A Resident’s Reflection on Participating in the QI to Eliminate Health Care Disparities Collaborative

By Rui Jiang, MD, Mount Sinai Hospital

Dr. Rui Jiang is a resident at Mount Sinai Hospital, which is a Pursuing Excellence site. Her focus is preventive medicine, primary care, and population health.

In the coming months, the ACGME’s Pursuing Excellence in Clinical Learning Environments initiative will complete its 18-month national Learning Collaborative focused on reframing the concept of health care disparities. The goal of the Collaborative is to prepare residents and fellows to engage in lifelong behaviors that eliminate health care disparities in their clinical learning environment.

At the last Learning Session in December, the teams were asked to reflect on the power of the collaborative experience, and how we might share this during our session at the upcoming Annual Educational Conference (SES095 on Saturday, February 29 from 8:15-9:30 a.m.).

My personal take-away has been that health care disparities is not a separate part of medicine to consider. It’s at the heart of the high-quality care that we want to deliver to our patients. More importantly, I have learned that health care disparities go beyond what we have named, and it is this ongoing practice of personal reflection and awareness that helps me to recognize them and address them.

When our institution announced its participation in this ACGME Collaborative I signed up because I was interested and also because I wanted to learn more. Prior to this initiative, I felt that I didn’t know how to talk about bias, inequities, race, and disparities. What if someone points out that I am biased? How do I react to someone else’s bias? What can I do about it? This Collaborative facilitated the creation of a space for us, the residents and fellows, to talk and to learn how to address health care disparities.

At the beginning, our team came in with a focus to address the health care disparities listed in our proposal, only to realize that we lacked high quality data to fully see the issues. The faculty members of the ACGME Collaborative encouraged us that “no data is data,” and we took a step back to focus on building the data infrastructure rather than feeling like we have to dive in and “solve” inequities. Furthermore, the same faculty members pushed us to broaden our vision from just focusing on one or two disparities to seeing that we are building the foundations to address all sorts of health care disparities.

In addition, we took stock of our assets, which were enthusiastic faculty members and learners, supportive leadership, and existing clinic-level projects addressing health disparities. However, we were siloed and had no central location to bring these great ideas together and share experiences. Thus, our group is building an education platform with an information repository for all residency programs to access.

I think that successes, however small or personal, through this process have shown me what this can be. I remember taking the concept of cultural humility back to my clinic with a patient who seemed “difficult.” But as I took a moment to confront my assumptions and really get to know what this patient had to say, it changed the whole encounter. She came back to me several months later with HA1C improved from 9 to 6 and told me how happy she was that I had listened to her. This success in my own practice began to make me think about how can we do it under time pressure, for every patient, and how would medicine look if we truly connected the dots between addressing health care disparities and patient outcomes.  

I look forward to seeing when our data structures are created at Mount Sinai so that each department can see the disparities within their walls. I look forward to seeing more learners and faculty members catch onto how they can address health care disparities through QI and cultural humility curriculum.

I don’t think that what we do is easy. In fact, this has been the hardest project I have had the opportunity to be a part of. But that’s where I think having this community of “those who are willing” really helps. Because the mission is the right thing to do, I know that eventually more and more will catch on.

Meanwhile, we have to continue to support each other’s ideas, rally our leadership with concrete steps, and incorporate concepts of health care disparities/inequities and cultural humility into the practice of medicine so that the next generation will not see health care disparities and inequities as a separate part of what they do, but as a crucial part of their jobs.

To learn more, those attending the Annual Educational Conference who are interested may consider our session, The Pursuing Excellence Initiative: Eliminating Health Care Disparities as a Strategic Priority.