The Next Generation of Work for Diversity in Our Academic Health Centers:

1. The Next Generation of Work for Diversity in Our Academic Health Centers: David Acosta, M.D., FAAFP Chief Diversity Officer, Office of the Dean Clinical Professor, Department of Family Medicine University of Washington School of Medicine Realizing Full Potential

2. TTUHS-PLFSOM E X C E L L E N C E EDUCATION RESEARCH CLINICAL CORE-MISSION

3. TTUHS-PLFSOM E X C E L L E N C E EDUCATION RESEARCH CLINICAL D I V E R S I T Y CORE-MISSION

4. TTUHS-PLFSOM E X C E L L E N C E Infrastructure Building Capacity Capital Culture EDUCATION RESEARCH CLINICAL D I V E R S I T Y CORE-MISSION

5. 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?

6. Challenges facing academic health centers

7. “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

8. 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

9. 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

10. Health Care Reform Law & Academic Medicine Rasouli T, Crytzer TW. Acad Med, 2011

11. 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

12. 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

13. 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

14. “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…” Darrell Kirch, M.D. President, CEO, AAMC AAMC Reporter, July 2011

15. “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….”

16. “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

17. What others are saying… • Association of Academic Health Centers • Need a ‘recalibration’ of AHCs  • Focus away from the tripartite mission = “functions” = means to improve health & well-beingof the communities they serve • AHC & community together must develop a viable partnership that brings direction and value to both Wartman SA, Acad Med 2010

18. Degree to Which Various FactorsInfluence Health…. • Traditionally AHCs have focused on the medical care domain • AHCs must take a broader view of health Wartman SA, Acad Med 2010

19. 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

20. Recalibration of AHCs - Wartman Wartman SA, Acad Med 2010

21. Recalibration of AHCs - Wartman Guiding Principles • Alignment of functions • Tangible commitment to community partnerships • Collaborative • engagement with • other AHCs Wartman SA, Acad Med 2010

22. What Job Did the AHCs Hire Diversity To Do?

23. Imperatives for Diversity

24. “Accreditation” Imperatives Driving Diversity

25. “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

26. “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

27. Definition of Excellence = Degree a medical school achieves its stated mission & goals Amount of resources expended

28. “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

29. “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

30. “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

31. “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

32. 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

33. “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

34. What can Academic Health Centers do to get there?

35. Academic medical institutions should strive to become multiculturalorganizations “Culturally competent organizational community” Ross HJ, Reinventing Diversity..., 2011

36. Academic medical institutions should strive to become multiculturalorganizations • 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

37. Academic medical institutions should strive to become multiculturalorganizations • 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

38. Diversity Smith D, Diversity’s Promise to Higher Education: Making It Work, 2010

39. Integration Model for Diversity & Inclusion Across Health Sciences Schoo D e n t i s t r y · M e d i c i n e · N u r s i n g · P h a r m a c y · P u b l i c H e a l t h · S o c i a l W o r k · Core Shared Values E Q U I T Y & D I V E R S I T Y & I N C L U S I O N

40. Integration Model for Diversity & Inclusion Across Health Sciences Schoo D e n t i s t r y · M e d i c i n e · N u r s i n g · P h a r m a c y · P u b l i c H e a l t h · S o c i a l W o r k · Core Shared Values E Q U I T Y & D I V E R S I T Y & I N C L U S I O N Common Mission Common Vision Common Guiding Principles

41. Integration Model for Diversity & Inclusion Across Health Sciences Schoo D e n t i s t r y · M e d i c i n e · N u r s i n g · P h a r m a c y · P u b l i c H e a l t h · S o c i a l W o r k · Shared Educational Resources Core Shared Values E Q U I T Y & D I V E R S I T Y & I N C L U S I O N Interprofessional OSCEs Service Learning Cultural Competency Training Professionalism Health Literacy SDH Patient Safety Facilities, i.e. Simulation, IT Standardized Patients Faculty

42. Integration Model for Diversity & Inclusion Across Health Sciences Schoo D e n t i s t r y · M e d i c i n e · N u r s i n g · P h a r m a c y · P u b l i c H e a l t h · S o c i a l W o r k · Faculty Development Faculty Recruitment & Retention Faculty Mentoring Faculty Collaborative Teaching Model Shared Faculty Resources Shared Educational Resources Core Shared Values E Q U I T Y & D I V E R S I T Y & I N C L U S I O N

43. Integration Model for Diversity & Inclusion Across Health Sciences Schoo D e n t i s t r y · M e d i c i n e · N u r s i n g · P h a r m a c y · P u b l i c H e a l t h · S o c i a l W o r k · Collaborative Research Addressing : Health & Health Care Inequities Health Care Delivery Diversity Workforce Issues Impact of PCMH Outcomes Shared Research Resources Shared Faculty Resources Shared Educational Resources Core Shared Values E Q U I T Y & D I V E R S I T Y & I N C L U S I O N

44. Integration Model for Diversity & Inclusion Across Health Sciences Schoo D e n t i s t r y · M e d i c i n e · N u r s i n g · P h a r m a c y · P u b l i c H e a l t h · S o c i a l W o r k · Shared Research Resources Shared Faculty Resources Shared Educational Resources Core Shared Values E Q U I T Y & D I V E R S I T Y & I N C L U S I O N

45. What AHC Can Do…. • Take Advantage of Funding from ACA • 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 • Collaborative care networks for low-income populations • Patient-Center Medical Homes • Chronically ill Medicaid beneficiaries

46. 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

47. 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

48. What AHC Can Do….. • Funding • Preserving public trust

49. What AHC Can Do….. • Funding • Preserving public trust • “Understanding the past to approach the future…”

50. 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