This feature was written by Studio MSP writers. While some of our advertisers were sourced, no advertiser paid to be included.
When it comes to our home state, there’s a lot to take pride in: our music-rich culture, our bounty of freshwater lakes, our extraordinary measure of winter fortitude. We still rank pretty high as a headquarters state. But in the summer of 2020, our backyard became the home base of a racial reckoning that rippled throughout the globe, forcing societies everywhere to take a mirror to the ugly parts of their biases and business practices and try to right decades of inequitable wrongs. Minnesota is, unfortunately, no stranger to racial disparities, even as our proverbial trophy case swells with “best of” lists and top rankings, and when George Floyd was murdered, some places felt a profound sense of urgency to take their diversity, equity, and inclusion (DEI) initiatives from words to deeds.
Of course, the follow-through on both a local and national scale wasn’t great—fast-forward three years, and some companies have done little more than share a one-and-done Instagram post pledging a “more inclusive future.” Health care communities, in particular, are feeling the heat in finding ways to address the industry’s deep-rooted history of microaggressions and conscious and unconscious discrimination and to reimagine an all-inclusive health care delivery model. There’s a lot at stake when the CDC declares racism a “serious public health threat.”
Ahead, a peek at the programs some of our local health care institutions are pioneering to create real, structural change and, as a result, move communities toward a healthier future with better outcomes for all.
Hennepin Healthcare
When Nneka Sederstrom started as chief health equity officer of Hennepin Healthcare in 2021, a role that was literally created for her, there was no blueprint on how to rise to the challenge that was presented by the organization’s board and leadership: Address racism and health inequities from the top down. She had to get comfortable with leaning into the ambiguity—and fast.
When it comes to problems that are bigger than ourselves, “you can’t get over it if you don’t start walking,” she says. “Start walking, and as you walk, yeah, you’ll fall and hurt yourself. But it is not insurmountable—we have been making a lot of progress since the formation of this country.” She says it’s important to remember that racism was central to the formation of America—it was never separate. “It is the foundation of our country, so you can’t undo a foundation if you don’t, one, own it, and two, start making changes.”
So Sederstrom started to take measured steps at Hennepin Healthcare and, within a matter of months, spearheaded the company’s first-ever dedicated Health Equity Department. That first year, she says, was mainly dedicated to planning sessions with her core team of six, but it did give rise to internship programming and a series of summits called Youth with Stethoscopes, aimed to help Black and Brown kids fall in love with medicine. It’s in its third year now and has expanded to targeting Latine youth and, new this year, American Indian youth. From 2021 to 2022, 296 youths of color underwent the program and passed the emergency medical responder (EMR) certification exam, and several individuals went on to serve as summer interns at Hennepin Healthcare, getting the opportunity to shadow professionals on the job all while getting paid.
“It’s important for us to not only understand how our community sees us but understand what they need from us,” she says. An EMR certificate will allow these young adults to work in EMR positions once they turn 18—as it stands, Minnesota’s EMS workforce is disproportionately white (70 percent, compared to 2.8 percent Asian, 2 percent Hispanic, 1.9 percent Black, and 1.9 percent American Indian or Alaska native).
Five months into 2022, the board approved a strategy to add 28 new positions to Sederstrom’s team. “These weren’t positions you could just search for on salary.com,” she says. “We had to think through what ‘holistic health’ would look like and figure it out on our own.” These positions were bucketed into different divisions, or subspecialties, spanning from workplace wellness to community engagement and health equity education—all grounded in DEI.
“We have a massive amount of educators and thought, Beyond an educational experience, we have to provide real-time bedside interventions, so we created a DEI clinician role, where mental health–trained, PhD-level professionals are positioned to help ‘in the moment’ discussions around racism,” she says. “When you’re stressed, you revert to your normal, and your biases can get magnified because you don’t have the brainpower to stop it.” The clinician acts as a bridge between the patient and the care team to help address cultural nuances together.
“During a time when health care is losing money, people are cutting jobs, there’s a COVID crisis, and payments aren’t coming in the right way, I got 28 roles and $5 million added to a health equity budget. Nobody does that!” —Nneka Sederstrom, Chief Health Equity Officer / Hennepin Healthcare
As part of the nine employee resource groups (ERGs) her team has launched for a host of gender-, ethnicity-, and identity-based groups, DEI coaches have created an outlet for team members and senior leadership to share experiences and challenges.
“We’ve done a big push to create safe spaces for employees to bring up bedside racism, so we created an ‘end racism’ inbox to submit in-the-moment stories and questions, and that gets triaged through our health equity team,” she says. “We established an anti-racism policy [internally and externally]; anti-racism is not a nice-to-have.”
She says you can’t claim to be a high-quality center for excellence if outcomes for Black and Brown people are abysmal. “That’s not what we put on our doors…. You’ve got to do the work.”
At the time of print, Sederstrom said she had just hosted her first full department meeting. Much of the conversation was centered on the 22-page Health Equity Report that they produced and compiled for the general public, outlining internal and external efforts, goals for 2023, and recent acknowledgements, including the highly coveted NCQA Health Equity Accreditation.
“A Star Tribune reporter asked me recently, ‘Why publish the report and not keep it internal?’ I said, ‘We want transparency and for other [health systems] to see that we’re trying [to make inroads] without a road map,’” she says. “During a time when health care is losing money, people are cutting jobs, there’s a COVID crisis, and payments aren’t coming in the right way, I got 28 roles and $5 million added to a health equity budget. Nobody does that! It was done because I was able to tell the story on how I know these things could be fixed.
“We’re vulnerable enough to tell others to look at our report—and to say, ‘Go ahead, judge us!’ There’s no way we’re going to make change in our country if we don’t open up our stuff and say, ‘Have at it—it’s all out on the table.’”
Children’s Minnesota
When the communities you serve are 40 percent people of color, as a business and a provider of people-centered care, you have an intrinsic duty to reflect equitable healing and access for all patient families, says James Burroughs, senior vice president, government and community relations, and chief equity and inclusion officer of Children’s Minnesota. “As the kid experts, Children’s Minnesota has a mission to champion the health needs of all children and families in our community,” he says. This requires removing obstacles to health, like poverty, and addressing the consequences of discrimination, which can lead to a sense of powerlessness and a lack of access to good jobs with fair pay, quality education, safe housing environments, and health care.
Since 2016, when Children’s Minnesota became the first health system in the state to explicitly name racism a priority health issue, the organization has acknowledged its own structural disparities and made efforts to advance diversity and inclusion in the workplace. In 2018, president and CEO Marc Gorelick joined the CEO Action for Diversity and Inclusion pledge. “At Children’s Minnesota, we strive to make diversity and inclusion a part of all we do—from patient care, to business operations, to how we treat one another,” Gorelick said in a press release. Burroughs joined the team shortly thereafter and was instrumental in establishing Children’s Minnesota as a founding member of the Minnesota Business Coalition for Racial Equity.
Beyond medical care, Children’s Minnesota’s Community Connect Program connects families in its Minneapolis and St. Paul primary care clinics to existing community resources, including food pantries and benefit programs, transportation services, legal assistance, housing support, early childhood education programs, and more. Burroughs says it’s a systematized approach to be responsive to social needs, with particular attention to families of color and Native American families. The process entails a yes-or-no form that asks families about access to essential needs. Their responses trigger real-time referrals to the team of resource navigators, who work with the families to determine which resources may be most helpful.
“Our data shows that families who enroll in Community Connect program end up needing less emergency room services and instead receive more care at the clinic and go to their regular checkups for their kids,” says Burroughs. “Those kids are also more likely to have well-controlled asthma.” In 2022, the program was selected as one of five to win the American Hospital Association Dick Davidson Nova Award, which recognizes the program’s contributions to improving community health.
Children’s Minnesota has also made a conscious effort to partner marginalized patient populations with cultural navigators, who are more than just interpreters—they guide families with culturally diverse backgrounds and health literacy needs through various aspects of their care journeys. “In our cancer and blood disorders program, we have our limited English proficiency patient family advocate,” he says. “The advocate is part of the care team, advocating on behalf of Spanish-speaking patients and their families, helping them understand the diagnosis.”
Evidence has shown that when providers and patients share the same race or ethnicity, the patient has better medication adherence; experiences higher patient satisfaction; and has a better sense of safety, validation, and trust. Health care systems have a responsibility to diversify the health care workforce. “We have dedicated employees doing the work of advancing diversity, equity, and inclusion work across our system,” Burroughs adds. “Our talent acquisition develops strategies to not only recruit but retain and engage a diverse workforce.” In 2019, 19 percent of staff at Children’s Minnesota were people of color. That number has risen to 24 percent, and the goal is to achieve 34 percent by 2024. Other quantitative measures of impact include increasing the promotion rates of diverse employees; better race, ethnicity, and language data capturing for both employee and patient information; and raising engagement numbers of employees with ERGs.
“Our data shows that families who enroll in [Children’s Minnesota’s] Community Connect program end up needing less emergency room services and instead receive more care at the clinic and go to their regular checkups for their kids. Those kids are also more likely to have well-controlled asthma.” —James Burroughs, Chief Equity and Inclusion Officer / Children’s Minnesota
Some employees have taken measures into their own hands, like clinical nurse specialist Heidi Shafland, who recently launched a hair care training program for health care workers to help them understand how to properly care for textured hair. “Literature really reflects that health care workers are not taught about textured hair care and how to care for Afro-textured hair and really what can happen if we don’t treat textured hair the way it needs to be treated…. It can cause hair follicles to fall out,” her colleague Courtney Kenefick said in a recent interview. “But additionally, it is a respect and dignity concern as well.”
HealthPartners
In 2021, a few doctors at HealthPartners got together and decided to take their analytic minds beyond the hospital walls, giving rise to a bimonthly podcast series called Off the Charts: Examining the Health Equity Emergency. Hosts Dr. Kari Haley and Dr. Steven Jackson bring in leading guest experts to talk about health care disparities, social determinants of health, and ways to effect change through open dialogue. Recent releases have tackled subjects like diversity in firefighting and emergency medical services, Black maternal health, and connecting communities of color to movement and the outdoors. “We’re also focusing on investing in the early intervention in birthing parent–infant health,” says Dr. Yeng M. Yang, medical advisor and co-chair of the HealthPartners Equity, Inclusion, and Anti-Racism Cabinet. Examples of this include “the Early Risers podcast with Minnesota Public Radio, which helps parents have conversations about race and racism in early childhood.”
University of Minnesota Medical School
Ana Núñez, vice dean for diversity, equity, and inclusion at the University of Minnesota Medical School, says she was compelled to move here from Philadelphia after seeing how the campus was making DEI a part of its inner teachings and community outreach. “In the difficult times, with the fires and smoke [that enveloped south Minneapolis in the aftermath of George Floyd’s murder], our Community-University Health Care Center jumped right in,” says Núñez. In the week that followed, “we were in the parking lot with food and water and supplies for people in the community. It wasn’t because there was a camera on them…it was because they were genuinely worried about the population.”
In the two and a half years since she joined the ranks, she says that addressing health inequities and being socially responsive is just the bottom line as a public land-grant research institution. “There are missions [here] for excellence in education, excellence in research discovery, and excellence in health care,” she says. “So what we have to look at is, what kinds of structural transformations do we have to undergo to get rid of the barriers?” She uses the idealized-firefighter-of-yesteryear analogy to make her point: “Back in the 1920s, it was touted as a great job—you had a union and steady food, and they said, ‘Hey, anybody can be a firefighter! You just have to be six foot five and be able to bench press 300 pounds,’” she says. Obviously, only a slim swath of the population possesses those qualifications, so “what are the invisible obstacles keeping you from reaching success if you’re a first-generation college student?”
She says that each of the school’s 27 departments has its own designated DEI lead and council. “How you strive for inclusivity in, say, orthopedic surgery looks differently than it would for pediatric medicine—it isn’t a one size fits all,” she adds. Having an individualized approach extends to a program called the Early Career Research Award, which provides dedicated funding to support recruiting early-career research faculty who are underrepresented in medicine. “We get people from across the nation to come with us to build out wonderful careers—we help create individualized development plans and match those scholars with mentors as they explore science challenges like PTSD or heart disease in women, helping them get established as diverse faculty members.” The recruited faculty members will also be provided with $500,000 in start-up funding to be used to support their research.
“We get people from across the nation to come with us to build out wonderful careers—we help create individualized development plans and match those scholars with mentors as they explore science challenges…helping them get established as diverse faculty members.” —Ana Núñez, Vice Dean for Diversity, Equity, and Inclusion / University of Minnesota Medical School
While the U has somewhere around 300 activities, workshops, and training programs combined to address racism in medical education—from affinity groups to a Bias Response and Referral Network and the conception of the Health Equity Work Group, whose mission is to give greater visibility to health inequalities research at the University of Minnesota School of Public Health and nationally—the school also counts a number of DEI interventions grounded in the arts and humanities.
Núñez says that TPT-Twin Cities PBS partnered with the U’s Center for the Art of Medicine to explore health care through story, song, and the arts through a four-part series called Art + Medicine. “Speaking of Race,” which premiered in April of 2022, featured physicians sharing stories about racism and anti-racist efforts in the medical community—it clinched an Upper Midwest Emmy Award.
Núñez cites the school’s advocacy efforts in addressing long-standing injustices in medical education. For decades, doctors used two different calculations to measure kidney health: one for Black patients and one for non-Black patients. The school and its affiliated hospitals stopped following this practice two years ago. In a press release, Dr. Kristina Krohn, who chaired the task force, said, “The race-adjusted eGFR algorithm makes a Black person’s kidneys seem healthier than they may really be. That can result in delays if that person needs access to nephrologists or counseling to manage their chronic kidney disease … As we find a better way, we need to stop doing what we know is causing harm.”
Núñez says the school has made great strides—the faculty is now made up of 26 percent of people of color—but Núñez acknowledges that it’s a work in progress. “If you don’t have all the voices around the table, you’re not even going to ask the right questions in the first place—right?”
Allina Health
“Health equity is a key strategic goal supported by our population health system strategy,” says Jacqueline Thomas-Hall, vice president and chief diversity, equity, and inclusion officer for Allina Health. “We review all the work related to DEI&B [diversity, equity, inclusion, and belonging] to improve outcomes with a focus on equity for our patients, employees, and communities served.” Thomas-Hall says that examples of responsiveness to health equity needs on behalf of Allina teams and departments include the rollout of COVID-19 community vaccination clinics, a patient cultural navigator pilot program, identifying cultural competency as a leader capability, and interpreter services that include more bi- and multilingual staff members. “We’ve increased our colorectal cancer screening goals for African Americans; nearly 20 percent of our leadership team are leaders of color; and 190,000-plus patients received our social needs screening assessment at point of care,” she adds.
Sources and Resources
Blue Cross and Blue Shield of Minnesota, Eagan, bluecrossmn.com
Children’s Minnesota, Multiple metro locations, childrensmn.org
HealthPartners, Multiple metro locations, healthpartners.com/partner
PrairieCare, Multiple metro locations, prairie-care.com/together
Rainbow Health, St. Paul, mnwalktoendhiv.org
Sankalpa Therapy and Wellness Center, Bloomington, sankalpatwc.com
University of Minnesota Foundation, Minneapolis, z.umn.edu/CARHE