The Check Up: Brian Peters of the Michigan Health & Hospital Association

On June 1, Michigan Gov. Gretchen Whitmer announced new rules that will mandate health workers in the state get annual training on implicit bias. Brian Peters, CEO of the Michigan Health & Hospital Association, talks about the new rules and what kind of impact they may have across the state.

MH: Hello, I’m Matthew Weinstock, managing editor of Modern Healthcare. Thanks for tuning into the latest edition of The Check Up. The COVID-19 pandemic has had a disproportionate impact on populations of color as we all know. Then the civil unrest from last year combined really accelerated the debate across the nation and within healthcare about the need to address implicit or unconscious bias in a more direct way. On June 1st, Michigan Governor Gretchen Whitmer announced new rules that mandate that health workers in the state get annual training on implicit bias starting next June. The rules stem from a coronavirus task force that the governor had set up in 2020. I’m pleased to be joined today by Brian Peters. He’s CEO of the Michigan Health and Hospital Association to talk about the new rules and what kind of impact they may have across the state. Brian, thank you so much for being with us to talk about this important topic.

Brian Peters: Matthew, it’s my pleasure. Thanks so much for having me.

MH: So first I just want to get your overall impressions and reaction to the final rules. I know MHA in the comment letter you submitted on the proposed regulations that you were generally supportive of the overall direction that the state was taking on the rules. There are certainly some things in there that you wanted to see addressed. But overall, what are your impressions of the final regulations that are coming out or came out?

Brian Peters: Certainly, yeah, the Michigan Health and Hospital Association is very supportive of this direction that Governor Whitmer and her team is taking and this is a group effort. This is, as I’ve said for a long time, an all hands on deck effort. Because if it is strictly hospitals or strictly a physician practices or strictly skilled nursing facilities that are doing this work, we’re never going to get where we need to be. This is something that the entire care continuum, but even beyond the care continuum, we need to join arms. We need to learn from each other. I think this is a step in the right direction. It’s one step of what I think will be many steps that that will be necessary in this journey. But the bottom line is we’re on the journey and that’s something to celebrate. I think having the conversation and the sunlight, if you will, on this issue finally is something to have to be very proud of. I know we’re very excited to be part of this work.

MH: Brian, one of the things that I saw in your comment letter that I was curious about that I was hoping you could talk a little bit more about was you wanted to move towards the phrase unconscious bias versus where the state landed, which is implicit bias. Can you talk a little bit about the distinction between those two and how that impacts a rule like this?

Brian Peters: Sure. Certainly, this is one of the small details, and sometimes language is important. But when you talk about implicit bias, there have been some in our membership and outside of our membership who have suggested that implicit implies that there is an existing racism or bias that is conscious. What we are saying in our comment letter and to those who are part of this journey with us is perhaps unconscious bias is a better phrase to use because then those people who we think could be and will be willing partners on this journey will be more likely to take up the mantle and join us in this work. Unconscious implies we aren’t doing anything because of an inherent bias that exists within our framework, within our own personal lives or our approach to what we’re doing day in and day out. It’s unconscious. We need help identifying what those unconscious biases are. That’s really a part of what this work is all about.

MH: So we know, as you’re sort of getting at, words matter. Obviously, throughout the COVID pandemic, words have mattered and there’s been a lot of politicalization of the effort. Governor Whitmer certainly has seen some of that on a number of fronts. Are you worried then that they did choose implicit as opposed to unconscious bias and what that may mean long-term for a plan like this, a rule like this?

Brian Peters: Well, regardless of what the terminology is, we’re going to get the job done. Implicit bias is a phrase that’s used as in Michigan and beyond. If that’s the phrase that’s used, we’re going to do the work. But our suggestion is simply unconscious bias may be a better phrase to use, more approachable. I think there’ll be more people willing to take up the mantle if we use that terminology, but we’re going to do the work regardless. There’s no question about that.

MH: Okay. Yeah. The rule states one hour of training a year for folks who are renewing their licensure. Is that enough training to try to get at the root cause of what we’re seeing here or should it be more?

Brian Peters: Well, it’s a starting point. The reality is many of our member hospitals and health systems here in Michigan already are doing all of the right things and already meet these requirements and then some. I would imagine that by the time this new regulation is fully implemented, which of course is a year from now, you’re going to see even more hospitals and health systems that have gone the extra mile because they understand this is the right thing to do. The evidence of that is very clear. The MHA board very recently authorized a pledge to end both racism and implicit or unconscious bias that exists here in the State of Michigan in our health care delivery system, and to do that by listening, by acting and by leading, those were the three components of that pledge. I’m very pleased to say we have virtually every single hospital and health system in the state that has signed on to that health equity pledge.

It really does indicate that we have a committed membership that is ready to act and ready to lead. So I think when you look at regulations, sometimes it sets a floor and that’s really the case here. I’m very optimistic. I’m very confident that our hospitals are going to do significantly more when all is said and done.

MH: Right. That pledge came out I believe November of 2020, your board approved that, right?

Brian Peters: Correct.

MH: So let’s talk about what these regulations mean for your members. One of the things that the regulation gets at is reducing barriers. It’s supposed to address reducing barriers to access to care, to outcomes, to disparities. How do you see your members playing a role in it? I think it will be accredited organizations that are doing the training, but how do they build that into what some of your members are doing on population health, on equity, on disparities?

Brian Peters: Well, it’s a great question. Absolutely, there is a perfect fit with the existing efforts related to social determinants of health. In fact, if we’d had this conversation even as recently as five years ago, there would have been virtually no organized, orchestrated effort within our hospitals and health systems to address social determinants. Today, we have entire offices, we have positions that have been created, vice-president level positions in some cases, that are dedicated to looking outside the four walls of the acute care hospital and to deal with community partners, to work with community partners on addressing those issues related to food insecurity and transportation challenges, language barriers, all of the things that we know are part of this health equity journey.

So I think we do have a good jumpstart in that regard. I think many of our member CEOs are looking at how they can mesh those existing efforts with these new requirements. I think many of them are very excited to do that. Now, they have the leadership in place to help guide that process where maybe a few years ago they didn’t. So that’s a real encouraging development that I would point to. I would also say that here in the State of Michigan, we have a culture of shared learning, and our hospitals, even though they compete very aggressively in the marketplace, they will come together on issues like this. We’ve seen it with patient safety and quality improvement where they’ve shared information with each other. They’ve shared data. Data’s going to be an incredibly important piece of this puzzle as well. We’re encouraging our members to collect race, ethnicity, and language or REAL data.

That’s something that’s relatively new in terms of the robustness of that data. The fact that we can potentially have an entire field of hospitals and health systems collecting it, sharing it, analyzing it and learning how we can improve together. So I’m really optimistic about how this is going to roll out.

MH: Just logistically, is a year’s time enough to stand up an education component like this? How will your members participate in standing it up?

Brian Peters: Well, that’s certainly one of the things that we expressed in this process was we’re on board. We fully support this direction, but there are a lot of things on our member’s plate right now, as you well know. So let’s give a fair amount of heads up so that everyone can get all of their ducks in a row. I think that one year timeframe certainly allows for that, particularly when you consider the fact that many of our hospitals are already well along in this process. So yes, I think that will give us sufficient time. I can tell you that the Michigan Health and Hospital Association is going to be very engaged and helpful to make sure that our members, when that timeframe arrives next June, that they are ready to roll.

I can tell you the health equity organizational assessment, that is a tool that we have been rolling out to our members, a large and growing number of our hospitals have already completed that assessment. So that gives them a great jumpstart in this process as well. So the bottom line is yes, I think in the next year we’re going to see an awful lot of progress toward this goal.

MH: Got it. I’m also curious, Brian. We’re talking about here, the Michigan rule impacting folks who are in the profession already. How do you think we should be addressing implicit, unconscious bias earlier at the medical college level that as students are beginning their journey to become healthcare professionals?

Brian Peters: Absolutely. That’s why I say this cannot be successful if it’s just hospitals and just other healthcare providers. We need the medical schools, the nursing schools. Frankly, we need a number of other organizations and components of our society to join hands and really engage in a similar fashion so that we’re saying the same things, we’re messaging the same messages. That’s the only way this is going to work. But you’re exactly right. I think, looking at the medical training organizations, whether that’s a medical school, whether that’s a nursing school, or any of the other training organizations, they absolutely have to embrace this. That’s where this has to start. I would say it starts even before that, to be perfectly honest. If you look at our K through 12 education system and undergraduate programs as well. I know that starting to take place in many places, so we’re encouraged by that as well.

MH: Absolutely. Just a couple of other questions here before we close out, Brian. Obviously, as you sort of think about the rollout of this, what do you think other states might be able to learn from what you’re doing in Michigan as they consider ways to address unconscious bias?

Brian Peters: Well, the American Hospital Association certainly has been a wonderful partner in this work. They’re very committed to this process, very engaged. So the AHA creates a good opportunity for state hospital associations like ours to come together. There are other mechanisms as well. I really applaud Modern Healthcare as well for shining a light on the issue and lifting up the fact that we can engage in shared learning. This is a process where we’re very pleased to share what we’ve seen in Michigan, both in terms of public policy development and outside of that realm. But we’re going to learn from our colleagues and other states as well. There’s no question about that.

MH: Do you think, too, as you’ve alluded to, your hospitals and hospitals across the country have been looking at social determinants and other things in their population health strategy, but it feels like it sort of took COVID and the civil unrest to really push the dialogue, accelerate the dialogue faster? Any reservations on your part that it took a couple of episodes over the past year to really push this dialogue further?

Brian Peters: Well, I think if you look at any movement in terms of social justice in the United States over time, there’s always been a sentinel event, a sentinel moment. So whether it was COVID or something else, the bottom line is we’re just very pleased that now this journey has been accelerated, as you said. That’s really the most important thing. When you look at the impact of COVID-19, there are going to be a number of things that are never going to be the same. Telehealth certainly has been accelerated. Remote work I think for those of us outside of the direct care delivery, that’s also been accelerated. The hybrid model that we talk about. So to celebrate the fact that perhaps that now we’re on this journey, it doesn’t matter what the event that triggered it was, the fact that we’re on the journey is what really matters in my mind.

MH: Right, right. Last question in the last minute we’ve got left. A couple of years, five years down the road, what do you think patients will see as an outcome of what you guys are doing in Michigan?

Brian Peters: Well, we pride ourselves on looking at data. When we went down the path of patient safety and quality improvement, when we founded the MHA Keystone Center some 18 years ago now, we looked at the data and we tracked the data in terms of bloodstream infection rates, and wrong site surgeries and all the rest, and that’s what I think is going to play out here. I’m very hopeful it’s going to play out here. In other words, when we reflect years from now, hopefully, we’ll be in a place where African-American women have the same good outcomes as other women in terms of their OB-GYN experience and delivering babies to use one example. That’s really what I think we should be aiming for where the data is going to back up the efforts that we put into this journey. That’s my hope.

MH: Right, right. Well, we’ll certainly be checking back in with you to see how this unfolds and probably next year as it kicks off next June. But Brian, we really do appreciate your time to talk about this very important topic and how MHA will be participating in it.

Brian Peters: Thank you so much for the opportunity. It’s been a pleasure.

MH: Thank you. I’m Matthew Weinstock with Modern Healthcare. Be sure to come back next Monday for another edition of The Check Up.


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