Not long after she graduated high school, Vivian Anugwom and her mother began traveling to their family homeland of Nigeria to do medical mission work, taking health care supplies to rural parts of the country.
The experience was formative. “Seeing folks not having access to basic health care and realizing how much people appreciate when you bring health care to them,” Anugwom said, “sparked my interest in working in health care and advocating for people who typically don’t have access to that basic human right.”
Eventually Anugwom went on to earn a master’s degree in community health. In 2013, an internship at Allina Health opened her eyes to the power of health systems to provide access to people of all racial and ethnic backgrounds. The internship led to a series of jobs at Allina, all focused on community health.
“With all the roles I’ve had at Allina I’ve always tried to do some work around health equity,” Anugwom said. “Even before I knew what the words, ‘health equity’ meant, I knew there was more we needed to do to serve historically underserved patients.”
In 2019, right before the pandemic descended on Minnesota, Anugwom learned that Allina had an opening for the leader of their health strategy. To Anugwom, director of health equity sounded like the perfect job.
Vivian Anugwom
“I went for it,” she said. “I was hoping to find some allies across the system to figure out what we can do to advance health equity in the state.” Inspired by her enthusiasm, Anugwom’s colleagues offered her the job. Though she went into the role with her eyes wide open, Anugwom quickly discovered that the job was much bigger than she expected.
“As an organization we’ve been able to say we are committed to advancing health equity,” she said. That means ensuring that everyone has fair and just access to health care as a basic human right. The next step in achieving this goal, Anugwom said, “is to figure out, ‘What does health equity actually look like?’ ‘What does that mean?’ There are so many different levels that we need to address to actually achieve health equity.”
Equity measures
To take a more exact measurement of how well Allina is actually providing equal access to health care for all of its patients, the system did an assessment of overall health quality outcomes.
“We did find some disparities,” Anugwom said.
One example of a health disparity is in colorectal cancer screening rates for the system’s Black and African American patient population. “We saw that this group was being screened for colorectal cancer at a lower rate than other populations,” Anugwom said.
To address this disparity, Anugwom led a group that took a deeper dive into the shared decision-making tools the system provides for its physicians and patients around colorectal cancer screening. The system’s primary care and quality teams also worked on the project.
“We worked to adapt those tools and make them more inclusive,” she said. “To do that, we worked with our internal BIPOC employee resources group. We asked them to review the updated material and give us feedback on ways we could make the language even more inclusive.”
Some of the roadblocks that limited patient participation in colorectal cancer screening has to do with language gaps, Anugwom said. When the literature is not available in a patient’s first language, their rates of compliance with testing goes down.
“We’ve done more of a deep dive for our Somali-speaking patients and made sure that our shared decision-making tools are translated into Somali,” she said. Allina has also added a Somali-speaking community health worker at one of its clinics that serves a more diverse patient population.
“The community health worker is really focused on the disparities we are seeing in measures like the colorectal cancer screenings,” Anugwom explained. “She is able to follow up and answer questions after a provider visit. She’s able to spend that time outside of the provider visit. Because she speaks the same language of some of our patients, she’s helping to bridge that communication gap, and helping to reduce disparities.”
Anugwom’s research also highlighted another care gap, within Allina’s Indigenous patient population. American Indian patients who have been discharged from the hospital tend to be readmitted at greater rates than other ethnic groups. Allina’s health equity team began digging into the issue, working to develop approaches that could reduce the number of preventable readmissions for this group.
The work required a closer look at typical patient behavior after hospital discharge. “In order to decrease preventable readmissions, you want to get a sense of who’s been discharged and is at a high risk for readmission,” Anugwom said. “To keep people from ending up back in the hospital, you want to make sure they get a primary care visit within five to seven days.”
What Anugwom’s team discovered was that that key primary-care visit wasn’t always happening for many Indigenous patients. One way to increase participation by members of minority groups in health care initiatives is to build connections with organizations with a proven track record of culturally specific service. With that in mind, Allina health equity staff is working on a partnership with the Division of Indian Work (DIW), building community collaborations to be able to support Indigenous patients in community.
“We are working on improving communication between our hospitals and our clinics but also bringing community into that communication loop,” Anugwom said. “We hope to connect our patients to culturally unique resources like DIW upon discharge.”
Further collaborations
The spirit of collaboration with outside organizations that are well versed in the cultures and ways of underserved groups led Anugwom and her staff to build a partnership with Open Path Resources, a local organization that supports and advocates for Minnesota’s Somali and Muslim faith communities.
Open Path, Anugwom said, “supported us at the start of the pandemic in improving our ability to support patients with their cultural and faith needs while being hospitalized.” In the months since, the two organizations have maintained that relationship, developing a six-part training series for staff around health care from the Muslim faith perspective.
“They led a conversation around mental health and preventative care,” Anugwom said. “Staff had an opportunity to join in these conversations.”
Maintaining the relationship with Open Path is an example of continuing collaborations that have the power to reduce health inequities, she believes. “We’ve really focused on being more proactive and having these critical conversations that lift up the community. The underlying theme of all this work is along the way we are trying to build and maintain trust in health care. We don’t talk about that enough.”
Anugwom said that her job, though it is far bigger than she first anticipated, has proven to be deeply satisfying. Though it didn’t take long for her team to uncover a number of significant health care disparities, she said she is heartened by the fact that in her short time on the job she’s already seen Allina making progress on closing those gaps.
“When I first took this position I was approaching it as, ‘Let me find some allies that will help with little projects here and there,’” she said. “I now have a lot of allies across the system, but we’ve also uncovered much more work that has to be done.”
Rather than feeling daunted, Anugwom said she’s quickly pivoting to: “How do we build that larger system structure to empower a whole bunch of health equity soldiers to work across the system within their sphere of influence? How can we improve the system of care to better serve everyone?”