Learning about, understanding and appreciating the community we serve are critical pieces for building trust along the health care journey. Toweya Brown-Ochs, the director of diversity and inclusion at HealthPartners, discusses how it doesn’t happen overnight, the differences between intent and impact, and why impact matters.
Learning about, understanding and appreciating the community we serve are critical pieces for building trust along the health care journey.
Toweya Brown-Ochs, the director of diversity and inclusion at HealthPartners, discusses how it doesn’t happen overnight, the differences between intent and impact, and why impact matters.
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guest: Toweya Brown-Ochs
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's 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 the show. In this episode, we spoke with Toweya Brown-Ochs, the director of diversity and inclusion at HealthPartners.
Kari Haley:
And we talked about the importance of trust in health care.
Steven Jackson:
Trust, whether we're building it or decreasing it by what we do, or what we say is something that as a care provider we just have to always be mindful of. People come from all walks of life. They've had all kinds of experiences and as a physician or any clinician for that matter, I can't just automatically assume that people are going to trust me because I have good intentions or I have the alphabet behind my name.
Toweya Brown-Ochs:
I think of an experience that I had with my son, my oldest son. I thought that my, water broke and so I was first-time parent. And I'm like you don't know what's going on with your body. Everything's all like a... Whatever. It's not yours. And so thought my water broken, but I wasn't sure. And I was all embarrassed. I didn't want to go in and call the hospital, called my doctor, because of my gestation I get transferred to the ER. "Come on in. You're good to go. We're just going to check it out. You'll be good sister." OK. Go in with my husband again, my husband is white. So go in with my husband, talk to the nurse that was on the phone. Life is OK. I'm in the bed. And then it was shift change and I got a new nurse and the new nurse came in and she walked in and she looked at Lance, my husband and said, "Who's this?"
Toweya Brown-Ochs:
And so right there, just I can't explain to you looking at him and saying, "Who's this?" Looking at me, I'm Black, he's white, "Who's this?" And I, in that moment, you know, "Well, he's my husband." I think I said, "He's the baby's father." And that was the reaction that I had and so then she comes on over and she's telling me how like, oh, my gosh, you're not wet. And you're not da, da da. And all this kind of stuff. Turns out. Nope, not, Nope. I did not. My water did not break. I think I was like praying that it would, and the doctor tells me like, you're good to go. You're going to go on home. Doesn't mean that you're not going to be in full-fledged labor. I'm just like so embarrassed. And as the nurse is checking me out, she explains to me that if this ever happens again, that I need to be seen at my doctor's office because it's very expensive to come into the hospital for the taxpayers.
Steven Jackson:
Wow.
Toweya Brown-Ochs:
Yeah. And I think about that and you know, now, so my son is now 20 and now I think, I didn't realize at that point how vulnerable I was as a Black woman and how vulnerable my child was as a Black woman and just from being Black in this condition. And all I knew was that I felt two feet tall. I felt so small and so stupid for not knowing what was happening with my own self and having this person reduce me to a dollar figure that was in her mind, I was brushing up against. And so to me, that is one of the most profound experiences that I had with health care. And so when I now coming to HealthPartners and being on this side of it, having interactions with our maternity groups that are asking why patients don't come in after the birth and their six-week checkup. Why specifically Black women are not coming in early enough or coming back at their six-week checkup? Why is that? And I can share my experience and say, this is how that made me feel and why I would not come back.
Kari Haley:
And as we talk about intent, I think that as most clinicians, I don't think anyone's necessarily going into a room with bad intentions. We go in with the best of intentions to take care of the patient that we have in front of us. However, sometimes the words that we say are not necessarily interpreted in the way that we are intending them to be, but that talks more about impact. So what impact are we having on our patient? And as Steve, you were saying, people come from all walks of life. They have a lot of different stories behind them, and that will often impact their experience that they have within the hospital or in the clinic or with any sort of health care experience that they have. I thought Toweya did a great job about telling us a story and really starting things off with this is her side of the story, and this is how she was impacted.
Toweya Brown-Ochs:
And so when we talk about intent to impact. Intent is what I didn't mean to let me explain to you. No, no, no, no, no. If I just elaborate to you enough, then you'll understand, and it probably won't have an impact on you. But when we focus on intent, we don't deal with really, truly the impact of what done to that person. So here I'm telling the story of my son's birth or non-birth 20 years later, obviously that is a big impact to me, regardless of what that nurse's intent was. I'm still talking about that story 20 years later. So that's where for us to truly transition to being not only more equitable, but with equitable outcomes and anti-racist, that's part of that journey is transitioning to impact versus intent.
Steven Jackson:
If we're honest with ourselves, then we know that it takes humility when thinking about the whole concept of intent versus impact. For example, I know for me, and it's not something that I like, but in full transparency, I judge others based on their impact of what they say to me or how they treat me. But I judge myself based on my intent. So if I hurt your feelings and I didn't mean it, I may stop there. Well, I didn't mean to hurt their feelings so you are going to have to deal with that. And I think that, especially as a care provider that's what we have to grow past. And then when we think about being an anti-racist organization or fighting racism in all aspects, shapes or forms, we have to be aware of that.
Kari Haley:
I like to think about it as taking the but statements out of things when we think about our intent versus impact. So if you say the sentence, usually what follows is, I didn't mean that, but, or I was meaning this, but. If you take that but out, thinking about the impact of that first sentence that you said, and reflecting on that piece rather than the but piece is a great way to kind of think more about that intent versus impact.
Toweya Brown-Ochs:
Also what I'd say from a person who feels like I have my two Black friends, I work with Black people every day. I'm down with this anti-racism. I think that part of us, we also know when things brush up against us or when we've managed to offend people. And what we are trying to strive for as an organization is my two Black friends and I work with Black people. That's not anti-racist, that's just race neutral, right? So beyond, you know, and those people's blackness has nothing to do with how you feel about them or how you feel about race. And so calling those things out, saying, and talking about those also part of this is holding each other accountable. So, we show our true selves in many different ways in which we speak and interact and treat people.
Toweya Brown-Ochs:
And so if you are coming from a very biased position, regardless, if you think that you have it in check and no one else can see it, or you're not even aware of it, other people can. And so some of that take us holding each other accountable and calling out when racism happens, even when we don't think that we're being racist, that's the really hard part. You know that's that intent versus impact. It's like, I don't think that I'm being racist. Well, it's kind of like if a doctor tells me that I have cancer, well, I don't think that I have cancer. Doesn't mean I don't have cancer.
Steven Jackson:
We often hear the term, I want to be an ally. And what does that truly mean? And Toweya does a great job of really breaking down lip service versus action. To those that want to be allies in this fight against racism and this fight against inequality what we say to those people is speak up. See something, say something, especially when it's unpopular, because that's when you can move the needle in the moment and then beyond
Toweya Brown-Ochs:
Going beyond just watching, right? Like what I heard a lot this summer from people, especially non-BIPOC (Black, Indigenous, and people of color) people or people who are not marginalized is, "I want to be an ally." And you know, people think like an ally is the person who during Black History Month, you buy Black or you show up at one of the rallies and you take a knee. But to me, an ally is when you begin to educate yourself. So when you begin to dig deeper into what these things mean, why these things are offensive, why is it not OK? What is not OK about saying to someone I don't see color or what is not OK about saying to someone all lives matter in the face of Black Lives Matter. So when you start to educate yourself to know how to show up to be an ally, that's part of doing the work.
Toweya Brown-Ochs:
And part of that work also is not just being silent, is having a conversation. And I will say from my professional side, my team has created tools and guides to help leaders have conversations. It's not just leaders, it's everyone. And whether you use these conversations, a planned conversation, so maybe you want to confront someone from something that you heard recently or an unplanned conversation, because you heard a patient say something that was really just inappropriate, but you have to prepare to age yourself and speak up. And if it's not OK to speak up in the moment to speak up afterwards.
Toweya Brown-Ochs:
What I've experienced or I've seen is people want to be an ally. And they'll recognize when something should not have happened or something racist or something that's discriminatory happen. But they feel like, oh, it's not my place to say something. But then after the fact they'll come to the person who's been impacted like me and tell me how bad that was. I can't believe that person talked to you like that. And if that person ever did that again, this is what I was going to do. And from my perspective, that doesn't help me, nothing, right? Whatever happened just happened. What I need is for you to go and fix that, that person hold them accountable and talk to them about what happened and why it's not OK.
Toweya Brown-Ochs:
And so part of it is just doing it. And I tell people, you're going to say the wrong thing. You're going to be uncomfortable and you should be uncomfortable, if it is comfortable, then you're doing it wrong. But not saying anything and being quiet is really sending a very different message. And most of the time that's not the message we want to send. So first it's educating yourself, it's speaking up and it's really leveraging your own privilege. Sometimes it's supporting someone in a meeting by advocating on behalf it's quieting so that their voice can be heard. And as far as just really showing up in the moment for them, however, that might look like. So for us to really change anything, we have to start with our behaviors. That's like a baseline that it is the right thing to do, but it's also what our obligation is.
Toweya Brown-Ochs:
We serve a very diverse organization or a very diverse community and to effectively serve those communities we need to ensure that the people who are providing those services understand and can appreciate, empathize, and relate to those patients and members in which we're serving. So, like I say, if for me as a Black woman, sometimes I want to have someone that relates to me as a woman or someone that relates to me as a Black woman based on my experiences and how things may be different for myself.
Toweya Brown-Ochs:
Steve, one of the things you and I have talked about in just in our conversations is I've talked about for me personally, sometimes skin conditions do not present on me the way in which they present on someone who's white. And if you have not had that experience or do not know that it takes away from the trust when you prescribe something to me and you tell me when your skin turns pink. I have very dark black skin I do not ever turn pink. And that erodes, if we're talking about building trust, if I don't feel like you see me and see my dark skin for all of its beauty and how things appear on it, then it's very hard for me to ever want to come back and see you and build any type of trust. So I think about, one of the reasons why we have to have these conversations is if you truly want to impact health equity, if you truly want to have our patients and see them, then we need to have people who have those experiences and see them for who they are.
Toweya Brown-Ochs:
And so that's just one way that I think that one of the reasons why we have to talk about it. The other reason is we are part of a larger community and the community that we all come from is not monolithic. Even when you live in very rural areas, you have multiple different forms of diversity. Diversity is not just racially diverse, socioeconomic gender, gender and I say just sexual orientation, political, religion, there's many different forms of diversity. We right now are focusing in a moment of race and that's because race is what is being called to the forefront. And it's one of the deep areas that we have yet to make any headway on. But we have many different forms of diversity in which we focus. And so, yes, we do have to talk about it because it's not as though those forms, those things are not with us. They are here. They are here with us every day, and we need to understand, learn, appreciate, and understand the community in which we serve.
Kari Haley:
And I think a big piece of the leveraging of your privilege or your stance where you have within the organization or within society or your community as a whole. But bringing it back to health care, really thinking about how we can build that trust. So building trust includes speaking up. It includes proving that we are willing to speak up and willing as an organization to recognize when things are not OK.
Steven Jackson:
An unknown author stated that in every interaction we increase or decrease trust. And I think Toweya did a great job of talking about the dynamics of trust being built, but also trust being so fragile and easily broken. I think when it comes down to what we want to do as clinicians, I think we want to build our brand, our loyalty so that when we make mistakes and I'm not talking about these huge medical errors, but a misstep, wrong tone of voice, avoid busy and it came out in the way we deliver care. We want to build up enough currency and build up enough trust currency specifically so that we can have grace from the people that we serve when we do mess up.
Toweya Brown-Ochs:
And we know trust is built and starts in an instant. And most of the time when trust is broken, the penalty is much deeper than the reward when you're earning it. So I think of it sometimes like a piggy bank or savings bank, right? So when I have these positive interactions with, I love Target. When I have a great interaction with Target, it makes me feel good. And it builds that trust. Now, when I have a bad interaction with Target, Target is hoping that the withdrawal from that piggy bank with them is not as deep as it could be because we have built that trust with them. And so that's what we want with HealthPartners. We know we're going to make mistakes. We are learning, we are ever changing, but we really need to start from understanding the patients, the members, the community in which we serve and the needs. Being equal and just consistent is not the same as being equitable. And we need to be equitable to the areas that we serve based on what they need, not just what we have
Kari Haley:
And to go even further than that. I think that really does involve not just everyone as individuals, but as the organization as a whole, because they're going to be instances where you're not going to be able to see the same people to build that relationship. So if they can have consistency with the effort, I think that helps still trust as the community, as a whole, within an organization.
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 is provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.