DeAnna Minus-Vincent on expanding the definition of health

What this conversation is about

DeAnna Minus-Vincent works across RWJBarnabas Health with internal and external stakeholders to co-design strategies that improve health outcomes and eliminate disparities. She came on Personalization Outbreak with Glenn Llopis a month before the 2021 Leadership in the Age of Personalization Summit.

She grew up in Trenton, New Jersey, which she describes with affection as the city that started the nation, and she is precise about what a zip code does to a life: the street where she grew up and a town a short drive away carry very different life expectancies. Her career has moved across housing, maternal and child health, planning, education and social services, and she describes the through line without ceremony.

Why the system had to change its own definition

Glenn asked why a health system whose mission is healthy communities does not simply focus on clinical care. Her answer is that it used to, and that it stopped being enough. The country spends more on healthcare than its peers and is sicker than many of them, so the definition of health had to expand to include social, behavioral and environmental factors. Most of what determines a person’s health happens outside the hospital: food, housing, education, economic status, racism.

That changes the clinical encounter itself, and her example is the kind of thing a busy clinician does a hundred times a day without thinking:

"we can no longer give a diabetic a medication that says take with food. If in fact we don't understand, can you afford food, or even if you're more affluent, do you know how to prepare healthy foods?" — DeAnna Minus-Vincent · 00:10:20

Hence the goal of screening every patient who comes through the doors for social factors, because a person sent home with instructions they cannot follow simply returns through the emergency department.

Language works the same way. Discharge papers in a patient’s preferred language are often not available immediately, and a day and a half is too long when a wound needs cleaning. So the system moved interpretation onto handheld devices and put language preference at the top of the record, where it can be seen when a decision has to be made in seconds.

It takes everyone, and most people did not know

Glenn asked whether this work has to be led by someone who has lived it. Her answer is more interesting than a yes:

"if it was up to black and brown people to end racism, we would have done it a long time ago. We would have said, we are over this. We're going to stop it today, but it takes everyone to end racism." — DeAnna Minus-Vincent · 00:06:30

What the table needs, she says, is people with lived and learned experience and allies who will speak when she cannot, including in the ordinary meeting where someone with less experience talks over her and the point lands only when a colleague repeats it.

The system began with what it called courageous conversations, because for many people talking about race at all was hard, down to describing a colleague by height and glasses rather than saying the word. Then came the responses from white colleagues who said they had not known how bad it was:

"My biggest aha moment was that you didn't know." — DeAnna Minus-Vincent · 00:18:50

She is not being flip. People may have imagined a slur every few years; what they had not seen was the daily accumulation, including how it wears on frontline teams when a patient refuses care from a Black nurse. The system now has a policy that no patient may choose a provider on the basis of physical characteristics.

Dignity requires knowing the problem

Glenn asked how we can build healthy communities without embracing human dignity, given how much suppression people absorb:

"how can we create healthy communities without embracing human dignity? Because I almost feel that we just keep suppressing individuals at a rate that's making us even more unhealthy than we already were." — Glenn Llopis · 00:21:10

Her answer starts with buy-in and ends with vulnerability. The system spent real time on what constitutes disrespect, including the compliment that is not one, the remark that someone is so articulate, unlike others. It also meant leaders admitting what they did not know, as she did when reviewing the holiday policy so people could take the days that actually matter to them, and had to call colleagues to ask how the dates of a holiday she did not observe are determined.

"So I think in order to get to dignity, we have to know what the problem is and be vulnerable. And I don't know that everyone is ready to do that." — DeAnna Minus-Vincent · 00:22:55

Governance, not pledges

Plenty of organizations signed something in 2020. Minus-Vincent describes machinery instead: a board committee on this work, a steering committee chaired by the president and chief executive, and four goals covering clinical care, workforce, community and operations, each with named leaders and priority initiatives. Clinical priorities target the conditions where disparities are documented; workforce work runs from recruitment to exit.

She also ties the work to safety. The system has been on a journey toward high reliability, where anyone must be able to speak up about a safety risk regardless of rank, and she wants the same power dynamic closed for racism.

Then the commitment that separates this from a campaign:

"not just programming, but policy change and not just policies that are racial policies, every policy, we will audit every policy because that's how you change systemic racism." — DeAnna Minus-Vincent · 00:28:18

Asked how she paces herself, she admits she is not good at it, then makes the case for going slowly on purpose: a policy rewritten in haste is a policy that will not hold. This has been built over four hundred years, she says, and it will not be undone in four minutes, four days or four months.