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  • Health equity

Fatima Paruk of Salesforce sees ‘huge opportunity’ for health equity


Even with longstanding problems, there’s more momentum to close gaps in outcomes. She talks with Chief Healthcare Executive about linking equity to business goals, getting started, and building on progress.

Even though “health equity” has become a buzzworthy phrase in healthcare, those who work in the field say the disparities in underserved communities have always been present.

Nonetheless, COVID-19 illuminated gaps in healthcare in ways that could no longer be ignored, and that has created more momentum in tackling these problems, Fatima Paruk says.

Even though the problems are daunting, Paruk, the chief health officer of Salesforce, says she sees one new development.

“There’s just a sense of hope,” she tells Chief Healthcare Executive®.

“The fact that the incentives are aligning, whereas before the incentives were never aligned, I think it's a huge opportunity to be able to make change,” Paruk says.

Increasingly, health organizations are seeing that they need to partner with others and work together to prevent health issues before they become costly conditions down the line.

It’s partly a growing recognition of moral responsibility and also an acknowledgment of financial realities.

“It's actually just an extension of moving the model towards preventive care,” Paruk says. “We’re in a situation where our system is going broke.”

“We cannot afford to deal with these things from an acute perspective anymore, and we have to shift the model to preventive,” she adds. “Health equity is another pillar underneath. It's about making sure everybody has the best possible chance of the best possible outcome.”

Paruk moderated discussions on health equity at the ViVE Conference in Nashville last week.

In an interview with Chief Healthcare Executive in Nashville, Paruk offers thoughts on tying equity to business strategies, getting started and building buy-in, and the need to partner with communities.

(See part of our conversation of Fatima Paruk of Salesforce. The story continues below.)

Getting started

For hospitals looking to make progress on health equity, Paruk says there’s no one right place to begin.

“I think starting with yourselves and looking within your organizations, and thinking about this with positive intent, as you think about starting programs around health equity, is a great first place,” she says.

To make meaningful progress, Paruk says health equity must be embedded in the organization’s top priorities. Unless everyone has some stake and responsibility, the initiatives can fail.

“It's got to be part of everybody's core business mission,” Paruk says.

Health systems can falter in their efforts to improve health equity if they don’t show sustain momentum and show employees - and the community - measurable progress. If systems create realistic programs, and track the progress of those efforts with data, they should be able to see the benefits, and show the returns to the organization, Paruk says.

Healthcare leaders can’t underestimate the importance of showing the teams the value proposition of those efforts.

“If you do it with positive intent, and you can demonstrate very clearly the return on investment and value, whether that makes life better for the patient or the provider, and reduces administrative burden, and demonstrates better outcomes, that's where you start to see things change,” Paruk said.

Look at yourself

Hospitals that are aiming to improve health equity need to consider the diversity inside their own organizations, among providers and in leadership roles.

“There has been a push, especially from the hospital and health system side, to include more of their staff and providers that look more like patients. And I think that's been very promising,” Paruk says.

“I think that goes a long way in terms of building trust with patients,” she adds. “It's good for the community. It's great for outcomes. You want to go to a provider who understands what you're going through at whatever point in life you are.”

Health systems should examine the ways that they are delivering care and identify process that could be creating or reinforcing bias and disparities. She pointed to the layout of the waiting room and protecting privacy for patients that may want discretion.

“So just even thinking from a process and a design perspective, there's so much we can do as we think about equitable access,” Paruk says.

“From a technology perspective, the technology needs to be the great enabler,” she says, rather than another barrier to care. Health systems need to be designing services that can be accessed via smartphones.

“I think it comes down to simplifying the processes and technology and making sure we can meet people where they are, and there's a lot of work to be done in that space,” Paruk says. “And there's a lot of big work that's being done as well. But we still got a long way to go.”

Don’t wait for perfection

Hospitals and health systems looking to improve the health of their communities must work with other local and regional organizations, including those tackling issues such as housing and food insecurity.

“If you're not partnering with those folks in the community,” she says, “how do you know about your population?”

If the health system has alienated certain groups, then leaders must extend olive branches to acknowledge past missteps and begin building trust.

Hospitals and health systems can look at some of their own data, including their own patient records, to get a sense of where outcomes for minority groups are lagging and need attention.

Health systems could also examine other sets of publicly available data, combined with their own electronic health records, to gain insights on their communities and disparities in care and outcomes.

“That might actually be very, very informative as you think about setting up services or understanding where the greatest need is within the community to deploy your scarce resources,” Paruk says.

Health leaders should undertake efforts to improve equity with a “growth mindset,” she says.

It’s not realistic to expect every effort will be fully developed at the launch. Besides, those who are convinced they have everything figured out are likely to be wrong, she says.

Still, starting with positive intent goes a long way.

“It doesn't have to be perfect,” Paruk says. “It just has to be something that you can learn from, that you can set up again, according to having data that will be actionable, where you can adjust your course as you learn more and know more.”

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