Choosing Change: How One Organization Transformed Toward Equity

It can be easy to ignore inequities when they have defined reality for so long, in many cases our entire lives. But that doesn’t make it right. People must actively choose equity to avoid becoming complacent with “the way it is.” In the July 25 plenary session, “Choosing Equity in Healthcare: An Organizational Transformation,” Thea James, MD, MPH, MBA, provided an inspiring roadmap for how to do that.

Since early in her career, James has been a firsthand witness to inequity in healthcare. As an ER attending in Boston, she often saw patients get treated differently based on their perceived race or socioeconomic status. The patterns she observed are no doubt replicated across many, if not all, hospitals in the country.

Providers often make snap judgments based on their own biases that affect patient care—whether it’s assuming a patient will make an expeditious return to the ER because they’re “hooked” on medication or that they won’t be back at all because they’re too irresponsible to follow-up, James explained.

“Given an opportunity, people will not choose suffering,” James said. “If they’re there [at the hospital], something is wrong that we’re missing.” When James treated patients with empathy and presented them with different opportunities, she saw results. “People couldn’t believe patients were doing what they said they would do,” she said.

James, who is vice president of mission and associate chief medical officer at Boston Medical Center (BMC), also provided a prescription for systemic change. She shared an example of one academic healthcare system’s approach to an enterprise-wide transformation toward organizational equity.

James’ inspiring talk traced a full circle back to lab medicine, as she began her medical journey as a lab scientist checking serum flowing through tubes for bubbles. In yesterday’s session, she described the incredible transformation BMC underwent under her leadership. “It’s not just been checking a box to address the topic of the day, it’s been a full-on pivot, for perpetuity,” James said.

At the beginning of this transformation, “we were all charged with coming up with 4-5 various gaps that we would work on to close over the next months,” James said. “There was a huge amount of accountability. We reported directly to the COO and CEO about our progress, and the methods we chose had to be new methods we hadn’t tried to do before.”

BMC already had decades of experience trying to address inequities. But various metrics, such as differences in maternal health outcomes between Black and white patients, remained stagnant.

James spearheaded an examination of preeclampsia outcomes. Currently, the only “cure” for preeclampsia is to deliver the infant. Thus, the sooner the decision is made to induce delivery or C-section, the lower the risk for complications. But for Black mothers, it took twice as long to make this decision than for white mothers. “The first step we took was simply standardizing this process,” said James. “And just in the process of standardizing, the gap closed!”

They also did community work as part of this effort, because so many problems come down to economics. “We created pipelines for new living wage jobs for people living in zip codes with low average incomes, and now we have more than 700 people in these jobs,” she said.

“Once you see inequity, you see it everywhere,” said James. And seeing it means you can address it. James’ plenary showed that doing this work can yield astounding results—and challenged all of us to do the same.