New consult service helping alleviate bias, discrimination at U-M Health

November 16, 2022  //  FOUND IN: Strategy & Leadership,

Approximately a 5-minute read.

Key takeaways:

  • The Healthcare Equity Consult Service supports patients and families who feel their care is affected by bias or discrimination.
  • Five case managers staff the service.
  • They reflected on the first few months of the service and how it is enhancing the work being carried out at U-M Health.

The Healthcare Equity Consult Service recently launched at U-M Health. This first-of-its-kind service seeks to support patients and families who feel their care is affected by bias or discrimination of any kind. The program supports the belonging and inclusion priority in the BASE strategic framework that guides the work within U-M Health. 

It is staffed by five case managers: Syma Khan, Samantha Guyah, Prianka Shakil-Brown, Kamau Ayubbi and LJ Brazier. 

Headlines recently had an opportunity to sit down and have a conversation with these case managers and get their perspective on this new service, common themes they have seen, and how faculty and staff can improve inequities in health care and access to care.

Here’s what they had to say:

What prompted you to join this service?

Guyah

Guyah: Breast cancer really impacted my family as well as violence in the community, and [I know] that African Americans have the highest mortality rate in the breast cancer population. I’ve always had this calling to really work with patients and families, to advocate and bring awareness. I appreciate the opportunity to make change and I couldn’t resist.

Shakil-Brown

Shakil-Brown: In my work as a palliative care social worker, I am already in charged situations. You add all the health inequities on top of that and I feel that this is something that we can do better. We can’t change all these complex chronic illnesses, but we’ve got to be doing better to change the things that we do have the ability to change.

Brazier

Brazier: Social bias and stigma have been serious safety issue since the birth of institutionalized and specialized medicine. Addressing it is work that calls for all of my skills – social ethics, medical ethics, spiritual care and health care business. This seems like the most important thing I can do for Michigan Medicine and our community.

What has impacted you most while working on this service?

Khan

Khan: Personally, it’s touching when I meet with families and discuss what their concerns are. They just really appreciate it, having a space to have their concerns noted and feel like someone’s really listening. They also appreciate that we could help them. They didn’t want other people to experience the challenges that they’ve had. 

Shakil-Brown: Often, as an individual provider, I felt stuck in how far I can escalate a situation. This service has given me an outlet to ensure these issues are being addressed. 

Guyah: The theme that screams out to me is that we use such stigmatizing language in our work and that is pervasive and long-term. So, every time a provider reads that chart, they frame their own perception of that person without meeting them. The pattern of our language, the use of our chart and how we describe the patient who we’re caring for really sets the tone for their outcomes and their interventions. 

How do patients and families react to the consult service?

Ayubbi

Ayubbi: In one of my cases, the request was initiated by a physician. He told the patient that he was going to consult the service. They [the family] were very welcoming and open to their experiences being heard and reported as something that needed to change. I think there is an openness for their [patient and family] voices to be heard. Since the institution is offering this, there is confidence that there is an outlet to address [health equity issues].

Guyah: I’ll echo that us doing this work validates all those ‘icky’ feelings [in our patients and families] that come with feeling discriminated against or stigmatized. We say, ‘we get it,’ ‘we hear you,’ and ‘let’s do something about it.’ 

How does the care team handle feedback from the case managers?

Shakil-Brown: By the nature of the work we are doing, no one is going to enjoy hearing the things we have to say. No one likes hearing that something racist or biased happened, that harm was done, no matter how unintentional it was. But I think it’s the way in which we try to elicit the perspectives and try to meet people where they’re at is what’s important. 

We provide recommendations and [different] language, but also empower people to partner with us and be able to have those conversations themselves. It is not just about the five case managers, but other people in the institution who are also championing these efforts. We want to provide education that will be effective and helpful.

Khan: We all approach cases with the positive intent of helping others. In social work, we talk about intent versus impact. We help the team recognize that their behavior did impact the patient, even if it was not their intent. We want to address the harm that was caused, knowing our shared goal is to support that patient and help them recover. 

What advice would you give to providers?

Ayubbi: To echo what was said earlier — there is nuance and complexity in trying to understand that words like ‘goes against medical advice,’ ‘non-compliance,’ or ‘drug-seeking’ have power. These are considered objective statements, but there are stories and narratives behind the phrases. They can become subjective, sometimes very oppressive and perpetuate more stigma. So, it’s important to question and re-evaluate word choices when you have authority as a medical provider. Use other language when you can. Start a new narrative so that patients can be seen accurately, and they are not approached with fear. 

Guyah: When we talk about alternative language, people ask what do I use instead? The American Medical Association, the Psychology Association and Centers for Disease Control all provide guides on patient-centered language. 

Brazier: Breathe. Take breaks. Allow yourself to get curious. Working in a high reliability organization means letting go of the assumptions that we’re always experts, opening ourselves up to challenges, feedback and opportunities for improvement all the time. It’s not easy, but it feels good to do things well and get things right! Social bias and stigma have been a serious safety issue since the birth of institutionalized and specialized medicine. This is a critical and exciting opportunity to make enormous progress toward being a more highly reliable organization. We’re here to help everyone be a part of being the leaders and the best. 

What can we do as a system to improve equity and access to care for all?

Ayubbi: As we talk about language, we should evolve with the desire to improve our knowledge, to serve in a better way, to listen in a better way and to ask questions in a better way. 

Khan: I think we should monitor health equity like we monitor other health outcomes like sepsis or infections. Health equity should be a standard thing we reflect on in every case, not just a special circumstance. We are here to support the teams — but these conversations need to happen in all areas, not just when we are present.

Brazier: Stay tuned! We and our advisory council are working with partners throughout Michigan Medicine to make these recommendations. We’ve already successfully worked with several departments to enact positive changes. We’re excited to continue doing that and to continue learning how to do this work as effectively as possible.

The Healthcare Equity Consult service is currently supporting inpatient areas with ongoing plans for a permanent structure and expansion to other areas within U-M Health. If you feel that you or one your patients may benefit from consult with the service, request a consult through MiChart or page 38571. To learn more about the service, visit the Healthcare Equity Consult site.

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