May 24, 2022

The Health Care Improvement Foundation’s (HCIF) Partner Profiles highlight the efforts of valued and innovative health leaders. Our partners’ work supports HCIF’s vision of healthier communities through equitable, accessible, and quality health care

As HCIF concludes year one of our Health Equity Data Strategy (HEDS) collaborative, we are pleased to feature Shonalie Roberts, MHA, ARM, LSSGB, System Director of Health Equity at Main Line Health. Shonalie serves on the HEDS Advisory Group that consists of health equity leaders and experts who have helped to establish the scope of the collaborative, support the launch of the program, and provide feedback on the HEDS Baseline Survey.

You serve on the Advisory Group for HCIF’s Health Equity Data Strategy (HEDS) and you played a key role in supporting the HEDS Collaborative launch and first year milestones, such as the HEDS Baseline Survey. What do you consider to be some of the greatest strengths of the HEDS Collaborative? What are you most looking forward to the HEDS Collaborative accomplishing in years to come?

Serving as an advisor for the HEDS collaborative has offered a unique opportunity to locally collaborate towards the development and enhancement of data collection and stratification initiatives that could help identify and reduce health disparities. Though functioning as individual institutions, collectively, the HEDS member organizations’ goal is simple – improving health outcomes for all by focusing efforts on where the greatest opportunities exist. One of the greatest strengths of this Collaborative is the forum it creates to foster collaboration through shared learning. I look forward to collective action to support hospitals in this region to taking tangible steps to improving health outcomes.

In addition to participating in HEDS, Main Line Health has demonstrated a commitment to health equity through its leadership and participation in a number of collaboratives, including the Institute for Healthcare Improvement’s Pursuing Equity Initiative. What is one of the most impactful changes that Main Line Health has achieved with regards to health equity?

For the past 10+ years, Main Line Health has been committed to addressing disparities in care, advancing health equity, and fostering a care and work environment that is grounded in diversity, respect, and inclusion. In that regard, and via our participation in IHI Pursuing Equity, we’ve adopted IHI’s 5-pillar framework. Notably, we’ve included health equity in our strategic plan, added Diversity, Respect, Equity, and Inclusion (DREI) as one of our core values, established accountable infrastructure to lead, implement, evaluate and communicate our DREI work, and are building and strengthening diverse community partnerships.

We are taking a holistic approach to achieving equity in every aspect of our organization’s work – for our employees, patients, and the greater community we serve. We have made many changes that have had tremendous impact but there is plenty that we still have to do. One of the most impactful changes has been with the collection of REaL data and, more recently, the stratification of key measures by REaL data. We embarked on a campaign to bolster accurate REaL data collection about 7 years ago, which included staff training and support on WHY it is important to collect patient self-reported data. Efforts from that campaign, called “We Ask Because We Care” and adapted from the Robert Wood Johnson Foundation’s Aligning Forces for Quality, helped us to significantly improve REaL data capture and reduce the ratio of race and ethnicity data captured as “unknown” and “other” within our electronic health record (EHR). Now, with this data, we can look at our key quality of care metrics and determine whether and where there are disparities in outcomes that we should be focusing on.

What is one key thing you would like the public, or someone not in health care, to understand about health equity and the role it serves in our communities and the healthcare system as a whole?

Health equity is an important and complex topic. There is no exact pathway to achieve equity and by no means is there a one-size fits all strategy. It is a continuous pursuit and journey that takes time and sustained effort.

The work around health equity, which includes addressing the social determinants of health needs (those non-medical barriers like access to stable housing, healthy food, and transportation, that may impact health outcomes) involves community and preventive care – something hospitals and health systems were not traditionally built or set up to address. From a hospital and health system perspective, we have been in the treatment business, not in the preventive care business. So we are navigating new and difficult challenges in a new and difficult space. We have to innovate and change is hard. Learning to provide community, preventive, primary, secondary and follow up care for a patient across a continuum is not easy because often the existing processes work contrary to that and more often than not, patients unintentionally fall through the cracks in our systems – creating disparities, and inequities. Also, most of the work to achieve optimal health cannot occur within the hospital walls, so it requires community outreach, partnership, engagement, and trust. Hospitals must engage with the communities they serve to address these barriers.

Reflecting on your own professional background and accomplishments, how did you become interested in health equity?  What is one of your greatest accomplishments within your field so far (in other words, what are you most proud of)?

I was attracted to health equity by the very same thing that attracted me to health care – helping others. Particularly those whose voice may not always be present or amplified to the level that influences decision making – those historically underserved and marginalized communities. These populations, despite individual successes within these groups and their own beautiful and rich community assets, experience barriers that negatively affect their health and in many instances these barriers are negatively impacting their opportunities to thrive in society. These barriers are steeped in individual and structural racism, bias (overt and implicit), underinvestment in their communities, and so on and so forth.

I think back to when I first moved to the United States and how difficult it was to access healthcare. My father – who had been an architect and project manager in the Caribbean where I’m from – could not get a job here in the US in spite of his credentials and years of experience. Without a job – health insurance was virtually unattainable for him and for us. In the US, employment creates access to insurance for most individuals. For my family, government-sponsored insurance was out of the question and in fact, for some, if not many Caribbean households, there’s stigma attached to public assistance and many avoid it. So, it wasn’t until my college years that I had access to care through my student status. Perhaps with education and trust-building, we can instill confidence in the resources (publicly-offered or otherwise) that already exist to help others who may need it. And of course by helping those who need the most help, you naturally help everyone. By addressing issues with how health care is delivered for the most vulnerable, you improve the way health care is delivered for all. And by improving access to care for more, you improve the health and wellbeing of the community. I see that as my role.

I think we still have a lot of work to do as a nation, within healthcare and even within my organization -MLH. Though I am quite proud of how far we’ve come. I’m most proud of the work we have done as a health system to educate, train, and support our staff to be more aware of DREI topics and to move from awareness into action. Through our mandatory DREI Learning Experience (now virtually offered), all employees will be re-trained in DREI principles. I’m also proud of our system’s growing partnerships with the community, including Together for West Philadelphia, a collaborative of more than 20 community, public, and private sector stakeholders fostering shared projects to maximize impact in health, education, food access and opportunity.

What have you found most valuable about working with HCIF? What is something you’ve learned through our partnership?

The collaboration within this region is most helpful. Often health care organizations see each other as competitors and this work is a good reason, the right reason, to come together and work together for the benefit of the patients we serve together. HCIF provides the necessary neutral forum to do this.

What is a quote that inspires you in your work?

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane” – Rev. Dr. Martin Luther King, Jr.

Something you may not know about Shonalie…

As a Caribbean-born American, I am eager to travel to more Caribbean countries, for the rich history and diversity across and within these countries, in addition to their warm weather and beautiful, clear beaches! My favorite book is The Other Wes Moore-One Name, Two Fates – An easy read that illuminates the lives of two kids with the same name who traverse different paths. It affirms the power and influence of our physical, familial, social, and economic environment to shape our life path.  For me in my role, it reminds me of the complexity of health equity because the very premise of this work is caring for individuals in the way they want to/need to be treated – not treating everyone the same or equally. The book, like my work, reiterates the complexity of our individual lives and circumstances and reinforces the importance of seeing people for who they are as individuals – with unique lived experiences – who must be cared for, in that way.

If you are interested in connecting with our partner on LinkedIn, you can find Shonalie Roberts here.