Accountable Care Organization

Episode 49: Health Equity & Cultural Competence

June 2023

MaineHealth VP for DEI Ryan Polly explores aspects of health equity and the results of a cross-cultural competency assessment completed by hundreds of MaineHealth providers.

Heather: This is BACON, brief ACO news from the Maine Health Accountable Care Organization, a rosemary infused monthly podcast for health care providers. I'm Heather Ward, your co-host and practicing physician participating in the Maine Health ACO. Unfortunately, my usual hosting partner, Mike Clark, had to bow out this month, but he'll be back for our July episode. Today we feature a conversation with Ryan Polly, Ph.D, M.Ed. He is Maine Health's VP for Diversity, Equity and Inclusion.

Heather: In the past year or so, we've devoted several episodes to topics that fall under the DEI banner, including caring for LGBTQ2+ patients and recently increasing the diversity of health care leadership. But we have not yet interviewed the leader of MaineHealth DEI efforts Ryan Polly. Until now, that is. As we mentioned in the intro, Ryan is the VP for DEI at MaineHealth. He's filled that role since early 2021, and previous to that, he was the director for DEI at Maine Medical Center. Ryan, welcome.

Ryan: Well, thanks, Heather. Great to be here.

Heather: Fantastic. So I'm a little curious to know a little bit more about you here. Really would love to know what led you down this DEI path.

Ryan: Yeah. You know, I didn't come to this work in a traditional way. That said, I don't know that anybody comes to DEI necessarily in a traditional way. Most of us come to the work either because of personal experiences or of experiences of close family members or friends, but certainly with a sense of the need for justice. And that's kind of what got me into this work. You know, my story is very similar. I've always had this justice-oriented mind, even as a little child being raised in San Diego and, you know, was I experienced poverty, I've experienced homelessness. I've seen the devastating impact of health care access feeling like a luxury and watching family members literally stitch themselves up instead of going into the ED because of not having the money and funds to receive care. And certainly, as a trans person, I've experienced, you know, both the good and the bad of health care and the personal reasons for wanting to advocate and support other people in equity. And so, you know, the personal reasons are my drive because I want to make sure and do work that contributes to having health care access and quality no matter who you are. And throughout my career, I built competency, right? Starting actually as a medical assistant when I was 17. I always loved the health care field, went in that direction, eventually got a degree and got into teaching and education and org development or organizational development. And all of that led to me being the person who kept saying: Let's do work. And it really built my competency in DEI at another health care system, the University of Vermont Health Network, where I kept being the person to raise my hand and eventually started to lead some pretty significant health equity projects and some DEI projects. And eventually it sort of just became my job. And I've been doing formally doing this work for close to a decade at this point. And informally, 20, 25 years.

Heather: That is inspirational. I love how you have the passion through experience and also the education and experience of leading this work behind you. That's fantastic. You know, as a provider, we always want to give the best care that we can to all of our patients. And we do strive to be culturally sensitive and equitable and have good intentions. But what are some of the things that you can identify as getting in the way of fulfilling those good intentions?

Ryan: Yeah, I mean, I think that everyone wants to provide good care, certainly, and we have two kind of competing things: We have 'health equity', the bigger health equity, which is really what I was mentioning a bit ago with poverty, for example, when you've probably heard of the social determinants of health and all of these things that impact a person's ability to be healthy. So that's the big macro. And then in a health care system, we have what we call 'health care equity', which is really at the bedside, it's the provider, and it's potentially not just the provider, right? It's our it's our system, but it's the ins and outs and the biases that show up when we provide the care that we provide. So when a patient comes in at the subconscious level, providers are making decisions about how we're treating that patient and those source of barriers can impact diagnosis, it can impact treatment. And it's not done consciously, right? It's done subconsciously. And in some cases, it depends on the where a provider may have received their training. Some of those subconscious biases actually showed up in training, for example, that someone with black skin might have a lower pain threshold. We know that's not true at this point, but it was taught that years ago. And so some people still have that in their consciousness, really.

Ryan: How do we then overcome that? Bias is truly unconscious. I mean, there is conscious bias as well. But we're talking about the unconscious kind, right? How do we overcome that? We overcome that through education, building awareness, through systems and structures and tools, and through understanding who our patients are and what their unique needs are. So you can get all the training you want, but you still need the tools and structure. So, for example, leveraging things like an epic tool to be able to remind you and understand what the pain thresholds might be regardless of race. Leveraging data to look for disparity that might exist depending on a particular community group, and then putting a structured intervention in place to best support that patient population. All of that falls in the big healthcare equity umbrella. It's really hard at the individual level. It's really a systemic intervention or a system intervention. At the individual level, it's being aware, right? Doing the education and really being aware and leveraging peers to ask questions and be provocative to make sure we're not missing something in the care we're providing.

Heather: Yeah, absolutely. I like how you differentiate between health and equity and health care and equity. I haven't heard it phrased like that. Kind of along the unconscious bias line, you know, we pretty recently the MaineHealth Medical group did the Cultural Competence Assessment for providers. So I'm very curious to hear kind of along the unconscious bias way of thinking, what did you learn from that? And then really, what are you going to do with that information?

Ryan: Yeah, well, it was it was great to launch that. So for those who didn't get to take it, it's a cross cultural medical assessment. So even a little bit different than cultural competence. That's a part of it. But what this did was also help providers understand their clinical understanding in treating a variety of diverse patients. So even it kind of spans beyond the unconscious piece all the way to: do you have the clinical expertise to understand the treatment needs of particular a particular patient populations? We had about 500 or so providers take the assessment, really it was for you as an individual provider to get a glimpse of your own readiness to treat various populations. For us, what we did was we took the data and we looked at what our themes were. One of the things we learned is we actually treat a lot of diverse patients. Our providers say they see LGBTQ, they see deaf and hard of hearing, limited English proficient immigrants, refugees, international travelers. We acknowledge that we see the gamut of diversity, which is great. We also learned that our clinical readiness has opportunities. Right? I'll give one example. We see a lot of LGBTQ+ patients, but the self-assessed readiness to really understand the clinical needs of this population and then the readiness to leverage the tools that are available to the providers is pretty low. So we have an opportunity, while we might treat these patients, we're not actually following best practice in the treatment of these patients. And that really happened with LGBTQ. We see that with deaf and hard of hearing, limited English proficient and immigrants and refugees were our four top populations that are the most opportunities for our providers to really build their clinical competency in treating and working with these patients.

Ryan: And again, that's things like best practices in using interpreters, using the sogi sexual orientation gender identity tools that are in Epic. So, asking the appropriate patient questions of our patient populations, understanding what sort of common conditions a patient, who is a recent refugee, might have depending on where they are coming from. All of that is the types of things this assessment assessed. So what are we going to do about it? Working with Dr. Mickey to start to think about how we build some education into things like grand rounds and other opportunities for providers. We did just invite the providers who took the assessment to participate in some vendor supported learning that has been shown to increase the clinical competency. And so we've invited people. We've already had this email just went out. We've already had several dozen providers sign up to take these sessions to help build competence. And if that's successful, we get great feedback. We'll expand that beyond this, this limited number of providers. From there, the goal is to annually start to find more opportunity to provide this training, and that's going to take some time, but that's the long term. Lastly, I would say we are bulking up things like our data collection, race, ethnicity, language and the sexual orientation, gender identity. And so next fiscal year, providers are going to receive more specific training on the best use of the sexual orientation and gender identity modules to teach them really how to assess the LGBTQ+ population, because that's one of our MaineHealth scorecard goals.

Heather: Shifting a little bit from individual provider level interventions to more of a system level. I know this year the ACO added health equity measure to its quality heat map. What is the significance of that do you think?

Ryan: It's timely is what it is. You know, health equity has been around for a very long time and this health care equity as well, like understanding who our patients are, what our needs are at the unique patient level is really foundational to providing quality care as we've talked about earlier. So by starting to now look at health equity measures, we can start to understand where the gaps are in our care. And up until now, up until this was added, we really couldn't do that with sort of guessing. You know, we can we can use national standards. There are there's a lot of work being done across the country on this, but it's best to look at our own patients, right? And to really look for where our gaps are. So, it's pretty significant and it's trending along with many other national bodies now that are saying, "hey, this shouldn't be optional, this should be what you do." And so, you'll see that some of our big organizations, regulatory organizations and accrediting bodies such as the joint commission, CMS, even our quality measures are now starting to say, "hey, health equity needs to be part of what you do." The great thing is MaineHealth was ahead of that. Our five-year DEI plan includes robust tactics to really achieve not just collection of data, but leveraging, you know, stratifying the data, looking for where we need to provide intervention. And we've got people at every local health system that are serving as leaders for health equity who are now going to start taking that data right and begin to build some intervention plans. We're not quite there yet because we're still collecting the data. The first step was let's collect it with precision. Let's make sure our data is accurate, and over the next fiscal year, we'll start to measure. In addition to the quality heat map, many other dashboards will include the ability to look from a health equity lens.

Heather: To follow that up, it's really not about provider purposely not caring for somebody in some group, right? This is to help us get information so that maybe at a system or community level we can do something about a group that's falling through the cracks.

Ryan: Yeah, that's the macro, right? That's that's the that's really the direction and why we need to understand themes and data. At the individual level, you know, each provider just kind of needs to check in with their own potential bias because we do know that at the individual level, there can be a misunderstanding of what the particular patient's needs that sitting right in front of you. And that's where the education comes in the macro level, the data collection is about what you just said. It's about understanding do we have a patient population falling through our cracks? And if so, is there something within the care we provide that we can do differently to reduce that disparity? So they kind of happen simultaneously. It can be very complex, but as a provider, it sort of sitting back and saying: "What kind of patients do I see? Do I treat on a regular basis and am I trying to treat every patient identically?" Because we know that not every patient needs identical treatment based on the various things that we're talking about today.

Heather: Ryan, thank you so much for joining us today and taking time out of your busy schedule. We really appreciate it. Thanks for being here.

Ryan: Yeah, it was really great to be here. I'm glad to talk about this. And certainly anytime anyone has any questions, they can reach right out to me and I'm happy to have a conversation about it.

Heather: Thanks for listening to BACON this month. You can find all our episodes on your podcast app and at our web page, And if you have questions, comments or suggestions, we'd love to hear from you. Please email us at That's Bacon is produced by the MaineHealth Accountable Care Organization. Thanks for joining us. See you next time.