The Cultural Demographic Shift Is Changing The Business Of Healthcare08/24/2015 10:03AM
By Glenn Llopis
“A new type of thinking is essential if mankind is to survive and move toward higher levels.” Albert Einstein said that, but we don’t need to be geniuses to implement new thinking in business. We only need real leadership that’s innovative and courageous enough to evolve and take action now. That’s how we close the growing opportunity gaps within the three pillars of workplace/workforce, external partnerships, and the marketplace/consumer. We must see these opportunities everywhere every day and anticipate the unexpected, sow those opportunities and unleash our passionate pursuits, grow those opportunities with a strategic focus and entrepreneurial spirit, and share opportunities with a generous purpose. That’s how we reinvent leadership for the 21st century and sustain growth.
And it starts by asking one question: What are we solving for?
This is the second of five articles to help you understand what is required to answer the question and compete in today’s fiercely competitive global marketplace across a variety of industries. The articles detail the insights and frontline experiences shared by leaders of the roundtables at my June 2015 Executive Summit, “Preparing U.S. Leadership for the Seismic Cultural Demographic Shift”. The first article featured Earvin “Magic” Johnson, chairman and CEO of Magic Johnson Enterprises, and Mike Fernandez, chairman of MBF Healthcare Partners. Both use their entrepreneurial spirit and passionate pursuits of excellence to fuel business innovation that most U.S. corporations don’t see. That article – and all six in this series – shows how the Cultural Demographic Shift represents a natural evolution of American enterprise and its business models.
How is the cultural demographic shift revolutionizing the healthcare business in the U.S.? Especially as an increasing percentage of individuals from fast-growing minority groups become insured and gain access to healthcare through the Affordable Care Act – at the same time that the ratio of those who are culturally competent enough to serve them is on the decline.
The roundtable discussing how the cultural demographic shift is changing the business of healthcare featured executives from summit host and sponsor CVS Health and supporting sponsor Aramark, as well as City of Hope, Kaiser Permanente, and Citrus Valley Health Partners.
We addressed some of the most burning issues in the healthcare industry as they relate to the three pillars of workplace/workforce, external partnerships, and the marketplace/consumers. To cite one such example, only five percent of physicians in the U.S. are Hispanic, even though we are on track to reach nearly a third of the population by 2050.
Beyond Hispanics, the cultural demographic shift has become a burning platform that healthcare stakeholders are not preparing for enough – even as the industry itself transitions from a physician-led to a patient-centric business model. Even when healthcare executives realize the shift must be addressed and can no longer be ignored, they still face a widening gap of intellectual capital and strategic know-how to:
• Best serve their rapidly growing minority patient populations;
• Recruit a more diverse workforce to serve these patients;
• Elevate a greater diversity of executives into the boardroom;
• Effectively engage more minorities in clinical research trials;
• Improve community outreach and tailor marketing efforts;
• Educate diverse communities about self-advocacy and preventative care;
• Identify the right external partnerships and resources to strengthen ecosystems.
According to Dr. Joseph Alvarnas, Director of Medical Quality, City of Hope, the many disconnects in medicine is nothing short of a crisis, but one in which we can take full opportunity. “The shift to a patient-centric model means changing the business of healthcare to a relationship-based profession where we grow together with our patients from beginning to end of life,” he says. “That’s the idealized version of medicine.”
In Dr. Alvarnas view, and many others in the industry, patients want to see people who look like them when they go to the doctor’s office. People who know and respect their culture, their values, and do so in a legitimate and authentic way. But this is at odds with healthcare getting progressively consolidated, regulated, and systematized – which fuels tension instead of trust, as organizations continue to unknowingly perpetuate an identity crisis amongst Hispanic patients and other multicultural groups.
“These are two profoundly opposing forces,” according to Dr. Alvarnas. “One path is intensely personal and pays off enormously in terms of patient care, while the other is highly regimented and disenfranchises the very people we are seeking to serve.”
I next asked Angela Patterson, VP/Chief Nursing Officer, CVS Health, how do we get to the point where the healthcare industry starts to mirror the communities we serve, so we can engage them more in preventative care, when the cultural demographic shift can represent as much as two-thirds of the patient population (as it does for City of Hope)?
She says that the first thing we have to realize is that health is something that for the most part happens outside of healthcare facilities, and where it really takes root is within the families and communities we serve. You also have to think of health in more than just physical terms. There are social determinants that come into play where health is concerned, be it culture, the economy, the school system, even the system of sanitation in your neighborhood. These all can have a powerful impact on the health and well-being of the community, so in addition to reflecting the patient population we have to create systems that are representative of community needs.
“There are two ways among many we can begin to impact health in a positive way. First are the decisions we make to help the community. This is why CVS Health decided to remove tobacco products from our shelves,” explains Patterson. “Second is how you deliver healthcare to the community. For example, our minute clinics, which we launched in Minneapolis/St. Paul, had a very standard look and feel that we realized wouldn’t work in all communities as we grew and expanded across the country. So we had to look at the social and cultural context within these populations in order to deliver a solution that would meet their specific needs – such as replacing kiosks with live interactions with human beings. Being greeted by someone who speaks your language and understands your culture shows that you care about them as a patient and as a person.”
That brings us to the other side of the coin, recruitment and training of a healthcare workforce that is representative of the community you are serving. Then once you hire them, Patterson says, you have to reevaluate your policies, procedures and the corporate culture through their lens in your efforts to retain them. For instance, Hispanics are very family-oriented, so you have to look at your corporate policies in terms of the personal commitments they may have to large and extended families.
Paul Heredia, Chief Human Resources Officer, Citrus Valley Health Partners, has experienced the transition to a patient-centric business model firsthand, as healthcare moves from cottage industry to big business. His biggest concern: what are we doing about the disconnect and the mistrust that exists within the cultural demographic shift?
His organization is not only going out into the community, but they are also bringing the community to them – into settings like patient advisory groups where they can hear firsthand where the mistrust comes from and try to rectify it. And they’re training thousands of healthcare employees to do the same, to be good listeners and truly engage in these conversations that need to happen with the community. To take accountability and really be present for their patients. To start to view diversity as a strength and not a weakness.
“From a cross-functional standpoint,” Heredia says, “we make sure that everyone we hire, train and elevate in the organization, every physician, caregiver and staff member that comes in contact with the patient, from the person greeting them at the door to those cleaning their room and serving their food, is able to suspend judgement and view the human being; they must be able to connect the 12 most important inches – those between the head and the heart.”
Yes, there is push-back from physicians and others who might be resistant to change. In that situation, Heredia advises, you’ve got to engage them in the process, coach them, and build connections with champions throughout the organization. It’s another case of suspending judgment, and not forcing people to change but bringing them into the conversation. You have to explain and educate how the change will benefit them and their patient base, and back it up with actions that match your words and fact-based, data-driven supporting evidence.
“If there’s resistance, you have to understand the why behind it,” says Heredia. “Resistance is just a symptom; you’ve got to get at the root cause of why someone does not want to change and gain a comprehensive view of their perspective by bringing together stakeholders from across functional areas. That includes the naysayers; let them challenge you but also challenge them to bring some answers and solutions to the table too.”
Beatriz Rojas, Senior Director Multicultural Marketing, Kaiser Permanente, knows what a challenge this can be and that there’s no one size fits all answer. But she does agree that the key to connecting with Hispanics and other multicultural groups is listening – and then more listening. The traditional relationship between physician and patient is one of authority, but now it must become one in which doctors listen to their patients’ needs and concerns and help put them in a position where they can start taking charge of their own health.
“We want to empower all of our patients and diverse members to take the initiative towards preventative care and be more proactive in managing their health,” says Rojas. “So we put a heavy emphasis on education, and that includes educating ourselves about the culture. For example, we can talk about obesity and the problems of being overweight, but when we listened to our patients we learned that many Hispanics thought they were eating healthy diets already because that’s what their mothers prepared when they were growing up. Knowing that helped us change the conversation about what it means to eat healthy to something that’s relatable specifically to them and their culture.”
She also acknowledged that how you deliver the information makes a difference too. Knowing that Hispanics are among the most tech savvy of us and that they get a lot of their information from the Internet and social media, Kaiser makes sure to provide the content they need to know online – as a complement not a replacement for live interactions – so that patients and their families can do their own research, become more knowledgeable and empower themselves to take more preventative care.
Rounding out the roundtable was Victor Crawford, Chief Operating Officer at Aramark. His company represents the impact and influence that external partnerships can have preparing for the cultural demographic shift, providing pretty much everything at the hospital that the doctors and other caregivers don’t do, including repair and maintenance of biomedical equipment, environmental and dietary services, infection prevention and control, etc.
Focusing in on one aspect of that, Aramark is one of the largest employers of dieticians in the country. “We deliver an experience of what we call enriched and nourished lives,” says Crawford. “With every patient who comes through the door, we sit them down with a dietitian, because with a lot of chronic illness you will typically find other issues, such as obesity, high cholesterol levels, and high blood pressure. For many multicultural groups, we’ve got to educate them that the way they’ve been eating in the past is not the way they should be eating going forward.”
Some of the solutions they’ve developed with their dieticians include a proprietary program called Healthy for Life and they also form partnerships with other health organizations centered around getting people to eat a more healthy diet. In hospitals, where 85% of patients are on some form of restricted diet, their dieticians work hand in hand with menu design, often going back to the culinary lab to make sure that the food not only tastes good but is good for you. There’s a lot of innovation that has to happen with hospital food when you start taking the fat, sugar and sodium out in terms of adding healthy ingredients and seasoning to bring the taste back to multicultural diets, he says.
There’s another important element to driving patient satisfaction too, says Crawford.
“You want to look at things from a health and wellness perspective, but you also want to be very mindful in terms of how you do that,” Crawford advises. “In our case, the patient doesn’t necessarily know it’s an Aramark employee and not hospital staff cleaning their room or delivering their meals. But that doesn’t mean you can just walk in and drop off a tray. There’s a hospitality aspect to the job and you’ve got to connect with the patient on a human level, perhaps culturally, perhaps from a language perspective. Oftentimes, if you’re delivering meals to a patient three times a day, you’re going to be seeing them more than even their doctor does.”
Like CVS Health, Aramark is rebranding itself as a health provider to serve the cultural demographic shift. And as with City of Hope, Kaiser Permanente, and Citrus Valley Health Partners, the cultural demographic shift is changing the business of healthcare. These companies are among a select few leading the way to better prepare for the cultural demographic shift. They’ve recognized the widening gap and existing disparities in solutions for diverse populations; they’re developing new best practices for a new patient-centric business model to engage with patients in more culturally sensitive ways, to build trust amongst diverse communities, and to educate them to be self-advocates for healthier lifestyles and preventative care; and they’re redefining a narrative through which key stakeholders – both internal staff and external partners – can authentically engage with and meet the needs of the cultural demographic shift through enterprise-wide change.
The leaders in this article have learned what they are solving for. Have you? Or better yet are you solving for the right things to establish your competitive advantage? Simple questions; hard to answer. But we must in order to establish the leadership America needs. Does your organization embrace this 21st-century leadership? Take the Workplace Cultural Assessment and find out.