Health equity is a state where every person has the opportunity to “attain their full health potential,” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.”
The way to achieve health equity, according to a 2018 study by Dr. Camara Jones, an American physician, epidemiologist and anti-racism activist, is by “recognizing and rectifying historical injustices, and providing resources according to need.”
In 2020, the UCLA Health Hospital and Clinic System developed a framework to advance health equity, diversity and inclusion for employees and patients alike.
The work arose from months of difficult and emotional conversations among the Black Leadership Coalition at UCLA Health, following a summer replete with protests against police violence during the coronavirus pandemic – which has disproportionately affected communities of color.
In the first eight months of 2020, 164 Black people were killed by police in the U.S., including Breonna Taylor, Ahmaud Arbery, Rayshard Brooks and Tony McDade. The killing of George Floyd by a police officer on May 25, 2020 set off worldwide protests against police brutality, racism and lack of accountability in cases of violence against Black people.
Shaunte Walton, system director of clinical epidemiology and infection prevention at UCLA Health, says it became difficult to prevent her feelings from affecting her professional life.
“I can't even describe what it was like,” Walton says. “I didn't want to break down emotionally in the workplace, but I needed help. I needed someone that I could cry with first, before articulating my feelings and thoughts about how we should move forward as an organization.”
Her first call was to Medell Briggs-Malonson, MD, associate clinical professor of emergency medicine and director of quality, at the UCLA Department of Emergency Medicine.
“We felt this at our core,” Dr. Briggs-Malonson says, “because these were our Black men and women being murdered.”
Like Walton, Dr. Briggs-Malonson said these events continued to weigh on her – personally and professionally.
“As a mother of two young Black boys, I felt upset and terrorized thinking that regardless of how smart or well-mannered my sons may be, the main thing the world would see them for is the color of their skin.”
Dr. Briggs-Malonson calls her experience, “double consciousness,” a concept ideated by W.E.B. Du Bois, American sociologist and civil rights activist, meaning the internal conflict of “always looking at one’s self through the eyes” of a white-dominated society.
Because the United States has historically repressed and devalued Black people, Du Bois said, Black Americans are forced to view themselves through a veil of “whiteness,” in addition to their own perspective. For Black women, there’s the added perspective of patriarchy. And these forced perspectives still linger today in the social structures and dynamics of U.S. workplaces.
The constant questioning of how to prepare yourself or see yourself in order to be perceived as “acceptable” in the workplace leads to “code switching and emotional overtime,” which Dr. Briggs-Malonson says felt draining to her and her colleagues. Code switching is the process of alternating different styles of speech, behavior or appearance depending on the setting.
In Dr. Briggs-Malonson’s case, it was taxing for her to show emotional fortitude outwardly, while internally feeling the opposite.
“We still had to come into work and fulfill all of our professional duties, while also feeling distraught on the inside.”
Turning conversations into action
Vernon Goodwin, security director at UCLA Health, says he’s seen many EDI proposals – and people working to further them – come and go in his more-than-20-year career at the hospital. He says despite some departments participating, the overall effort to advance a culture of racial equity and justice had historically lacked accountability.
“Sometimes I'm the only dark face in a room full of leaders making decisions,” Goodwin says, “and it's been that way for years.” It’s been challenging to make his voice heard despite being in a leadership position, he says; in some cases, it took him going through a “white voice” – having his words put forward by a white colleague – to get visibility.
Goodwin says there were many instances where micro-aggressions, the everyday subtle – sometimes intentional and oftentimes unintentional – insults, jokes and offhand comments posed to historically marginalized groups, would go unaddressed by managers and human resources personnel.
“And there was really no way to express how you felt,” he says. “We did not want to be looked at as the ‘angry Black person’” – mischaracterized as hostile, a racist bias common in U.S. workplaces.
Goodwin says these experiences made it tough for him to sit among non-Black leaders to discuss how he felt following the murder of Floyd. That’s when he and others, such as Walton, and Dr. Briggs-Malonson, came together to share their thoughts and feelings.
The Black Leadership Coalition emerged organically, out of after-hours conversations during which leaders could openly share their experiences, frustrations and ambitions.
“We all got together simply to support each other,” says Jerome Crawford, director of Performance Excellence and interim chief of staff for quality at UCLA Health.
Crawford says while the conversations began as a safe space to share what was on their hearts and minds, it shifted into brainstorming and problem-solving. What came out of it, he says, was, “us asking how can we give back to UCLA and spur the changes that have been on people's minds, but never realized.”
The changes he and the BLC sought to implement were initiatives rooted in transparency and accountability. Crawford says they wanted to put structures in place that would ensure that any efforts created were not just part of a “2020 conversation,” but embedded into the foundation of UCLA Health for years to come.
The five original members – Dr. Briggs-Malonson, Walton, Goodwin, Crawford and Erik Eggins, director of environmental safety and health – as well as several other leaders from the health system, drafted a proposal for UCLA Health senior leadership on how to initiate action in shifting the health system’s culture toward racial equity and justice.
Crawford says seeing unity from top leaders across the Hospital and Clinic System, the David Geffen School of Medicine at UCLA and even the Office of the Chancellor has signaled an alignment to a new degree.
In Sept. 2020, Johnese Spisso, president of UCLA Health, appointed Dr. Briggs-Malonson to interim chief, Health Equity, Diversity and Inclusion for the UCLA Hospital and Clinic System. Her role would become pivotal in unlocking the necessary changes she and her colleagues would propose.
Crawford felt this was a positive move for the organization. “Dr. Briggs-Malonson is someone that inspires,” he says. “It’s almost like we’re her soldiers and she’s our general. If she said, ‘take that hill,’ we’d take it.”
An equitable workplace
Some of the changes the group brought forth involve much of what you see in the current HEDI strategic plan. Eggins, a 24-year employee of UCLA Health, says one of his primary goals is to ensure fair and equal opportunities among staff.
“Tapping into the talent that we have here, regardless of educational background, that’s the most important thing for me,” he says, noting the immense potential in the UCLA Health community for career advancement with the help of tools such as mentorship and staff development.
These ambitions align with the second HEDI goal, which is to support “organizational learning to achieve cultural humility, anti-racism and bias elimination.”
Cultural humility is defined by the National Institutes of Health as a lifelong process of self-reflection and self-critique, whereby the individual not only learns about another’s culture, but begins with an examination of their own beliefs and cultural identities. This term was coined by health care professionals in the late 1990s to educate those working with racially, ethnically and culturally diverse populations.
To Goodwin and Walton, mitigating structural racism and bias means upholding transparency and accountability when it comes to discrimination investigations and dealing with grievances.
“We’ve had complaints over the years that have gone unchecked,” Goodwin says. He says he’s witnessed situations such as harsher performance evaluations for some and outright displays of favoritism for others. “If we don’t fix this, the culture is not going to change, because this is systemic.”
Moving forward, Walton says, investigations and disciplinary action plans should include transparency to minimize bias and uphold accountability. The HEDI plan calls for additional reporting structures and internal reviews of discrimination allegations to provide further oversight and mitigation tactics.
Walton’s motivation is to ensure future generations inherit a world that is more just. When she was just nine years old, she experienced racism for the first time. “This deeply affected me as a child,” she says.
Walton says she has had to explain to her son that sometimes he has to smile, or do things in a certain way so he's not perceived as a threat.
“I remember having to sit down and explain the world that we live in,” Walton says, “and what we have to do or what he has to do to prevent any sort of negative responses to his behavior.
“It's not right,” she says. “It was hearbreaking having that conversation with him at such a young age. I want to make sure that when my son gets old enough and has his own children, that they can live in a world where those types of conversations aren’t seen as normal.”
Conversations and behaviors like these, she says, have been normalized for Black Americans and affect decisions such as when and where to put purchase gas or take a walk, choosing between a hoodie and a sweater, and other benign daily occurrences.
For most people, the experience of being pulled over by police while driving is one filled with dread, but for many Black Americans, the event triggers more than trepidation. The death of George Floyd gave Goodwin flashbacks to the numerous times he had been pulled over without reason.
“I was taken out of the car, searched and asked if there were any guns in the car, if I had any drugs, if I sold drugs,” he says.
Goodwin says the events that transpired in the summer of 2020 caused him to channel his anguish toward making change. “We know that things aren’t going to change overnight, but you chip away a little bit at a time, until you break it all down. Then you can build it back up to how it really should be.”
Since these conversations were initiated, the UCLA Health Hospital and Clinics System has accomplished:
- The launch of the Health Equity, Diversity and Inclusion framework
- A leadership series dedicated to advancing racial equity
- The formation of the UCLA Health Hospital System Equity Council, an oversight and accountability body for HEDI initiatives
- In partnership with the David Geffen School of Medicine, the launch of a research theme in Health Equity and Translational Social Science to promote equitable care by studying and developing new models to address the impact of social determinants of health
- Development of resources groups to provide staff, faculty, trainees and students with strategies to build a more inclusive culture
- Equity, diversity, inclusion and anti-racism training for all health system leaders
- Allowing for real-time reporting of incidents of discrimination that may occur within the UCLA Hospital and Clinic System
- Courageous Civility Training, focused on enhancing awareness and understanding of key anti-racism principles.
There’s much more to do, but Dr. Briggs-Malonson says she’s prepared for the journey ahead.
“There are still some deep wounds and institutional racism and bias that have occurred over decades that we need to address, overturn and dismantle,” she says. “I don’t anticipate it taking decades to resolve, but it will take some time and it will take commitment.”
Though the core of this work is dedicated to be within the institution, Dr. Briggs-Malonson says the HEDI work extends beyond the medical system and into the community.
“We are thinking about equity in terms of the clinical care we provide, access to care, health education in the community and overall well-being,” she says.
There’s nothing more exciting to her, Dr. Briggs-Malonson says, than “being at the very beginning of a cultural transformation rooted in unity.”
To learn more about health equity, diversity and inclusion efforts at UCLA Health, visit uclahealth.org/hedi.
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The 1619 Project and Blackness in medicine: A UCLA fireside chat with Nikole Hannah-Jones
The science of treating the inequalities that make us sick
Discussing COVID-19 vaccine hesitancy in communities of color
