As healthcare leaders and clinicians, we must “walk the walk” to promote inclusiveness and recognition of inequality. The noticeable influence of racism permeates heavily throughout our society, with healthcare injustice being one of the most pervasive and dangerous determinants.
2020 was a watershed year for healthcare justice. The pandemic, which killed Black and Hispanic Americans at disproportionate rates, illuminated the racial fault lines running through our health system. Meanwhile, the murders of George Floyd, Breonna Taylor, Ahmaud Arbery, and others highlighted the discrimination and danger Black citizens face in their daily lives.
So as leaders, how can we keep the wheels of justice turning in 2021? For inspiration, I recently sat down with Carolyn Caldwell, FACHE, president and CEO of St. Mary Medical Center in Long Beach, California. Carolyn’s healthcare experience spans 30 years, including 20 at the executive level. She holds a bachelor’s degree from Alabama A&M University and a master’s degree in healthcare administration from Texas Woman’s University and is a fellow of the American College of Healthcare Executives.
In today’s interview, she shares some inspiring thoughts on how we can improve healthcare for all.
Q: To me, the social justice gains we made in 2020 still feel fragile. What are your thoughts, Carolyn? Once we get past the pandemic, do you think we’ll see lasting change?
Carolyn Caldwell, FACHE: I’m really hopeful about this. While we all hate what happened to George Floyd and other victims of racially motivated violence, their stories forced us to pause and appreciate the trauma and discrimination many Americans live with. So I believe the focus on healthcare justice is here to stay because these tragedies really touched people in ways they can’t forget.
Fundamentally, healthcare justice starts with valuing diversity, and I think our leaders are embracing that message. For example, our mayor here in Long Beach just gave his State of the City address, and diversity was front and center. So while there’s hard work ahead, I’m guardedly optimistic.
Q: Vaccine distribution (or lack thereof) highlights many of the inequities in our healthcare system. What needs to happen to improve vaccination rates in diverse communities?
CC: I think sometimes we believe that just because we’ve got clinics, health centers, and now vaccination pods, patients should just come to us. However, many of our essential workers don’t have the luxury of leaving work — twice — and traveling across town to the convention center for a shot. And what about older people? Now that we’re vaccinating patients over 75, we’re realizing that sign-up and scheduling apps don’t work for that population. So we really need to think about how we can bring care to patients, not the other way round.
Another barrier to vaccination is trust. Throughout history, researchers have either exploited Black patients or neglected them. One reason we desperately need diversity in healthcare is because patients tend to trust people who look like them. I've had minority patients ask me, "Are you going to get the vaccine? Can we trust it?" And it's powerful when those of us who understand the science can say, "You can get this, and you need to.” That’s the way that we're going to all heal as a country.
Carolyn Caldwell, FACHE
President and CEO
St. Mary Medical Center
Q: What are your thoughts on the emergence of virtual care? Is the trend toward telehealth opening up access for underserved patients?
CC: Virtual care has helped my hospital reach more patients during the pandemic, including those most at risk. A great example is our CARE Clinic, which was established in the 1980s to assist people living with HIV and AIDS. In addition, we now offer comprehensive primary care, behavioral health care, and dentistry regardless of ability to pay.
When the pandemic hit, the clinic had to stay connected to these vulnerable clients. So probably more than any other department in our system, they leveraged telehealth. This was a very challenging time for their clients, especially those with behavioral health needs. Fortunately, the providers know and understand their patients and used telehealth to make sure they didn’t fall through the cracks. We were proud to provide that level of service, and it convinced me that when it comes to health disparities, virtual care will be part of the solution.
Q: As we move into the post-pandemic period, what new health disparities might we face?
I was reading an article this week that really made me think about this, particularly now that I know people who have survived COVID. It was about post-COVID clinics. The idea was that while most people recover, some still have long-term complications. And it got me thinking about how to extend this service into our underserved communities where people were disproportionately affected but have less access to follow-up care.
We want to make sure we're following up with COVID patients over time, checking their lungs, checking their kidneys, and so on. And maybe as a system, we need to partner with FQHCs, which provide much of the care for our [Medicaid] and uninsured populations. We also need to ensure that anyone who qualifies for healthcare coverage gets signed up.
Q: We’ve talked about the importance of expanding care beyond hospital walls and into communities. Are there other key areas we need to address?
CC: I think recruiting is going to be crucial, especially in diverse areas. We’ve seen firsthand that patients experience better outcomes when their doctors look like them. It’s also important to recruit locally when possible. Patients deserve providers who understand the history, needs, strengths, and challenges of their communities.
Q: Have you seen any examples of healthcare justice in action this year that you’d like to highlight?
CC: In the summer, when we saw social unrest across the country, our two CommonSpirit Health
CEOs Lloyd Dean and Kevin Lofton got in front of it right away. They sent a letter to all employees denouncing systemic racism and calling for justice for the victims. And to see it happen at that level of the organization was very touching. When you work for a large corporation, you sometimes hear strong words from your local leaders. But to hear it straight from the top was really telling and very heartwarming.
Q: Wow, that’s amazing to hear. When people in an organization see that level of passion, support, and endorsement from the top down, it really motivates them to think differently and get involved. Carolyn, thanks so much for sharing your wisdom today. It’s truly an honor.
CC: Likewise! Here’s to surviving 2020 and better times ahead. I look forward to working with you and all our healthcare justice champions to create great things in the new year.
For more insights from healthcare leaders on bridging the healthcare equity gap, view the replay of a recent webinar hosted by Vituity and featuring Imamu Tomlinson, Carolyn Caldwell, and Howard University’s President, Wayne Frederick.