Building equity into MUSC’s DNA

Disjointed diversity, equity and inclusion (DEI) initiatives can struggle to bring about changes in attitude that are more than skin deep: Efforts can be duplicated. Resources aren’t used wisely. Lessons learned aren’t shared, and momentum is difficult to build.

This lack of cohesion is one reason why many hospital leaders across the nation were caught off guard when The Joint Commission, which accredits health care institutions, announced that in 2023 it would begin requiring evidence that hospitals were addressing health care disparities in their regions.

But Willette Burnham-Williams, Ph.D., who was recently named MUSC chief equity officer for the MUSC enterprise Department of Diversity, Equity and Inclusion, wasn’t worried.

Burnham-Williams knew she could point to her collaboration with the Integrating Special Populations (ISP) program at the South Carolina Clinical & Translational Research (SCTR) Institute and to  its long track record of equity initiatives and outreach to diverse communities.

“We thought that if we put our shared missions together, we could accomplish so much more together than we ever could separately.”

-- ISP director Marvella Ford, Ph.D.

“The ISP team has figured out the importance of collaboration in that space,” said Burnham-Williams. “And I think that, for the first time, we can say in a proactive way that we’re already doing that instead of scrambling to figure out how we demonstrate it. We can just show them what we’ve done through this collaboration.”

When Burnham-Williams was appointed to her new role, the ISP co-directors saw that MUSC had made an important step in building diversity and equity into its DNA, both on the clinical and research side. They reached out to her and suggested joining forces. They saw that, through such a collaboration, they could better realize their mission of diversifying clinical trial participation while also supporting institutional diversity efforts.

"We always say the whole is greater than the sum of all its parts,” said Marvella Ford, Ph.D., ISP co-director. “We thought that if we put our shared missions together, we could accomplish so much more together than we ever could separately.”

“Dr. Burnham-Williams’ role as chief equity officer is to clarify that this is one big house of DEI, and it doesn’t have to sit in different playgrounds and duplicate efforts. Instead, let’s maximize the infrastructure we have.”

-- ISP co-director Cristina Lopez, Ph.D.

Instead of separate DEI initiatives for caregivers and researchers, the ISP-DEI collaboration enabled better coordination and use of resources across the enterprise.

“Dr. Burnham-Williams’ role as chief equity officer is to clarify that this is one big house of DEI, and it doesn’t have to sit in different playgrounds and duplicate efforts,” said Cristina Lopez, Ph.D., ISP co-director. “Instead, let’s maximize the infrastructure we have.”

Burnham-Williams gladly agreed to the collaboration because she admired the work of the ISP.

“And one of the things I love about working with these women is that they’re so brilliant, yet they’re so modest,” said Burnham-Williams. “They don’t talk much about all the really great work they’re doing because they’re just so busy doing the work.”

Opening doors and knocking down barriers

 

Burnham-Williams sees her job in the collaboration as supporting and amplifying that work. For example, she provided the ISP a bigger stage for their outreach and educational efforts, inviting them to participate in the Black Expo and other diversity-oriented community events and approving ISP-developed trainings such as “lunch and learns” for institutional DEI credits. 

“My role is to open doorways and take down barriers that might be there prohibiting their success,” said Burnham-Williams. “It’s also to get the word out not just in the community but to get as many of what I call big loud voices we can get to talk about the work when we're not present.”

One of her first actions was to invite the ISP co-directors to present their work to the MUSC Board of Trustees so that leadership was more aware of and could better support their efforts. She has also invited Ford to sit on the executive search committee for the inaugural chief of the Health Equity Integrated Center for Clinical Excellence.

“My role is to open doorways and take down barriers that might be there prohibiting (the ISP team's) success."

-- MUSC chief equity officer Willette Burnham-Williams, Ph.D.

“It’s going to be a big lift for that person because his or her job as health equity officer will be to make sure folks realize that we can’t take a siloed approach to diversity,” said Burnham-Williams. “All of what we do has a component of health equity that is going to have to be present and accounted for.”

Addressing COVID-19 disparities

With the support of the ISP-DEI collaboration, MUSC Black Faculty Group co-leaders Ford and James Tolley, M.D., worked with key members of the group, including Ruth Adekunle, M.D., Mileka Gilbert, M.D., Ph.D., and educational navigator Ayaba Logan, to  put together a packet of information encouraging underserved communities, including those of color, to get vaccinated against COVID-19. Burnham-Williams helped to ensure that the packet was sent “to every single county in South Carolina, even the most rural and underserved,” she said. 

 

When the Black Faculty Group learned that teachers in Marlboro County, the population of which is more than half black, were reluctant to receive the COVID-19 vaccine, it arranged for a photo of Marlboro County School District superintendent Gregory McCord, Ed.D., getting the vaccine. After the photo was shared widely on social media, the number of teachers in his county willing to be vaccinated increased by 50%.

When it became clear that vaccination rates were lower among MUSC faculty and staff of color, Ford and other Black and Latino faculty held a virtual information session, on consecutive weekends, to answer their questions and address concerns.

With Burnham-Williams’ help, a link to that recorded event was included in the materials that were distributed statewide.

Many rural communities, especially those of color, were hard hit by COVID-19. Rural South Carolinians had higher rates of COVID-19 cases (19.2%), hospitalizations (22.7%) and deaths (23.7%) than those living in cities, according to the Department of Health and Environmental Control (DHEC, updated April 2022). According to DHEC, rural residents diagnosed with COVID-19 were also older than urban residents and more likely to have existing health conditions that put them at greater risk of severe disease. Blacks living in rural areas also had higher rates of COVID-19 (24.8%) than those living in cities (18.4%). According to Ford, one of the legacies of the pandemic is exposing these health care disparities.

“There were a lot of tragedies brought about by the pandemic, but one of the graces of it was uncovering these deep-rooted disparities,” said Ford. “And so now we have an opportunity to do something about them.”

To address these disparities, the Alliance for a Healthier South Carolina and the SC Hospital Association (SCHA) partnered to form the Rural Hospital DEI Learning Collaborative, whose membership is made up of hospitals located in underserved counties. The collaborative is centered on aligning hospitals with their communities’ needs to build and strengthen partnerships that improve health outcomes. MUSC Health was invited to join, with particular emphasis on its Kershaw and Williamsburg communities. Burnham-Williams immediately thought of ISP coordinator Kimberly Brown and asked her to represent MUSC.

"It’s been another great opportunity to see the partnerships that are happening to overcome these COVID disparities on the health side but also the community partnerships happening on the research side,” said Brown. “It’s really enabled us to overcome working in silos and to bridge those gaps. We want to find out where there is opportunity for synergy through partnership."

Optimizing care and clinical trial representation for the LGTBQ community

Through its consultations offered through SCTR's SUCCESS Center, the ISP team has long encouraged research teams to recruit clinical trial participants who match the region’s residents, and that includes members of the LGTBQ community. To do so, the teams need access to demographic data about potential participants. In April of 2021, the ISP held an LGBTQ “lunch and learn” that addressed, in part, challenges to collecting sexual orientation and gender identity (SOGI) data.

One of the community panelists, Chase Glenn, was later appointed as the director of LGBTQ+ Health Services and Enterprise Resources in the MUSC Department of Diversity, Equity and Inclusion and, in his new role, invited the ISP team to organize a panel on "LGBTQ Research 101" for the 2022 inaugural LGTBQ+ Health Equity Summit.

 

 

The summit was attended by 600 people, across two days of virtual learning, and further reinforced the need to push forward with initial efforts to activate tools in Epic, MUSC’s electronic health record, for collecting SOGI data. These tools were activated October 4 and will provide the data needed to improve the quality of patient care and the inclusiveness of clinical trials. 

“It is very much in line with our values around respect and patient care to create the best experience for every patient, no matter how they self-identify,” said Burnham-Williams.

By working together to make SOGI data available to both clinicians and researchers and to encourage best practices in their use, ISP and Burnham-Williams are also helping to ensure research efficiency.

“What we hear from researchers is that they don’t know where to start to ensure that the LGTBQ community is represented in clinical trials,” said Tara Pittman, recruitment manager for SCTR’s SUCCESS Center. “And so, when we remove silos and are able to work together with the clinical side, we can start to develop workflows for our researchers, as well as clinicians, that are less overwhelming when it comes to being more inclusive.”

There’s much work left to do. But the ISP-DEI partners feel that they are up to the challenge.

“We talk about an idea, and then it’s on the agenda, and then it gets carried out, and it’s just a really smooth operation because of all of our networks and because the rubber hits the road fast with this crew,” said Lopez.