CEO Power Panel: leaders develop patient engagement

A major lesson learned over the past two years has been the need for leaders to take a more active role in meeting the social and economic needs of marginalized communities in order to fully address health disparities. For some more progressive healthcare providers, those issues often align with a broader strategy on delivering patient-centered care and improving patient engagement.

Modern Healthcare public health reporter Steven Ross Johnson recently held a roundtable discussion with Dr. David Callender, president and CEO of Memorial Hermann Health System in Houston and Marcos Pesquera, vice president of community benefit and health equity, diversity and inclusion for Christus Health in Irving, Texas, to learn how they approach consumer engagement. Both organizations have had a focus on improving equity for years, from addressing workforce diversity to community revitalization initiatives. 

The interview, which has been edited for clarity, is part of Modern Healthcare’s quarterly CEO Power Panel series. 

MODERN HEALTHCARE: What is effective patient engagement?

Marcos Pesquera: It’s a give and take, and that’s what needs to happen in every good communication. Particularly in this day and age, it’s a leaning in to achieve understanding. In our trainings, we talk about creating a safe environment in which both parties trust each other. That’s not easy, especially when you consider things like virtual care that bring us closer to communities, but also bring further challenges for good patient communication and engagement.

Dr. David Callender: We think about patient engagement in the individual sense. When we’re working with a patient, we want them to feel cared for, respected, valued, and that experience leads to a furtherance of trust. That is necessary to connect with patients and work with them to help address whatever issues they bring to us.

MH: How does cultural competence increase consumer engagement?

Callender: It’s absolutely critical. Everybody thinks about cultural competence through a different lens. I think that’s very good. Sometimes if you’re thinking about some specific aspects of a culture, you actually can enhance the play of biases, as opposed to reducing them. So if we think more generally, and this is the advice that we give to our caregivers in particular, then we’re better equipped to listen and learn and focus on the needs and desires of the individual patient. So that broader perspective to us is very important.

Pesquera: We have four pillars in the health equity space. The first one is diversity and inclusion, and that helps us understand not just the demographic diversity of our associates and communities, but also social issues that impact their ability to experience health. 

The second pillar is culturally competent care, because we want to integrate all those learnings into the skill-building trainings for our front-line staff and clinicians. Frankly, I look at cultural competence as really where the rubber meets the road. Once you enter the patient exam and you begin this dialogue, we’ve got to leave our biases behind. We don’t split cultural competence by race and ethnicity. I mean, people are people, and everybody is different. All this is easier said than done, but cultural competence is critical in communication and building that trust, and that trust is the one thing that is ultimately going to get us to good health outcomes.

MH: How did you start developing your engagement strategies? 

Pesquera: When it comes to the health equity piece, as healthcare organizations we’re dependent on data. We’re very, very data-driven. So one of the things we did is look at the diagnoses and the utilization patterns of different communities that were coming to our emergency department. We found that they were coming in for non-emergent things that could be cared for in primary care outside of the hospital. So we stratified the data by race and ethnicity, whether people were insured or not, or underinsured, what ZIP code they live in, and what languages they spoke. That’s how we were able to identify some of the conditions—that are really primary-care things—where we’re seeing an overutilization. That has helped us when it comes to health equity.

Callender: It’s something that has developed and changed over time, as we gathered data, as we’ve been able to create additional connections through partnerships. We actually started with clinics and schools. We have 10 school-based clinics that serve about 80 schools, many of which serve vulnerable populations around greater Houston. In taking care of their health issues, we learned a lot about the health issues in the neighborhoods. We then developed partnerships that led to additional opportunities. So listening and learning has been at the core of that all along. But many times, I think for organizations like our two, it happens over the course of time. You don’t just suddenly develop this super comprehensive strategy that sees all and knows all. You really have to learn about the people that you’re serving. You have to be willing to admit when you got it wrong and kind of readjust based on the latest data, and then move forward again.

Pesquera: It does take time. One of the things that we’ve been really battling is this whole connectivity of our hospital’s EMR (electronic medical record) with FQHCs (federally qualified health centers). We’re making progress, but I know that as soon as that switch turns and we’re able to get data both ways, what a wealth of information we’re going to have. I can’t wait for us to get there. We’re inching along.

MH: What engagement efforts have brought you the most success thus far?

Pesquera: One program that we started about a year ago, right after the protests and the murder of George Floyd, was a physician task force for health equity. Many of these are minority physicians who helped reach out to some communities. They did a beautiful video that we put all over social media, which we used around safety of the vaccine. In addition, they went to the communities, they went to the churches.

The task force also helped us look at quality indicators and select which ones to stratify by race and ethnicity. So we can really see if we can identify any disparities, and then follow up on those. This group has been tremendous in advising us with that.

Callender: I think Marcos makes a really good point about just looking within your own organization. We typically as healthcare organizations are pretty diverse. It’s very important to listen to our employees. They represent the communities we serve. 

Two of our hospitals serve as what are referred to as anchor institutions. We’re involved with local community partners, educational institutions and academic institutions in thinking about creating pipelines of employment, hiring people out of the neighborhoods, recruiting young people into the healthcare or service professions. The community resource centers, the anchor institutions, and the role they play, have really continued to open doors for us.

MH: What did the pandemic teach you about patient and community engagement for future efforts?

Callender: I think that both of our organizations were on a good path relative to understanding there’s a diverse set of needs. But I think the pandemic, more than anything else, has really emphasized that those are huge needs. If we’re going to effectively address those needs and truly improve health, we’ve got to be out beyond the walls of our clinics and hospitals and service delivery sites. We need to be in the neighborhoods. We need to be developing that trust. We need to be working with trusted partners, particularly with vulnerable populations where we know that social determinants like food insecurity, lack of safe housing, unreliable transportation, are huge barriers on the road to good health. We’ve seen tremendous negative impact from COVID on some of the most vulnerable populations, and it just really has confirmed we’re going to have to work quite differently as a group of healthcare providers if we truly are going to improve health.

Pesquera: The issue of health disparities has come front and center. It’s been there, and we all have been working on this, but COVID has really brought it front and center to us. When I think about our equity-of-care programs that we’re doing in terms of reaching out to vulnerable communities, we look at this ZIP code data, we look at the language needs, and we look at some of the other areas that are contributing to these things. Just having people that look like you and talk like you and speak your language does make a difference. But even with vaccine outreach, it was very interesting how we have tried to say, “Well, if you talk to this community, the African-American community, it’s this way, or the Latino communities it’s that way, or that way for Asian communities, or for women.” We have to get a little more sophisticated than that because there are generalities, but we cannot rely on that.


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