Health care organizations have long been grappling with what their role is within their communities and how to approach health equity.

Barry Ostrowsky, president and CEO of RWJBarnabas Health, sat down with Radio Advisory's Rachel Woods to talk about the role of social justice in a health care organization and the specific steps that that he took to embed equity into every aspect of RWJBarnabas Health’s strategic plan.

To hear more from Ostrowsky, including why he "tore up the mission statement" to achieve his approach to diversity and inclusion, listen to the full episode of Radio Advisory below.

The health care CEO’s guide to advancing health equity

Rachel Woods: You were talking about the exact same advice that we give to every single health care 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?

Cheat sheet: Equity impact assessment

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.

And one of the things we ought to talk about is what you bump into, which 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.

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?

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.

The board has set up a committee to oversee that pillar. And so the anti-racism pillar, as I say more like a log that goes horizontally, has to be part of everything we do, including medical education which by the way, has been structurally racist for a couple hundred years.

Infographic: 7 excuses for not making health equity a priority in word and action

So the students we're teaching in medical school—from the way we've developed and deliver care, to what 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.

Woods: 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 they 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?

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?

Ostrowsky: We had a very active DE&I program for years. We had an executive who ran it from the 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.

And so now we have this executive who's running the Ending Racism Together program, who has a full staff outside consultancy. 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've got to get rid of that, so the DE&I can actually attain its aspirations."

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.

The one thing is, 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.