Meghan Lane-Fall, MD, MSHP, of Anesthesiology, wears a mask and a face shield labeled “Dr. Meghan” while speaking to a seated woman wearing a blue mask.In June 2020, nearly 1,000 people from Penn Medicine and CHOP gathered in Franklin Field to kneel in memory of George Floyd and other victims of racism during a White Coats for Black Lives rally. A week later, Penn Medicine held a virtual Town Hall attended by over 1,200 people and replayed nearly 1,000 times. This community dialogue would be the first of many opportunities for Penn Medicine faculty, staff, and students to talk openly about race and racism — a critical component in the transformation of Penn Medicine to become an anti-racist, equitable, diverse and inclusive organization. By the end of that month, Penn Medicine had launched ACT (Action for Cultural Transformation), the framework leading to those crucial goals.

ACT is the enterprise-wide unifying plan for all of Penn Medicine. It is co-led by Eve Higginbotham, MD, ML, vice dean of the Office of Inclusion, Diversity, and Equity (OIDE) in the Perelman School of Medicine, and Dwaine Duckett, SVP and chief Human Resources officer of the Health System. The team knew from the outset that making sure all voices were heard was key; it was not to be a “top down” effort. Specially trained volunteers used multiple approaches — anonymous online forms, virtual community dialogue forums, group-led discussions, and town halls — to gather data in open, unfiltered, unbiased conversations from more than 5,500 faculty, staff, and students over a span of months. From this feedback came six strategic priorities to accomplish the ACT vision.

The efforts to transform the culture have continued throughout the year — and will continue to expand. ACT leaders note that this process is very much a marathon, not a sprint. Still, positive changes have already occurred.

Armenta Washington, MS, senior research coordinator, holds cards about health information while speaking with a man wearing a Black Lives Matter cap.“We are committed to cultural transformation at Penn Medicine,” said J. Larry Jameson, MD, PhD, EVP of the University for the Health System and dean of the Perelman School of Medicine. “The ACT initiative is a framework for enduring change, and we will not let up.”

As Health System CEO Kevin B. Mahoney noted, this transformation is both essential and inclusive: “Providing world-renowned care is synonymous with providing equitable care,” he said. “We are using every means at our disposal to address health inequities in an intentional, targeted, and culturally appropriate manner — and we are doing it together.”

One year into this ongoing process, here is a snapshot of the progress underway. The work spans six key “pillars,” the strategic priorities identified from the inclusive, months-long discovery process: clinical care, research, education, community, culture, and people.

Engaging Every Person in Learning and Change

One early goal was to have every person at Penn Medicine undergo unconscious bias training. Significantly, more than 98 percent of employees have now completed the training. These online trainings were led by expert facilitators who combined instruction and interactive exercises with videos, and many participants logged off at the end of the session feeling informed and empowered. “We walked away with a strategy on how to move forward and address such incidences [of unconscious bias] in the work environment or in our personal life,” one wrote in feedback. Another commented, “I now have resources and ways to work through these biases.”

Unconscious bias training was an essential part of the People pillar under ACT, which encompasses education for staff and leaders, training and advancement opportunities, consistent expectations and fair recognition — all in support of greater diversity at all levels of the organization.

“We need to continue connecting with our people and our communities as a premier source of employment and economic opportunity in the Philadelphia region,” Duckett said. “In the Health System we have the privilege of being able to impact individual lives through providing jobs and promotions, all while fulfilling our mission around providing excellent care.”

In parallel, ACT’s Culture pillar aims to build ongoing learning into the culture of Penn Medicine, among other goals that help to establish unity across the organization in becoming an anti-racist culture.

“Our power is in numbers,” said Larissa Morgan, MSN, RN, HUP Nursing Professional Development specialist and co-leader of one of the four key action items within the pillar focused on culture with Phillip Ramautar, MSW, of Clinical Resource Management at Chester County Hospital. “We need to come together to do this. We’re moving something big, and it has to be moved together.”

Equitable Care for Patients, Now and in the Future

This June, 4,000 Penn Medicine primary care patients received a package in the mail that could save their lives. Inside the friendly blue box slightly larger than a thick paperback book, they found an at-home testing kit that could help determine if they needed more advanced screening and ultimately treatment for colorectal cancer. Colorectal cancer is the second-leading cause of cancer death, and Black patients are 20 percent more likely to be diagnosed with it and 40 percent more likely to die.

Improving colorectal cancer screening rates is among the highest-level goals set by Penn Medicine’s leadership for the entire organization this year, connected to the ACT’s Clinical Care pillar. The testing kits, targeted to patients living in neighborhoods with low overall screening rates, were one of many ways Penn Medicine has tackled this disparity. The results of the overall effort, which also prioritized community outreach, are clear: In the last fiscal year, more than 70 percent of Penn Medicine’s Black adult patients ages 50-75 were screened, higher than the overall national average for adults of 68 percent in 2018 (most recent available data). That rate was not only on par with screening rates for white non-Hispanic patients, but also remarkable for an achievement during the pandemic, when most cancer screening rates nationally declined.

Karimah Ferguson holds her baby while looking at text messages on her cell phone that she sent to Penn Medicine when monitoring her blood pressure after her delivery.Parallel system-wide efforts are helping to drive improvements in pregnancy and birth outcomes for Black mothers and their children — an essential effort that OB-GYN Chair Elizabeth Howell, MD, MPP, calls “a unique opportunity to meet the moment at a transformational point in our patients’ lives.” It matters, especially, she added, because “healthy moms delivering healthy babies are the foundation of setting up healthy communities.” Penn Medicine is also now leading the field in diagnosing and treating anemia in all pregnant patients based on the same clinical measures regardless of race. The current national standard — which Penn researchers are advocating to change through evidence-based research — requires Black patients to have a lower level of iron in their blood than non-Black patients before they are considered anemic and in need of treatment.

The push for health equity driving these broad goals did not stop there. Penn Medicine has sought to change clinical practices that perpetuate disparities in health care such as other medical test parameters that are applied differently based on a patient’s racial background, in multiple disciplines beyond Obstetrics and Gynecology. Plus, ongoing monitoring of health equity data is now built into the Health System’s quality improvement systems. As a result, any clinician who wants to work on a quality improvement initiative can filter data based on groups of patients’ demographic characterisitics such as race, ethnicity, or LGBTQ identification, to spot patterns of inequities that need to be addressed. In addition, there is an always-on Health Equity Dashboard where specific health measures such as 30-day readmission rates are shown in an at-a-glance view of potential differences across demographic groups as well. Penn Medicine has partnered with an external agency for ongoing monitoring and grading of the Health System’s efforts to improve inequities in areas of the dashboard where racial/ethnic disparities were identified in the past.

When it comes to discovering and testing future treatments — and training future doctors and scientists — efforts underway through the ACT Research and Education pillars are helping to extend today’s health equity advancements toward sustained change in the future. Among goals in the medical school for Education are various curriculum efforts to ensure that graduates are prepared to advance equity. As an example of the type of research work that will continue, the Abramson Cancer Center (ACC) reported this year that it had doubled the percentage of Black participants in cancer clinical trials by engaging in community-based outreach, promoting studies that address the cancer burden of Black residents, and more.

“We’ve shown here that a multifaceted, community-based engagement initiative works to improve access to cancer clinical trials by Black patients with cancer,” said Carmen E. Guerra, MD, MSCE, FACP, an associate professor of Medicine and associate director for Diversity and Outreach in the ACC.

Enriching Our Community

Forging strong partnerships with the community to enrich the community’s health and wealth is a key component of the final pillar of ACT: Community.

“During the fall 2020 influenza season, our staff and providers came together to set up pop-up vaccine clinics at two local churches and two domestic violence shelters to improve vaccination access and provide education about vaccines, noted Renée Betancourt, MD, an assistant professor and vice chair of Diversity, Equity, and Inclusion in Family Medicine and Community Health. These efforts were funded by grants secured by the department’s anti-racism task force — which was also the inaugural winner of the Champion in Inclusion, Diversity, and Equity Award established under ACT.

As COVID-19 vaccines became more widely available and it became clear that underserved community members of color were more likely to lack access or feel hesitant about vaccination, numerous efforts across Penn Medicine arose to connect with the community, listen, engage, educate, and help overcome barriers. In West, Southwest, and South Philadelphia, Penn Medicine engaged with faith communities including Black churches, as well as secular community organizations, to stand up convenient community vaccination clinics with accessible, shareable text-message-based signups.

“Addressing the vast disparity in both COVID outcomes and vaccine distribution is a critical priority both locally and nationally,” said Kathleen Lee, MD, of Emergency Medicine and the Penn Medicine Center for Health Care Innovation. In the suburbs, Chester County Hospital invited leaders from a local Black church to be vaccinated and take part in an educational session to help answer questions from other congregants.

Beyond just vaccination, community engagement to address health inequities touches on every area of health need, from cancer screening to training community-based mental health providers, to Penn Medicine’s commitment to community-based preventive care as a partner in the new PHMC Public Health Campus on Cedar, where HUP – Cedar Avenue officially opened in March.

The Momentum Continues

As seen from above people are gathered seated and standing at folding tables arranged for a job fair in a lobby with a marble floor.Transforming to an anti-racist and equitable culture is a monumental task with much work still ahead. One year into the journey, ACT’s leaders express optimism and excitement for the progress so far.

“We have achieved remarkable forward momentum,” said Higginbotham, who is also a professor of Ophthalmology. “We’ve developed the framework to guide our work, and we developed it using an inclusive process that’s action-oriented. With infrastructure that includes anti-racism councils throughout the system, vice chairs for diversity, equity, and inclusion in all clinical departments, and more, we are poised to expand upon these first steps and push forward through all the important work that remains to be done in the years ahead.”

“Last year‘s work was a great first step where literally hundreds of next steps have been outlined,” Duckett added. “We will measure our progress through data but also by checking in with real people to see whether there is impact or change in our climate — and their lives.”

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