As an essential health system in Cleveland, MetroHealth System leaders have adopted digital patient engagement technologies to identify at-risk patients and make proactive, timely interviews to ensure patients receive equitable care access. Margarita Diaz, MSN, RN, director of health equity, inclusion, and diversity at The MetroHealth System, recently spoke with Healthcare Innovation via email about the Institute of H.O.P.E. and how a technology-driven approach is successfully addressing health disparities within the community.
Can you elaborate on what the goals of DEI at MetroHealth are?
Diversity, equity and inclusion (DEI) are ingrained in how we identify as an organization and the values we uphold every day to honor each patient, employee and community we serve.
Following the murder of George Floyd in 2020, the boards of trustees of MetroHealth and The MetroHealth Foundation redoubled their commitment to fighting systemic racism, social injustice and health care inequity. The health system’s DEI team partnered with industry-leading consultants to develop ways to explore unconscious bias, enhance the development of respectful empathy and generate conversation about diversity, equity and inclusion among employees. The effort is designed to improve the overall operation of our institution while better meeting the diverse needs of the patients and communities we serve.
The resulting goals are:
· Deliver compassionate and culturally competent care.
· Demonstrate respectful empathy with all constituencies.
· Build shared trust across the organization and communities served.
· Create connected understanding between diverse individuals and populations.
· Provide equitable service and support.
Through the efforts of our CEO, Dr. Airica Steed, the first female, first Black person, and first nurse to lead MetroHealth, our DEI goals have been embedded into our overall System goals to ensure diversity, equity and inclusion are woven into everything we do and how we measure our success.
How does the system’s status as a public hospital influence your perspectives on DEI?
As a safety-net organization for 187 years, our mission has always been to serve all people regardless of their race, ethnicity, who they love, gender identity or ability to pay. We turn no one away. Almost 60 percent of our patients are from underrepresented or marginalized communities, and this further enhances our overall commitment to diversity, equity and inclusion. This focus is particularly important given the crippling health disparities these communities face.
Heart disease, stroke, cancer, asthma and diabetes are far more likely to kill you if you are a minority. In addition, minorities are more than two times as likely to die from pregnancy-related causes than white women, while Black women are more than three times as likely to die. And in Cuyahoga County, Ohio, despite being home to some of the best healthcare institutions in the world, Black babies die at nearly four times the rate of white babies. Also, the city of Cleveland has been ranked the least livable place in America for Black women. These statistics are unacceptable.
MetroHealth is committed to zeroing out this death gap by eradicating health disparities—not just slowing them down or putting a dent in them but ending them. This is the only way we can achieve health equity in society.
How do the broad goals of DEI interact with the goals of MetroHealth as an organization, particularly as one with the bulk of its reimbursement under Medicaid?
We have specifically sought to improve equity and inclusion through our institutional goals surrounding eradicating health disparities, improving clinical and academic excellence and creating a people-first culture at our institution. This will not only benefit our patient population but everyone in society.
All healthcare institutions—MetroHealth included—should strive to reflect the communities they serve. That is why we have made a concerted effort to expand our talent pipeline to better represent underserved populations and increase the diversity among our leadership. This is a central component of DEI because we trust people who look like us, who have the same lived experience, who have shared our struggles.
We also launched a series of community conversations across our service area to hear directly from the communities we serve about what we are doing well, what challenges remain and how we can close the gaps that exist. We are also creating permanent community advisory councils that will build off these listening sessions and ensure more voices are included in the decisions we make, from future clinical investments to the facilities we build and where we build them.
Finally, we host a series of Multicultural Health Fairs and Expos in the communities we serve to address the issues underserved populations face every day. Our next event, dedicated to women’s health, takes place on September 30. It will feature free health screenings, panel discussions and empowerment sessions on a range of topics from social isolation to breast cancer and heart disease to job training.
Our ultimate goal is to ensure that DEI remains at the forefront of everything we do to support the communities we serve.
Where do you see DEI at MetroHealth in the next five to 10 years?
It is our distinct hope that in a decade we will have made significant progress in improving diversity, equity and inclusion at the institutional level while also making real movement on eradicating health disparities in our communities. We are confident this is possible, but to accomplish this goal, we must transform healthcare by becoming more patient-focused, more community-focused and more willing to change. And above all we need to listen more – to our employees, our patients and our communities.
When everyone has a voice and a seat at the table, we make more inclusive and equitable decisions that have a more positive impact on our communities.
Can you describe the Institute for H.O.P.E.’s focus areas and how it informs MetroHealth System’s approach to addressing social determinants of health (SDOH)?
MetroHealth launched the Institute for H.O.P.E. (Health, Opportunity, Partnership, Empowerment) in 2019 to address the health-related social needs facing our patients – things like access to food, safe housing, transportation, and job opportunities. Other factors include social isolation, intimate partner violence, and digital connectivity.
MetroHealth screens all patients for these factors, which are often called the social drivers of health. Individuals who identify specific needs and indicate they are interested in help are connected with partner agencies that can provide food, housing, economic assistance, and other support services. We are also implementing new software that will assist us in further connecting and following up with individuals who have been screened to ensure they are receiving the support they need.
Whether these determinants are related to the built environment or the fabric of a community, addressing them helps create healthy social and physical environments that are proven to lead to better health outcomes.
To date, we have screened more than 120,000 individuals, and the data is also being used to better inform the Institute’s work and other clinical and research efforts at MetroHealth. The screening has been successfully implemented in our outpatient settings and will soon be added to inpatient intake procedures.
In addition, Institute for H.O.P.E. manages MetroHealth’s Food as Medicine program, which works with patients who have nutrition-related illnesses, such as diabetes and heart disease, to develop healthier eating habits and ensure they have access to foods that best meet their medical needs. This is based on research that shows that medication along with a healthy diet is significantly more likely to improve treatment of these illnesses than medication alone.
Moving forward, the Institute for H.O.P.E. will be heavily involved in MetroHealth’s broader efforts to enhance community engagement and expand access. This includes supporting our involvement in the Greater Cleveland Food Bank’s Community Resource Center in Cleveland’s traditionally underserved Collinwood neighborhood. The effort seeks to collocate outpatient medical services with social service agencies that can provide holistic care and support for patients. Participating organizations can refer individuals to the onsite MetroHealth clinic, which can also connect patients with additional social services that address specific SDOH challenges they face. The center is expected to open this fall, and the outpatient clinic will open in early 2024.
How does your organization use digital patient engagement technologies to address health disparities in the community that MetroHealth serves?
The pandemic led to numerous opportunities to expand telehealth services, virtual care models and overall use of new technologies. MetroHealth has sought to take full advantage of these avenues to first support our patients during COVID-19 and now to enhance convenience, healthcare access, and overall clinical innovation across the enterprise.
For example, the Hospital in the Home program was launched in 2020 to provide COVID-19 patients with high quality in-home healthcare that reduced hospitalizations and the danger of infection for caregivers. Patients received regular virtual visits with doctors and were provided diagnostic devices, by mail, to regularly monitor vital signs which were electronically transmitted to clinicians who could monitor remotely. Since then, the program has expanded to support inpatient or observation levels of care for those with acute conditions such as heart failure, COPD, cellulitis, pneumonia, and kidney infections. Qualifying patients receive daily nursing and doctor/provider visits, both in their home and virtually, along with medical monitoring of vital signs. The effort allows patients to stay in their homes to receive acute care, reduces the risk for hospital-acquired infections (HAIs), and decreases the need for transportation for regular hospital visits, which is a significant barrier for many patients in underserved communities.
MetroHealth is also partnering with the local service organization DigitalC to address the digital divide which prevents many individuals from taking full advantage of virtual care. The collaboration received support from the Federal Communications Commission and DollarBank to deliver high-speed, low-cost internet access to multiple Cuyahoga Metropolitan Housing Authority (CMHA) apartment complexes and provide digital skills training to residents. The effort will increase access to virtual delivery models and online appointment scheduling, while also providing skills that can support individuals in applying for jobs online and accessing additional social services.
In addition, we are working with Wolters Kluwer to optimize the Emmi patient education platform and engaging patients with certain social risks. Every patient that screens at high risk for social isolation, physical activity or stress through our Epic-based SDOH screening process automatically receives educational content related to the specific area of risk. Access to this material is available in multiple ways to meet various patient circumstances, including delivery via MyChart, e-mail or telephone.
