Episode 137. Following on from a workshop titled “JEDI Journey: This is the Way,” our diverse panel discusses the importance of processes such as integrating the social determinants of health (SDOH) into information systems via Z codes to advance Justice, Equity, Diversity & Inclusion (JEDI) & anti-racism. With episode host Charla Johnson, DNP, and guests Tonya Jagneaux, MD, Holly Pilson, MD, and Daytheon Sturges, PhD.

The group also explores achieving workforce diversity in general and orthopedic surgery specifically, which is the least diverse specialty of all. With current trends it will take 217 years to reach parity in terms of race and gender representation, and the group shares strategies for accelerating the pace. We hear how part of the challenge is getting diverse students into schools, but once this is achieved the environment must be set up for success. Otherwise, tokenism can lead to isolation and burnout. With pointers towards actionable steps and resources, this episode takes DEI up a notch.

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Host: Charla Johnson, DNP, RN-BC, ONC

Secretary, Board of Directors, Movement is Life

System Director, Nursing Informatics

Franciscan Missionaries of Our Lady Health System Baton Rouge, LA

Featuring:

Tonya Jagneaux, MD, MSHI, FCCP

Chief Medical Information Officer – OLOL

Associate Professor of Clinical Medicine, Pulmonary/Critical Care, Louisiana State University Health Sciences Center, Baton Rouge Campus

Holly Pilson, MD, FAAOS, FAOA

Associate Professor of Orthopaedic Trauma, Vice Chair of Social Impact, Co-Director of Diversity and Inclusion, Co-Director of Clinical Research, Department of Orthopaedic Surgery and Rehabilitation, Affiliate Faculty of Maya Angelou Center for Health Equity, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine

Daytheon Sturges, PhD, MPAS, PA-C, DFAAPA, CHES®

Assistant Professor of Family Medicine, Vice Chair for JEDI, Associate Program Director for Regional Affairs and Academic Affairs, JEDI, MEDEX Northwest Physician Assistant Program, University of Washington School of Medicine

Producer/Editor/Writer: Rolf Taylor 

Resources: 

USING Z CODES: The Social Determinants of Health (SDOH) Data Journey to Better Outcomes: https://www.cms.gov/files/document/zcodes-infographic.pdf

Advancing excellence in PA education through leadership, scholarship, equity, and inclusion. DEI Toolkit & Best Practices Guide: https://paeaonline.org/diversity-equity-inclusion

Fewer Words, More Action: Cultivating an Anti-Racist Environment Strategies/Solutions (CARES) Framework for Physician Assistant Education. Carl Frizell et al: https://pubmed.ncbi.nlm.nih.gov/34817435/

Excerpts: 

We need to do a rebranding and a paradigm shift, so that we don’t view diversity as a risk, but we view it as a strength, and we view it as beautiful. I use that term because this is not only hard work it is heart work, and there is some emotional exhaustion that comes with that.” ~ Daytheon Sturges PA-C

“It’s voluntary in 2023 then mandatory in 2024 to be screening for social determinants of health for Medicare and Medicaid for reimbursement. So, people really need to understand the importance of this, and it can’t be just another check the box. At Our Lady of the Lake we have a marketing slogan, “we listen, we heal,” – which is perfect alignment with integrating social determinants of health.” ~ Charla Johnson, DNP

“Just like we look at things like A1C, I’d like to see Z codes be reviewed routinely so we ask the questions, have we resolved food insecurity, have we resolved homelessness, and we can report on that and close that loop. And I really appreciate a provider wanting to use Z codes.” ~ Tonya Jagneaux, MD

“From the vantage point of the good, the bad, and the ugly, the good is that the trend for gender and race diversity is that orthopedic surgery has got better. But the bad is that we remain, year after the year, the least gender, race and ethnically diverse specialty in all of medicine, recruitment efforts alone have not reversed that. To get to parity at the present rate would take 217 years.” ~ Holly Pilson, MD

“I liked how you laid it bear that your zip code is more of a social determinant than your genetic code, and speaking of codes, I really like that you introduced the Z codes as well because that introduces a level of accountability. When you document it, you then have to have a plan about it.” ~ Daytheon Sturges PA-C

“We had two great talks from Cara McLellan and Frank McLellan, and I am going to start using that term: The power of the purse. Until you incentivize it, it does not become a priority. When people see a target then they see this is the journey we are taking.” Tonya Jagneaux, MD

“My part of the session was about workforce diversity, particularly in orthopedic surgery, and what better specialty to talk about in terms of workforce diversity than the one that struggles the most with it.” ~ Holly Pilson, MD

“When you fix policy at the system level then you are able to see more results. We need to look at policy with a JEDI lens, so Justice, Equity, Diversity, and Inclusion, but I also add in anti-racism, to become anti-racist we have to center and discuss race. We are looking at our policies using an equity impact tool, and we are looking as possible harm as well as alternative approaches.” ~ Daytheon Sturges PA-C

“One of the quotes I heard recently is “Nothing about us without us,” it takes bringing those stakeholders to the table, working alongside them and with them, to figure out how we get to more equity in this space.”  ~ Holly Pilson, MD

“It’s important that the minority people who are leading these efforts are doing it alongside and with the majority members of our departments and institutions, because it takes both together. “It’s important to equip the champions and provide education. I have my lived experience as a gender and racial ethnic minority, but I’m not a (DEI) expert.” ~ Holly Pilson, MD

“Medical students have consistently said that orthopedics as a specialty is less welcoming. I don’t know if it’s the surgical culture, some the other specialties mentioned as being less welcoming were also surgical.” ~ Holly Pilson, MD

“I like to offer a DEI toolkit that the Physician Assistant Education Association (Diversity and Inclusion Advancement Commission) has developed.  It’s 6 steps of a quality improvement loop.” ~ Daytheon Sturges PA-C

“Target the leadership structure: what is the racial composition? What voices are there? Do you have buy-in? These are the people who are yielding and wielding power. We need to look at admissions and ask how can we kick the door open and look at our applicants holistically, because this is where the gatekeeping is. We will never have a diverse medical workforce if the schools are not admitting these students.” ~ Daytheon Sturges PA-C