Rae Woods:
From Advisory Board, we are bringing you a Radio Advisory. My name is Rachel Woods. You can call me Rae. I am so excited to bring to you a conversation about health equity with frankly one of the most candid leaders that I've talked to in the industry. I've brought on Barry Ostrowsky he is the President and CEO of RWJBarnabas Health. He is a white male here of an organization. But frankly, I have never heard somebody be so candid, about the role of social justice in an organization, anti-racism. And frankly, the fact that hospitals should do a lot more than just clinical work. I was so inspired by our conversation, not just because he sets the bar high on what the organization should do, but he's really taking the time to unpack the how behind it and the inner journey that RWJBarnabas Health has been on to go from a mere mission statement, to true structural advantage. So I hope you enjoy our conversation with Barry Ostrowsky. Hey, Barry.

Barry Ostrowsky:
Thanks Rae, good to see you again.

Rae Woods:
Well, we are going to be talking about the strategic role that leaders can play in health equity, and I want to start by talking more about you and your journey. Tell me about the beginning of the health equity journey for you as a CEO? What was that first spark that led you to pursuing equity at RWJBarnabas Health?

Barry Ostrowsky:
Thanks Rae. I was not conventionally trained to go into healthcare management, I'm a lawyer by training. I always felt healthcare was a social service, even though everyone came into the business with a whole bunch of clinical training and conventional kinds of business training. And so for all the years I've been in this business, I felt we were in the social service business. Our number one product line happened to be clinical services. So about eight years ago, I was finally able to say, "Well stop. Clinical services are great, but we're in the social service business and that requires us to have a social program platform." And so for me, it's been a long time coming to be honest with you and I was delighted to be able to do it, as I say, about eight years ago, and it's really picked up a great deal of traction in our organization.

Rae Woods:
So you were actually questioning the role of the health care provider, the role of the hospital in the community, right? People talk about this today as health instead of healthcare, and what you're describing as the social impact and the social responsibility that providers have today.

Barry Ostrowsky:
You're absolutely right. I felt that if you limited yourself to clinical services and programs, and those things that are typically the sweet spot if you will, have a health care facility, institution or system, you weren't really going to get at what I felt the mission should be when you talk about caring for your communities. So it was always a frustration to me. Now, mind you the reimbursement system and the regulatory system didn't encourage that which we ultimately rolled out eight years ago, and so there are always some excuse as to why we shouldn't do it. But for me, I wasn't going to be satisfied being in this industry, until we were able to have a robust social platform that addressed everything from social determinants to economic development for the communities we serve.

Rae Woods:
And that's exactly what I want to talk about, is how you go from having this idea, this kind of purpose to that robust platform. And to be honest, a lot of the folks that are listening to this podcast, have only recently come to this conclusion, right? You had your own aha moment eight years ago, most folks listening probably had this aha moment 18 months ago. So take me back to the very beginning. What was the very first step that you said, "This is what we need to take to move into providing more of this kind of social care?"

Barry Ostrowsky:
Well, it's interesting. So the sequence of development in our organization, and I didn't learn this from any book frankly, or institutional curriculum. I met with the chairman of our board and I said, "I want to come to the board and change the mission of the organization. I want it not to be exclusively phrased in clinical service and healthcare education and the like. And changing that mission, will lead us to develop a completely second platform of attention, which are social programs."

Barry Ostrowsky:
And what was interesting about it, a very sophisticated businessman, someone who understood the health care industry, at least as a very active trustee. He and I spoke for probably two hours. But in five minutes, he was convinced. He wanted the planner ready. So his enthusiasm was contagious, it was spectacular. And I said that it would take me probably six months to develop a comprehensive enough plan to present to the entire board, which we did literally seven months later. And so I then chose one of my colleagues, and I asked her to develop this platform, and she put together an incredible plan for us and we brought it to the board.

Barry Ostrowsky:
And I must say the enthusiasm of the chairman of our board, was shared by the remainder of the board, and in fact dominated a strategic planning meeting that we have once a year to the point where we couldn't get to other agenda items. Everybody wanted to know about food insecurity, substandard housing. And when you think about it, trustees and organizations like ours, are successful people generally in their own right, but they're not trained in healthcare. So when you talk about-

Rae Woods:
That's true.

Barry Ostrowsky:
Food insecurity, and housing and economic development, you're really talking about topics about which they know more typically, than they would naturally innately know about fancy neurosurgery or valve replacement, that kind of stuff. And so they immediately gravitated to that, and we were off and running. The challenge for most folks will be, getting the management team to buy it.

Rae Woods:
I want to go back to this initial moment of tearing up the mission statement, because I'm really inspired by that as the first step. When I think about most mission statements today, some have the challenge that you already articulated. The fact that it's all too clinical in nature. But there's this other challenge that at least I'm feeling, which is that the mission statement is just too ghazi, right? Every single mission statement basically says something about wanting to provide care for all people or make the world a better place and sunshine and rainbows. That's fine for a plaque on the wall, but it doesn't exactly translate to some of these next steps you're talking about when it comes to breaking down a strategic plan. So what do you see is the role of the mission, in making something that's actionable?

Barry Ostrowsky:
You cannot undertake the mission until you get the objective right. And the objective to the extent that it's encased in a mission statement, needs to be effective. As you point out, we have one of those poetic statements of mission and vision and Nobel winning kind of activity. And I said to our folks, "Junk it. I want no poetry, I want a clear and easy to understand objective." And we came up with a mission that said, "It is our job to make our communities healthier," period. So now, if that's what our job is, tell me how you make a community healthier?

Barry Ostrowsky:
So someone says, "Well, you need all the latest equipment, and you need great clinicians." Yes. Except the data says, that only affects 30% of the health of the community, what about the other 70%? Well, that's about food and it's about housing, and it's about safety in the streets. So I said, if we have the right objective which we do, and it's a simple sentence, then you need to be able to show me how we're going to make it happen. We'll get the great neurosurgeon, but we also need to make sure people have food. And one of my colleagues who runs one of the great institutions in Boston, when I spoke to her about this, Kate Walsh, by the way, who is a fabulous-

Rae Woods:
She's amazing.

Barry Ostrowsky:
She's amazing. So I spoke to her about this maybe six or seven years ago, and she said, "Barry, well, what if it makes the community healthier to fix the potholes?" I said, "I'll fix the potholes." We'll put it to you on the street to fix the potholes because you can't limit it. Now, some things are just not, we can't build a bridge over a river necessarily. We don't have that capacity, but we have the capacity to go out and get someone to fix potholes and address stoplights that aren't working, and make sure little things of everyday life are addressed.

Barry Ostrowsky:
That is our role, that's our job. And let me tell you after the first little bit of time, when people started to think about it, they became enthusiastic as well. Our rank and file generated so much enthusiasm around this, that we had people sending in notes, "Can I join the Social Impact Community Investment team? I don't want to be a respiratory therapist anymore, I want to do that stuff." And so it did build this great enthusiasm, but it does start with understanding what the objective is.

Rae Woods:
Yeah. So the what is, we're here to make communities healthier.

Barry Ostrowsky:
That's it.

Rae Woods:
And how you do that, it sounds like is in two areas. It doesn't mean throwing away the clinical arm that hospitals have succeeded at first for centuries. But it means equally, at least I'm assuming, investing in the social programs and the social platform.

Barry Ostrowsky:
Exactly. And so during this period of time, we've committed a billion dollars to medical research. So that's a pretty good investment in what I would consider to be the conventional aspect of healthcare for sure. But at the same time, we are combining our social programs with our clinical programs, we're building a $750 million freestanding cancer hospital, and so this is what we're doing. The people who are working on that job, 22% of them, have been trained from unemployment, to be actual construction workers and other participants earning an income to help build this building.

Barry Ostrowsky:
And so we're using minority and women owned businesses, we're using local, so we're doing economic development, job training, and we're building a clinical facility. That's ultimately in my view, that's how you intersect in certain areas, the social commitment with the clinical commitment.

Rae Woods:
That's right.

Barry Ostrowsky:
We have discrete food programs and things of that nature. But when you can do that, I think you can really accelerate and compound the positive impact.

Rae Woods:
You were talking about the exact same advice that we give to every single healthcare organization. It's not about I do either this or that, it really is both, and you have to have dedicated investments to health equity, dedicated investments to the social aspects. But you also need to be thinking about the equity impact of your existing portfolio, right? We're building this building, how do we make sure we're reaching out and using local black owned businesses whenever possible? But that doesn't mean we're not also creating dedicated strategies to say, increase the diversity at the leadership ranks, it has to be both.

Barry Ostrowsky:
We've always been criticized our organization in particular, for having 100 number one priorities, everything is a number one priority. So it's true, you can't possibly get it done that way, but you can also do one thing at a time. You're going to have to do multiple things at a time, and our system has about 40,000 employees and folks in it. So it's a big operation and it's got the capacity to do a lot of things at the same time. And as you point out, you have to have discrete investments in certain areas and joint investments and others, you have to have partnerships with people in the community, you have to do all this stuff if you're going to make an impact.

Barry Ostrowsky:
And one of the things we ought to talk about, is what you bump into, unfortunately, is structural racism, which we've now taken on over the last 14 months as a very serious principle of our existence. Unless you're going to address that, you're going to constantly have pushback overtly and subtly, to some of the things we want to do socially, unless you're cognizant of the fact that you have to be an anti-racist organization. It's an uncomfortable topic.

Rae Woods:
And where does that specifically fit into the process, the operations, the strategic plan that you set out to rebuild eight years ago? Where does acting as an anti-racist organization fit into that or how does it?

Barry Ostrowsky:
It takes a certain amount of integration and balance, but it takes real focus. So as I tend to describe it, we have a clinical platform with all of the medical schools and things of that nature, and clinical facility venues. We have our social program platform, everything from food to housing. And then what we've decided to do, is create an Ending Racism Together pillar, which permeates everything. So it's really more of a horizontal pillar if you will, but it has a discrete executive leader, with a discrete set of programs and training that we do throughout the organization.

Barry Ostrowsky:
The board I asked, the board has set up a committee to oversee that pillar. And so the anti-racism pillar, as I say more like a log I guess, that goes horizontally, has to be part of everything we do from medical education, which by the way, has been structurally racist for a couple 100 years. So the students we're teaching in medical school, to the way we've developed and deliver care, to that which we do on social programs, all of that has to have a vein of anti-racist teaching, training, program and behavior. And it's among probably other than candidly clinical and end of life conversations, the Ending Racism Together conversations we've had over the last 14 months, have been the most difficult conversations that we've had.

Rae Woods:
Yeah, I believe that, I believe that. And I want to ask you a bit of a bullish question, because in the last 14, 18 months, we've seen a lot of organizations appoint a person to a new role. Maybe they never had a DEI lead before, maybe they've added a chief equity officer. And what I find, is that a challenge upon appointing a single person to one of these roles, is oftentimes there are a leader in name only. When I start to dig into the layers of what resources does this team have, do they actually have the autonomy to make executive level decisions? Who else is on their team?

Rae Woods:
I hear a lot of organizations falling short, and it's almost like, "Well, we put this person up on a pedestal, but we didn't give them anything they actually needed to succeed." I'm not hearing that that's the case with you, but I want to ask, what kinds of resource investments did you have to give to this team, in order for it to be actually successful at cutting across the clinical and the social pillar?

Barry Ostrowsky:
We had a very active DE&I program for years. We had an executive who ran it from board level straight through rank and file, we were able to diversify a great deal not sufficiently in decision making roles, I have to say, but we have a very diverse workforce, but not the people who make the decisions. We were way underrepresented, but we had that structure, we had that infrastructure of leadership and resource along comes ending racism now, and needs to somehow as you've pointed out, link with social determinant attention and DE&I.

Barry Ostrowsky:
And so now we have this executive who's running the Ending Racism Together program, who has a full staff outside consultancy. And so she works with our DE&I lead, and our Social Impact and Community Investment lead, three executives, who, as it turns out, are people of color. But it just so happened to be that way, and those three people collaborate on program, and of course, how we execute. In my view, you can't possibly give all that to one executive. Also, there is no way you will be successful in DE&I unless you tear down races. People hire people that look like them. So I said to our DE&I executive, I said, "Look, you're doing a great job. But the reason you'll never get to where we all want to go, is we have racism in our system. We got to get rid of that, so the DE&I can actually attain its aspirations."

Barry Ostrowsky:
And so what I'm really gratified about, after a little bit of whose turf is on whose turf, is these three executives who are working together posits three separate executive vice presidents, all of whom have budgets and staffs, you can now start to address these things more effectively. The easy way out of this is you appoint one person to oversee this, and you send him and her to seminars around the country most of the year and you get to report. I'm not much into that. Frankly, I don't do that myself. So we got serious about this.

Barry Ostrowsky:
The one thing Rae you know, this stuff costs money and no one reimburses you for this stuff. And so if you don't have a commitment, or if your board is squeamish about the financial aspects of this, or if there's a lot of carping about it, "We have money to do this, but I can't get a new ultrasound machine in this clinic." That's going to happen, that is going to be part of the challenge of taking on some of these missions, even though there's no one paying for it.

Rae Woods:
What I've heard you say so far, are three important pieces. First is that you were willing to architect the right team of people and resource them appropriately, whether it's part of the Initial DE&I team or what you've built now in this underpinning of anti-racism. Frankly, you're also willing to go there as a leader. I will tell you that I have been in rooms where folks have referred to racism as the R word. In fact, this is a room of HR leaders who said, "Our CEO refers to this as the R word because they're not willing to go there."

Rae Woods:
And it is so, so important, we will never be able to unpack these challenges unless we're willing to frankly, use the correct terminology. My goodness, I mean, healthcare in general should understand that. But then the third piece here, is being able to put your money where your mouth is. That is much easier said than done, when we know that there may or may not be a direct ROI from some of our initiatives. Frankly, some of the changes that we want to see made, might take years, might take decades to see themselves actually influence the community. So how do you approach the balance of needing a business imperative, rooting your solution in a business goal, but also not forcing yourself to only invest in solutions that are going to be profitable?

Barry Ostrowsky:
Well, so that is the challenge. Now the way I look at it, is undoubtedly outlier is a little bit too many of my colleagues. First of all, it does start with financial health, we're fortunate, we have a terrific balance sheet, we have aware with all, but if we didn't pursue the things you and I are talking about, that money would continue to build or it would only be invested in clinical facilities. And for me, that's no way to make sure the community is healthy. So right off the bat, just keep buying more and investing in more clinical facilities, brings us up short to our very mission.

Barry Ostrowsky:
So now I said, "Okay, so let's use that money to do these other things." And as far as I'm concerned, when you allocate capital in our system, what you look to do is gain strategic advantage and financial return. That's our simple equation. Someone brings me a transaction, and I say, "Okay, we're going to put X number of dollars in there, show me the strategic return and show me the financial return."

Rae Woods:
Can you give me an example of what you mean by a strategic advantage?

Barry Ostrowsky:
Exactly. So if someone says, "I think we should buy or open an XYZ clinic in this location, it's going to cost $10 million." I'd say, "Okay, tell me why that's a strategic value?" And the argument or the advocacy should say, "Because people in that area need this service, the demand is unmet, we'll be able to go out there and meet the demand, train people, do all those things." So strategically, the expansion of our footprint to that particular location in this particular way, is of strategic advantage.

Barry Ostrowsky:
Okay. Now, you put the $10 million up, and you say, "What's the return on the 10 million?" And they give me a financial analysis. "Well, we'll make our money back in six years, or eight," or whatever it is. And I'll say, "Okay, the combination of those two returns, makes it a go project, please do it." I apply the same thing here. So you want to talk about ending racism, I think it gives you a strategic advantage. It will make your communities healthier, it will make us a more effective organization.

Barry Ostrowsky:
Now, the question is, what's that financial return? And that is a lot less quantifiable of course, so I could make the argument that if we're an anti-racist organization, reputationally we're enhanced, where people come for other services, we'll make our money back. It's not as direct, but I could make that argument and you're going to have to be flexible if you're going to stick to a straight return on investment analysis, you can't do this stuff, you just can't do it.

Barry Ostrowsky:
But if you're willing to be flexible to realize you're enhancing your ability to attain your goal, and frankly, the reputation of the organization, I could make the case and there is one that says it will attract more business, which will add to your margin, and a piece of that margin will be your return.

Rae Woods:
I'm actually really inspired by the term strategic advantage, because to your point, it opens up the opportunity to think about the business advantage in multiple ways that isn't just ROI, right? You can think about your brand reputation in the market, you can think about your employee compact. Providers are in this moment where relationships with their staff and clinicians, are actually really, really fragile. And everyone is trying to figure out how do I become the employer of choice, and this could be a way to cement yourselves and differentiate yourselves in a market.

Barry Ostrowsky:
You're absolutely right. When you burnish your reputation on topics like this, you add to your ability to be a real participant in policymaking by the regulators in your jurisdiction. Now, we're lucky, we've always had that because of our size. But I have to tell you when we launched these social programs, we were invited to every conceivable conversation by legislators and regulators and thought leaders, so you can make your organization absolutely essential in policymaking, if in fact, you pursue this kind of programmatic shift, if you're in a jurisdiction where that's important.

Barry Ostrowsky:
In New Jersey, it's clearly important. So there are advantages, as you're pointing out to your compact with your employees and a bunch of others, that give you a real IMI view, give you very important enhanced status as an organization. And for me, it's ultimately fulfilling what I think our role should be as a community resource and the society in which we're practicing.

Rae Woods:
I love that. You've gotten to be at tables, that wouldn't have been available to you or wouldn't have been offered to you had you not gone down this path, and that is absolutely a strategic advantage.

Barry Ostrowsky:
And by the way to my colleagues who are considering this, look, I'll name drop. We're not Johns Hopkins and we're not Mayo, we're not University of California, San Francisco. So if you're going to compete exclusively for NIH grants in those kinds of clinical support, you're going to be up against nameplates, that you may find to be very difficult by way of competition. We are competing with them nonetheless, but in this area, you can in fact, establish yourself as a leader quickly and you can attract the kinds of support from foundations and government that you will have fewer competitors, chasing those dollars than you might when you're in the competition with well established research institutions doing some of the other more conventional clinical activities.

Barry Ostrowsky:
So you can carve out a very real purpose that will attract support with fewer competitors for that support. Look, it's not that I'm jealous, I hope everyone does this. But in the meantime, you can get this support more easily than you could necessarily some of the other kinds of grants that we all look for.

Rae Woods:
I love what you're describing, because it sounds like once you have this foundation of the clinical and the social pillars, that you have moved the goalposts for yourself, you've moved it to include an openly and transparent anti-racist agenda. You've moved it to include, not just how do we do the best by our patients, our community? How do we compete on the best employee value proposition? How do we compete in a space where there are competitors that are bigger and bolder and have more name brand than us? And how do we integrate ourselves in policy that is going to be affecting not only your organization, but organizations in your market and maybe across the country.

Rae Woods:
You've moved the goalposts for yourself. My question is about the how. Who have been the most important leaders that you needed by your side, as you've developed the initial strategy and evolved it over the last eight years?

Barry Ostrowsky:
Our healthcare system really grew out of a collection of hospitals. So most of our employees are working at these big institutions, which are led by very effective management teams. They are critical. You've got to have the folks who oversee your rank and file people be part of this. And I have to tell you, they weren't automatic in their embrace of this approach, because they're all conventionally trained healthcare people and they weren't trained like this, they weren't educated like this. And we ourselves kept saying to the executives, we want to see a bottom line, we want to see a return, we want to see more volume in our building.

Barry Ostrowsky:
So we kept pushing them to enhance the outcomes based on their conventional training. Now we come to them and say, "That's not good enough. I need you to be a thought leader on social programs and community integration and all of this." And they were skittish about it, because they were worried they didn't know much about that. And if they paid too much attention to that, would the metrics that we looked at on a regular basis start to slip, and where does that put them?

Barry Ostrowsky:
So one of the things I would suggest to people who are undertaking this, you need to have a group of executives, obviously, that are bought in, that are close to the employees. And they have to be told that you're not going to sacrifice their success as an executive, because we're into some unchartered waters here. And I held all the executives harmless, literally harmless in terms of compensation when we went down this path, because I understood they were going to have to do some things for which they weren't trained. And maybe early on, we're not believers and you can't punish people, at least from a compensation standpoint, you can't punish people when you put them in that position.

Barry Ostrowsky:
And so I had those folks, my corporate team, was also hesitant I think in the beginning, because yet again, they didn't know much about what we were talking about in terms of social determinants ultimately and anti-racism. So we began an educational process that was required. We insisted that they got training, they read things. I mean, to this day, we have a monthly meeting on anti-racism that hundreds of employees and executives join every month.

Barry Ostrowsky:
So you have to incorporate that into the culture of the organization, not suggesting it's easy, but you can't do it alone. And to your point, I could sit in my office and think about this all day, but nothing's going to happen. And one of the things I said to our folks, which had some interesting results when we launched anti-racism, I told our executives, "I don't want a meeting in the organization that had an agenda that didn't have this as an agenda item. I don't care if you're talking about supply chain or privileging, in the case of anti-racism, I want there to be an anti-racism reference discussion statement. And I don't care. It doesn't have to be an hour, someone has to say something about it because that's the only way it becomes part of the everyday conversation, the only way."

Rae Woods:
And that's a different form of accountability. I've been thinking about the kind of pushback that leaders get from their staff, and I think about it on a bell curve. Of course, you're going to have the folks who are incredibly enthusiastic about the shift in strategy and you're also going to have the very vocal naysayers who are probably the loudest folks in the room. But in the middle is a different kind of pushback. It's not somebody directly arguing with you and saying, "This isn't the role of healthcare." It's just people who are going to put equity or put these social initiatives at the bottom of their to do list.

Rae Woods:
I hear you trying to come at that, through education, through some of these things of making it a normal part of practice. But how else do you combat this idea that folks are just going to keep pushing it to the bottom of their to do list?

Barry Ostrowsky:
We launched a high reliability commitment about four years ago. That's an approach that you use to ensure quality and safety in your institutions, and it required a daily safety huddle. So we've done that and people who also are naysayers, "Man, do we have to get together once a day?" "Yes, you have to do it," which they did and it gives you the right to stop the line. So if you are the third in the pecking order of some healthcare service, you can say, "Stop, we're operating on the wrong hip." So we've done that for a number of years.

Barry Ostrowsky:
That was a lubricant to now insisting, that this become every day activity and behavior. The other thing you have to do in our view, is as you are talking about it and as you are integrating into the behavior, you have to take very real steps. So for instance, we looked at our HR policies throughout the system, and they were impliedly in some cases racist. They didn't mean to be, but the manner in which they were executed and enforced, were in fact, not consistent with an anti-racist agenda. For instance, we looked at employee punishment, boys who are sanctioned or otherwise cited for certain things, everything from tardiness to what have you. And when I tell you overwhelming majority, if our employees are 23% black, [inaudible 00:35:48]. 72% of those who were punished were black. Now, how is that possible?

Rae Woods:
Yeah, exactly.

Barry Ostrowsky:
Right? So it's not being handled on an equitable basis. So we gave everyone the data and we said, "It has to stop, and this is how we're going to change it." So if you just talk about it, and say, "I want it on the agenda of every meeting," it's not good enough. But if two days later, you put this out and you change that policy, and you change the manner in which it's implemented, now, the meaningfulness of having talked about it in the meeting becomes clear, because they can say, "This crazy guy is actually going to do something about this."

Barry Ostrowsky:
And so we have done that, we have specific goals on anti-racism that run everything from education to HR policies, you name it, because it's 100% behavior. It's everything we do. The New England Journal of Medicine, to name drop, I think over the last six months, doesn't have one of its editions that doesn't talk about this. Embarrassingly, they had to admit that medical education was racist, because medical students and interns and residents were taught when a black person that showed up in the emergency department, he or she had a higher tolerance for pain, so they don't have to prescribe. How is that possible?

Rae Woods:
I know, it's deplorable.

Barry Ostrowsky:
In 2021 in this country? But there it is. So look, this is what I said to our folks. "I understand racism is a public health issue, it's not a private health issue." So if someone comes to my office and says, "Look Barry, I hear what you're trying to do, I just don't believe. I just don't believe that there's racist activity that are stretched. I don't believe any of that and I just can't get on board." So my answer is, "Then this is the wrong place for you to work." If that person leaves and sues us, I'll take that headline, I don't care about it.

Rae Woods:
That's another form of accountability by the way. It's drawing the line in the sand and saying, "Go work for a purely clinical institution then."

Barry Ostrowsky:
"Go somewhere else. I don't want to see you spread racism, but you can't live here and not be anti-racist." See, it's not good enough to say "I'm not a racist, because of that." So I need you to be actively engaged in tearing down racism. And look, let's face it. People could take the pledge if you will, but you don't know whether they're actually doing it in a proactive way. So all these programs and policies, you have to force them to do that. People will self-select out, we've terminated people for things that they posted on their private social media page, because everything is traceable.

Barry Ostrowsky:
I have one of the people said, "I didn't make reference that I work for the organization." And we said, "Are you kidding? Everyone knows you work for the organization." I told our people I'm not worried about legal vulnerability, what we're challenged on, is being anti-racist. I don't care about that.

Rae Woods:
Well, you mentioned briefly the role of high reliability, and I can't help but as you're talking about this, here a direct correlation to what hospitals and health systems have been doing to become a high reliable organization to focus on quality and safety. It also takes a data and analytics backbone to understand where are we falling short today. It takes the uncomfortable, but important conversation with clinicians for them to realize they are providing variable care to patients, or in this case, they're providing inequitable care to patients.

Rae Woods:
It requires the infrastructure of things like the daily huddle and that checklist to make sure that you're operating on the right hip. And it requires having a line in the sand to make sure that you are only hiring people who believe in that high reliability organization, and you're willing to see people go away. And I think it should feel comfortable for a lot of our listeners to say, "Hey, we've done this before. When it comes to safety, we can use those same principles, when it comes to being a more equitable and ultimately anti-racist organization as well."

Barry Ostrowsky:
Well, that's an eloquent statement of certainly my feeling. But I have to tell you something Rae, it's not nearly as translatable as I had hoped.

Rae Woods:
Oh, really? Have you tried this?

Barry Ostrowsky:
Well, because I'll tell you what happens. When we had the anti-racism initiative launched, I made all the very same analogies because I really felt strongly about it. And I had executives come to see me individually and say, "Barry, I don't know how to talk about this." I said, "Well, we're going to train you on how to talk about it." And they said, "It's an uncomfortable conversation." I said, "Whoa, whoa. We're in the uncomfortable conversation business, we're in that business. We sit with patients and give bad news. We sit with families, we sit with clinicians and say, you got to change what you do.

Barry Ostrowsky:
So an uncomfortable conversation shouldn't be the reason for not doing it. You're uncomfortable about this conversation, and I understand that. You got comfortable on HRO because it was clinical. I mean everybody again gravitates to their training of some form of clinical intervention. This is not trainable, in those venues, we're going to train you." And so there is a real issue and I think most people will experience this and face it when folks say, "What language should I use? The R word?"

Rae Woods:
The R word.

Barry Ostrowsky:
So it takes that kind of training, but you got to get over it, you have to get over the obstacle, about being able to talk about it. I have a policy, there's nothing so dangerous you can't talk about it, it's that simple. I mean, some of it is infuriating, don't get me wrong, but it's not so dangerous you can't talk about it, and you have to have that to be able to talk about some of these things.

Rae Woods:
Yeah. Well, that perfectly leads me into my final question. We've talked about so much of what it means to embed equity into the DNA of an organization. And you've had a lot of practice at this over the last eight or so years. If you had a moment to speak directly to the provider leaders who are listening to this podcast, what is the one action item, the one takeaway that you want them to do, as a result of listening to this conversation?

Barry Ostrowsky:
I really would like each of them to look at their mission, their purpose for being and understand that in order to be as impactful as we all aspire to be, you cannot simply do it, because you have great clinical program. You have to have these other programs, and developing them and executing them, will be among the most fulfilling things anyone ever leads. It's just that simple. And so it starts to me with that very basic concept of what is it I'm trying to accomplish and I think most of the folks will want to accomplish that which can only be accomplished, if you add to the great clinical platforms people have built, this kind of social platform.

Rae Woods:
I could not agree more. And I also just want to thank you for not just coming on the podcast, but for being a leader out there fighting the good fight, and really trying to make a difference in your community and in your organization. So thank you.

Barry Ostrowsky:
Well, thank you Rae, because getting the word out is what it's all about. And it was real privilege for me. I look forward to speaking to you again soon sometime.

Rae Woods:
If there are two things I want you to take away from this conversation, I want them to be this. First, it's that it is so important to think about the operations and the processes behind any initiative, perhaps, especially a health equity initiative. But the second piece is just as important, and that is to make sure you are living up to the leadership in charge. If you're listening to this podcast, I want you to be willing to be on the frontlines of making a shift at your organization. And whether you're a CEO, a department leader, or a frontline clinician, we're going to need everyone to actually make a change here. And if you're looking for more, remember we're here to help.