About
What is the goal of JUSTICE SQUARED?
JUSTICE SQUARED is a transformational learning and action collaborative to advance racially just healthcare. JUSTICE SQUARED will support teams of five from diverse healthcare organizations to:
1. Share power and accountability across healthcare and patients/communities experiencing healthcare inequities and engage others to change systems.
2. Create tangible, structural change by shifting: 1) how we measure and account for racism (not just race); and 2) how we remove racism from clinical, operational and administrative diagnostics and algorithms.
3. Build lasting change by shifting policies and practices and building trustworthy relationships between healthcare and the communities, grounded in joy, love, and justice.
Why RWJF is investing in addressing structural racism in healthcare
In a moment when some in this nation are shrinking back from their commitments to advancing racial justice, RWJF is leaning in to provide bold leadership to address a root cause of health inequity, structural racism.
Are we really going to take on structural racism?
JUSTICE SQUARED is an invitation to make a bold co-investment in addressing structural racism in healthcare by building collective leadership relationships, capacity, processes, and structures to create meaningful change. It is an invitation to get in relationship with communities experiencing inequities and to learn together how to transform ourselves, our relationships, and our policies and systems. We will try, learn, fail forward, and practice both historic and present-day accountability. And we’ll create spaces for learning, healing, resilience, conflict resolution, joy and celebration.
We know it will take decades–and many initiatives–to abolish structural racism in our healthcare system, not just one leadership program. It is a generational goal. But if a journey of a thousand miles begins with a single step, we better get started–this two years is just the first step in that journey and will prepare you to make this work long-term in your organization and community.
Why will we need to change ourselves to do this work?
Our healthcare system is a reflection of and encodes what we believe to be normal. To change it, we need to change ourselves, to be willing to do the hard work of understanding that we too may have created harm even if we meant to do good–and to be willing to change. It challenges us to heal ourselves, to heal our relationships, to heal our world. This is why JUSTICE SQUARED is designed as a transformational process.
We cannot change the world without changing ourselves. And in the words of Mahatma Gandhi,
“We must be the change we need to see in the world.”
Breaking the work into key shifts we need to make over time
The design process identified key leverage points where shifts were needed to dismantle and transform structural racism in healthcare
- Lack of accounting for our racist past.
- Certain bodies cherished more.
- Profit over purpose in both the goals of the system and the structure of payment.
- Lack of Black, indigenous, people of color and other marginalized voices in decision-making.
- Disproportionate burden on and marginalization of people of color in the work.
- BIPOC voices discarded.
- Insufficient education of the healthcare workforce in antiracist approaches to racial justice.
- Undermined public health systems.
- Lack of accountability to communities.
- Racism and racial bias in research & diagnostics.
- Racism’s role in outcomes not being measured.
- Lack of relationship and accountability to communities experiencing inequities and the broader public health system.
- Lack of cross-system approach to structural drivers of health.
- Focus on treating disease rather than valuing whole person, whole system wellness and well-being.
These shifts are interconnected and build from one another–and will take generations to shift, with multiple initiatives. We will directly take on two of these to begin our work in JUSTICE SQUARED–and weave others into the fabric of how we do our work.
Which of these shifts will we take on first in JUSTICE SQUARED?
This inaugural cohort of JUSTICE SQUARED will focus on two of these shifts, but draw from a number of others. These two shifts are tangible, relevant, and timely, and build a foundation for many of the other foundational shifts.
Shift 1
Measuring racism that is not being measured
Whether we like it or not, too often, “what gets measured gets improved”, to paraphrase Peter Drucker. Where and how is racism currently being measured–or not being measured in your healthcare organization? How is that being understood? Who holds and shared accountability and governance?
Shift 2
Removing racism in operational, clinical, and administrative diagnostics, algorithms and protocols
Race-based corrections and assumptions have become embedded in healthcare diagnostics and clinical and operational algorithms in ways that perpetuate racial inequities. As a field, we are at the tip of the iceberg about how to remove racism from our existing “measurement” systems. This shift challenges us to begin to account for and eliminate racism in diagnostics and algorithms.
Why do we need to change our way of leading to address structural racism?
Understanding the various ways that racism manifests within healthcare organizations requires a shift in our collective understanding of how the system is operating to create racist outcomes. People working within healthcare systems, who understand the inner workings of how healthcare operates, and people with lived experience of racial inequity and systemic oppression both have vital perspectives to offer in building a shared, structural analysis of how racism is operating in healthcare. By coming together and leading change collectively, diverse, equitable, and inclusive teams will be better equipped to shift the norms, policies and practices of healthcare organizations to support health, justice, and liberation.
Collective leadership emerges from diverse people who commit to one another and to a common cause, where people not only work effectively across their differences, but leverage those differences as sources of innovation and resilience; where they develop a shared structural analysis and powerful shared strategies; and where they lead together with mutual accountability across and between organizational, sectoral, and even political boundaries to change the deep structures around them
