Our focus on reducing disparities led to a partnership with the Institute for Healthcare Improvement. A gap in care with our Somali patient population was discovered after reviewing numbers for colorectal and breast cancer screenings, pediatric immunizations and diabetes. In the Season 4 finale, two HealthPartners colleagues, family nurse practitioner Munira MaalimIsaq and senior project manager Greg Fedio, share how the Equity Action Lab project, or what they and participants called "Open Faces," helped assess and better understand the gaps and determine steps for changes. "Off the Charts" returns June 11.
Our focus on reducing disparities led to a partnership with the Institute for Healthcare Improvement. A gap in care with our Somali patient population was discovered after reviewing numbers for colorectal and breast cancer screenings, pediatric immunizations and diabetes.
In the Season 4 finale, two HealthPartners colleagues, family nurse practitioner Munira MaalimIsaq and senior project manager Greg Fedio, share how the Equity Action Lab project, or what they and participants called "Open Faces," helped assess and better understand the gaps and determine steps for changes.
"Off the Charts" returns June 11.
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guests: Munira MaalimIsaq, FNP; and Greg Fedio
HealthPartners website: Off the Charts podcast
Got an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.
Kari Haley:
He is a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together, we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is "Off the Charts."
Steven Jackson:
Welcome to another episode of "Off the Charts: Examining the Health Equity Emergency." One of the goals of this podcast is really to explore many things related to health equity, and one of those things includes examining the gaps with regards to health care access and things such as colorectal screenings and other screenings that we recommend and are performed. But because of different factors that we'll probably highlight and talk about today, there are obviously gaps and there's a lot of work to be done. So to that end, we are very excited to welcome our two guests. Today we have Munira MaalimIsaq, she's a family nurse practitioner at HealthPartners Clinic Maplewood, and we also have Greg Fedio, senior project manager at Park Nicollet. Welcome, guys, and thank you for your time today.
Munira MaalimIsaq:
Thank you for having us.
Greg Fedio:
Yeah, I'm excited to be here.
Steven Jackson:
So tell us just by starting off, what drives you in terms of the work that's needed in the realm of health equity? What drives you guys?
Greg Fedio:
The heart and head together, but also having a clinic background where I did work in clinic and was patient-facing. I miss that piece of it, so I get the head piece right now, and so the heart piece is... so when you're a project manager and you're behind the scenes, you forget sometimes how your work does impact the patients. You mentioned colorectal cancer screening. I work on that initiative, so I'm doing outreach to patients about getting them in from screening, we're sending them fit kits, things like that, but you forget how that impacts patients. So really for me, this drive comes from the head and the heart, but I'm also a data geek too, so I like to look at where we do need to focus on and which communities we need to focus on too. So that's me personally.
Munira MaalimIsaq:
Bless you. That sounds amazing.
Steven Jackson:
Don't take his answer, Munira.
Munira MaalimIsaq:
I think for me, I would say collaborating efforts and breaking down barriers, and I think leading with the voice of the community, making sure that they have an input. We're not just going in and we're not just going, "OK, this is how I'm going to change something for you," but rather, "What is the issue and how do we come up with things that fit your needs?" and listening to them going back and saying, "Is this what you meant?" I think that helps in getting owner... they take ownership in what we did and we in turn are proud of what has been done and it's something that can be used for everyone. So I really like that part and that's what drives me.
Kari Haley:
I'm just going to dive right in. Can you guys tell us a little bit about the project that you're working on? What is it called, what is it doing and how did it start?
Greg Fedio:
Yeah, so HealthPartners has a longstanding tradition working with the Institute for Healthcare Improvement, or IHI, so it was an... Equity Action Lab was actually the model and it's their model that we are working with them on. We found out really early on when we were talking to Munira and other community members that the word lab really didn't resonate well with the community. I mean, you can think of a lab as coming in and doing tests, so we wanted to make sure that we weren't using that terminology, so we shifted it to be a project as we move forward. So it's just a basic model of working with the community and community stakeholders to really identify what their needs are. And Munira mentioned not just coming in with our thoughts and what are we focused on, but really working with the community to identify ways to improve health with them.
Munira MaalimIsaq:
Yeah, absolutely. And how much do they know and how can we grow on that?
Kari Haley:
What have been the main targets that you've started off with for the project?
Greg Fedio:
So we did come in with ideas, of course. I said we shouldn't, and then of course we did. So we mentioned colorectal cancer screening, breast cancer screening, diabetes management, and then immunizations is a really big focus area in the Somali community.
Munira MaalimIsaq:
And we went in and we asked, what does being healthy mean? Just to understand their perspective and where they were at and try to meet them there. Yes, we did have an agenda, but at the same time, making sure that they understood where we were and met them there.
Greg Fedio:
And there was a reason we were very specific with the Somali community. I mentioned being a data geek and we really did our due diligence. When we knew we were going to be working with IHI, we looked at the data and we said, "Which community really does need our help when we're looking at these metrics?" And it was clear that it wasn't necessarily... it's the Somali community as a whole, but it was in particular the Somali-speaking community. When we look at that data, luckily here we can have access to data at that level, and we really did see a lot of disparity gaps in the Somali-speaking community. So we started putting feelers out and trying to find community members that wanted to work with us, and luckily Munira is on staff here and had a lot of resources.
Munira MaalimIsaq:
And I think for us, for me especially, I volunteer in the communities. I'm part of the community, whether it is in the churches or the mosques and stuff. And because I'm a familiar face, they were willing to come in and let us know what they thought and be honest with us. And if we did something wrong to say, "Hey, this does not fit us right now," or, "This is not OK," and I really liked that part to get their honest feedback. And right now, I went back a couple weeks ago to the mall, Karmel Mall, which is predominantly just Somalians, and I saw one of the guys that was at the event or part of the project teaching other people about diabetes, and this was one of the most proudest thing I have seen because he's out there doing the education.
So I'm like, "OK, how can I give him other resources? How can we help him?" Because in places where people do not read that much or do not look at brochures, having him out there and educating them in languages that they understand with a community member that they understand, and we as part of HealthPartners taught him those, gave him tools and I'm really proud of that.
Steven Jackson:
I just want to highlight the fact that, number one, you guys are not only being a voice to those that don't have a voice, but you're enabling people to have a voice or to speak louder with the voice that they already have. And I think that's powerful because when you empower others, then it's almost like you can step back and watch them go. You walked into the mall and to your surprise, there's one of the guys that you met teaching others. And that's I think is one of the goals.
You want something like this to probably run itself, and I don't want to say it's like selling, but in a sense you have to sort of sell the concept of, "You need to be screened and this is why." But if you really believe in the product and you present it well, it'll sell itself. And I think that's what we're seeing. The other thing also I think is important to note is that not everybody trusts health care, whether it's a previous bad experience or culturally. The culture of my family is check you out first, trust you later kind of thing. And that's not uncommon amongst many other cultures and many other upbringings. And I just think it's important to acknowledge that, in order for you guys to have the success that you've had so far, they have to trust you.
Greg Fedio:
It's a really important point. And it actually, throughout the course of the four days that we spent working with the Somali community, we did need to come up with a name for the project. So there was an activity around that and how we do that. And it came out that there was a phrase, Open Faces.
Munira MaalimIsaq:
Yes. Because in Somalia, there's a saying that you do not go to an open door, you go to an open face, so your door can be open to me and you could tell me, "My business is open to you," but if your face shows something else or you're not welcoming to me, I'm not coming back or I'm not sitting there. So one of the females that was part of the group said that's how she felt in this project, so let's call it "Faces" or "Open Faces."
Greg Fedio:
So that's the name we chose for the project was Open Faces, right?
Steven Jackson:
That is awesome.
Kari Haley:
That is great. Have you been able to identify so far some good strategies in terms of reaching community members or being able to find that, I don't know, angle? I don't know if is the right word, but that angle of how you approach a subject or a thing such as screening to the community that has been successful? So what has worked, maybe what hasn't worked, but what is the biggest thing that you've learned?
Munira MaalimIsaq:
For Somalians in particular, the life expectancy is like 47. So there's not a lot of prevention that is being done back home and a lot of the people that we are seeing that need the most help are people that have lived here for the last five, 10 years. How do we tell them what prevention is and to actually take your medications if they do not understand where taking a medication every day is needed?
Because if you're used to getting only acute care, now, "Oh, do I have to take this medication all of my life?"
Greg Fedio:
"All the time or every day?"
Munira MaalimIsaq:
That is a turnoff. So how do I meet them where they're at? Or how do I educate them? Because a lot of the times they do not understand doctors, so how do we give them information in languages that they understand, ways that they understand? And that's one of the things that they've measured. "Don't give me paperwork because I can't read, so I need somebody to read it to me or have it recorded so that I can understand it," or different ways of learning. And that was eye-opening for me.
Greg Fedio:
Yeah, me, too. And I think we think so much about translating materials being the answer, and that came out very loud and clear in our conversations is that's not going to be enough. We're going to need recorded options. So we have started taking some steps around projects, but it also became very clear that this is our first step with this group. This is really where we're starting. So even the beginning things that we have put in place since the project, we have so much more to learn and so much more to do. So implementing things like recordings into the AVS, trying to do more things on social media within the Somali community. But we were able to have a couple of Somali women health fairs already, one at the Midway clinic and one at the Minneapolis clinic where we had the Mammo a-go-go truck there, and really focused on that and getting people in for breast cancer screening. And then we also gave some fit kits for colorectal cancer screenings.
Steven Jackson:
How important was it? Because Munira, you've said it a couple of times, we've met people where they were, and that's very meaningful. So what does that mean for those that don't know what that means and how important is it to meet people where they are for a project like this to be successful?
Munira MaalimIsaq:
I think recently I read somewhere that Minnesota, 10% of Minnesotans, have been diagnosed with diabetes or were told by their providers that they are diabetic. And if I didn't know that over 76% of them, or diabetes, type 2 diabetes, is related to foods that we eat or diet, then how do I take care of myself? And if the person does not get the concept of food, diabetes, hypertension, all of them are related, then I'm not sure that I can impact them the most.
So for us, is making sure that we understand our audience and how much they know. And with this project, what was different was in the beginning we did not just say, "OK, this is what we're going to get done." We went in, we listened, we waited, and just got to know each other, and I think in most places when things like this is being done, same concept could definitely work for any community that we work with.
Steven Jackson:
I love it. I love it. And I wanted to add to that, too, because I've quoted this before on our podcast, but it was told to me that our interactions with patients or potential patients and family members and community members, it should be less transactional and more relational because I think it's through the relationship, and even if you go to any plaque in any conference room at HealthPartners, it talks about relationships built on trust, but it's relationship, relationship, relationships.
And I think it's very wise of you guys to approach it in that way because I think people know what's real and what's not. "You're just here to get my information or you're just here to collect my demographics so you can do your little project and I won't hear from you again," but, "You really want to get to know me and what's important to me. You want to see me hear me, know me, partner with me," which is something that we're doing here. And I just think it's amazing that what you guys are saying, it's universal like what you just said. Any community, really any setting, health care, education, finance, if you get to know the people, that's probably more than half of the problems that you'll have simply by forging a relationship and caring about the people you care for.
Munira MaalimIsaq:
Absolutely.
Steven Jackson:
Mic drop, but these are expensive, so I won't drop them.
Greg Fedio:
We talk about a lot about in our projects around closing disparity gaps, learning the patient's story. You have to really go upstream and keep finding out what's going on with their life. And I think unfortunately, a lot of times, we don't have the time to learn the patient's story. So that's one of the unique things and great things about this project was we actually had several activities where we talked to people and learned their story and really to help identify not only the differences in the community, but the similarities between all of us, too. We did an activity that was part of the IHI round.
Munira MaalimIsaq:
Our favorite breakfast or something.
Greg Fedio:
Yeah, planning the perfect breakfast.
Munira MaalimIsaq:
And it was so unique in how most of us had a lot in common and some of us from the same country did not have the same thing in common, which was different.
Greg Fedio:
Yeah. Yeah, it was really interesting.
Munira MaalimIsaq:
Yeah.
Kari Haley:
I'm thinking, too, bringing this back into a clinical space and the patient-facing piece of things. So I think building these relationships are so important and it's awesome when we have a group that can have the time to build those relationships, plant some seeds of trust for a health care system at least. But what can the individual... when you're in clinic, you have a 15-minute appointment, or when you are in the emergency department, we might have to make a huge decision and it's in within minutes. How can we use those seeds that are being planted within the community to do the day-to-day job?
Greg Fedio:
That's a great question.
Munira MaalimIsaq:
I think for me as a new grad, I've learned a lot honestly in terms of if I... because we could always say, "Oh, send a message." Nowadays, you just send a message, you're like, "Oh, you're pre-diabetic, and do this, this, this," rather than... or your diagnosis, someone with diabetes for the first time, instead of just telling them, "I am giving you a referral to a nutritionist," but actually having them come into the clinic, having that first discussion with them about their diabetes, you setting the stage for a diabetes educator before they went in to see the diabetes educator, and that warm handoff is something that I learned in moving forward in a way that I want to practice as I get better at this, I guess.
Steven Jackson:
Sure, sure.
Greg Fedio:
I keep going back to that Open Faces concept, honestly. I mean, it's really beautiful when you think through it and you start... in your daily life, what is the face that I'm presenting to people when I'm interacting? And I think that really... I mean, that could be the beginning of just really having the patient trust you is the face that you're presenting when you're interacting with them for the first time.
Kari Haley:
And I mean even having... because that came from your conversation and that initial encounters, and that's not something that maybe someone who's not familiar with the Somali community would know is something that is like a saying or is something that people know about and think about when they're presenting themselves or receiving people. But just being able to share that so other members of the care team can know that as well, and at least be maybe more cognizant of the face that they're putting forward. Because we all have bad days. We all carry our emotions sometimes on our sleeves, but just to know-
Steven Jackson:
Who does that?
Kari Haley:
... that what we're putting out does make a difference for how people are receiving the information that they're being given.
Munira MaalimIsaq:
Right. Or the pressure of time, right?
Kari Haley:
Right.
Munira MaalimIsaq:
That 15-minute time.
Kari Haley:
Yes. "Oh gosh, I'm running 30 minutes late."
Greg Fedio:
Absolutely.
Munira MaalimIsaq:
Or there was one of the participants said, "Whenever I get roomed, the doctor takes forever. Is it because that's how you make money? Every minute that I'm sitting there, is that part of it?" And I found that interesting because now I'm like, "OK, how do I make sure that that is not there?" Because that is a mistrust that's there, that people are thinking that, "Hey, you're making money off of me because I'm running late," or how do I apologize for being late if I was, and let them know that I spent a little bit more time with another patient to make sure that they understood their care better, right?
Kari Haley:
No, it's so hard, that kind of communication piece, because their perspective is different than your perspective. And you've sat... we've all probably hopefully been to the doctor? We're good patients, right? But when you're sitting there, you have no idea. And it's really easy as the provider to forget that people... you might be super busy, but they're just sitting there and they have no idea what's going on.
Steven Jackson:
Yeah, I think it's important. So when you think about the face that you make, because in clinic, you might have several people back to back to back, and maybe you're leaving the room of a really bad interaction, and now you have to quickly reset because now you're going into another room who had nothing to do with the previous interaction, and you're potentially carrying that with you to the next interaction. So when I think about those kinds of scenarios, I think about the importance of the work that we do outside of the hospital or outside of the clinic, meaning working on yourself, whatever that is for you.
Maybe it's your faith tradition, maybe you meditate, maybe you take nice walks, maybe you eat good food and watch bad TV. Whatever it is that gets you to your happy place, I think it's also important to acknowledge the fact that as care providers, we're human, too, but we're challenged with needing and having to be at our best when we're taking care of others. Any thoughts on that? And are there any things that you guys have noticed in your own personal lives that work when it comes to keeping your tank full so you can be full for others?
Greg Fedio:
That's a loaded question. I was just telling Munira I lost my father recently, and-
Steven Jackson:
Oh, sorry to hear that.
Greg Fedio:
I appreciate that. But I've been so struck by chosen family. I'm also lucky enough to do a lot of LGBTQ+ health equity work at our organization too, and that's a term that's very common in our community. And so just in addition to my blood relatives, my chosen family and those people that I've opted to spend my time with and how much they fill up my tank, even being a self-proclaimed introvert and not getting my energy from people, it's been really nice to have those folks around.
Steven Jackson:
You're an introvert?
Greg Fedio:
I actually am.
Kari Haley:
I didn't think so.
Greg Fedio:
I can socialize well.
Steven Jackson:
OK. We're learning some new stuff here.
Kari Haley:
Extroverted introvert, I think is a term. Right?
Greg Fedio:
Right, right. I can socialize well, but...
Munira MaalimIsaq:
I think for me is work life alignment. So what has to give and how can I make sure my work life and my home life match up? And then it's not always going to be what I'm giving one thing up, it's doing what you love. So when I am home, I am a hundred percent mom. I appreciate who I have around me. I am spending... I'm giving it in a way that I'm always proud of that time I spent with them. And then when I'm at work, same thing. That is my priority. And when I'm with the community, same thing. So just making sure that I'm showing up for myself and checking in, or loved ones, they'll tell me, "Hey, you are burning out, calm down." Just having that, I guess, community within my family that would see when I'm burn out or when I need to just take a moment to step aside.
Steven Jackson:
Yeah, I need to be taking notes because that work-life balance sometimes is imbalanced.
Kari Haley:
Currently.
Steven Jackson:
Sorry, Mrs. Jackson, if you're hearing this episode.
Kari Haley:
Yeah, I mean, I think that part of it, too, that I've learned is just being honest with yourself too, because it's really easy to lie to yourself and say like, "Oh, I'm fine, or, "I could do that extra meeting." Technically yes I can. I can fit that in. But just taking an honest look and being like, "Oh, am I doing that just because I feel burnt out and I just don't know how to say no? I don't want to deal with saying no right now?" And if that's the case, I should probably just say no.
Greg Fedio:
And then sometimes you just squeeze it in because you're like... want to get it over with, right?
Kari Haley:
Yes.
Greg Fedio:
Because it's going to come back later if I don't do it now.
Kari Haley:
Right.
Greg Fedio:
And that's a whole mindset, too.
Munira MaalimIsaq:
Or there's the helium hand saying, "I can do this." Making sure that you're tucking your hand and you're not saying yes to a lot of things.
Steven Jackson:
I like that.
Greg Fedio:
I've not heard that term before. I have not.
Steven Jackson:
Because it goes up.
Kari Haley:
It keeps going.
Munira MaalimIsaq:
"I can do it. I can help."
Greg Fedio:
I have one, definitely. But I never knew that's what it was called.
Steven Jackson:
You and me both.
Greg Fedio:
Whether this makes the podcast or not, I just need to say how amazing Munira is and how... I have to. I mean, honestly, you've been such a great partner in all of this work, and you're such a strong human being and so lovely. And just even everything you're saying here, I'm in awe of. I could listen to you forever, and these two as well. But just really happy to be working with you on this project.
Munira MaalimIsaq:
Thank you. Thank you. You're amazing.
Steven Jackson:
So how much did you pay him?
Munira MaalimIsaq:
A lot. A lot.
Steven Jackson:
A lot? No, that's awesome.
Munira MaalimIsaq:
But I think for me, it really fits work-life balance again, right? This is the only place I've ever felt like I was home, or that Open Faces was actually real for me. I felt welcomed. I felt everyone that I've connected with was someone that I admired and wanted to learn from. So you, for instance, yes. So learning a lot.
Greg Fedio:
Thank you. Our team has been very lucky to be... the clinical quality of team has been very-
Munira MaalimIsaq:
They're amazing.
Greg Fedio:
... lucky to work on these initiatives and we've learned so much. Yeah, it's just been... we're very lucky as well.
Munira MaalimIsaq:
You can tell the love. By the time we were done, I think the last day everyone was crying and just on the project-
Greg Fedio:
Yeah. We danced and sang to the Somali national anthem on the last day.
Steven Jackson:
Wow.
Munira MaalimIsaq:
The community members were crying with happiness, because I think for once, they felt like people heard them, and that was important.
Greg Fedio:
Well, now it's the accountability piece, right?
Munira MaalimIsaq:
Yes.
Greg Fedio:
So we've heard them, but now we have to take action.
Munira MaalimIsaq:
Right.
Greg Fedio:
We can't just let this go silent. And there were several members that it was clear they're not going to let us not act on this work.
Munira MaalimIsaq:
They were like, "We are holding you to this."
Kari Haley:
So with that, what are the next steps? What's next?
Greg Fedio:
Well, I mentioned the project at Midway and Minneapolis around a health fair. So those were the first steps. We are also talking about doing a children's health fair. As I said, immunizations was one of the focus projects, and we know that there's huge gaps and lack of understanding in this community around immunizations. So child health fair's hopefully coming soon. We also are thinking about ways... we mentioned ways to incorporate non-translated materials in that, more recorded type things in our patient materials, and doing more social media things within the community.
Munira MaalimIsaq:
Absolutely. And I think that could work for all of our patients, honestly, because for me, I'm like, "OK, if it works here, we don't have to recreate the wheel." And how can we make sure that we are noticing the... we're speaking up for our other patients that may be struggling also in education part, right? So when we think of our Hispanic patients, we think if we have thought about our Hmong patients, all of that, is something that we can go back to. Recently, I learned that in Hmong, we do not have a word for pancreas. We were doing translated stuff... or in Somali, we do not either. So how can we make sure that people that do not even have a word for the part of the body that is responsible for it are able to get that education piece? And I think that's why having those recorded materials for those communities would be really helpful.
Greg Fedio:
We also talked about doing more projects within the community, so not losing sight of those people that have already worked with us, and doing things maybe on Somali Independence Day, which is July 1st, correct?
Munira MaalimIsaq:
Yes.
Greg Fedio:
So maybe doing something at one of those events that are going on in the community where we really could have health information in a way that is receivable by the community.
Munira MaalimIsaq:
Yes, absolutely. And I think being part of that community, again, those familiar faces, I think that makes a big difference. HealthPartners was here, so definitely.
Steven Jackson:
Are there opportunities for those who want to volunteer and help the project along to join in, to join forces, speak to maybe a couple people who are in the audience who, "Hey, how can I be a part of this? This is great. I want to join."
Greg Fedio:
Yeah, we're still formulating our next steps with it. I think the one thing, especially if you're in a clinic, we are trying to put together more toolkits, if you will, around how to hold a community event and how to talk to the community.
Steven Jackson:
That's great.
Greg Fedio:
So that stuff is stuff we're moving forward on. I'm more than happy to field any emails from people within the organization on our next steps. I think we're trying to figure that out too, still. How do we even as our team continue to be engaged, but also be able to pass this on to the people that really are patient-facing, right? Because we can come in and hold this project, but we walk away and we have great learnings, but we do want those that are going to be interacting with the patients to really utilize this information more.
Munira MaalimIsaq:
Right. And I think volunteering in the community anytime... for us, for me, I would say I'm part of the George Floyd Square. We do health fairs there every year during the year, so be part of that community, give back, have coffee there. I would say during the Somali events, come show up and get to know them. Eat food together. And I feel like that would make a big difference in how we connect with our patients, and we can bring that back to the clinics. It's not as scary if you're a part of the team.
Steven Jackson:
That's right.
Kari Haley:
That's true.
Steven Jackson:
That's right.
Kari Haley:
Wise words.
Steven Jackson:
I love it. Well, I think we've learned a lot. I think anybody that would press play on this episode will be feverishly taking down notes. And again, the subtitle of this podcast is "Examining the Health Equity Emergency." Obviously, that there are emergencies out there, a lot of gaps, a lot of disparities, and you guys have rolled up your sleeves and you've dove in and are making a difference. So we appreciate your time and your efforts, and let us know how we can be of service. We'll continue to promote and spread the word about what's going on around here.
Greg Fedio:
Thank you.
Munira MaalimIsaq:
Thank you.
Steven Jackson:
"Off the Charts" is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with Creative by Peggy Arnson, Tina Long, Tim Myers and Jeff JonDahl.
Steven Jackson:
Production services provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.