How Mass General Brigham Plans To Dismantle Racism In And Outside Hospital Walls

Mass General Brigham is out with a plan to dismantle racism within its 12-hospital network. The project, called “United Against Racism,” includes changes in leadership, culture and patient care. It also expands efforts to address hunger, housing and job opportunities outside hospital walls.

“We want this to be a major change in the culture of our organization,” says Dr. Tom Sequist, MGB’s chief equity officer, “that we think about equity and anti-racism and treat them as the urgent public health crisis that they are.”

MGB leaders say this is a multi-million-dollar project, mapped over five years to start. They aren’t saying exactly how much they’ll spend.

The plan is a response to anger, frustration and calls for change within the hospitals that were heard following the deaths of George Floyd, Breonna Taylor, Ahmaud Arbery and others this year. Employees shared reactions and ideas in small discussion groups, hospital town halls, petitions, employee surveys and protests.

The hospital’s response is a list of system-wide goals, many with tracking and accountability measures. With regard to patient care, for example, every clinical department will be asked to identify a health disparity between whites and a minority group, come up with an improvement project and test whether it works. MGB will develop a new reporting process for discrimination complaints. Some Black and Latinx doctors have said they don’t report insults or bias out of fear of retaliation.

The MGB plan to eliminate the impact of racism builds on changes in the works or approved at some member hospitals. Brigham and Women’s is already increasing translation services inside the hospital and expanding testing and food distribution in Boston neighborhoods with high coronavirus infection rates. Mass General mapped a 10-point plan in June that includes reviewing the use of race when diagnosing and treating disease, revising hospital police goals and interventions and a more robust reconciliation program to address acts of racism.

Dr. Joe Betancourt, chief equity and inclusion officer at MGH, has been working on these issues for many years.

“The difference now is we will be more rigorous, more focused, and have much greater resources,” he says. “Essential to this work will be metrics that we will develop to hold all of us as leaders fully accountable.”

Other health equity leaders in Boston agree, you can’t change what you can’t identify, measure and track with good data.

Mass General Brigham is certainly not the first hospital system in Massachusetts to focus on food, housing, jobs and other so-called social determinants that contribute to poor health. Boston Medical Center opened a food pantry in 2001, has invested in a grocery store, housing and routinely screens patients for basic needs.

“People can’t prioritize health when they are missing the basic necessities to survive,” says Dr. Thea James, vice president of mIssion at BMC.

James says Boston hospitals are collaborating to reduce social inequities in ways that “can only, hopefully, be beneficial.”

The early reviews of MGB’s anti-racism plan are mostly good.

“The leadership of Mass General Brigham should be commended for developing this comprehensive plan,” said Harvard School of Public Health professor David Williams in an email. “The devil will be in the details and in the level of commitment to doing what is necessary in order to really be successful: a long-term commitment, adequate financial support, ensuring appropriate expertise, accountability and evaluation.”

Dr. Taison Bell, who trained at Mass General, urges the hospital to consider adding a community health center in one of Boston’s predominantly Black neighborhoods.

“That would go a long way to making sure African American patients have access to MGH,” he said.

But Bell, now an assistant professor of medicine at the University of Virginia School of Medicine, applauds MGB’s plan as a whole.

“This is one of the broadest efforts I’ve seen around institutions enacting anti-racist policies,” Bell says. “They use the word 'racism' throughout. That’s a charged word and can be a loaded term at times, but as our article points out, racism is the underlying core problem facing employees and patients.”

Bell co-authored a recent New England Journal of Medicine essay that looked at anti-racist changes academic medical centers should consider making.

“As a premier academic hospital system, other institutions and allies will look to this to demand action and design initiatives like it at their institutions, so overall this is a great step,” Dr. Hisham Yousif, one of Bell’s co-authors, said in an email.

MGB says it will be transparent.

“We hope to be at the leading edge of this work that we are not only taking action here but also generating new knowledge that will help a lot of other health systems understand what the path forward is,” Sequist says.

The audio attached to this post is a Morning Edition conversation between WBUR's Bob Oakes and Mass General Brigham's Chief Equity Officer Dr. Tom Sequist.