Changing Ourselves to Change Our World

Why do we need to change ourselves to change our world?

We have very different experiences of life in this nation and within our healthcare system.

Depending on our race and economic and insurance status, we have very different experiences of the exact same systems.

This means that we diagnose the problems incorrectly when we base it on our experience of the system.

The only way to overcome this is to build relationship between those who have access to power and resources and those who have the lived experience of the system from a place of marginalization.

We don’t have a shared understanding of how structural inequities—like structural racism–leads to operational or clinical inequities. This is not part of the toolbox most clinical or operational or equity or business leaders are trained in.

This leads to an absence of a structural analysis of most problems.

We work to address the symptoms of the problem, not the causes.

This leads to solutions that only address one problem at a time, rather than addressing them strategically at the root.

The idea of individual, heroic leaders who have all the answers is embedded in our culture, and in the healthcare sector in particular BUT the leadership of most healthcare organizations is rarely representative of groups experiencing inequities (as a result of structural inequities)

That means insights of frontline team members and people experiencing our healthcare system with less power or resources are missing from decision-making tables.

That leads to critical gaps in understanding of both the problems and potential assets and solutions.

Sets everyone up to not have all the pieces of the puzzle needed to create effective change even when they are trying to.

This both preserves the system as it is and erodes trust with marginalized groups who experience repeated harm with little or no mechanism for shared leadership or accountability.

What is the leadership we need?

The leadership we need emerges among 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.

How is collective leadership conceived of in JUSTICE SQUARED?

In JUSTICE SQUARED, we conceive of collective leadership between a healthcare organization and a community who are working together to dismantle structural racism and advance justice. This means building a collective of people who hold a different part of a puzzle including:

A core team will help to guide the work of this collective, building in roughly equal proportion from these three groups.

1.

Shared leadership and vision of brilliant and trusted patient and community members who experience inequities, community organizers, and trusted community stewards across sectors

2.

Multidisciplinary everyday leaders across the healthcare system and community who can bring together their understanding of how the many different parts of a healthcare organization–like billing, clinical care, care management, nursing protocols, lab/diagnostics, purchasing, community benefits, information technology, policy, HR, operations, and finance–might be working to improve or worsening racial and other inequities

3.

The support of leaders who have access to power and resources within the system, who act as enablers and mentors rather than gatekeepers or solution-keepers.

How will we get there?

This core team will engage in a journey of changing ourselves to change our world using an adaptation of the WE WIN Together Transformation Framework.

KEY COMPETENCIES AND CURRICULAR ELEMENTS (WAYS OF BEING AND DOING)

Connecting with one’s own story, identity, and why this work matters (better ancestors).
Tending to one’s spirit and journey as a leader (healing trauma, decolonization of minds and spirits).
Balancing being and doing.
Reimagining leadership from individual and positional to collective.
Gaining a fundamental understanding of how racism impacts health inequities.
Developing a structural analysis of problems within the context of the system

KEY COMPETENCIES AND CURRICULAR ELEMENTS (WAYS OF BEING AND DOING)

Using stories to map and understand how a system of structural inequity can be changed.
Developing measures of structural racism (and other inequities) in the system (building on a foundation of REAL SOGI measurement of outcomes) in partnership with communities.
Identifying opportunities to improve the system of inequities together with patients and communities experiencing inequities.
Developing measures to monitor improvement.
Developing shared accountability for the system with communities experiencing inequities (shared governance)

KEY COMPETENCIES AND CURRICULAR ELEMENTS (WAYS OF BEING AND DOING)

Understanding that we can do more together than we can alone – Developing an asset-based, abundance-generating collective frame.
Understanding who one is in relationship with—and who one isn’t
Getting proximate to those experiencing inequities in non extractive ways.
Mapping trust and system influencers.
Skills in building and maintaining trustworthy relationships.
Facilitating trustworthy processes.
Skills and processes for constructive conflict and conflict resolutions.
Tools for healing and reconciliation

KEY COMPETENCIES AND CURRICULAR ELEMENTS (WAYS OF BEING AND DOING)

Shifting narratives about why people of some groups have worse outcomes within the healthcare system.
Understanding and shifting the flow of funds to create standing change.
Understand how the flow of resources and capital upholds systemic inequities.
Engaging others in the healthcare system and community to scale the change.
Advocating with others to support public policies that create a more just system.

KEY COMPETENCIES AND CURRICULAR ELEMENTS (WAYS OF BEING AND DOING)

Changing ourselves as a collective:
Engaging in a process of truth-telling and reconciliation.
Building systems of accountability and shared governance with communities to monitor improvement and identify new opportunities.
Using tools like BEACON for Equity to monitor how well we are sharing power and building equity in our collective leadership processes.

Changing our world as a collective:
Identifying opportunities to improve the system of inequities together with patients and communities experiencing inequities.
Developing a strategy to change the system.
Implementing accountability measures for structural racism.
Begin to address racism in diagnostics (using key examples around organ transplantation and algorithms).
Developing measures to monitor improvement.
Run 90-day WE Health Equity Action Labs (HEAL) that offer space for community-building, wider engagement, learning, reflection, and celebration.

Our Commitments

Here are our commitments as we begin this work as a community.

We must be able to lead with love and cultivate the self-awareness, vulnerability, and empathy that’s needed to do that.

We must commit to risking ourselves and our social capital in this work; this is especially true for white partners. As one leader noted, “Equity requires bold leadership and white people who are willing to take the heat.”

We must commit to being changed—and changing ourselves—as part of this work. This means actively interrogating our own biases, beliefs, and assumptions and disrupting our own unhelpful mindsets and behaviors. “We need to turn the lens on ourselves, our own biases and prejudices,” one leader noted. “There is a need for greater self-reflection and self-honesty.”

We must commit to challenging our own cultural norms and preferred ways of knowing, being, and doing work. “The focus cannot simply be on supporting BIPOC people to assimilate into the given culture,” one leader noted. Leaders must understand and honor multiple ways of knowing and working.

We need to disrupt the legacy of white institutions to treat ‘equity’ as merely hiring more people of color who think, act, and do like them, but merely look differently than them.

We must commit to centering the voice and experiences of people and communities most impacted in setting the vision and goals, analyzing what’s going on, and deciding on strategies. As one leader put it, this means “working in authentic partnership with communities, embodying the principles of ‘nothing for me without me.” We must be accountable to the work and to one another. One person noted that “being accountable means our ability to give an account of ourselves that we can be proud of. Accountability needs to be spelled out and needs to include people being served and equity principles.”

We must express our learning, awareness, and analysis in real action, moving far beyond works and commitments to the structural changes that are needed.