Betsy Cerulo: Welcome to Room at the Table, an opportunity for you to join me, Betsy Cerulo and my guests for conversations about creating equitable and inclusive workplaces where leaders rise above mediocrity and our teams thrive. Pull up a chair, there’s always Room at the Table.

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Welcome to another meaningful conversation on Room at the Table. I am Betsy Cerulo, your host. And, welcome to my guests today from Chase Brexton Health Care, Sam McClure, Executive Director of the Center for LGBTQ health equity, and Aya Shuman, Executive Director of the Institute for Equity, Diversity, and Inclusion. Both inspiring women are passionate about ensuring that excellent health care and opportunities are available to all people. Their intentional actions work to remove the barriers that we still face in underserved communities and diversity in general. They are champions for inclusion. Today, we’re talking about equity. What does it mean? And why equity is paramount in everything we do. So pull up a chair, enjoy your favorite beverage, and let’s get started. Welcome, my friends.

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Sam McClure: Great to be here.

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Aya Shuman: Thanks so much for having us.

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I’m just really appreciative that you were able to make time. I know you both are so, so busy in the world of change and health care and equity. I’m hoping that, today, for our listeners in talking about equity and just having a really rich conversation that we can help to educate people who sometimes, maybe, don’t understand the full scope of equity, or those of us that think, “Well, you know what, I have everything I need, and I’m good to go.” Because I think many of us who are in places of influence and just generally have a voice have a responsibility to take care of other people as well. So I want to talk about the simplest question. What is equity? How would you answer that?

 

I would first say, it’s not a simple question at all, but it doesn’t mean it’s not the right place to start. 

 

Would you prefer to start in a different place?

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No, I just think the more we talk about it, the more its simplicity falls away and we realize how complex inequity is, right? If you’re in the pursuit of equity, there’s an inherent unwinding of existing inequities. And I think once one starts to dig into that, complexity is really part of the conversation too. So I really just wanted to throw that in there. Aya and I work together at Chase Brexton. I think we both have really different valuable perspectives. I’ll throw in something, it doesn’t exactly answer the question, but I think it’s in the lane of the question that really says a lot about what we’re doing at Chase Brexton. We just recently went through a whole exercise of redoing our mission statement and our values and all of these things that large organizations do to kind of reset our compass. One of the things that we did this time with our mission statement, which has always had the phrase “honors diversity,” was we added the phrase, “addresses inequities.” And I think it was a really important moment for us to sort of shift our compass to being very action oriented. So not only understanding what equity is and why we are working towards equity, but really to identify and address inequity as well.

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I definitely agree with everything that Sam said, it is a very complicated topic. I think a lot of times when people try to understand what equity is, they kind of position it next to things. It kind of makes it easier. So Sam mentioned inequity. Sometimes it’s a little bit easier to spot. It’s often positioned next to equality, equality being sameness, equity being fairness and justice. So I define it as giving everyone what they need in order to achieve similar outcomes. It won’t be the same outcomes but similar outcomes. What is needed in order to get everyone to somewhat equal footing? And that will be a unique approach and unique needs based off of the individuals in question because we’re all dynamic. So many things have contributed to our experiences. It’s a way to level the playing field, but it is distinguished from equality, which again is offering similar things, which may or may not be applicable.

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Right. Within healthcare, a lot of people are beginning to notice that within certain diverse groups people do not get the same quality health care, which is heartbreaking, and it’s wrong. Would either one of you like to speak to that, what you see as the ways to shift that? And I know it’s certainly not an easy thing to do. It is an endless process.

 

I would say a conversation like this is one of many steps in the right direction. I would also say the fact that you didn’t use the phrase “health disparity” gave me hope. Health disparity is such a go-to phrase and when I first got to Chase Brexton, Betsy, you and I go way back long before my tenure here, and you know health care is not really my background, but I’m thrilled to be in health care, this is a dream opportunity for me. One of my early questions was, gosh, we’re talking about health disparities constantly. And I wanted to really break down what does that mean, exactly. What I finally got to is that it just means difference. It just means difference. And really, we use that phrase “health disparity” more than we should. And more often, we should point to an inequity, because if you see a disparity, a difference in health outcomes, there is almost no doubt that there’s an inequity sitting behind that. So the disparity is the outcome, and sometimes researchers and thought leaders and folks, we get to talking in our lingo about social determinants of health or health disparities, or all these phrases that we get used to using, and really, there are inequities behind anything that we read as a health disparity. To me, that’s where I like to start thinking about it once we’ve measured this different outcome or health disparity, getting to the inequities, understanding the why.

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I think that it’s really important when you get stuck with a lot of these phrases and you use them and they’re overused. And there’s some comfort there because most people in the field of public health have some awareness of what you’re talking about. But if you don’t dive deeper into what each of the phrases mean, then it can be a barrier to actually completing the work and to actually doing meaningful work. I think, to answer your question, let’s take the maternal mortality crisis as it pertains to black women. Working in the federal government, this was something that a lot of us were concerned about. There are barriers along the way in political administrations, there are barriers along the way in terms of organizational structures. I think it starts with an acknowledgement that this is actually happening. It also starts with compassion. You have to not only be aware, but you have to feel that charge to do something about it. And in a lot of organizations and institutions that start with leadership awareness, you need a leader, or multiple leaders, ideally, to advocate for it, otherwise, initiatives will fall flat. So I think those things are key.

 

When you talk about that deeper dive, is there a point that you both see? People can begin to make the initial inquiries, ask initial questions, but is there a theme or a point when you start doing that deeper dive where the discomfort begins?

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Yes, definitely. It’s a good barometer for when you’ve approached the cusp of change, its potential, when you’ve hit that because if you don’t hit that, then you’re just maintaining the status quo a lot of times. We often say this, Sam and I have had conversations about this and we talked about this at Chase Brexton as well, we don’t shy away from discomfort because we understand that it can be transformative.

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In leadership in general, there are many times that we do have to have that discomfort, and I know for myself, and Sam having known you for many years too, when you do get to that place of discomfort, there’s a lot of growth there. I know for myself, in learning a lot more about the inequities in health care, there’s that pang that happens inside of me, my heart. And I say this, I’ve said this a couple times on different podcasts that if we do nothing or say nothing that is doing something, that’s allowing it. And I’d like to know from your perspective, there’s the leadership perspective, but let’s say just any listener who’s wanting to know more, what’s a small thing that any individual can do when they hear or see about the inequity? What do you think that someone can do? What steps can someone take? I know, it’s not an easy question.

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Yeah, it definitely is multi-layered. But it’s a great question. I love what you just said about inaction being an action. I love what you said. In his book, How to Be an Anti-Racist, Dr. Ibram Kendi says the opposite of being a racist isn’t not racist, it’s anti-racist, which is very action based, it’s action-driven activity. So I think, in order to be authentic, I think that we all need to do a deep dive into the biases that we hold. We have to look within and explore various perceptions that we have about individuals and groups, our upbringing, and where things came from. You can ask for people to do it on an ad hoc basis. But if you’re not willing to, again, do that deep dive where you look within and you say, “Hey, well, how does this show up for me? What are my triggers?” then I just don’t see it being sustained, any action, any one given action being sustained in the long term. So I think that’s a good place to start.

 

Yeah, that’s well said. My brain went to like, well, what’s the context? What’s the context of someone hearing something? Because I think it makes a really big difference. I mean, if you’re sitting with someone, and they’re talking about their own experience, and something that they have a barrier between them and good health care outcomes, to stay in the lane of health care, just learning to listen differently is a really big step, especially if it’s an area where, maybe one hasn’t had their own experience. I’m never surprised when people talk about struggling with health care, because I’ve felt my own struggles with health care during my lifetime for a variety of reasons. And I know when I got to Chase Brexton and started working in The Center for LGBTQ Health Equity, and really started listening to patient experience, I found out that being informed by my own experience is not enough to be a champion for not only all people under that LGBTQIA+ umbrella but all people, people who have maybe have different citizenship status, maybe they’re not living in their nation of origin, English might not be their first language, maybe they’re experiencing an invisible disability that is really hindering their ability to navigate their healthcare. Whatever exact thing it is, the lens of my own experience is just not going to be enough. So to really hear and listen with compassion, and just dismiss your natural tendency to judge and categorize, and then, to get to what Aya is talking about, like, when you get that twinge of discomfort, what’s it really about? What’s activating this emotional response in you? Is it because you’ve heard something unimaginable to you? Or is it something else? I know for me, as I’ve gone through my career working in diversity, inclusion, and equity work in a variety of different areas, I know a common pain point for me was hearing something that made me realize many things I had been taught were completely, wildly incorrect. That can be a moment of discomfort when you realize that your perception of the history of something is wildly inaccurate because it was fed to you by a system that is innately not inclusive in its narratives. Just take a minute in your listening to deploy your curiosity and your compassion. Why do I have this feeling? Where’s that coming from? What’s going on for the person who’s trusting you and making themselves vulnerable to you? And take the steps you have to take to both understand your own mind and perceptions and really understand, where is this person coming from? And what can you actively do to meet their immediate need that they’re talking to you about, but also address the system that created that need? 

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I think to patients what’s really important is something as simple as going to the doctor’s office and knowing that there might be someone in front of you who’s taking a little bit longer because maybe there is a language barrier. Maybe they’re at a point in their life where they’re not fully understanding something, or the invisible disability, I can go down the list and I think, too, sometimes when we go in for our own health care, a lot of times there’s a backup, and you think you’re going for a certain time, for an appointment, and it tends to be longer. And I’m guilty of that, too. I think, “Okay, well, I allotted this much time. I’d like to be complete.” But I’ve noticed that as I’ve gotten older just to be more patient because there are people ahead of me that maybe just need a little extra care. And the care starts in the waiting room. Something that sometimes has come up for me when I’ve been witness to someone who is not being treated fairly is a feeling of shame because I know where I’ve come from, I know that I’ve been fortunate, and this guilt of watching someone else be marginalized, minimalized and seeing that I would be treated differently or have been treated differently. And it has bothered me many times over the years, which has made me tend to not want to and also to say something to assist someone that may need it, again, rather than do nothing, and maybe if I do nothing, the discomfort will go away. I’m more uncomfortable when I don’t do anything.

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Yeah, I think that’s excellent. It’s excellent that you have that internal awareness and that you’re exploring what you should do about it to alleviate the pressure. When we sit with these kinds of heavy feelings, it can be motivating to move out of it. And there’s ways to use our privilege and social advantage. So individuals who experience privilege in this society need not just sit with the heaviness of it. There are things that can be done that can help better others who do not experience that. I know that I have social advantages in certain situations. So I encountered a situation in a restaurant a couple of months ago where someone was very rude to the restaurant worker and said, “Go back to your own country.” And we all have different emotions that kind of rise to the top. For me, it’s a bit of the fire element that will kind of rush up because I feel like it’s important for me to be an advocate for those who are not able to or not willing to because they’re at their place of work. So that was a situation where I was able to speak to the person and then we actually ended up having a great conversation. It was uncomfortable at first. But I stepped in and said that’s not appropriate. I guess you have to kind of weigh, to Sam’s point, the context of the situation, where you are at the time, your own emotional load, or your own emotional capacity as well.

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Yeah. And I’ve had instances in business where I’m working with a customer and the individual on the other side, maybe I’ve known them for a long time and they have not really progressed with a lot of the changes, so some of the things that come out of their mouth, I would just open my eyes and now I say, “Look, I want to have a sidebar conversation with you,” and I’ll call them up. And I’ll say,” I just want to educate you on what the changes are.” And usually when I have those kinds of conversations where it’s not making anybody wrong, I usually just say, “I’m also evolving with the changes that we see out there in business, but I want to just give you some insight.” And usually, when I approach it, I don’t make them wrong. I also make it sound like I’m also in training of learning, an eternal student, and they’re usually appreciative. I’ve been fortunate that no one’s come at me in a really negative way but I’m prepared if it is. But not everybody wants to engage like that. Not everybody’s prepared. But we do have an opportunity for that change. The two of you are incredible educators to create a safe space for people to learn with the changes, which I’m always appreciative of. Let me ask you from a leadership standpoint, because my question is, how, as leaders, do we create equity in our workplace? Your workplace happens to be healthcare related but what do you see from your perspectives? How do we make some changes? How do we shift the culture?

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I think that in order to shift the culture, first, you have to look at your stakeholders. So you have to look at who you serve. And for Chase Brexton, that’s our workforce, our entire workforce, that’s our patients as well in the greater Chase Brexton community. So it’s a different approach for each target population. I mean, that’s the formal term. But for our community, for our people, it’s a different approach for everyone. So for our workforce, it would be looking at ways to ensure that there is fair advancement across the organization, regardless of a person’s sexual orientation or gender identity, regardless of an individual’s race or disability status, so on and so forth. For our patients, it’s access to care, it’s the removal of barriers. Barriers are things that plague our patients, and a lot of times our patients don’t come to us with just one issue, they come to us with multiple. So looking at our patients and ensuring that we’re there to help, that’s key. And then looking at the greater Chase Brexton community, and for the greater Chase Brexton community, it could be an issue of doing a deep dive beyond the bounds of health disparities, as we discussed. What are the issues that plague our communities? For Baltimore, it’s a high prevalence of HIV, it’s individuals who are food insecure, it’s individuals who are low income and may not have access to the care that they need. So I think that’s a way, it’s complicated, but that’s a good way to tackle the various groups that we interact with.

 

Yeah, I agree. The two of us don’t disagree very often. I can’t remember any situation where we’ve ever disagreed. But if we do today, it’ll probably be an opportunity for us both to stretch in some direction. When thinking about our culture inside of our organization and how we work with our workforce, I think something that always stays front of mind to me, and I think this goes back to exactly one of the ways you defined equity earlier, with inclusion work there, and there’s so many aspects to inclusion work, really, the outcome that we want is a sense of belonging. Like, I’m here, this is where I belong. And to me, one really major thread that creates that sense of belonging is, “I can grow here. I’ve just arrived, and this is where I’ve arrived. I’ve arrived at this spot right here. But I can see the landscape of the whole organization, and there’s opportunities for me to grow from where I begin to some other place in the organization. And then, if and when I choose to leave this organization for another chapter of my career, I’m going to leave it stronger and more prepared with more education, more tangible skill sets.” And I really think every person who goes to a job wants that on some level. They want to grow, they want to stretch. Maybe they’re in an entry level position, but it’s serving our mission, it’s meeting their community with what they need and delivering on that. People want to just get better and better at what they do, and be able to stretch and grow, and maybe teach someone beside them help them stretch and grow, and just having that really vibrant ecosphere of stretch, and growth and challenge and that everybody has access to that if they want to, to me, that’s a really important element of what we’re trying to do. And it’s going to be different for every person, it’s not a thing that you can just have, like, here’s our advancement opportunity map, it looks exactly the same for everyone. It can’t be like that. It’s got to be something that really meets each individual with exactly who they are and exactly what they want out of their time with an organization. That’s a big thread that stays with me. I think about it, really, every day, I think it’s very important to addressing culture change inside of an organization, really, whether you’re a business more of the size of yours, Betsy, or if you’re a Chase Brexton with close to 450 employees, five locations, you know, we have a big footprint. But that compass of creating that sense of belonging, I think it’s really, really important.

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Absolutely. You both see possibility in everyone, and that is not one size fits all, because we all come to the table with different gifts, with different wounds, and I think that makes the workplace quite interesting. And we can all attest that there are times that could make a workplace toxic too. On the flip side, what mistakes do you see leaders doing in their attempt to put equity into the culture?

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I would say that a lot of leaders or a lot of organizations are interested in EDI, we say EDI, or DEI work, but only in a performative way. And employees can feel that, individuals who interact with the organization can feel that. When you want to check off a box that says, “Oh, look at what we’re doing.” an incident happened, here’s a statement, and then just leave it at that. Chase Brexton is very unique in that it has invested in bringing leaders on board to tackle these issues in a meaningful way. So I feel just very blessed to be a part of an organization like that. So I think a mistake would be just, again, saying, “We’re going to do a little bit,” and think that that’s enough. The more you do, the more you have to do.

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I agree. 100%. And I would say there are phrases that are red flags for that kind of behavior. One is, it’s a journey. If you throw a note in a bottle and chuck it in the ocean, do the message in a bottle, that bottle is going on a journey. Right? We’re not on a journey, we’re on a clearly defined set of activities. So every time I hear the journey metaphor, I always think, “Okay, is there an actual map? Are we going to move those pins? Are we going to have measurables? Are we just going to say, congrats, we’re on the journey.” I just think it’s too easy to give oneself a pat on the back. “Now we’re doing it. We’re doing it,” without constantly going back to exactly what are we doing? And how are we measuring it? And how are we holding our whole organization accountable for whatever their responsibilities are? You can’t do that if you treat it like something squishy like a journey. No shade on the word journey. But to me, it’s just too squishy. This work is exact and data driven, and process-oriented and strategy-oriented as any other business imperative. If you treat it any other way, it’s not going to work.

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We don’t typically arrive. We’re constantly moving. So when you say that about journey, I always think of point A and point B. You can think you got to point B, but then all of a sudden, there’s going to be a shift, and B needs to be C. And that’s just because people are on that ship, if you will, and everyone has relatively different needs, certain pieces of what a workplace does, it’s just different for people. And I think when we have this notion of it’s defined, I think that’s where people get in trouble. Perfect example is through COVID. I thought I knew some things and then most things that I thought I knew had to be put aside, because you just had to move quickly and intentionally to make sure people were served.

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I think it’s great to have a plan. And I think that it’s great, also, to your point, ensure that you’re flexible. As you learn best practices and you learn things along the way, are you willing to pivot? Or do you stay stuck, because you invested a lot of time in the plan on the front end? So you have to learn along the way and realize that this is an ever-growing field. And even when we think we’ve got it, we don’t always got it, even with lived experience and things like that. We all like to say that we’re experts in this and maybe we are. We’ve devoted a lot of time to it, but again, it’s not a static thing. It’s ever-evolving.

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I’m glad both of you said exactly what you just said. I think my point about treating it like any other business imperatives, it really points to that because no one’s surprised if you have a strategy for new client acquisition or some other imperative and 60 days into your strategy, you make a few adjustments. That’s a very natural business strategy thing. And I think when you’re really treating inclusion in that same way, and you’ve got something to measure, you see the data isn’t showing you what you thought it would, understanding that you can make an adjustment and that all the leaders that work with you will support that. I think that’s really important strategically, that we’re not just checking the boxes, that’s compliance, actually, to me, that’s compliance oriented. But if we’re change oriented, then it’s alive and it’s organic, and it will be shifting just like any other business challenge that we have.

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And sometimes we make mistakes. I mean, I can certainly say that as a leader. Sometimes we make mistakes, and when we’re accountable, if we have made an error, people tend to respect that in the end, and we’re all willing to dive back in and say, “Okay, let’s throw away that plan. Let’s recreate and start from scratch.”

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Because it’s authentic too, when you’re your true self and you’re vulnerable. And a lot of times people appreciate that rather than when you only show the polish, it doesn’t feel real. Folks can’t necessarily connect with that as well. So ultimately, I do think it’s important to acknowledge mistakes openly.

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Yep. Agreed.

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As we bring this conversation to a close, I’d like to ask you both, what would you recommend? When it comes to equity, wherever that equity is, what could be a small step or a small change that anyone can, perhaps, look at differently to be moving in the right direction towards the healthy change?

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I think that a lot of times individuals think that certain things are in the past. A lot of times folks think, well, slavery was generations ago. They don’t really factor in the cross-generational effect of slavery, of poverty, not having citizenship, or various immigration statuses. So I think that knowing the history and understanding the root causes of some of the issues and being open, so that it’s not a matter of, “Well, other populations are just not working hard enough.” That narrative is very toxic and troubling. So I think that it’s important for all of us, whether we’re people of color, whether we’re allies to people of color, whether we support individuals who are low income, or we are low income ourselves, we must educate ourselves, we must learn more about the issues that either plague us or plague our communities to get a better sense of why folks are where they are. And with education comes understanding. It’s an elementary step, but at the same time, it can lead to that deep dive that we discussed and be very complicated. But once they’ve done that, then they can proceed with more authority. Because if anyone then questions them, they can say, “Well, no, this is still very, very relevant today.”

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I love that one. And it’s always powerful to be in the room when that’s being addressed as well, because it’s like, some people are already thinking about being more evolved in that respect and others are not. It goes back to Betsy’s comment about that discomfort that’s going to be in the room when people are confronting their long view of history. I was trying to think of a small thing, and I couldn’t think of a small thing so I’m going to give you a big thing, because that’s just how it is. I think we have to be really, really cognizant, mindful, and focused on essential public policy changes, especially when it comes to data collection. We talked earlier about the importance of measuring our work, and when we’re working around equity to really be measuring what is inequitable, and then tracking our progress on that. And it’s really important to know that for all of us in business, data is the voice that’s telling us what to do and how to react to things, and just to remember that data systems in our country are really, really flawed. They’re flawed for not giving people enough options to bring their whole self, and then in some cases, not giving any options at all. For LGBTQIA+ people, there’s still a massive gap in opportunities to use self-identification. You can use it in some places, and you can’t use it in other places. Maybe you can do sexual orientation, but you can’t do gender identity, maybe there’s not enough blanks to really recognize someone’s full identity. I think for people who are experiencing disability, there are also huge gaps in data and a lot of arguments about what is a disability and what’s not a disability. I think we really need to just create spaces where people can identify who they are, what’s their experience, what’s the context they’re interacting with your organization, and do it with data that represents who they are. Because if we go back to look at the data and we start making decisions, but we didn’t realize that not everybody was really included, we’re going to make decisions we have to undo later. So that’s a big one. I think any health equity public policy opportunity we have is going to be really important. And with that, I would just like to acknowledge that the Trans Health Equity Act passed in the state of Maryland. It’s on its way to the governor’s desk. This is a really important bill that provides access to health care for people on medical assistance in Maryland who need affirming gender care. This is something very important to Chase Brexton, this is a major patient population service area where we work and this law is a huge victory. And it makes me proud to be a Marylander, especially proud of the transgender led organizations that really made this bill happen, and then championed it all the way across the finish line.

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I know. I’m so impressed by the initiatives that we see in the legislation in Maryland. My hope is that we continue to be ahead of everyone else, and people will maybe pay attention and learn from us because what we’ve done is so important. All we can do is just take it one step at a time, one person at a time.

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The work never ends.

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No, no. Well, I want to thank you both for being here today. I know my listeners are going to learn a lot, and they’re going to be able to take some of this information into their organizations and, perhaps, into their families. My feeling has always been that change happens one person at a time, one heart at a time. And I’m really grateful for both of you. So thank you for being here today.

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It was a pleasure.

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Thanks so much.

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We’ll come back if you ask us.

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Well, after this series, there’ll probably be another part to it.

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Well, you are a leader I’ve long respected, and I am grateful for every moment that our paths have crossed. I was thrilled to see that you were doing a podcast on this topic of leadership. I think it’s a beautiful, beautiful concept and we wish you every success with it.

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Thank you both. I appreciate you so much.

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Thank you. I echo that sentiment, really appreciate you having us.

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Thank you for joining us. And if you enjoyed this episode, please follow Room at the Table on your favorite platform and share with a colleague or two or three. You can find the full transcripts, links and more resources to creating more equitable workplaces at RoomAtTheTablePodcast.com.

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