The Exec: Intentionality Essential to Addressing Health Equity, New CMO Says
To address health equity, a health system or hospital needs to have intentionality about identifying gaps in care and closing those gaps, the new CMO of University of Chicago Medical Center says.
Tipu Puri, MD, PhD, was appointed as CMO of University of Chicago Medical Center last month. He joined UChicago Medicine as an internal medicine resident in 1999. Puri has held several physician leadership roles at the academic health system, most recently serving as associate CMO.
To address health equity concerns, a health system or hospital must be inquisitive, according to Puri.
“It starts with asking questions about health equity,” Puri says.
The next step is harnessing data, Puri explains.
“You need to have data that you can act on,” Puri says. “Our data and analytics team has done a good job of creating an equity lens that we can use when we look at any of our data and break data down along multiple patient demographics, including race, gender, and Zip codes.”
Finally, a health system or hospital must decide how to address a health equity gap, according to Puri.
“If we see gaps, we ask, why do those gaps exist and how can we intervene?” Puri says. “Then you need to monitor whether the things you are trying to do to close a gap are working. Are you seeing the gap in care closing? We want our patients—regardless of who they are and where they come from—to have the same outcomes.”
According to Puri, University of Chicago Medical Center closed a health equity gap in blood pressure management, with a disparity between Black and non-Black patients. It started with identifying that the medical center was not meeting the targets with the Black population, then leaders asked why the medical center was not meeting its targets.
“To close the blood pressure management gap, we implemented programs such as remote patient monitoring and pharmacy-assisted blood pressure management,” Puri says. “Then we monitored the data to see that the difference in patients meeting the targets and outcomes were no longer different between racial and ethnic groups.”
Biggest challenge
University of Chicago Medical Center serves an urban patient population, and according to Puri, the biggest challenge in serving that population is providing access to care.
“There is a significant need in the community that we serve, and a high burden of chronic disease,” Puri says. “Maintaining access to our patients through our ambulatory clinics, emergency department, and specialty care programs is a challenge.”
“That generally focuses on looking at avoidable delays, improving the timeliness of care delivery, improving the planning for patient discharge, and improving medical decision-making,” Puri says.
In terms of discharge planning, Puri says the medical center has completely restructured its care coordination team to maximize their coverage of patients, cross-train them, add resources and staff, and lower patient-to-care-coordinator ratios.
“We do care coordination assessments within the first 24 hours after patient admissions,” Puri says. “We identify needs that may come up at discharge and identify social determinants of health that we might be able to address.”
Mentorship responsibility
As CMO, one of Puri’s roles will be to provide mentorship to physician leaders and frontline clinicians, and a big part of mentorship is providing empowerment and support to physician leaders.
“They need to feel empowered to implement solutions,” Puri says. “The decision hierarchy and the command chain need to be simplified where they can be simplified. If they have a solution, they should feel empowered to run with it.”
A mentor should be able to challenge physician leaders when necessary, Puri explains.
“Sometimes, mentorship involves challenging physician leaders if we are not meeting the targets and the goals we have set for ourselves or if we are not providing adequate access to care,” Puri says.
To provide mentorship for frontline clinicians, accessibility is crucial, according to Puri.
“A CMO should be seen,” Puri says. “There should be opportunities for hallway conversations. It can be random rounds on the wards. It can be sitting in lounges or being seen in the food service areas.”
“If frontline clinicians have an issue they want to talk about, they should feel comfortable coming to you to talk about it,” Puri says. “By being accessible and approachable, that is where we are going to get our best information to act on.”
Interdisciplinary care team success
The most important factor for success of interdisciplinary care teams is communication, according to Puri.
“As leaders, the best thing we can do is make that communication as easy as possible,” Puri says. “It can be as simple and pragmatic as putting offices or workrooms close together. It can be encouraging multidisciplinary rounds to happen at a nursing station, so the nurses can more easily join the session.”
Sometimes, CMOs and other physician leaders need to enforce communication among members of interdisciplinary care teams, Puri explains.
“You need to challenge care teams when communication has not been as good as it needs to be,” Puri says. “You need to tell an interdisciplinary care team that they need to be better because our patients are counting on it.”
Christopher Cheney is the CMO editor at HealthLeaders.