Stanford Medicine Children’s Health maintains focus on equity in care

Ndidi Unaka, MD, says her passion for health equity is driven by her personal experiences.

Dr. Ndidi Unaka, the chief health equity officer at Stanford Medicine Children's Health, talks about the value of partnerships and patients when working to close disparities.

Unaka is the child of Nigerian immigrants and her parents were social workers. She says they modeled a career in service. At times, her family didn’t have access to commercial health insurance, she says.

“I think for me, just understanding the ways in which some individuals or populations have access to quality health care compared to others, and developing a greater understanding of the ways in which health inequities impact overall health and well-being in our patient populations during med school and during my pediatric training, just really ignited a desire to really try and contribute to solutions,” Unaka says.

Now, Unaka pursues those passions as the inaugural chief health equity officer for Stanford Medicine Children’s Health. She began serving in the post last year. She previously worked at Cincinnati Children’s Hospital Medical Center as the medical director of quality improvement and data analytics for the office of population health.

Unaka tells Chief Healthcare Executive® that she feels “really blessed to be in a position where I can serve in this capacity.”

“I think Stanford Medicine as a whole is absolutely committed to the work of identifying the ways in which children and our maternal patient population are impacted by social drivers of health, and thinking about the ways in which what is currently within our systems might contribute to health inequities. I think that commitment is more than clear,” she says.

“I think this is a place that has so many passionate people already doing work in this space,” Unaka adds. “And, you know, I just wanted to be a part of it.”

‘Committed to our mission’

Stanford Medicine Children’s Health has been working on ways to provide care to children and families whose primary language isn’t English, Unaka says.

“We know that communication failures can contribute to health inequities, can contribute to safety disparities, and obviously impact the patient and family experience, both in the inpatient setting, in our emergency department and in our ambulatory clinics,” she says.

The health system has been working to use medical interpreters consistently. But some of the staff interpreters may not be available 24 hours a day, so the system is making sure providers have access to video interpretation systems, she says.

“We are clear about how we capture data to ensure we're providing language concordant care,” Unaka says. “And actually providing feedback to our clinical areas on how well we are doing has been a huge focus of our institution, and I think it certainly has been impactful for our patients and families.”

Unaka also cites the importance of having a diverse workforce at Stanford as part of the effort to improve care, even at a time when some states and colleges have pulled back on their DEI initiatives.

“At Stanford Medicine Children's Health, we are committed to our mission, and our mission is to provide excellent and compassionate care to every patient who comes into our health care system,” Unaka says. “And we will do whatever we can to honor that mission.

“And so to me as the chief health equity officer, that just means staying grounded and focused on the things that our hospital has really shown a commitment and a desire to do, and ensuring that our patients know that we are a place where they will be taken care of, where they will be treated with respect. And, you know, I think that's what our hospital is all about.”

Developing solutions together

Hospitals that are looking to close disparities need to identify key areas of need. She says that’s particularly important for smaller hospitals that have limited resources.

“We can't tackle everything at one time,” Unaka says. “So I think having shared purpose on the issues that we want to tackle first is really important.”

Health systems that are striving to be better in caring for underserved populations need to develop a strong partnership with their communities.

“We cannot do this work without engaging and building trust and relationships with people with lived experience,” Unaka says.

“Oftentimes, we try and develop interventions to do for our patients and families, instead of co-developing these interventions with them, and I think that further erodes trust,” she continues. “And so we have to be committed to understanding the perspectives of our patients and families and community partners and invite them to co-create interventions that will work for them, that meets their needs. I think without that, we will continue to struggle.”

Health systems also need to consider a “cross-sector approach,” she says. Hospitals need to work with other sectors, such as community groups focused on housing, education and food insecurity, to tackle key drivers of inequities in health.

Hospitals also need to leverage their data, looking at outcomes in different racial groups or those in different neighborhoods, Unaka says.

“Data has to tell us the story of where we need to intervene, where we should prioritize,” she says. “So how well are we doing at collecting demographic information that could help us see trends in disparate outcomes as it relates to safety, patient and family experience, quality and patient outcomes.”

The value proposition

Hospitals and health systems need to understand that efforts to close disparities in outcomes are going to take time, Unaka says.

Sometimes, organizations set themselves up for disappointment by expecting to see progress quickly.“I think one trap in doing this work is that we do it in such a way that we think there's going to be a quick fix, right? So, we identify health inequities or disparities that we want to address, and we say we are going to put effort towards addressing this, and we should see improvement in six to 12 months,” Unaka says. 

“I think that if that is our mindset, we will lose the battle because it, in essence, means that we don't understand the complexity of all of the things that lead to that disparity,” she adds.

To sustain support, Unaka says leaders in health equity should celebrate small wins along the way. She also says it’s important to articulate the return on investment for efforts to close disparities.

As Unaka says, better and earlier interventions with underserved groups could help patients avoid a hospital stay. And that keeps a bed in the hospital free for a patient with complex and urgent needs.

“The value proposition is we want to be able to provide the right care at the right time, in the right way and in the right place for every patient,” Unaka says. “And addressing health inequities is the way in which we can do that.”