Mass General Brigham’s fight against racism and for health equity
In the Fall of 2020, Mass General Brigham took a stand – a stand against racism and for health equity – and launched United Against Racism, a systemwide journey toward becoming an anti-racist organization. Based on input from staff and leadership, the plan includes a series of specific timelines and metrics to measure success. While there is much work ahead, tremendous strides have been made.
Fostering More Diverse Leadership
The effort to increase diversity among Mass General Brigham leadership begins at the top. In March of 2020, People of Color held only 18% of board positions throughout the Mass General Brigham system. A goal was set to reach 30% within five years. With 14 racially diverse new board members, the ratio already stands at 28%. Additionally, this past year named Elsie Taveras, MD, MPH, was named Chief Community Health Equity Officer and Allison Bryant, MD, MPH, as Senior Medical Director for Health Equity. Drs. Taveras and Bryant are highly respected clinicians deeply dedicated to providing all patients with exceptional care.
Clinical Strategies and Initiatives
Removing Race in Clinical Protocols
Too often in healthcare systems, a patient’s race has played a role in clinical decision tools and policies. Historically marginalized communities have suffered as a result. As an example, race has traditionally been factored when calculating eGFR, a measure of how well the kidneys are working. This may have contributed to Black patients with chronic kidney disease being underdiagnosed and undertreated. Mass General Brigham shifted to a race-free calculation of eGFR. As a result, one in three Black patients are being reclassified to reflect the more severe chronic kidney disease stage they actually face.
Similarly, for years, race and ethnicity were used to determine how likely expectant mothers were to have a successful vaginal birth after previous cesarean (VBAC) delivery. Mass General Brigham recently adopted an updated calculator that removes these factors from the equation and as a result all patients, regardless of race, will have equal opportunity for a successful VBAC. System clinical leaders are now reconsidering 14 other calculators and assessments where race played a role, with more to come.
Increased Screening and Resources to Reduce Health Gaps
Mass General Brigham has launched new screenings for food insecurity, housing needs, and other determinants of health across 22 primary care practices as one way to help reduce the impact of structural racism on health. Dozens of community health workers have been hired in these clinics to connect patients to community resources for unmet health-related social needs.
These efforts will focus on management of diseases with racial and ethnic disparities, including hypertension, diabetes and pediatric asthma and enhance prevention and early detection of some of the most persistent diseases and conditions facing communities of color.
Improving Access for All Patients
Caring for 1.5 million patients every year, Mass General Brigham has a responsibility to dismantle health inequities so that more people can access clinical programs. To that end, the system has hired 11 bilingual digital access coordinators who collectively speak Spanish, Portuguese, Haitian Creole, Arabic, Russian, Mandarin, Cantonese and Cape Verdean Creole. Additionally, the system’s Patient Gateway platform is now translated into six of the languages most commonly spoken by Mass General Brigham patients.
Building a Culture of Health Equity Improvement
This year, leaders of Mass General Brigham hospital departments identified health inequities in their organizations and applied for grants to address them. A selection committee funded 18 grants to reduce racial disparities in patient experience and/or outcomes. These included everything from reducing disparities in the use of physical restraint in emergency departments to improving access to mental health treatment for non-English speaking trauma survivors.
Mobile Community Care
Some patients are more comfortable in a community setting than in a hospital. Therefore, Mass General Brigham has expanded an initiative that began during COVID, to bring mobile care into communities. Mass General Brigham has partnered with community organizations to deliver thousands of meals in Chelsea, Revere and other Boston communities. The mobile program has also administered thousands of COVID-19 tests and vaccines. System leaders plan to build upon this promising model for community care to drive better outcomes in underserved neighborhoods.
Improving Accuracy of Patient Race, Ethnicity and Language Data
Early in 2021, Mass General Brigham received a National Institutes of Health (NIH) grant to study the long-term effects of COVID-19. A key factor in the NIH’s decision was our systemwide biobank, which combines genetic material from 100,000 patients as well as imaging and electronic medical records. This grant reminds us that data is one of our greatest assets and helps to ensure all our patients receive high-quality care informed by research.
Because we lack even the most basic race, ethnicity or language information for many of our patients, we have now begun a major outreach effort to gather this data from 1 million adult primary care patients. Having this information will help us do a much better job of identifying and addressing health disparities.
$50 Million Dollar Investment in Community and Mental Health
Mass General Brigham recently announced a $50 million dollar investment in community and mental health. These are transformative grants to community partners throughout the Commonwealth that are dedicated to solving some of the crises stemming from the pandemic. The investments will provide necessary funds to organizations working to ensure food and nutrition security, equity, and access. These funds also help support organizations striving to increase access to mental healthcare and build a new pipeline of workers to address the mental health crisis.
Creating an Equitable and Thriving Workplace Culture
Racism has many impacts on patients and employees alike. In August 2021, Mass General Brigham launched Stepping Stones, an anti-racism educational program designed to help employees understand how racism exists and functions in our society — and affects patients, colleagues, organizations and workplaces. Additionally, all of the system’s top leaders have completed an additional executive briefing course, entitled “Race Conversations.”
Hiring, Promoting and Retaining a More Diverse Workforce
In a state that is 24% racially diverse and specifically in Boston, a city that is represented by a majority of Persons of Color, Mass General Brigham lacks diverse talent — with Black, Latino/Latina/Latinx and Native American employees representing only 11.6% of managers and 7% of doctors. This disadvantages the people the system serves.
As part of the Diverse and Inclusive Hiring Pilot launched at Brigham and Women’s Hospital in 2021, interview panels for director-level and above positions actively promote gender and racial diversity. This has helped to diversify talent at leadership levels, and now the process is expanding across system member organizations.
Additionally, this past year, the Mass General Finance Department piloted an effort to identify and support racially and ethnically diverse employees. Informed by these learnings, there are plans to launch new efforts to retain and promote top talent across the system. Leaders will be equipped to identify and empower all talent through mentorship.
Becoming a Greater Force for Equity and Inclusion
While this progress is meaningful, it is only the beginning. Mass General Brigham is building the strong foundation to drive lasting change in the years to come for patients and employees alike. These efforts will reduce racial disparities in healthcare and establish the culture of health equity improvement required to meet today’s healthcare challenges.