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2015 AHA Equity of Care Leadership Summit

Stephen K. Jones, FACHE President and CEO Ryan P. Parker AVP and Chief Diversity Officer Robert Wood Johnson Health System

Our Time Today

• What is the RWJ Health System
• RWJ’s Approach to Thriving in The New

Environment

• Executing The Diversity & Inclusion Strategy
• Looking Ahead

Diversity is innovation.

RWJ HEALTH SYSTEM

Robert Wood Johnson University Hospital

• 965-bed Academic Medical Center located in New

Brunswick, NJ

• Principal Teaching Hospital of Rutgers Robert Wood

Johnson Medical School

• Flagship Hospital of multi-hospital system
• Centers of Excellence: Cardiovascular; Cancer;

Women’s & Children’s; Level 1 Trauma Center

• Located mid-way between New York and Philadelphia,

serving six county population of approximately 1.4 M

• Owner of Physician-Led Accountable Care

Organization

Diversity is innovation.

The Power of Collaboration

Our remarkable campus is comprised of:

• RWJUH
• Rutgers Robert Wood Johnson Medical School

– Child Health Institute – Cardiovascular Institute – Eric B. Chandler Health Center

• Rutgers Cancer Institute of New Jersey
• Bristol-Myers Squibb Children’s Hospital
• PSE&G Children’s Specialized Hospital

Diversity is innovation.

RWJ Health System

• $1.6 Billion in Annual Revenues
• 10,300 Employees
• 3,250 Medical Staff
• 1,733 Beds

Diversity is innovation.

National Recognitions for Excellence

Diversity is innovation.

National Recognitions for Excellence

In 2014, RWJ was named “Best in Class” for Diversity Management and Strengthening the Workforce.

Diversity is innovation.

National Recognitions for Excellence

• RWJ was chosen as No. 19 in

Diversity MBA Magazine’s 2015 rankings for 50 Out Front Companies for Diversity Leadership: Best Places for Women & Diverse Managers to Work

• Top 10 Best in Class for:

Succession Planning and Accountability

Diversity is innovation.

National Recognitions for Excellence

Diversity is innovation.

RWJ’S RESPONSE TO THE CHANGING HEALTHCARE ENVIRONMENT AND GROWING DIVERSE POPULATIONS

Triple Aim  Population Health

Diversity is innovation.

The New Healthcare Paradigm

“Market Justice” “Social Justice”

Diversity is innovation.

• Although RWJ had a rich, 25+ year history of educating health

professionals and advancing the health of diverse communities, no formal Program for diversity and inclusion had been created.

• In 2010, RWJUH Board of Directors asked hospital leaders to

create a diversity and inclusion plan for RWJUH.

• In 2014, RWJ completed its first three-year diversity and

inclusion plan, and the Board approved another three year plan.

• In 2015 RWJ received national recognitions for its diversity and

inclusion program

• Upon completion of its first three-year plan 2014, RWJ CEO

submitted a plan to expand diversity and inclusion efforts throughout the RWJ Health System.

RWJ Diversity and Inclusion Timeline

Diversity is innovation.

• 22% of Board is comprised of racial and ethnic

minorities

• Diversity is 15% of organizational goals
• 34% increase in executive leadership diversity
• Embedded annual mandatory diversity training

for leadership team

• Embedded mandatory diversity and cultural

competency training for every new employee

Diversity is innovation.

Diversity and Inclusion Impact 2012-2015

• Embedded mandatory culturally competency

training for all nursing staff

• Reduced readmissions of low-income patients

through DSRIP program by 50%

• Served nearly 50,000 individuals through our

targeted education and disease management programs for diverse populations

• Increased utilization of minority and women-
• wned businesses by more than 5 million dollars

Diversity and Inclusion Impact 2012-2015

Diversity is innovation.

• Host site for Institute for Diversity Summer

Enrichment Program for three consecutive years.

• Host site for a high school health careers program

for more than 15 years. More than 40 past participants of the program are employed at RWJ

• Engaged a LEAN Six Sigma Project to improve

collection of race, ethnicity, language

• Expanding diversity programming throughout the

RWJ Health System

Diversity is innovation.

Diversity and Inclusion Impact 2012-2015

AHA’s Equity of Care Goals

• Increase the collection and use of race,

ethnicity and language preference data (REaL)

• Increase cultural competency training, and
• Increase diversity in governance and

leadership.

Diversity is innovation.

RWJUH: INTEGRATING DIVERSITY AND INCLUSION

Diversity and inclusion are drivers for operational excellence. This plan integrates diversity and inclusion as a crosscut of RWJ’s operational pillars. Diversity will provide the innovation we need as we develop innovative strategies for executing the Triple Aim. Diversity is innovation.

The Strategy Crosscuts RWJ’s Operational Pillars

Diversity is innovation.

INCREASING DIVERSITY IN GOVERNANCE AND LEADERSHIP Equity Of Care Focus:

Diversity is innovation.

 A diverse workforce could help remedy the poor quality of healthcare that minorities receive  A more diverse nursing workforce will help lead to better communication, interaction and treatment for patients of all backgrounds (IOM, 2004)  “The lack of minority health professionals is compounding the nation’s persistent racial and ethnic health disparities” (Sullivan Commission, 2004)

Diversity: A Determinant for achieving Health Equity

Diversity is innovation.

Employee-led Business Resource Groups

Promoting Respect, Outreach, Understanding & Dignity

Diversity is innovation.

• Partnership with New Brunswick Health Sciences Technology High

School for 15 years.

• Provide internships for all students 9-12.
• Program Participants have pursued Allied Healthcare Career education
• r are employed as Allied Healthcare Professionals.

 2 med school  3 occupational/Physical therapy school  6 Pharmacy school—two currently employed as pharmacists  1 in physician assistant school  5 pre-med  3 healthcare administration track  1 registered dietician

• 40 Students currently employed at RWJ.

Health Professions Scholars Program

Diversity is innovation.

AHA Institute for Diversity Administrative Internships

Andrea Peine-Ardila, MHA Manager of Operations RWJUH Foundation Co-Chair of SALUD BRG IFD Intern 2013 Stephen K. Jones, RWJ President & CEO 2014 IFD Administrative Interns

Diversity is innovation.

Undergraduate Administrative Internships

Diversity is innovation.

Pathways to Professional Nursing

RWJUH and Rutgers University School of Nursing partner to build a diverse nursing pipeline. Program Components:

• personal academic

advisement

• academic tutoring, tuition

grants

• book stipends and childcare
• stipends to reach their goals

to enter nursing school.

Diversity is innovation.

INCREASE THE COLLECTION AND USE OF RACE, ETHNICITY AND LANGUAGE PREFERENCE DATA Equity Of Care Focus:

Diversity is innovation.

89 percent of hospitals report collecting race and ethnicity data, and 79 percent report collecting data on primary language (AHA, 2008).

Diversity is innovation.

U.S. Hospital Utilization of REaL Data

Regenstein and Sickler, 2006

Diversity is innovation.

Charter updated: <1/19/2012>

Problem Statement: Patient language is an important field to capture in the records of the RWJ registration. From 01/01/2014 through 07/31/2014 there were discrepancies in the data collected in SCM and Optimum – [approximately] 17% of language fields did not match when compared between SCM and EPSI. This information is used to understand our demographics, safely discharge our patients, and eliminate variation in care.

Objectives: Standardize process to ensure patient language (preferred/spoken) is accurately collected in SCM and Optimum

Project Scope Information:

• In Scope: All [competent] adult in-patients, Pediatric in-patients, outpatients
• Process Begin: Patient registered for admission and outpatient registration
• Process End: Patient discharged
• Key Milestones: Kick-off, Work-out, Pilot, Hand-off
• Constraints: FTE Neutral, budget neutral

Project Owner: Linda Pryzbylko

Deborah Fugaro

PI Facilitator: Barbara Romito

Kathy Soriano

PI Mentor:

Sara Gonzalez

Team Members:

Ryan Parker, Lois Dornan, Nicole Martinez, Yesenia Hernandez, Lazara Richardson, Kathy Zavotsky, Patricia Andrews

Start Date: February 3, 2015 Planned End Date: October 31, 2015

Project Charter for: Language Data Integrity

Executive Sponsor: Dr. Rajiv Arya METRIC BASELINE

(January – July 2014)

GOAL Language 17% Defects 5% Defects Guidelines for registration/ inpatients and alignment of computer systems No process in place Process for

• btaining language

information and aligning systems MD Champion: Dr. Josh Bershad

Diversity is innovation.

Background and Scoping

• Drivers

– Patient Care – Data Collection

• Defects in language data collection
• REaL Language

Diversity is innovation.

Results

• Standardized questions
• Standardized language option answers
• Patient and caregiver questions
• Scripting and Education
• Interpreter documentation flow throughout

patient record/nursing flow sheets

Diversity is innovation.

INNOVATION

DSRIP Transitional Care Clinic

Delivery System Reform Incentive Payment

• CMS demonstration project that converts Hospital

Relief Subsidy Fund from a fee-for-service model to a pay-for-performance model.

• Outreach focus is low-income heart failure patients
• Overarching goal is to accomplish the TRIPLE AIM.

Diversity is innovation.

DSRIP Process

• Patient Identification
• Patient Screening
• Patient Encounter
• Home Visit
• Clinic Visit
• Follow up Phone Calls

Diversity is innovation.

RWJ lowered its overall 30-day hospital readmission rate for low-income patients from 13% in 2013 to 5.2% in 2014.

kite kite Our Results

LESSONS LEARNED

• Begin with patients, employees, and business
• bjectives in mind.
• An engaged and diverse board will help guide the

journey, embed sustainability, and accountability.

• Embed diversity and inclusion into operating

culture of the organization.

• The behavior you incent changes.
• Measurable success can be achieved in a short

period of time.

Lessons Learned

Diversity is innovation.

Innovations for Elimination of Healthcare Disparities

October 14, 2015

Kimberlydawn Wisdom, MD, MS Denise White-Perkins, MD, PhD

Integration Across 9 Business Units

• 4 acute care hospitals
• Henry Ford Medical Group
• Henry Ford Physician Network
• Community Care Services
• Behavioral Health Services
• Health Alliance Plan

2015 Awards

• HFHS has been on

Diversity Inc.’s Top 10 list of hospitals and health systems for diversity and inclusion since 2000 and topped the list at #1 in 2015.

2015 Awards

• After being

recognized as a finalist for the inaugural Equity

• f Care Award

by the American Hospital Association in 2014, in 2015 we won the award

Awards

• For the past two

years, HFHS has been recognized as a leader in LGBT Healthcare Equality by the Human Rights Campaign Foundation.

Intersections of Equity & Diversity

From “Prioritizing health disparities in medical education to improve care,” (2013) Awosogba, et al. Ann NY Acad Sci.

Employee Resource Groups

• Amigos de HFHS

– Hispanic/Latino

• eMERGe

– Middle Eastern

• GenERG-Y

– Generation Y

• OPAL

– African American Physicians & Leaders

• Pride

– LGBT

• WIN

– Women

Find the report at: http://www.henryford.com/healthcareequitycampaign

Collecting & Using REaL Data

Equity Dashboard Measures

– % REL data collected – Demographics, by site: race, ethnicity (Hispanic, Arab), English proficiency, preferred language – 30 Day Readmissions – Average Length of Stay – Mortality – Ideal Delivery – ED Left Without Completing Service – Diabetes Bundle Score – Prevention Bundle Score – Satisfaction (in progress) – Advanced Directive documented (in queue) – My Chart utilization (in queue)

55

Priority areas for eliminating hc disparities:

• cultural competency
• language access
• health literacy

(1) Training & Education

(2) Evaluation & Demonstration Projects

(3) Partnerships & Technical Assistance for Organizational Change

Integrating Equity into Programs & Policies

• System Awards: Quality Expo (Equity Award), MLK Jr.

Day (HEAL Award), Medical Education Research Forum

• Employee Engagement and Performance Management
• Leadership Academies
• Senior Staff Orientation
• Resident Education
• Medical Group Values Statement
• Collection of race, ethnicity, primary language data
• System Quality Dashboard, Equity Goals

EXAMPLES OF EQUITY INITIATIVES

Healthcare Equity Scholars Program, 2014-2015

• AAMC Learning Health System Award
• Launched in March 2014; graduated in June 2015
• 20 employees from each of our business units
• Meet every month for half day
• Homework between sessions

Healthcare Equity Scholars Program (HESP) Goals

• 1. Create internal experts in the field of healthcare

equity who are skilled in creating organizational change to address disparities at the departmental and organizational level

• 2. Implement multiple quality improvement or research

projects that address disparities across various areas of the health system

• 3. Integrate lessons learned from successful projects

into System policies, processes, or infrastructure, and share findings more broadly through publications and presentations

HESP Projects

How can we improve recruitment of minority patients into clinical trials at Henry Ford Hospital and decrease the number of minority patients who drop out of trials? What methods/processes are effective for starting a conversation with African American patients about end-of-life care? How do we decrease readmission rates for Detroit-based dialysis patients?

Intervention:

“Using Diabetes Trained Community Health Workers to Reach Northwest Detroit Clinic Patients” Pilot Project

• Objectives of the project:

– Testing feasibility of CHW as part of diabetes care team – Understand barriers to accessing diabetes care services – Demonstrate improved diabetes care

• The pilot intervention used trained community health workers

(CHWs) in partnership with Diabetes Care Center staff in order to…

– increase utilization of HFHS diabetes care center programs and services – increase HbA1c and LDL testing – increase the percentage of patients with diabetes who have HbA1c measures < 8% and LDL measures < 100 (in control) – increase the percentage of patients with diabetes who show improvement in their HbA1c measures and LDL measures (in control) – demonstrate improved HbA1c and LDL measures among patients who interact with the CHW as compared with those who did not

Background: Diabetes Disparities Workgroup and HFHS Gail and Lois Warden Endowed Chair in Multicultural Health

• There are significantly more patients with poor diabetes control at
• ur clinic sites located in urban underserved communities (DNW)

than there are within other areas of the Henry Ford Medical Group.

• Programs and resources for diabetes care were reallocated to target

this high need population but were underutilized by patients

• The DNW patient population have structural, financial, and
• rganizational barriers to accessing care that need to be addressed

in order to achieve better diabetes control- thus, they are a special population with a wider range of needs

• We explored the feasibility and efficacy of using a community health

worker to assist patients with diabetes in addressing social barriers to care/disease management

Impact: Community Health Worker Intervention

CHW contacted patients who failed to engage DCC program through normal process or started programs did not complete CHW informed patient about programs and assisted in enrolling in DCC program. After obtaining a consent asked patient completed to “barriers to engagement” survey.

The CHW contacted patients two weeks after initial contact in

• rder to ascertain

whether referrals were completed and follow- up on additional barriers was needed

The CHW worked closely with DCC staff at DNW in order to provide to patients regarding clinic-based resources

Game-Changing Partnership: Sew Up the Safety Net for Women & Children

Community Kick-Off Event, Matrix Human Services, Osborn, Fall 2012

Sew Up the Safety Net for Women & Children

The Concept

Community Influence & Social Support Education for Health Care Providers & Professionals Intervention for women at-risk for poor pregnancy

• utcomes

Chadsey-Condon Brightmoor Osborn HFHS DMC Oakwood

• St. John

Providence Public Health Agencies Academic Institutions Community Organizations UW 2-1-1, Social Service Agencies

Role of a CNN

• Recruitment and enrollment
• Mentoring pregnant women

during home visits

• Nurture community

partnerships

• Connect women with

resources and support

• Liaison to Task Force and

WIN Network management

• Educate and Support:

– Pre- and inter-conception health – Prenatal health – Goal setting – Skill-building

www.WINnetworkDetroit.org

Program Summary:

January 2012 – December 2014

BRAND EVOLUTION

From: To:

Follow us!

www.WINnetworkDetroit.org

Policy Support of CHW model

• Aligns with policy efforts for Medicaid Reimbursement Ex: HFHS

working with statewide CHW initiatives, including MiCHWA (Michigan Community Health Worker Alliance)

• National Standards for Diabetes Self-Management Education &

Support encourages “lay health and community workers and peer counselors or educators may contribute to the provision of DSME instruction” provide they are supervised by diabetes educators or

• ther health professionals
• American Association of Diabetes Educators (AADE) has Career

Path Program Training for CHW

Watch: A Community Mosaic Mural

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https://www.surveymonkey.com/r/hpoe-webinar-10-14-15

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reference Important topics covered in the digital and mobile editions include:

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transformation

• Reducing health care disparities
• Reducing avoidable readmissions
• Managing variation in care
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records

• Improving quality and efficiency
• Bundled payment and ACOs
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@HRETtweets #hpoe #equityofcare

Upcoming HPOE Live! Webinars

• October 27, 2015

– Preventing Violence in the Hospital and Community For more information go to www.hpoe.org