Addressing the Other Public Health Crisis
Nemours has challenged associates to identify, discuss, understand, and address racism and its impact on children’s health, and to correct systemic racism and any resulting inequities within our own organization. We have a clear commitment to combatting racial disparities and other biases that impact the health of children. Therefore, our work to achieve optimal health outcomes for all children includes addressing the social determinants of health (SDoH) and ensuring access to equitable opportunities including but not limited to medical care.
Creating a Culture of Belonging
Nearly 10 years ago, Nemours Office of Health Equity & Inclusion (OHEI) was created with a vision of providing national leadership in the elimination of pediatric healthcare disparities. Initially focused across the Delaware Valley, OHEI has worked to ensure the highest levels of care and respect for all patients, families and communities through six core functions: Quality, Cultural Competency, Community Engagement, Workforce Diversity, Language Proficiency & Healthcare Literacy, and National Leadership in Healthcare Equity Research.
In 2020, OHEI added leadership in Florida to support the expansion of its successful DEI strategies across our system, including associate resource groups and pipeline programs for underrepresented minorities. Internally, OHEI’s efforts in Florida include oversight for the Nemours D.R.I.V.E. initiative (see below), along with serving as DEI coaches and mentors for individuals, teams and leaders. Externally, OHEI is working to better understand underserved communities in Florida and explore ways to reflect their needs while embedding a mindset of inclusion among those who deliver their care and services.
Driving Toward Equitable Health
The Centers for Disease Control & Prevention (CDC) identifies racism as a fundamental driver of racial and ethnic disparities to advance health equity and a healthier nation. As one of the major barriers to health in the United States, racism is a public health crisis — and it threatens the health and future of children. Nemours is committed to improving the health of all children and as such is an anti-Racism organization.
To formalize Nemours’ commitment to driving out racism and inequity, Nemours established the D.R.I.V.E. (Diversity, anti-Racism, Inclusion, Value and Equity) initiative across our health system. Led by a 75-person taskforce of representative associates, the D.R.I.V.E. initiative was designed by associates to enact changes necessary for optimal associate engagement and patient care and satisfaction.
While Nemours has always been committed to equitable health, D.R.I.V.E. formalizes these efforts, establishes transparent workstreams and holds our system accountable to a higher standard. Nemours D.R.I.V.E. workstreams include:
- Child & Family Impact: Ensuring interactions and care with patients and families are respectful of their backgrounds and experiences, including identifying key disparities and decreasing language-based barriers to care
- Research & National Prominence: Analyzing links between quality and safety and health disparities, as well as conducting research focused on health disparities and sharing best practices to improve the healthcare of all children
- Community Engagement & Health: Increasing involvement in and from diverse communities in our surrounding neighborhoods, and generating and maintaining partnerships that help address preventive measures and SDoH
- Education, Development & Programming: Providing opportunities for cross-cultural learning for associates, including monthly town halls, web-based training and guided learning, and enabling access to opportunities and resources for further immersion
- Associate Engagement & Retention: Building a culture of inclusion and belonging through listening sessions, associate resource groups and other forums to collect input and feedback
- Pipeline, Recruitment & Onboarding: Expanding current efforts to develop underrepresented candidates for careers in healthcare and opportunities for leadership positions
- Policies, Processes & Culture: Reviewing all policies, practices and culture to ensure alignment with diversity, equity and inclusion
- Communications: Providing education to patients, families and associates regarding how our work will impact the health of our communities
During 2020, Nemours declared itself an anti-Racism organization, optimized recruiting and hiring practices to promote diversity, evaluated compensation and benefits equity, created an open forum for critical and honest conversations, and developed mandated associate education in those areas to ensure more effective, respectful dialogue. Learn more at Nemours.org/OHEI.
Identifying Disparities & Removing Barriers to Health
The American Academy of Pediatrics recommends surveillance for risk factors related to social determinants of health (SDoH) during all patient encounters — yet, there is no standardized or reportable way in typical pediatric practice. Over the past three years, multidisciplinary teams throughout Nemours have created, piloted and refined a standardized SDoH screening tool connected to the electronic medical record.
Domains within the questionnaire cover topics such as food insecurity, transportation, housing, social support and other non-medical needs that impact health. Scored by risk (green, yellow or red), the tool helps providers triage the needs appropriately and in ways that respect family preferences. For example, the very first question asks families if they would like to complete the form, and the very last question asks if they are interested in receiving assistance or information. Future implementation in Nemours’ clinical settings will include all primary care, inpatient, emergency and specialty care with a goal of having families complete the survey annually.
The SDoH tool went “live” in 20 Delaware Valley primary care locations to assist care teams in identifying and addressing the social needs of patients, as well as providing connections to appropriate community resources.