Patient Advocacy Perspectives

• Culture: Encourage expansion of unconscious bias and racial disparities training
• Public Health: Emphasize preventive care
• Access: Support Medicaid expansion in all states or a form of universal coverage

Greensboro Health Disparities Collaborative: Addressing racial disparities in treatment

In the U.S. racial and ethnic minorities are less likely to receive preventative medical treatments than whites and often experience lower-quality care. One way to reduce this disparity is for health care providers to acknowledge that racism and race factor into health care.

"Assertions that patient mistrust drives disparities obscures the etiologies of racial health inequities and tacitly blames affected patients for their disproportionate suffering. This is particularly true for Black patients. Any mistrust Black patients may harbor toward the US healthcare system is a result of their never-ending mistreatment, not the cause of it.”

Boyd et al. via Kellan Baker, Building Trust Advisor

• Governance: Ensure leadership positions reflect the diverse communities being served
• Culture: Enable people of color to participate at all levels of decision-making
• Education: Support diversity and inclusion training in medical education and certification
• Career Pathways: Create career opportunities for a diverse workforce

Doctors Back to School Day: The importance of participating in youth mentorship programs, that emphasize diversity and inclusion

Research shows that minority physicians are more likely to practice in underserved areas and provide care for minority, poor, underinsured and uninsured patients. Participating in ‘Doctors Back to School Days’ helps students discover the many practice areas available to them but also encourages them to consider other health care settings as well, including academic, research and clinical.

“Who is “invited” to the table and to be “engaged” is typically decided by leadership that lacks diversity and representation of communities of color, minority communities, marginalized communities and vulnerable communities. That leadership also tends to not select diverse voices to lead their engagement efforts. The end result is that engagement work is not reflective of ALL voices, but a few voices.”

Hala Durrah, Patient Advocates Transforming Healthcare

• Culture: Support strategies to address social determinants of health
• Partnerships: Cultivate partnerships with community leaders and organizations to create trust

Central Oregon Health Council: Improving health care by bringing down costs and raising both quality and satisfaction

The Central Oregon Health Council exists to build an equitable and integrated health ecosystem that improves the health of Central Oregonians through collaboration and partnerships, data-driven decisions, quality improvements, lowered costs, and empowered providers.

“In addition to developing partnerships between community organizations/members and health system and policy actors (very much needed to address the systemic roots and social determinants of health), there is an important need for spaces and opportunities within communities (however defined) to discuss priorities and develop a collective agenda so that when individuals are invited to participate in partnership efforts they are bolstered by the power of a diverse constituency.”

Lauren Wechsler, Philadelphia Health Partnership

• Data: Ensure data includes information on race, ethnicity, language, disability status, sexual orientation, and gender identity
• Analysis: Recognize biases in algorithms and in the collection/analysis of data

The American Institutes for Research: Principles for making health care measurement patient-centered

Patient-centered measurement involves partnering with patients in a meaningful way to decide what to measure, how to measure it, and how to report and use the results of measurement. It also requires that the needs and concerns of other key stakeholders such as health care providers, health care organizations, payers, insurers, and policymakers are considered, allowing for increased information flow between stakeholders; improved partnership; and shared responsibility and accountability for outcomes.

“We did not talk so much yet about health care quality and safety here yet, and how to address problems of medical harm. But for those things data and transparency are also key to accountability...We should want to promote effective patient engagement and informed decision-making, which doesn't always come from blindly trusting that the folks in the white coats have all the information”

Chuck Bell, Consumer Reports

• Culture: Inspire physicians to prioritize quality of interactions over volume of patients seen
• Payment: Ensure reimbursement rewards value rather than time spent in patient-caregiver interactions
• Access: Support increased implementation of language translation services
• Communication: Encourage meaningful conversations between physicians, patients, and caregivers

BMC Medical Education: Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study

New patients are a particularly vulnerable population because they are at high risk of missing a subsequent visit or dropping out of care completely. However, few data exist on what new patients value in the beginning of a relationship with a new provider. Informed by patients’ real experiences, this study aims to identify what patients see as the most critical elements for building trust and rapport from the outset.

“One source of mistrust is the sense people get, whether they’re walking into a clinic or trying to find information about their health insurance, that the system is focused mainly on the needs of companies, care providers, and the institutions rather than the needs of patients. A way to rebuild trust, therefore, is to assess all these systems through the eyes of those receiving care and their lived experience.”

Stacey Chang, University of Texas at Austin