Faculty and staff of the Department of Medicine (Cardiology) took part in International Yoga Day. Front row, from right: Annapoorna S. Kini, MD; Lori B. Croft, MD, Associate Professor; and Joseph M. Sweeny, MD, Assistant Professor.

Mount Sinai Heart faculty and staff recently participated in International Yoga Day at Guggenheim Pavilion, with multiple sessions starting at 7:30 am. However, the enthusiasm for the practice goes well beyond a one-day event. The organizer, Annapoorna S. Kini, MD, Director of the Cardiac Catheterization Laboratory at The Mount Sinai Hospital, and the Zena and Michael A. Wiener Professor of Medicine, Icahn School of Medicine at Mount Sinai, practices yoga herself and recently published a list of recommended yoga and meditation techniques in the CRT Times, including a 10-minute sequence specifically for physicians in the Cardiac Catheterization Laboratory.

Dr. Kini says, “At Mount Sinai, we strongly advocate yoga and meditation to counter musculoskeletal discomfort, to relieve stress, and to maintain focus and concentration.”

At the start of a meeting, give participants a few moments to reflect quietly on the subject at hand, then call on each person for their thoughts. When people do speak, “listen to understand, and not to reply.”

These were some of the specific and achievable strategies discussed in the inaugural Health Care Inclusion Summit, which was in June at the Corporate Services Center and sponsored by leadership in Service Excellence and Patient Experience.

The keynote speaker of the event was Mary-Frances Winters, founder and Chief Executive Officer of the Winters Group, a consulting firm that has been working with top leaders of the Mount Sinai Health System on inclusion strategies for more than a year. “It is important to recognize that inclusion is a developmental process,” Ms. Winters said. “We must address changes in attitudes one stage at a time.”

Leona Hess, PhD, left, and Ann-Gel Palermo, DrPH, MPH, led a discussion on the mindsets of inclusive change makers.

Ms. Winters used an interactive tool to ask the 150 attendees how they defined themselves. The anonymous answers appeared on a screen at the front of the room:  A daughter, a Buddhist, an African American mom, a gay man, a husband, a millennial, a person with ADHD. These “identity markers”—some visible and some not visible—influence how each person sees and reacts to the world, Ms. Winters said, and understanding this is the beginning of understanding and accepting others.

Panelists during the half-day summit were David Muller, MD, FACP, Dean for Medical Education, Icahn School of Medicine at Mount Sinai; Chaplain Rocky Walker, MDiv, Center for Spirituality and Health, Mount Sinai Health System; and Erica Rubinstein, LCSW, CPXP, Vice President, Service Excellence and Patient Experience, Mount Sinai Health System. Maxine Legall, MBA, MSW, Assistant Director, Patient Experience, Mount Sinai St. Luke’s, served as the moderator.

The panelists said that both staff and patients were benefiting from inclusion efforts—which have the overarching goal of making every person feel heard, understood, and respected. Among other measures, the Health System has revamped a panel that addresses patient complaints and created the Strategic Leadership Collaborative to improve equity in medical education. In addition, ODI has expanded its portfolio of education and training on unconscious bias, LGBTQ health care and workplace equity, and cultural and disability awareness.

Leona Hess, PhD, Director of Strategy and Equity Education Programs for Medical Education led a discussion on the mindsets of the inclusive change-maker with Ann-Gel Palermo, DrPH, MPH, and Chief Program Officer. Attendees were advised to focus on how their mindset as a leader was created and how it informs their interactions with staff and patients. “Understanding your own personal and social identity is critical for the development of the skills and behaviors needed to understand, work with, and integrate the perspectives of staff and patients with a diversity of identities.” Dr. Hess said.

Planning is already underway for a summit next year, said Pamela Y. Abner, MPA, CPXP, Vice President and Chief Administrative Officer. “The response has been overwhelmingly positive,” she said after the event.  “We see an opportunity to make inclusion and equity even more integral to patient care, medical education, and every other facet of the Health System.”

Takeaway thoughts

“You have to stay open to different perspectives and different mindsets. Be open to other voices that might challenge you.”

Erica Rubinstein, LCSW, CPXP

“I have learned that you have to have humility—professionally and personally. Just take a step back and listen to people.”

David Muller, MD, FACP

Participants at one of several community workshops sponsored by the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai

There is wide acknowledgement that health care and social services need to be better integrated to achieve community health, especially for the most vulnerable. The best way to do this is not always clear. Health systems and community-based organizations need to better understand how to create these successful, sustainable partnerships.

The Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai has taken up this challenge.

The Institute recently convened representatives from community organizations and Mount Sinai Health System, along with philanthropic donors and thought leaders.

During a panel on August 1 at the New York Academy of Medicine, participants discussed the benefits of participating in a year-long initiative led by the Arnhold Institute for Global Health and ideas on how multi-organization collaborations can be improved to better serve community members. The participants included Maxine Golub, Senior Vice President, Planning and Development at the Institute for Family Health; Stephanie Wang, MD, Assistant Professor, Medicine (General Internal Medicine) and a primary care physician at Mount Sinai Saint Luke’s; Shoshanah Brown, Chief Executive Officer at AIRnyc; and Judy Secon, Senior Director of Programs and Operations at New York Common Pantry. The panel was moderated by Principal Investigator Natalie Privett, PhD, Assistant Professor, Global Health, Medicine (General Internal Medicine).

Panelists highlighted that building relationships and having candid conversations with people from other organizations is a critical initial step. Ms. Golub emphasized the importance of making a long-term commitment to working in a community to truly effect change. Participants felt strongly that as the work progresses, it is vital to incorporate members of the community into the process. An important aspect of this will be looking at how care can be better coordinated across health care systems and community-based organizations.

Laurie Zephyrin, MD, MPH, MBA, left, Vice President, Delivery System Reform, the Commonwealth Fund, and Rachel Vreeman, MD, MS, Interim Director of the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, Vice Chair of Research for the Department of Health System Design and Global Health, and Director of the Global Sites Network. Photo credit: Andrea Archer

In 2018, the Institute received support from the Commonwealth Fund to develop and implement a participatory process to bring together community health stakeholders to identify and brainstorm how to collectively improve a community health issue in Central Harlem. The Institute facilitated several workshops that included leaders from Central Harlem-based community organizations and health systems.

Stakeholders included AIRnyc, New York Common Pantry, City Health Works, the Institute for Family Health, Mount Sinai St. Luke’s, and the Mount Sinai Performing Provider System (MSPPS), a population-health focused, integrated delivery system in Manhattan, Brooklyn, and Queens. Through design and facilitation techniques, stakeholders identified potential challenges, opportunities, and shared value. Stakeholders began strategizing about potential implementation steps.

Lessons from the initiative workshops were captured and generalized in a guide that is now available for implementers to support community health transformation efforts.

The guide is designed for anyone who wants to improve community health through collaboration across health systems and community-based organizations. It will help people build meaningful partnerships, achieve consensus, and scope out a strategy for community health issues. It is meant to be instructive in thoughtfully convening community-based organizations and health care systems to work towards a collaborative goal while building trust. The guide offers exercises, instructions, and tips to help others create a successful collaboration. It is rooted in the Institute’s experiences developing the collaboration and incorporates lessons learned from leading the collaborative. It was developed with support from the Commonwealth Fund.

Experts agree it is clear that systematic change is needed to improve collaboration. It is complicated and will require dedicated involvement from community organizations, health systems, health information technology experts, policy makers, and payers.

As Arthur Gianelli, President of Mount Sinai Saint Luke’s, noted, “The only way to make change is to change policy at the top and piece-by-piece make improvements at the bottom. We look forward to deepening collaborations across health systems and community organizations.”