A series celebrating nurse leaders who go above and beyond.
Mobile medical vans that take healthcare out into the community around Boston's Massachusetts General Hospital are a part of the institution's decades-long commitment to diversity, equity, and inclusion (DEI).
Deborah Washington, PhD, RN, Mass General's DEI health and community partnerships manager, has been a fixture in the hospital's DEI initiatives since the mid-1990s and is responsible for such programs that serve underserved community members and work to sweep away longstanding inequities.
Washington spoke to HealthLeaders about how nurse leaders can begin to implement DEI in their organizations.
This transcript has been edited for length and clarity.
HealthLeaders: For nurse leaders who are working toward DEI, what is required, generally, for correcting course from bias and inequities toward real and lasting change, first for patients, and also for nurses?
Dr. Deborah Washington: My answer would be the same for each. The nurse leader needs data, a data driven story, for the workforce and terms of recruitment and retention, meaning the demographics of the workforce that they're meeting and the turnover rate. In terms of patients, once again, demographics in terms of the mission of their organization in identifying who they serve and getting the demographics of the geography of those patients where they live and their ethnic identity.
HL: How have you been approaching this at Mass General? What are some DEI programs that have been implemented?
Washington: We have been on this effort of diversity, equity, and inclusion for decades, so we're not newbies. We've had several starts and regroupings around some of the things that I just mentioned: Taking a look at our workforce, getting the data-driven story, paying attention to the national conversation around disparities and equal treatment, listening to the stories of the communities we serve, and designing programs and training and education for our staff in response to those stories in particular. Because through the stories that we collect, not only do we get exposure to the lives that our patients are living, but we develop communication skills for our clinical care services in terms of how we deliver them and how we shape them to be responsive.
COVID changed everything for everybody. For us, the most significant change was understanding the value of bringing services to the community as opposed to the community having to come to us, so we refitted and developed a program around community vans that are staffed by doctors, nurses, and patient care associates who staff those vans to go into the community to do patient education, to deliver the vaccine, [and] to be a presence in terms of fielding questions and stepping deeper into that model of the trusted messenger that rose to the surface as a critical need during COVID. And we're continuing that service, because we are incorporating lessons learned, and this is a model that can forever benefit the community we serve.
HL: What are some other Mass General DEI programs that have evolved?
Washington: We're constantly taking a look at, as an anchor institution, how can we be more effective and supportive in terms of social determinants of health, specifically, improving the economic opportunities for small businesses and the BIPOC [Black, Indigenous, and People of Color] community.
We have a stronger presence in the Black community in particular, because we have expanded our concept of who we serve. Some communities went to one institution for care, and other communities went to other institutions for care. Well, we have decided that as a healthcare system that serves everyone, we're going to break those predictions, and everybody who cares for the community will cross those traditional lines. That is a new model and a new way of thinking about healthcare, in that all healthcare is public healthcare when you really get down to the cases of it.
So even if somebody comes for care in the inpatient environment, we have to keep in mind that this is an episode in the patient and family's life. As a holistic way of taking a look at that human being, we have to realize that for this episode, we're going to keep the context of their community life in mind when we do our treatment planning and when we do our discharge planning.
HL: What kind of results are you seeing?
The trusted messenger piece has been eye-opening in terms of our ability to occupy that space as a healthcare institution. I know that we had a tremendous response to the number of BIPOC people who responded to our presence in the community to get the vaccine when everybody was raising questions about the efficacy and safety of it. So we recrafted our presence and the meaning of our presence, and we're building relationships that are not going to be superficial. We've learned, and we're staring into the face of what is needed, and we're not going to let old traditions and rivalries stand in the way of us moving forward and breaking down some of those barriers.
That's where the CNO is extremely important because what I find to be problematic in this discipline I love, is that when we problem solve, we tend to speak only to each other within the system. The missing piece that COVID has taught me is that the trusted messenger conversations have opened up the realization that nursing leaders need to create a public discourse around the value of the discipline and the difference it makes in terms of healthcare.
HL: And how do nurse leaders do that?
Washington: We need to get into the papers, we need to develop our voice in the public square, and engage in making ourselves more visible. We need to have the CNO voice saying in the BIPOC community, "We as nurses are going to be doing X, Y, Z. Come and join us." We're going to be doing podcasts that talk about our value and the difference we make. We're going to use social media differently. We're essentially a valued but well-kept secret in terms of being a player in the power structures of our impact. Everybody talks about medicine and medicine's impact; well, nursing is not medicine. We have a separate story. And that story needs to be more public.
HL: What are some first steps that chief nurses can take toward DEI regarding employment?
Washington: We need to be more audacious in terms of using our organizational power, our positional power, and the influence that we have in terms of our voice and values, and by that I mean, having the chutzpah to create programs to address the problems that are of concern to us. If I'm concerned that I don't have enough diversity in my nursing staff, I need to reach out to my human resources department or I need to take advantage of my BIPOC staff and say, "Would you be willing to spread the word about this organization in which you work and be an ambassador of recruitment?"
I, as a nurse leader, would be happy to talk to anyone interested in working here. I will be happy to go out into community organizations to talk about our values and how we are aware of the needs of the community and build our presence. We need to step out from under medicine or the organizational name and step out of the name of our discipline. And we need to exercise the power we have in order to make that choice.
See the other nurse leaders featured this week:
Related: National Nurses Week 2022: A Feature With Maria Knecht on How to Grow Nurse Leaders
“We're not going to let old traditions and rivalries stand in the way of us moving forward and breaking down some of those barriers.”
— Deborah Washington, PhD, RN, DEI health and community partnerships manager, Massachusetts General Hospital
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.