Addressing diversity and health equity issues in cardiology departments

"These problems have existed for a long time," Albert said. "In healthcare, there needs to be an educational component so the healthcare workforce has implicit bias training, and the effect of that training needs to be measured over time. The healthcare workforce also needs to be trained about disparities in medicine and trained in how to ask questions that can get them addressing it."

As a starting point, addressing these training needs is a good start down the road to addressing equity in medicine. 

Albert also said there needs to be conversations between people who are experiencing the brunt of discrimination and those who are not. She said a lot of times these conversations happen in siloes so others in the organization are not aware of issues and do not address them. 

"People need to be willing to come into those meetings with open ears, listen and exchange ideas. I think that is really important," she explained. 

Money also need to be made available to develop programs to address issues that are identified. Albert said there is no standard template for an ideal program, and these need to be tailored to each specific site because issues will be different place-to-place.  

"These programs need to be co-developed with leadership along with the persons who have the 'lived-it' experience," Albert said. 

Need for advocacy in addressing health disparities in cardiology

There also is a need for advocacy to help address health disparities. The American College of Cardiology (ACC) and the Association of Black Cardiologists are two organizations that have worked to provide advocacy agendas. They both have worked with federal and state agencies to put policies in place to reduce structural discrimination to address disparities not just in healthcare, but in society in general. 

She said another issue that needs to be kept in mind and explained to clinicians is that equality is not necessarily enough. 

"These days we may need more than just equal opportunity, because so much of our society who are not traditionally disadvantaged have had an upper hand. So it is no longer about being equal, because if you are equal, a segment of the population will still be behind at this point," Albert explained.

Working outside the health system, there are other ways people can help address disparities in society. This includes helping people get adequate employment, voting for candidates in elections that will support inclusion, diversity and policies that help address inequity. Albert also encourages people to get involved in their own communities, organizations, schools and local government to ensure people are aware of disparities and to try and find ways to raise awareness and start addressing issues at the grass roots level. 

Chief diversity officers at healthcare systems

A big trend in the past few years has been for hospitals and health systems to create the position of chief diversity officers to show the organization is trying to address equity issues in both staffing and in how patients receive care. 

Albert said in theory these positions are a positive step in the right direction to addressing health disparities. However, she said the positions are often created without a clear policy direction or a budegt to implement changes. 

"Often persons get put into these positions without a budget and without the support systems to be able to be very effective," Albert explained. "And they often only get called upon when there is a problem that is deemed a diversity issue. What really needs to happen is that leaders, not just the chief diversity officer––the CEO, CFO and COO––they need to champion diversity."

She said hospital administrators can do this by mentoring and sponsoring people within their own environments to not only help their own health systems, but to put people in place who have diverse backgrounds that understand issues minorities and underserved populations face. 

Another solution is to have a health equity board that looks at health disparity issues and works on ways to address them, Albert explained. 

"A nice diagnosis to take a look at is hypertension, and looking to see if blood pressure management is equitable across race, ethnicity and socio-economic status and other parameters. If it's not in your own house, then you need to pay attention and ask if your providers are not increasing intensification or care to get it under control, or are there physical things in the system preventing patients from making this happen," Albert said. 

She said hospitals should work to be an anchor in the community and actively look at their own staffs for people who may be good for promotion or additional training who bring a diverse prospective to their organizations.

"An anchor institution begins to invest in the educational development of its surrounding community. What that means, is if you have someone in your employment working in the cafeteria or sweeping the floor, many of those people tend to be black and brown folks and come from the surrounding community. Making sure they have opportunities to take classes and learn leadership skills will help them move up in the organization. Often times they already know the organization very well because they are really observing the bones, so to speak, of the organization," Albert said.