Rae Woods:
From Advisory Board, we are bringing you a Radio Advisory.

Rae Woods:
My name is Rachel Woods. You can call me Rae. I wanted to do something a little bit different with this episode. We spend a lot of time at Advisory Board talking about success stories. We highlight the institutions or the practices that set the advanced organizations apart. But the truth is that transforming healthcare requires leaders who see, think, and act differently. Leaders who can navigate this moment of unprecedented uncertainty. And we want to share how those breakthrough moments actually happen because, often, they are the hardest moments. The moments when leaders face barriers, confront fears, and even when they fail. And you know that I cannot talk about leadership without my colleague Matt Cornner. Hey Matt,

Matt Cornner:
Hey Rae.

Rae Woods:
Matt, are you surviving the summer of cicadas so far?

Matt Cornner:
I actually went out into my backyard the other day and we have a lot of green trees and so forth. And I went up underneath the trees and it was just swarming with cicadas. I took out my decibel meter and registered in at 93, which is the equivalent of a jazz concert.

Rae Woods:
Matt, I mentioned that you focus on the leadership in your role at Advisory Board, but what you do is really unique. You work with organizations and you work directly with their leaders to understand how to improve their leadership capacity, and work in highly complex situations. So, with that in mind, what made you want to have a conversation with the leadership at Whitman-Walker?

Matt Cornner:
Well, given this moment in time, which is both highly complex and, where across the last year, we have brought an uneven greater and a much needed focus on health equity we've done a lot of work with Whitman-Walker over the last several years. And we have this tremendous story of an organization that is making tremendous progress on those issues right here in Washington, DC. And I had a chance to sit down and chat with their CEO, but let me let her introduce herself.

Naseema Shafi:
My name is Naseema Shafi. I use she/her pronouns. I'm the chief executive officer of Whitman-Walker Health located in Washington DC.

Matt Cornner:
And one of the things that's most striking to me about Whitman-Walker is how incredibly devoted they are to serving the most vulnerable, often marginalized populations and what that actually means in practice.

Naseema Shafi:
For those of us at Whitman-Walker to serve the people that we take care of is really to see everyone as an individual. We believe that everyone comes into the health center sites with a story, and that that story really implicates the way that not only they access healthcare, but the way we can support them in their healthcare journey. So, we say, we see you here. And we really mean that in the way that we provide care.

Matt Cornner:
And that idea of we see you is absolutely foundational to the organization. It is the guiding principle and it's how the organization was formed. And it is why they exist today.

Naseema Shafi:
And we came to be because members of the LGBTQ community couldn't find a good healthcare. They couldn't find safety and family without each other. And so, they gathered and created this place that's now grown, 40 plus years later, into the organization that I run. But the way the dignity shows up, the way we show it to patients, the way they show it back to us is so rooted in that. I think often that what we're offering is safety and comfort, and the ability to be who you are. And that that's all about dignity. That we deliver healthcare. We clean your teeth, we do all kinds of things like that. But if you don't first feel that Whitman-Walker sees you, that the clinicians here just recognize your person I just don't think we'd deliver the experience that we're trying to deliver on. And I don't think we deliver on our mission.

Rae Woods:
Naseema referenced the mission of Whitman-Walker. And we know that every organization has a mission that is usually rooted in service but, oftentimes, I can feel like those mission statements are pretty abstract. So, Matt, what do you find is different about the Whitman-Walker way?

Matt Cornner:
I think what's most noteworthy is that it is concrete. It is manifest in everything that they do in the physical space. In the way that team members look patients and family members in the eye, greet them by name, if possible. Everywhere that you go in that physical space, you can feel, we see you.

Rae Woods:
And that's rare, right? It is rare to talk about and have specific examples about how mission plays out in those terms, the specific population, the specific injustices, the specific human beings that you interact with that, to me, is very different from a plaque on a wall.

Matt Cornner:
Absolutely. And I think that's true certainly in healthcare, but it's really true across all industries. Every organization has a purpose, a mission, a vision. What is different is the degree to which that is manifest in reality, the degree to which what we do, what we say, what we invest in, how we present ourselves is aligned with that purpose in ways that those whom we're serving can feel.

Rae Woods:
Now, the purpose of this organization is to serve vulnerable populations. But the kind of history that Naseema shared with us was really specific to the LGBTQ population. And I have this fear when we talk about health equity, that it can feel like a zero sum game. That you can't serve all vulnerable populations because there are specific needs of specific marginalized communities. So, I have to believe that as a leader Naseema has had to make some difficult decisions or trade-offs. What are some of those trade-offs?

Matt Cornner:
Naseema talked about opening a new clinic in Southeast DC. And the population in Southeast Washington, DC isn't necessarily reflective of the sort of original population and focus area for Whitman-Walker. So Naseema, as time has gone on and as Whitman-Walker has extended the scope of their services beyond the LGBTQ population, Naseema and her leadership and Whitman-Walker, more generally, they've had to work really, really hard to balance decisions about who they serve, and how they serve those populations so that each and every person and population that they serve feels genuinely seen, served, and cared for.

Naseema Shafi:
There's a tension between being an HIV provider and that pride, and that expertise, and wanting to make sure that everyone knows you do other work too. And so, in a way, how do we open ourselves up to being known as something other than the HIV provider of choice in the District of Columbia and still doing that work? And I think it's really important that the broader community know the vast nature of all of the other care that we offer without losing that connection and commitment to the HIV work. But it's hard.

Naseema Shafi:
The tension in kind of balancing primary care and HIV care shows up in everything from how care teams prioritize their time and attention, and kind of love for the HIV work with diabetes management, chronic care, other chronic care management's really important. It's really important, I think, for the listeners to know that there have been huge advances in HIV prevention and in HIV treatment. And we're doing a good job if we can get people engaged in care. The parts of where there are huge disparities are in the social determinants of health that impact everyone else in our society who aren't accessing good healthcare. And so, we really have to be ready to provide additional support around those social determinants of health and connect to partners in the community who do that work well.

Rae Woods:
This tension that Naseema is talking about is exactly what I hear from other institutions that are focused on health equity, even if they don't have the very strong history that Whitman-Walker has. And I think the challenge is less about, are we equally giving out resources, or are we focused on the ins and outs of our strategy in an equitable way? I think the problem here is much more about perception and the perception that one group might be getting differentiated treatment from another. How has that perception problem played out specifically in this new location that you're talking about in Southeast DC?

Matt Cornner:
So, Southeast DC is in a different part of Washington. And when you cross the Anacostia River into Southeast DC, you move into an overwhelmingly Black and historically underserved area. It's literally a food desert. 14th Street, which is another core location for Whitman-Walker, is a hub for the LGBTQ community. And that area has gotten revitalization over the years. So, on the one hand, you have sort of the original focus of Whitman-Walker of the LGBTQ community, first of all, feeling very, very protective of the attention and care that they've received from Whitman-Walker over the years.

Matt Cornner:
Meanwhile, Whitman-Walker, really trying to make the case that we are here to serve the broader community as well. Of course, the broader community is looking at this location in this really beautiful part of town and really wondering how serious is Whitman-Walker about that? So, that tension is certainly a play. And I think, more broadly in my experience with Whitman-Walker is, when you are leaving a population that has traditionally been underserved and unseen, when you leave them feeling genuinely seen, there's a protectiveness of that. You want to hold on to that. And so, I think communities come by the fear of losing that quite honestly.

Rae Woods:
And that's where Naseema has to balance making sure that the LGBT community continues to feel protected and seen while, also, expanding services to a different vulnerable population that is in a different community that has differentiated needs.

Matt Cornner:
Absolutely. And I think the big challenge is we see you is inclusive of everyone but, because of those historic expectations, that can a really difficult tension to navigate.

Naseema Shafi:
The folks who live on this part of town, it's where I'm sitting currently, know us for much broader diversity of healthcare work than in Southeast DC. And that means we have to go to more local meetings, be engaged in more community boards, be around the table for more events than we would normally be at, and be at those events not to talk about HIV. And really bring all of our other expertise so that people start to connect us to that other work.

Naseema Shafi:
And I think you're going to ask me, what's hard about that? And what's hard about that is not only the time that it takes and time is hard, but also we will be in rooms where people don't want us there. And to build trust in communities that have been historically marginalized you can't give up when people don't want you there. You must build the trust. And that is a long game. And so, we've got to really double down on that commitment of time to listen to the communities we haven't yet reached. And I actually think that's one of my callings as a leader of this organization, that it has to be some of my time, a big part of my time.

Matt Cornner:
So, just as we discussed, the fact that everything about Whitman-Walker's existing facilities is designed to leave those whom they're caring for feeling genuinely seen and cared for. So, too, are they putting that level of care into the design decisions around the new location as well. That becomes absolutely critical. I mean, one thing she spoke about was making decisions for young people.

Naseema Shafi:
Well, young people are considerably younger than I. And so, 13 to 24 and should have a space that feels that it's representative of them. And when I think about all the pediatric providers, it is not a pediatric space. This is really meant to be for young people. So, there's a vibrancy in textures in the finishes in that space. There are kind of ledges where young people can be on their laptops, or their phones. We were thinking about where someone is going to social media from, as we're designing this space. And I think that that's going to be really important.

Naseema Shafi:
The red carpet needs to be rolled out for people so that they will come to care for us. There are a lot of healthcare providers that if you're just passively waiting, you're not going to get people in. So, I think that's going to be really important. And then another space on the ground floor of our new site, we hope to be able to offer cooking classes and other kinds of group experiences for the community members who, we hope, will be our patients. And so, how do we get people in the doors just to learn and experience us, again, with that dignity and respect of who they are in a way that makes them curious enough to come upstairs and start care?

Rae Woods:
It really strikes me that Naseema referred to those design decisions as rolling out the red carpet. Whitman-Walker is a federally qualified health center and those are not institutions, or facilities that are typically known for red carpet treatment.

Matt Cornner:
I mean, it's another way, and this comes all the way back to purpose, which is to respect the dignity of every human being. If you want to leave people feeling genuinely cared for what does that look and feel like? What is the experience of receiving care? Does it feel like I've walked into a space that doesn't feel warm, doesn't feel thoughtful, doesn't feel hospitable? Or is it a place that feels like care?

Matt Cornner:
And so, you heard that in what Naseema was describing there. Patients, especially vulnerable populations won't feel like their provider sees them, cares for them, if they feel like they're receiving second rate care. And I'm always struck by the fact that when they first opened their facility on 14th Street, patients were sort of, "Am I in the right place? This doesn't seem like it should be the right place because I'm on Medicaid. Or this is not what I'm used to." And, of course, designing with dignity in mind, isn't just about patients either.

Naseema Shafi:
In this space, we have our kind of team huddle rooms where our medical assistants, and medical providers, and nurses hub in and out of all against the windows. So, they have the exposure to light that I think is really important for the workforce. And they're larger and they're kind of surrounded by the exam rooms. So, the opportunity to do case collaboration, to have multidisciplinary team approaches to delivering healthcare will be in that space. And when we think about the complex healthcare needs... We have a very sick adult population, and when we think about their complex healthcare needs, you need a lot of different experts and a lot of different skill sets around the table. And so, having the building offer the design that allows for that collaboration is really going to be spectacular.

Rae Woods:
I love that Naseema is speaking in specifics. I mean, she's literally talking about the finishes at a new facility that she is building, and those are the kind of nuanced trade-offs and decisions that leaders practically have to make. But I'm also interested in learning about Whitman-Walker at a higher level. What has Naseema learned about leadership at this institution, in general?

Matt Cornner:
I mean, it's obviously important for an individual not to give up in the face of a challenge. I would characterize Naseema's approach as a relentless orientation to purpose and alignment. And the challenge, I think, every single day is how do you maintain that energy and how do you ensure that that is not limited to the top of the house? How do you make sure that that's not limited to the executive team? And that every single person rendering care feels that and extends that in everything that they say and do?

Naseema Shafi:
The leadership of Whitman-Walker can say lots of things lots of times. The way that we demonstrate that we believe in those things, the values that we show people and not just talk about makes a difference. But you've got to really create room for people to grieve their losses. You have to make room for them to experience shame. And I think when you're working with marginalized communities, there's a great deal of shame associated with what some people have and some people don't. And how important it is to learn and adapt.

Naseema Shafi:
One of the most profound ways that Whitman-Walker has learned and changed over the years has been in our care for transgender and gender expansive people, where we have been the experts. And we have constantly been taught that we are not the experts, that the patients are the experts. And we have to change all the time. And I think there's a deep commitment here, but it requires the kind of smaller groups, smaller safe spaces for staff to say, "I messed up and I'm sorry that I messed up. How do I do better next time," without feeling that they will be punished for it and not experience shame in that reaction.

Matt Cornner:
I mean, what Naseema's getting at here, this idea that the patient is an expert in their own care, it's something that is so hard to wrap your head around in sort of the classic way of delivering care. Doctor's orders that's, frankly, quite patriarchal. It takes an incredible amount of vulnerability for a CEO to say, "I don't know the right thing to do here," for that CEO to create a culture where frontline providers embrace that vulnerability, and engage the patient as a co-creator of that experience. For them all to agree, we need to learn from the patient here.

Matt Cornner:
So, this commitment to ongoing education, learning and development was something that Naseema brought up time and time again. That we have to create space both for ourselves, and for leaders throughout our organizations to learn, grow and develop.

Naseema Shafi:
In other jobs I've had here, I've been complementary and part of a team. And, now, I meant to be in front of the team and leading with voice. And as a woman and a woman of color, this has been a really continuous learning process.

Naseema Shafi:
I think that I have been taught, or experienced leadership in a way where I was supposed to fit. Whitman-Walker and the communities we serve will benefit from more voice because as I shift and attenuate the time and the nature of the time that I contribute, it makes room for others. And, by extension, brings more voice into more space, which I think is hugely beneficial for our communities. And what that benefit is to me is not only the celebration of getting to see my colleagues do really, really, really amazing and important work, and get the light shone on them that they so rightly deserve. But my attention gets to be focused in a way that is being asked of me, which makes me feel better because I get to do my job. And that's exciting for me.

Rae Woods:
I really appreciate Naseema's reflection on her own journey to the executive table. But also, what that meant in terms of finding her own voice, especially as a woman of color.

Rae Woods:
Matt, what do you want other leaders to take away from that idea?

Matt Cornner:
I mean, I think it's this idea and this growing recognition and a recognition that, frankly, we're not executing as well as we need to, at this point to create space for other voices. This means assembling a diverse team that's going to push you on your own instincts, your own biases, help you see things that you do not see. But remember that just having a diverse group of team members is not the same as creating space for their voices to emerge, and to draw out, and invite that diverse perspective. And that's what Naseema does exceptionally well.

Matt Cornner:
I think this is an especially important lesson for white leaders and white male leaders, in particular. Most leadership spaces are designed to amplify our voices. And I think we have to work especially hard and recognize what's lost when we don't create space for other voices to emerge.

Rae Woods:
Matt, I'd like to end this episode like I end every other Radio Advisory episode. When it comes to Whitman-Walker's story, and when it comes to Naseema's leadership specifically, do you know the one thing that she would actually want our listeners to take away or act on?

Matt Cornner:
Well, I'll just let her tell you.

Naseema Shafi:
I think the thing that I want other healthcare leaders who are listening to this to take is a willingness to understand that if we're really going to get at why more people of color have died in the COVID pandemic as healthcare providers, we have to listen more than we are now. And create spaces where our staff and our patients are their whole selves every day i [inaudible 00:24:06].

Rae Woods:
Well, Matt, thanks for joining us on Radio Advisory. And thank you for sharing this incredible conversation with us.

Matt Cornner:
Thanks Rae, my pleasure.

Rae Woods:
At Advisory Board, we're in the business of making healthcare better. And that requires leaders, like you, making the same kinds of changes that Naseema shared with us today.

Rae Woods:
And I love this story because it tackles the trade offs that yield people need to make in support of their providers and in support of their patients. So, remember, we're here to help.