When tailoring care to a community, essential hospital leaders must consider how the community’s history and demographics could affect patient trust and health outcomes. Context matters, and association member WakeMed, in Raleigh, N.C., understands just that.
WakeMed was founded in the mid-1960s as a hospital filling a safety net role in southeast Raleigh, which has a 65 percent Black population, says Rasheeda Monroe, MD, physician leader and director of Health Equity Scholars. The area historically has had lower life expectancy rates, lower income rates, and worse health outcomes than the rest of Wake County, which is considered one of the healthiest capital counties in the country, Monroe says.
“The experience in southeast Raleigh and the zip code in which we are situated was a different experience,” says Monroe.
Recent demographic data collection showed continuing health disparities in the community, says Theresa Amerson, MD, the health system’s chief medical officer, population health. So, in 2023, the hospital launched Beyond our Walls, a year-long hospital staff training program aimed at shining a light on the health inequities that impact Wake County and identifying strategies to mitigate them.
“We really wanted a curriculum that provided historical and current day education to deeply have an understanding of the ‘Why?’ behind these inequities,” Amerson explains. “We wanted there to be an action part of that education. We didn’t want it just to stop at a root cause. “
The first part takes a deep dive into the historical policies and practices that shape marginalized communities and communities of color, the second looks at contemporary examples of how structural racism and historical factors impact communities, and the final section uses evidence-based quality improvement principles to dissect data.
The three-part program curriculum, developed by Monroe in collaboration with Uprooting Inequity founder Ayo Magwood, MSc, and Jessica Isom, MD, MPH, founder of Vision for Equity, synthesizes a wide range of research, data, primary sources, and abstract concepts to tell WakeMed’s unique story in the context of national history.
In 25-person cohorts, participants — including physicians, advanced practice providers, and clinical and nonclinical staff across the health system — watch informational videos, participate in small group work, and analyze data to further understand how structural racism affects health disparities.
Phil Echols, EdD, senior organizational development and diversity specialist, says the group sizes are intentional.
“We didn’t want the groups to get too big because we didn’t want voices to be lost in the conversations,” explains Echols. “It’s easy to kind of hide in a room of 40 people or 50 people.”
Echols says the program has been transformative for staff to better understand “the inner web of connections” that make up patient needs.
“People show up with different lenses, and so people are in different places,” he says. “Some people show up ready to take action, who may have a little more context or understanding of some of the things that we cover around race, income, and environment as it relates to present-day health outcomes. And then a lot of people are just mind-blown that this information and this research and data is out there, and we’re not having more conversations around it.”
Beyond Our Walls also introduces staff to the hospital’s Patient and Family Advisory Council and the WakeMed Center for Community Health’s Community Advisory Board. Participants are encouraged to work with these groups to deepen their awareness about community members’ lived experiences and use that knowledge to improve care.
“We have a super strong quality improvement foundation and culture here,” says Monroe. “Continuous process improvement is the basis of our culture.”
By including the community in quality improvement efforts, WakeMed aims to empower patients to make sure their needs are being heard and met.
“We’ve [taken] all of the deeply embedded knowledge of process improvement and translate it . . . so that we add the pieces in that make for an appropriate and successful equity-minded improvement project with our communities, not to our communities,” Monroe says.
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