEMIC MEDICAL INSTITUTIONS SHOULD
STRIVE TO BECOME MULTICULTURAL
ORGANIZATIONS
“Culturally competent organizational community”
Ross HJ, Reinventing Diversity..., 2011
ACADEMIC MEDICAL INSTITUTIONS SHOULD
STRIVE TO BECOME MULTICULTURAL
ORGANIZATIONS

Has within its mission, goals, values & operating
system explicit policies & practices that prohibit
anyone from being excluded or unjustly treated
because of social identity or status;
Jackson B, Holvino E., 1996
ACADEMIC MEDICAL INSTITUTIONS SHOULD
STRIVE TO BECOME MULTICULTURAL
ORGANIZATIONS
Has within its mission, goals, values & operating
system explicit policies & practices that prohibit
anyone from being excluded or unjustly treated
because of social identity or status;
 Creation of an inclusive, oppression-free
environment for all identity groups
 Advocates these values in interactions within the
communities we serve;
 Understands the strengths & advantages that
social diversity brings

Jackson B, Holvino E., 1996
Diversity
Smith D, Diversity’s Promise to Higher Education: Making It Work, 2010
Core
Shared
Values
Core
Shared
Values
Common Mission
Common Vision
Common Guiding
Principles
Core
Interprofessional OSCEs
Service Learning
Cultural Competency
Training
Professionalism
Health Literacy
SDH
Patient Safety
Shared
Values
Facilities, i.e.
Simulation, IT
Standardized Patients
Faculty
Faculty Development
Faculty Recruitment &
Retention
Faculty Mentoring
Faculty Collaborative
Teaching Model
Core
Shared
Values
Collaborative Research
Addressing :
Health & Health Care
Inequities
Health Care Delivery
Diversity Workforce Issues
Impact of PCMH Outcomes
Core
Shared
Values
Core
Shared
Values
WHAT AHC CAN DO….
 Take



Covers 32 million currently uninsured (by
2019)
 16 million added to Medicaid
Establishes a 5-year, 10% Medicare bonus for
PCP & for general surgeons practicing in
shortage areas
Partnering with community health centers


Advantage of Funding from ACA
Collaborative care networks for low-income populations
Patient-Center Medical Homes

Chronically ill Medicaid beneficiaries
WHAT AHC CAN DO….
 Take
Advantage of Funding from ACA
 Pediatric ACO
 School-based clinics
 Rural clinics
 Primary care residency training programs in
community-health centers
 State grants for service in MUA
 State grants for improving universal access to
safety-net trauma care
Andrulis DP et al, Health Affairs, 2011
SUGGESTED READING:

Andrulis DP, Siddiqui NJ, Purtle JP, Duchon L.,
Patient Protection and Affordable Care Act of
2010: Advancing Health Equity for Racially and
Ethnically Diverse Populations. Joint Center for
Political and Economic Studies, Washington DC,
July 2010
WHAT AHC CAN DO…..

Funding
 Preserving
public trust
WHAT AHC CAN DO…..

Funding
 Preserving

public trust
“Understanding the past to approach the
future…”
WHAT AHC CAN DO…..

Funding
 Preserving





public trust
“Understanding the past to approach the
future…”
Cross-cultural sensitivity/awareness training
Interrupting implicit bias training
Community-based participatory strategic
planning
Defining the role of minority faculty as liaisons
& “connectors” of the institution to the
community
WHAT AHC CAN DO…..
Funding
 Preserving public trust

 Defining

our role
Social accountability of medical schools

“The obligation to direct their education,
research, and service activities towards
addressing the priority health needs of the
community, region, and/or nation they have a
mandate to serve.”
Rourke J, Acad Med, 2012
KEY SOCIAL ACCOUNTABILITY ACTIONS
FOR MEDICAL SCHOOLS:
Select medical students who reflect the
demographic & geographic diversity of the region
served
 Provide curriculum that reflects the region’s
priority health needs
 Produce graduates with appropriate knowledge,
skills and interest who will practice how and
where needed in the region
 Do ethical research activities that are inspired by
and respond to the health needs of the region

Rourke J, Acad Med, 2012
WHAT AHC CAN DO…..
Funding
 Preserving public trust

 Defining
our role
Diversity can be the driver for new research
on
 Health care delivery
 Health care inequities
 PCMH outcomes
 Workforce interventions
 Community-based participatory approach to
research (& curriculum development)
 Door of opportunity for minority faculty

WHAT AHC CAN DO….
Funding
 Preserving public trust
 Defining our role

 Educating


our physicians of the future
Culturally-responsive care
Patient-centered medical home
PATIENT-CENTERED MEDICAL HOME
AND CULTURALLY-RESPONSIVE CARE
Components
PCMH
CRC
Patient-centered
Respect patient’s
wants & needs,
preferences
Respecting & valuing
perspective of others
Comprehensive,
team-based
Team of providers
Community liaisons,
promotoras, traditional
healers
Coordinated
Organized care across
health system &
community
Provider concordance;
identifies community
members who are not
normally considered
Accessible
Value & importance of Value & importance of
ancillary patient
interpreter services, cultural
services
brokers
Committed to
quality & safety
Health IT, patient
health education
Trust building; decrease
health illiteracy
WHAT AHC CAN DO….
Funding
 Preserving public trust
 Defining our role

 Educating
our physicians of the future
Culturally-responsive care (cultural competence
aligned with patient-centered care)
 Patient-centered medical home
 Social & behavioral determinants of health
 Health & health care disparities

WHAT AHC CAN DO….
Funding
 Preserving public trust
 Defining our role

 Educating
our physicians of the future
Culturally-responsive care (cultural competence
aligned with patient-centered care)
 Patient-centered home
 Social & behavioral determinants of health
 Health & health care disparities
 Interprofessional team building

Core Competencies for Interprofessional
Collaborative Practice (2011)
http://www.asph.org/userfiles/CollaborativePractice.pdf
•
“The goal….is to prepare all health professions students for
deliberately working together with the common goal of
building a safer and better patient-centered and
community/population oriented U.S. health care system.”
•
“Collaborative” competencies = diversity & inclusion
WHAT AHC CAN DO….
Continuous diversity improvement
Continuous Quality Improvement
Analyze
Reassessment
CQI
Targeted
intervention
Identify deficit
Continuous Diversity Improvement
Analyze
Reassessment
CDI
Targeted
intervention
Identify deficit
WHAT AHC CAN DO….
Continuous diversity improvement

Means for measuring accountability &
continuously monitoring progress
Performance trend analysis
 Report results  dashboard  transparency
 Not static  once excellence is achieved, it must be
sustained

Diversity & Inclusion Standards
•
•
•
•
•
•
•
•
Departmental Operations
Departmental Culture & Climate
Faculty Recruitment
Faculty Retention - Faculty Development & Support
Clinical Practice
Education & Training
Research
Community Outreach
Strategic Goal
Sets the standard for achieving the overall
organizational mission
Intended Impact
What the program’s stated strategic goal(s) should
yield and how “success” can be identified.
Specific
Measurable
Actionable
Relevant
Timebound
Metric
Defined, measurable parameters of
the desired outcome.
Defense Centers of Excellence…http://www.dcoe.health.mil/
Continuous Diversity Improvement Plan:
Example
• Goal: Attract & retain diverse faculty
– Priority 1: Improve recruitment process & practices for
UGMBS faculty by utilizing best practices
• Action Plan: Create a departmental toolkit and workshop trainings
re: UGMBS faculty recruiting and workplace diversity, with
attention to recruitment strategies, interviewing, orientation,
career advancement & succession planning.
• Persons Responsible: xxxxxx
• Timeline: xxxx
Metric
Baseline Target
Percent of departmental faculty that have received training
Percent of UGBMS faculty by academic unit
URM
Women
0
85.0
5.9
40.1
8.0
45.0
WHAT AHC CAN DO….
Continuous diversity improvement

Means for measuring accountability & continuously
monitoring progress
Performance trend analysis
 Report results  dashboard  transparency
 Not static  once excellence is achieved, it must be
sustained


Accountability  Connect to performance evaluation
(and possibly compensation [incentives])
“Caminante, no hay camino….
Se hace el camino al andar.”
- Antonio Muchado Ruiz
“Traveler, there is no road….
You make the road as you travel.”
References
1.
Kirch D. A Word from the President: Realizing Just How
Much We Have in Common, AAMC Reporter, July 2011.
2.
Rasouli T, Crytzer TW. AM Last Page: The Health Care
Reform Law and Academic Medicine, Acad Med 2010;
85(11): 1810.
3.
Wartman SA. Commentary: Academic Health Centers:
The Compelling Need for Recalibration, Acad Med 2010;
85(12): 1821-1822.
4.
Association of American Medical Colleges (AAMC).
Striving Toward Excellence: Faculty Diversity in Medical
Education, 2009, Washington DC.
5.
Liaison Committee on Medical Education. Standards for
accreditation of medical education programs leading to
the M.D. degree accessed at
http://www.lcme.org/functions2011may.pdf on 9/8/2011.
6.
Accreditation Council for Graduate Medical Education.
Core competencies accessed at
http://www.acgme.org/acwebsite/RRC_280/280_corecomp.
asp on 9/8/2011.
References (continued)
7.
U.S. Department of Health and Human Services, Office of Minority
Health. National Standards on Culturally and Linguistically
Appropriate Services accessed at
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=1
5 on 9/8/2011.
8.
Nivet MA. Commentary: Diversity 3.0: A necessary systems
upgrade. Acad Med 2011;86: 1487-1489.
9.
Nivet MA. Commentary: Diversity and inclusion in the 21st century:
Bridging the moral and excellence imperatives. Acad Med
2012;87:1458-1460.
10.
Smith DG. Building institutional capacity for diversity and
inclusion in academic medicine. Acad Med 2012; 87: 1511-1515.
11.
Page SE. The Difference: How the Power of Diversity Creates
Better Groups, Firms, Schools, and Societies. Princeton University
Press, Princeton, NJ, 2007.
12.
Smith DG. Diversity’s Promise to Higher Education: Making It
Work. Johns Hopkins University Press, Baltimore, MD, 2009.
13.
Ross HJ. Reinventing Diversity: Transforming Organizational
Community to Strengthen People, Purpose, and Performace.
Rowman & Littlefield Publishers, Inc., Lanham, MD, 2011.
References (continued)
14. Jackson BW, Holvino E. Developing multicultural
organizations. In: Cultural Diversity Sourcebook: Getting
Real About Diversity, Abramms B, Simons GF (Eds.),
1996, Amherst, MA.
15. Andrulis DP, Siddiqui NJ, Purtle JP, Duchon L. Patient
protection and affordable care act of 2010: Advancing
health equity for racially and ethnically diverse
populations. Joint Center for Political and Economic
Studies, Washington, DC, 2010.
16. Rourke J. AM Last Page: Social accountability of medical
schools. Acad Med 2013; 88(3):430.
17. Beach MC, Saha S, et al. The role and relationship of
cultural competence and patient-centeredness in health
care quality. Commonwealth Fund Pub. No. 960, 2006
18. AAMC. The Interprofessional Education Collaborative,
Core Competencies for Interprofessional Practice,
Washington DC, 2011.