Full episode transcript.

*Please note that this podcast transcript has been autogenerated and may contain errors or inaccuracies. We recommend referring to the original audio for the most precise representation of the content.

------

Desiree Duncan (00:02.626)

Welcome everyone to the NoNormal Show brought to you by BPD. This is where we leave all things status quo, traditional, old school, boring in the dust and celebrate the new, the powerful, the innovative, the future, all related to how brands can lead the way in health. I'm Desiree Duncan, Vice President of Health Equity and Inclusion at BPD. And I'll be your host for this episode, but we are joined by Vice President of Communications at BPD, Nicole Terry. Welcome to the show.

Nicole Terry (00:30.94)

Thank you for having me. It is a pleasure.

Desiree Duncan (00:33.602)

Yeah, I we've been working on projects together, but it's glad to get your voice here on an episode of Know Normal. And then also joining us is chapter president of the South Florida chapter of NOLI, Vanessa Nazario. And we have been excited to have you on. I know we've been partnering together on some health equity work, the three of us, kind of like the little dream team. So excited to have you on. Welcome, Vanessa.

Vanessa Nazario (00:59.142)

Thank you, Des, and nice to see Nicole again. I'm excited. I'm excited about this conversation. Extremely timely.

Desiree Duncan (01:05.836)

Yes, yes, so as you've seen and folks have been reading in the headlines that there's been a bit of a DEI backlash. know, before terms like DEI and wokeness and inclusion became hot topics and part of the lexicon, know, communities have been doing this work for quite a while. But in recent times, we've been seeing this backlash in the sense of legislation, policy.

kind of reversing a lot of the work that had been done, especially throughout the pandemic in the last few years. But it's still important to carry out this work, but kind of curious, just off top, given that this is such a focus in all the work that we do, Vanessa, I'm just kind of curious, what are some of your initial thoughts as what's going on from a DEI perspective?

but how you're staying the course and thinking about health equity as a key focus for healthcare providers.

Vanessa Nazario (02:07.288)

Yeah, I love this question. It's a nice way to sort of start framing up the conversation. I think for me, as I do a lot of reflecting on where we're at, know, as of today.

This work is extremely meaningful work. I think a lot of the times we get caught up in a lot of rhetoric, a rhetoric that's unfounded around what we're trying to do here in terms of moving communities to be healthier. Right. And I think once we of get sort of refocused on the fact that there are populations here and across the country that are definitely in need of working with organizations like health care systems to make sure that they are getting not only, you know, the best quality care, but that it's

equitable treatment. And, you know, that really requires so many stakeholders to come into place and play because health care systems can only do but so much, right? They play a certain part, but then you have other community stakeholders that definitely should be around the solutions table and providing resources and guidance in terms of what really needs to happen to drive this sort of agenda forward to get to a place of real health equity. Again, I think a lot of the times

you know, depending on what news outlet you read or who's at the microphone.

You get sort of the impression that this work around diversity, equity and inclusion is around dividing people and preferential treatment and not really bringing people together. And, you know, the message I have is actually the opposite, it's about bringing people together and being extremely focused on those that have historically been excluded and marginalized to make sure that they have access to the same resources and benefits that others have historically had. So I think once we sort of educate and raise awareness about what this work is truly about,

Vanessa Nazario (03:52.568)

then I think we can really sit at a table and have meaningful conversation around addressing the needs of our communities. Again, there's a lot of need, whether rural communities, urban communities, those that have insurance, those that don't have insurance. You if you're a certain race, gender, mean, the disparities are just so broad that I think, you know, in my opinion, we really require all hands on deck, all hands on deck to really move forward in terms of addressing the needs of our communities.

So, know, Des, for me, I think we need to kind of take away all the noise, as I like to label it, and really get down to what is this work truly meant to do and for whom? And I think once we sort of level set there, then we can start moving the conversation forward. But until then, all you'll keep hearing is, you know, us versus them, and this work is not about that.

Desiree Duncan (04:46.85)

Yeah, I completely agree. And what you mentioned about those that are often overlooked, we still exist. We still need that care. And even though there is all of this noise out there in the atmosphere, it still doesn't change the fact that there are a number of us out there and are growing. Now, Nicole, I'm kind of curious your thoughts, given your role in the comm space. You're always kind of living in the headlines.

I'm kind of curious, kind of your thoughts and what you're kind of picking up from the conversations that are having around this.

Nicole Terry (05:24.028)

Yes, it's interesting because in this space, as you look at those who are willing to take a stance and speak up about it, and you see that's actually fewer and farther between. Oftentimes, we see a lack of response and a lack of engagement in communication. And we ask ourselves, why is that? And I think from a communications perspective, we

oftentimes don't acknowledge the opportunity that we can have in that, the real impact that we can make when we do choose to communicate. I think that might be stemmed from maybe a fear of an unknown or maybe not recognizing what we can do with our messages, with our communications.

And so from a communications standpoint, think that encouraging marketing and communications leaders to see the opportunity to be more proactive in speaking and providing our support to where we can help communications in being a way to

to bring people together as Vanessa mentioned. And I think there's a great opportunity for that and truthfully, I don't think that we're seeing many organizations today seizing that opportunity.

Desiree Duncan (07:00.438)

And it's it's so interesting the language, right, in terms and what kind of gets reclaimed and what kind of gets canceled and that oftentimes there's this great work that's happening that health systems hospitals are viewing. But then because of words being kind of co -opted, such as, you know, like DEI hires and what have you, the term woke, that folks start to shy away from that. But there is all kinds of other language.

and terminology to be used to still get that sentiment out. So that's why I'm excited to talk to both of you because you're doing similar work but kind of different aspects of it. so Vanessa, for you, knowing that you are focused on the work from understanding social determinants of health and then addressing them to support patients. And then Nicole, for you, looking at how to best communicate those efforts to note.

where are the best places for those overlooked patients to go? I wanna back up a little bit. So as we know, this is not new work. This is something that's been going on and health equity from a care delivery standpoint has been going on for quite a while. But would love to understand how hospitals and health systems have been addressing this and kind of the places that you've been, And like what's important.

Vanessa Nazario (08:21.447)

Thank

Desiree Duncan (08:23.611)

for consumers and patients and loved ones to understand the kind of care that can be expected from these orgs that are still doing this great work.

Vanessa Nazario (08:34.948)

Yeah, I think consumers, they want to be able to go to an organization and receive care from an organization, health care, that really meets them where they're at relative to their culture, right? All their diversity dimensions, religion, language, and that

the care again is deliver competent manner because t the difference between rea and trust, particularly have distrust of healthca and just medical care peri unfounded. I mean, let's k there's reason many of co I mean, all you have to do things that have occurred and the mistreatment and

Desiree Duncan (09:15.575)

Mm

Vanessa Nazario (09:21.716)

of research among specific communities. So I think for hospitals and healthcare organizations that wanna do this work is recognizing the fact that it cannot be a one size fits all. You cannot treat everyone the same, right? Yes, everyone bleeds red, but the ultimate fact is that everyone comes from different places and spaces and the way they wanna receive care might be different. And you might have to sort of think about that culture when it comes to.

creating an affirming environment if you're transgender as an example and making sure that that person, that individual feels really comfortable coming into a space because as we know historically, they've been excluded and a lot of discrimination from fair and equitable treatment.

So for any organization that wants to do this work and do it well, it's really recognizing that we're serving very diverse communities and it's becoming more more diverse as we sort of continue down this path and different communities evolve. And for any organization, again, that they have to sort of follow, who are the communities we're serving? What do they look like? What are their sort of race, gender, ethnic makeup, their language, religion?

and are we curating a space that really is inviting them to come to us? then once you've done that, shifting the conversation from, I'm gonna treat you because of whatever you came in to see me for and then releasing you back and hope that you don't show back up into the hospital under an emergency situation, really shifting the conversation so we're gonna treat you, but we also wanna have a conversation regarding social determinants of health, right? These are...

sort of the factors that come into play for our communities where if you don't address social determinants of health, again, if someone is, for example, food insecure, and you're telling them, you have to take this medication, you have to eat before you take this medication and da, da, da. Again, if that person does not have access to healthy foods or worse yet, you know, they have to refrigerate a medication and they're like, well, I'm unhoused. These are questions and conversations we historically have never really had with our

Vanessa Nazario (11:31.27)

community. So there's a definitely shift. So any organization that wants to do this has to sort of commit to culturally competent care, but then also addressing those social terms of health and really thinking about how to address them, how to meet patients where they're at, and then providing the necessary resources to address whatever specific needs they might discover as part of the conversation that they have with them. So it's really shifted in terms of, you know, the historical sort of

treat and release kind of methodology, right? You come, we treat you, and we release you back, and hopefully you'll be well. But now it's shifted where it's, well, we need to talk a little bit more about your social and environmental environment, and are there things there that will prohibit you from actually getting well and being better because, I mean, again, that's the reality of some of our communities. It's really shifting this whole mindset, Des.

It's exciting to see that some organizations have adopted this, but I think some of them are still kind of trying to figure it out, which is okay. But this is why you have a podcast like this so they can learn a little bit more.

Desiree Duncan (12:38.951)

Yeah, you know, Vanessa and Nicole, both of you, I'm kind of wondering, this is something that I think about and I'm kind of curious of other folks if this is something that, where their mind tracks to as well. When we talk about health disparities and social determinants of health and what have you, know, yes, we are talking about supporting the unhoused and those who don't have access to healthy foods and what have you.

But when I think of health equity, it's beyond that. It's honestly like a person like myself. I'm essentially this middle class, black, I guess, approaching middle -aged person. That is what health care marketers point out as the target audience, commercially insured and what have you. However, my experience is going into the doctor, the hospital, and those who look like me.

It makes me not want to necessarily be very, very judicious in who I choose to go and get care. But I feel like, and I'm testing this out, do you feel like when people talk about health equity and health disparities that the mind automatically goes to the socioeconomic status and aren't necessarily considering the folks that are kind of look like me, identify as me?

and feel free either of you to jump in.

Vanessa Nazario (14:04.56)

And we're done.

okay. I didn't know if you were directing to me because I'm like, yeah, let's get into it. I think at the end of the day, you can't make any assumptions about who's in front of you and sort of what is sort of going on in that person's life. Now, the reality is, and the data has shown that bias and discrimination is a very real thing, regardless of your socioeconomic status, right? So if you think about Serena Williams and Beyonce, who have given testimony to the fact that, you know, they encountered

Desiree Duncan (14:09.387)

you

Vanessa Nazario (14:35.868)

bias as part of their treatment when delivering their children. And here they are, know, wealthy, very well -known superstars. And I'm like, if it can happen to them, imagine the individual who doesn't have sort of the power or they don't feel like they have the power to voice their concerns. And there's been so many cases of negligence. And I think it goes back to creating awareness and educating our physicians and our medical staff around the reality that

There's something called unconscious bias and it's very real. And that's where thinking about how do you deal with culturally sensitive care and being mindful of the person that's in front of you and some of the historical aspects I talked about a little earlier, right? And being sensitive to that, that there might be a reason that this patient is not forthcoming and doesn't want to disclose certain things because they are still trying to figure it out and test it out. Can I trust this provider?

am I gonna be the next person who experiences an unfortunate circumstance because I did trust them and there was bias in play when they were delivering care to me. So it's a really real thing, Des, and I'm glad you brought that up because I think it needs to be put at the forefront that that's a reality for many communities, whether black and brown, LGBTQ +, I talked a little bit about the transgender community.

and even those with disabilities. I mean, let's keep it 100. if, know, obesity is another area where I keep hearing, you know, the judgment that they face when they go receive treatments. And I think there's more work that needs to happen to do education and awareness about combating unconscious bias, right? To making sure that that does not come up as part of the interplay when working with patient populations.

Desiree Duncan (16:26.306)

Yeah, obesity part, that's definitely a universal experience. I know we've done a number of consumer interviews where when asking them about their care experience, they jump into the, just essentially the shaming that can occur from the doctor's office. But then also something you noted about the patients and consumers who identify with the LGBTQ plus community and that oftentimes

so much of their healthcare is focused more on their sexuality than their actual health. And I think about the potential to communicate and market to those that are part of the queer community is they have organs, they have hearts, they have lungs, they have all these health needs as well. But Nicole, I wanna give you a chance to answer just kind of what your thoughts on where minds and assumptions go when...

folks mention health equity and social determinants of health.

Nicole Terry (17:27.62)

Yeah, does. I think you do make an interesting point that we found that with some of our health systems across the country, there can be a range of reactions when we discuss health equity and a range of the acceptance or the eagerness to be in the conversations and

When we've discussed different approaches and supporting communications, whether it's posing some questions of why are we asking these questions? Why are we bringing these to our patients when they have an exam? We've seen different responses to that. And part of that being is, I think, because they do attribute

the terminology to certain maybe assumptions, learned assumptions, which truthfully, I think we all have and have some of that. And because a lot of that is unknown. But to your point is, we're recognizing that health equity now encompasses almost a majority of our patients. You know, part of us is what we do in healthcare is we want to provide personalized healthcare. And that starts with understanding you and knowing you.

And that goes much further beyond just the medical chart that's in front of us. And so as part of this conversation, as we're thinking about communications, how can we help, one, support patient communications, and so that patients feel informed, feel educated, feel empowered about their own health, about their care? How can we help the providers and the care team be able to have those conversations?

help provide some questions that they can ask to better know and understand their patient. What kind of materials can we provide them leading up to the appointment and helping them be prepared for the appointment so patients know what questions to ask? Also, how can we support the discharge process so that patients now feel informed about what's next and able to be a part of their process?

Nicole Terry (19:43.928)

or their care journey to come. Then we also want to think about our internal audiences and our staff of how are we showing up authentically as an organization? So how are we bringing this to the forefront and talking about it on a regular ongoing basis? Because to your question about the terms and the perceptions,

Truthfully, the terms are changing. We're recognizing it. It's an ongoing journey as we continue to learn more. And so there needs to be leadership and guidance within the organization to help our staff come along the journey. So ongoing discussions for them to feel like they can participate in, ongoing materials and support to help equip them to understand the terms or to understand different perceptions.

and particularly their patient populations that they can encounter. And so that's first, supporting our patients, second, supporting our workforce, but third, then is our opportunity to bring awareness in our community and around community engagement. So I think we do have a responsibility and a role also to

to be bringing the conversations, to be engaging in the community, to supporting two -way conversation so that we can learn what's important to you. so that speaks a little bit to your question in terms of terms because I think it are, and the perceptions because I think it's changing. But the best thing that we can do is I think to be proactive and to recognize our role in it.

and just to support the conversations to

Desiree Duncan (21:39.592)

Nicole, you bring up a very important point about essentially the communications that a patient gets, their family gets, is a part of that patient experience. leads into whether they choose this system as their system of choice, that this is their hospital, that they're gonna go because they feel understood and that they are respected and the healthcare information is shared with them in authentic manner.

I'm kind of curious your thinking around. So depending on, I know you've done some work around this and depending on where you're located, there's going to be a difference in how perceptions are laid out, terminology, what have you. So for example, if you're in South Florida, Vanessa's region of predominantly brown folks, black and brown folks, and various languages and identities and what have you versus an area

that's a little less racially diverse and might have a bit of opposition to the kinds of language that are going out there. You almost have to tailor that language and not to throw a little ring in your way. However, I'm wondering when it's one thing to be dealing with a system, a hospital that focuses on one region and it's another thing to

to talk to a system that has multiple locations across the country. I'm curious your thinking, your philosophy around how folks can address that depending on the climate of the area that you're communicating with patients in.

Nicole Terry (23:20.326)

Yes, it's an incredibly important point to effectively communicate with our audiences. We want to understand them. And we recognize that there are very diverse and different populations across our communities, whether you are focused in one community or across the country. So I will say first off, I would start with some simple principles that you as an organization can support.

in terms of what's our stance in communicating. This goes beyond just simply posting a press release or a social media post about the activities and efforts that we are doing around health equity. It starts with as we're thinking about our strategic plans and our planning and how we can be proactive of asking ourselves, what's the role that we want to make?

as marketing and communications leaders, what's the impact that we can have in health equity? And then that can stem from, well, here's all the ways, whether the channels and tools that we can look into to support patient communications, here's the messages that we can support our staff. And to your point of it might vary by region, that can help them understand what words.

can we lean into in these areas versus others because they do range and they are different. But that I think that does get into doing some research. have a role to play in this of doing our own research. If we identify in our strategic priorities that this is one of our goals to support, then we will do our rightful research and look at utilizing the best data.

something that we do have is power behind us is we do have the ability to do research to build off from some data and then also we can utilize our current communities to test messages and so if we can pull some groups together, involve them in the development of the messages and to get their perspectives, let's invite them in the process as well.

Desiree Duncan (25:44.258)

Yeah, I love that. Especially there's a lot of conversations around data and how are we finding it? How are we using it? How are we helping it to optimize? Vanessa, that's something that you have been very involved in in your past roles. And I'm kind of curious, given your connection to leadership on these kinds of things, I'm thinking about the business case for Headywork, for health equity, diversity and inclusion.

and just kind of curious some of your thoughts around, we're doing all of this important work all in the name of supporting our community in healthcare delivery. But that beyond this just being a moral imperative as we have heard in years past, you know, what is it that an organization has to gain or has to lose essentially when it comes to this kind of this work and creative?

and inclusive space.

Vanessa Nazario (26:44.974)

That's a million dollar question. think that's the one that once it's figured out, you'll get all hands on deck and all big checks signed, right? I think what, you know, it's when you look at this, going back to, I think where I the conversation around raising awareness, understanding exactly what this work is about, like you have to start there. And when you start addressing health disparities and you get your communities healthier, that has an absolute,

positive effect on the bottom line of organizations, healthcare organizations that are at full capacity for things that could have been preventable or for example, things that weren't caught because there was not a conversation with the patient, maybe it was a language barrier or something along the lines around cultural sensitivity, cultural competence that was not considered.

and then ended up being a case where maybe that patient fell or sepsis or an infection or they didn't take their medication accordingly. We're talking about dollars out the door for possible malpractice suits. So when you improve your quality metrics, which is a big, big performance indicator for any organization, then you have to talk about how does that improve the bottom line when it comes to Medicare and Medicaid reimbursement.

when it comes to getting accredited by Joint Commission. I these are things that really matter to healthcare organizations. so once, even at the federal level with Joint Commission at CMS, they're leveling up their health equity agenda and putting sort of the organizations saying, we're gonna hold you accountable for these results. So I think the business case is already there. It's just a matter of how deep

does an organization really want to take this work and are they truly committed? And maybe that's where you start. Are they truly committed to this or is it, they're gonna do the minimum required to get by, to get accreditation and reimbursed. And that's their prerogative. I think organizations that are gonna take this serious are gonna sort of figure out a way to make sure that they're investing the necessary resources. And the other piece of this, which I want to make sure we talk about is,

Vanessa Nazario (29:05.382)

having the workforce reflect the community it serves, right? So healthcare organizations. when Nicole talked about, you know, working with the community sort of test messaging and branding, you have individuals within the organization, right? That are different levels that live in the very same zip codes that you're receiving your patients from. And many of them are the patients because many of them are, you know, they have the health insurance through a self -managed organization. So.

You know, you've got to look at all this stuff. there's definitely a business case there. then, you know, the byproduct of a lot of this work is when you have an organization that has proven that they are delivering culturally centered care in a very quality, effective manner. And, you know, the word of mouth spreads in communities, right? They'll say, you know, I've gone there, I've been treated with respect and dignity. I've never had a problem.

as opposed to, no, my cousin went there and you know how this goes, right? My cousin went there, they got an infection. They didn't wanna even talk to them in their language. They didn't understand the instructions. right, so it's all of the things that you have to consider. So when you have a community that embraces a healthcare system and says, you know what, I'm not gonna go anywhere else except here because I trust them. They really wanna make sure that I live a healthy life and I see them investing back in my communities.

That's a win -win. I don't know what organization will not want access to that kind of formula, but that's their prerogative. So let's hope that there's more of the organizations that say, want all then I want to invest in this because I know that this ultimately will help us from a financial performance perspective as opposed to this is just a loss leader in terms of money.

Desiree Duncan (30:52.674)

And so as we're wrapping up this episode and kind of compiling all the key takeaways from this conversation, wonderful conversation, it sounds like, you know, if you're looking at a healthcare workforce that feels included, feels like they belong, you there is great employee experience, then that leads to lowering costly turnovers, as well as improvements in care delivery and outcomes.

which then leads to potentially the patient satisfaction and loyalty as well as some of the financial benefits of that. it's thinking of that opportunity to expand your market reach as a place that patients can go to get that inclusive care in their language, understanding their culture that then leads to kind of what we're talking about with the social determinants of health about

reducing those preventable issues that affects the financial performance and helps with reimbursements. But then that potential for the enhanced reputation that comes from this. Maybe there's even a recognition of the work that's being done. But also just that.

You know, your employees as a brand ambassador, know, them as the patients going out and kind of spreading the word about like, don't come here or, you know, yes, please do come here to feel, to get care that is respectful and provides dignity. Anything else you might add as a key takeaway from this conversation as we wrap up?

Vanessa Nazario (32:32.6)

Yeah, I am well for your listeners. I really encourage them to do more research around this work and American Hospital Association their Institute for diversity and health equity has a tremendous amount of resources. They actually developed this health equity transformation roadmap and it really walks through the six levers needed to really address health equity and really provides an exceptional roadmap to this work. In my prior organization I did there's an assessment you can do to really sort of figure out where you are relative to that journey and where the opportunity

So I encourage them to do that. you know, there's a healthy people 2030 agenda, which is Department of Health and Human Services. They work with many stakeholders and every 10 years they refresh this national priority around creating healthier communities. And there's so much data and resources just baked into that. So, you know, for someone to say, just don't know where to start, I'm giving you two key places where you can go.

mean, the White House signed an executive order last year around advancing racial equity to support underserved communities. And it was a call to action for all federal organizations to work together to make sure that the most vulnerable communities, their needs are being addressed. you know, do some research, see what's out there. There's a lot of support at the federal level, and then that gets sort of localized in terms of adoption of certain.

frameworks and again, it's not, no one is sort of reinventing the wheel and I wanted to talk about this a little bit. At the end of the day, you

There are organizations that have been out here doing this for a long time. A lot of not -for -profits, community -based organizations that have been addressing the needs of the most vulnerable communities, whether it's food pantry, job development, work skills training, economic development, micro lending, right? And you have your federally qualified medical centers. Let's give them a plug because they've been in the trenches for many, many decades treating those without insurance or lack of insurance and Medicaid and all this sort of stuff.

Vanessa Nazario (34:34.165)

And they can serve as great leaders and partners and stakeholders as part of this overall process. So for those health care systems that do not know where to start, I've just given you, I think, a nice outline and bullets of where you can even just dive in and start your research. Thank you.

Desiree Duncan (34:52.802)

Yeah, thank you. And yes, very important for these organizations to tap into the communities that they're serving. All right, so let's wrap it up here. Vanessa and Nicole, thanks so much for being here. And for all of you listening, thank you so much for joining in. If there's something you want us to cover on the NoNormal show, shoot us an email at nonormal at bpdhealthcare .com. Make sure you share the show with friends and colleagues and give us a review and ratings on height.

iTunes and Spotify, preferably 5 stars, all of that would be greatly appreciated. And until next time, don't ever