Nemours Children’s Health’s first chief equity officer looks at health beyond medicine

Rachel Thornton talks about her new role at Nemours and the importance of equity and early intervention to improve the health of kids.

As a pediatrician who has spent much of her career studying health disparities, Rachel Thornton found the ideal place to pursue her passion to help children.

Thornton joined Nemours Children’s Health as the system’s first vice president and enterprise chief health equity officer. She began her new role March 1.

“I have always had a passion for delivering care and had the privilege really to work in care and service to patient populations that are coming to the table with a lot less material resources than many, and who have a lot of needs,” Thornton said.

“When I learned about this role, I could think of no better way than to be part of a health system that was articulating its role as a part of a coordinated cross-sector, cross-disciplinary, whole-of-society effort to really move beyond medicine, well beyond medicine, and into health for children," she said.

In an interview with Chief Healthcare Executive, Thornton talked about her goals at Nemours, the importance of taking health equity beyond medicine, strengthening communities and the need for more diversity in healthcare.

“Before we get to the point of treating an illness, just investing in the health of children is a force multiplier,” Thornton said. “It's a potentiator of future success, of productivity, of positive things in our society.

“There’s no better way to spend time and resources,” she continued. “I’m biased, because I’m a pediatrician and health disparities researcher, but I was really drawn to the articulation of the mission and sort of this humility the system has as seeing itself as part of something bigger.” (The story continues after the video.)

‘Daunting and exciting’

This isn’t the first time Thornton has taken on a new role at a leading health system.

Before joining Nemours, Thornton served as the inaugural executive director for clinical services in the Johns Hopkins Medicine Office of Population Health. She also worked as the health policy advisor in the U.S. Department of Housing and Urban Development from 2011-2013.

When Nemours announced Thornton would become the system’s first chief equity officer, Nemours Children’s Health Executive Vice President and Chief Population Health Officer Kara Odom Walker said she is well-suited to address health equity and the social determinants of health.

“Dr. Thornton is exactly the kind of nationally recognized leader who can set the course for Nemours Children’s to be a model for child health equity, diversity and inclusion for the entire country,” Walker said in a statement.

When investigating the opportunity at Nemours, Thornton said it wasn’t just the new role in the organization that held an appeal.

“The short answer is the idea of being responsible for building out health equity strategy, building on the strong foundation and commitment the organization already has was attractive,” Thornton said.

‘It was as much about the organization, about the focus on children and families, and the demonstrated commitment of senior leaders, even before I arrived, to the concepts that drew me,” she said. “The idea that I’d get to build it is daunting and exciting at the same time.”

She noted the work Nemours has done to bolster health equity before her arrival. Thornton pointed to the system’s “DRIVE” initiative (Diversity, anti-Racism, Inclusion, Value, and Health Equity) to improve equity for all children.

“What I’m having everyone do right now is reflect on the many successes, on the goals that we’ve met, on the work we’ve already done and to use that reflection as a time to think about what we want to do next,” she said.

Thornton views health equity from a variety of different vantage points. And she stressed throughout the interview with Chief Healthcare Executive, improving health equity for children goes far beyond treating illness and injuries.

“Health equity really is mostly about where children live, learn and play,” Thornton said.

“This notion of creating the healthiest generations of children, that is really a driving part of the mission at Nemours, and the focus that the organization has on expanding the aperture of our involvement in healthcare beyond medicine as the totality of health, is really important,” she said.

Thornton said Nemours will work with communities to get a better understanding of health needs.

“Health equity exists in the community,” Thornton said. “It exists in ensuring children have the building blocks of health. It’s about nutrition. It’s about safe housing and shelter. It’s about healthy and developmentally appropriate environments. It’s about potentiating health in the absence of disease.

“There’s so much in health equity that is not the provision of medical care or clinical services.”

Thornton said there’s no way to be part of the solution of helping communities without building partnerships. She said that is something deeply ingrained in her training.

“The analogy for me as a physician is parents with such limited resources, I have watched them do amazing things for their children, that I don’t think I ever would have thought or known to do,” Thornton said. “And communities are the same.”

“Sometimes when we talk about social determinants of health, we talk about the things that need to be improved,” she said. “But the flip side of that is to really recognize the capacity and the ingenuity that already lives in communities.”

‘Top-notch talent is diverse talent’

To connect with the community, and to achieve the goals of improving health equity, Thornton stresses the importance of diversity in the workforce.

She said expanding the diversity and inclusion at Nemours is an important step to unlocking the potential in the communities the system serves.

“We can’t do that if we don’t have people on our own teams that can help us with connecting, that can convey a wide variety of viewpoints and experiences, and feel free and open and empowered and included to offer those many perspectives,” Thornton said.

She said she learned in her career that equity is an important part of improving healthcare quality and safety.

“In safety culture, we talk about speaking up and offering a different point of view and highlighting when we think something is not working the way it should, and we really encourage people to do that,” Thornton said.

“And so it’s for those same reasons, we’re better when we know what the potential downsides are of something, or when we know what someone else is seeing that we may not be primed to pick up on.”

Thornton said Nemours aims to hold itself accountable in terms of adding more diversity to the system.

“It’s about ensuring that we are able to retain and develop top-notch talent, and top-notch talent is diverse talent,” she said.

At the same time, Thornton said it’s not enough to simply bring in more diverse workers. Healthcare systems need to provide opportunities for those workers to grow, advance their careers and move into leadership roles.

She said it’s important for healthcare organizations to measure their success in moving people from underrepresented groups into leadership roles.

“I think organizations can do that by embodying their commitment to retaining and developing diverse talent by really aligning it with the way that they assess their own performance,” she said. “I think that that is something that is innovative and cutting-edge for organizations to consider and put into action.”

‘Thinking about children and families 24/7’

Thornton said the mission of health equity takes on a different meaning for a pediatric health system such as Nemours.

“I will say personally as a pediatrician, for me, nothing beats thinking about children and families 24/7,” she said. “So on a personal level, yes it’s different, because certainly so much of our energy and attention tends to get focused on addressing equity once the medical complexity is already there.

“So this idea of well beyond medicine, and the role of the health system in moving well beyond medicine, is something that I think a pediatric health system is particularly well positioned to be a leader in, because we are so clear on, and pediatrics just focuses, on optimizing outcomes.”

As she discussed her aims at boosting health equity, Thornton repeatedly refers to her own work in pediatrics.

In many ways, she views it as the ideal experience as she looks to make a bigger difference in improving the health of children.

“In pediatrics, there’s just this incredible recognition and commitment to optimizing health over the lifetime by starting as early as possible to keep people on a healthy track,” she said.

““That’s what’s going to get us the healthiest generations of children in the future. It’s,  don’t wait til they get sick. It’s meet them in the community and keep them well.”

“In pediatrics, we’re seeing all the possibility and we want to keep it, we want to optimize it,” Thornton said. “We don't want to wait until those bumps in the road start to chip away at health and produce disease.”