Advancing Heath Equity With Data: Collaborating With Stakeholders at Mount Sinai Queens

Jill Goldstein, MA, MS, RN

At Mount Sinai, a key pillar in advancing health equity focuses on the collection and use of self-reported patient demographic data to identify gaps in care. The Health Equity Data Assessment (HEDA) team is engaging key stakeholders across the Health System and collaborating to address variances.

A highlight of these efforts is the Mount Sinai Queens Nurses Against Racism (NAR) system council, which endeavored to evaluate incidences of hospital-acquired pressure injuries (HAPI) using an equity lens.

A pressure injury is a localized injury to the skin and/or underlying tissue, resulting from compression between a bony prominence and an external surface for a prolonged time. Monitoring HAPI specifically focuses on the occurrence of these injuries during an inpatient hospital stay.

According to Jill Goldstein, MA, MS, RN, Deputy Chief Nursing Officer, Vice President of Nursing at Mount Sinai Queens, and NAR sponsor, their collaboration with HEDA began in January 2023, combining subject matter expertise and data modeling to evaluate differences in HAPI rates across patient populations. She  noted that the interdisciplinary team explored the impact of race, gender, age, language, payor, length of stay, clinical service, and other factors on the incidences of hospital-acquired pressure injuries.

Further, the data showed that in terms of race, there were no meaningful differences observed between white, Black, or Hispanic patients in any model.

Notably, the most actionable finding was the elevated risk for patients who prefer to speak a language other than English or Spanish. In these patients, 40 percent were more likely to have documented HAPI when compared to English-speaking patients.

With the data the HEDA team helped to collect and interpret, the system-wide nursing team will seek interventions to eliminate this disparity. This interdisciplinary approach serves as a model to incorporate an equity lens into other quality work, according to Ms. Goldstein.

Mount Sinai’s Million Dollar Circle Recognition Honors Underrepresented Vendors

From left: Tiffany Oloke, Sourcing Lead II–Value Analysis; Patrice Gordon-Poyser, Supplier Diversity Manager; Carlos Maceda, Chief Supply Chain Officer; and Lynn Oxner, Director, Supply Chain, at the Million Dollar Circle Recognition event on February 9

Mount Sinai recently held its inaugural Million Dollar Circle Recognition event—celebrating 28 underrepresented vendors that each provided more than $1 million in products and services to the Health System in 2022 and 2023. More than $70 million was spent with the Million Dollar Circle vendors in each of those years.

“Supplier diversity is embedded in the culture, even the DNA of Mount Sinai,” Edward Robinson, Senior Vice President and Chief Resource Officer, Mount Sinai Health System, said at the event, which was held on February 9 at Mount Sinai’s Corporate Services Center. “This is our mission, to advance health equity and socioeconomics in the communities we serve.”

The event, attended by vendors and Mount Sinai staff and leadership, was moderated by Patrice Gordon-Poyser, Supplier Diversity Manager, Mount Sinai Health System. Leaders from three of the vendor honorees participated in the Million Dollar Journey panel. They discussed the services they provided to Mount Sinai, the effect of their long-standing business relationship on the growth of their companies, and ways in which they have been giving back to communities through charitable initiatives.

One of these vendors, a technology procurement fulfillment company that is Asian-American owned, was tasked with procuring iPads for patients, which allowed them to communicate with their loved ones while they were isolated during the COVID-19 pandemic.

“Getting there, not just from the technological perspective, but from one of procurement, putting it together, and delivering it, was one of the areas that I feel really stood out during our relationship with Mount Sinai,” said the vendor’s chief technology officer.

Another vendor on the panel, a veteran-owned staffing business, provided 50 crisis nurses for the Health System during the pandemic. “We all came together, Mount Sinai, our company, everybody here,” said the company’s chief executive officer. “It was an amazing New York moment, and something we are very proud of.”

The third vendor, a woman-owned office supply business, worked with Mount Sinai’s architectural design team to redesign Health System spaces that support employee well-being, including ergonomic chairs for nursing staff. As a health care provider, Mount Sinai posed unique challenges that helped the business evolve.

“Our client is not just Mount Sinai, our client is also the patient,” said the company’s director of marketing and workplaces strategy during the panel. “It really prompted us to develop a whole new health care department. Our staff all have more training and understanding in health care specifically.”

Carlos Maceda, Chief Supply Chain Officer, Mount Sinai Health System, commended the vendors for reaching the $1 million milestone. “I ask you to never forget where you came from, and to never forget your roots to be able to always help someone,” said Mr. Maceda.

Pamela Abner, Senior Vice President, Health Equity Officer, and Chief Diversity Operations Officer, Mount Sinai Health System, said that community vendors provide solutions through innovation and creativity in ways that would have been challenging for larger companies. She also noted how Mount Sinai’s relationship with local vendors helps New York City.

“By building community wealth, we build community health,” she explained.

To learn more about Mount Sinai’s commitment to supplier diversity, please visit Supplier Diversity or email supplierdiversity@mountsinai.org.

New Opera on a Gender-Affirmation Pioneer Is Authored by Mount Sinai Neuroradiologist

A new opera, Lili Elbe, tells the story of one of the earliest recipients of gender-affirming surgery in 1930. The opera is a collaboration of Grammy Award-winning composer Tobias Picker and Aryeh Lev Stollman, MD, a neuroradiologist at Mount Sinai, who wrote the story and lyrics. Photos: Edyta Dufaj

“It’s a love story,” says Aryeh Lev Stollman, MD, a neuroradiologist at Mount Sinai, and the librettist for a new opera, Lili Elbe, which tells the story of one of the earliest recipients of gender-affirming surgery, in 1930. The opera, commissioned by the Theater St. Gallen of Switzerland, was named “Best World Premiere of 2023” at the OPER! AWARDS ceremony on January 29 at the Dutch National Opera in Amsterdam.

Lili Elbe focuses on a successful Danish painter who was married to another painter, Gerda Wegener. Though their marriage was eventually annulled by the King of Denmark and Lili’s name and sex were legally changed, they remained in love with each other. Lili’s case drew international attention, and a semi-autographical account of her story was captured in a book, Man Into Woman: An Authentic Record of a Change of Sex. Another book, The Danish Girl, was loosely based on her story and has become an important text in LGBQT+ literature and the basis for a film.

“We based our story on historical sources,” emphasizes Dr. Stollman. “The Danish Girl was highly fictionalized. But Lili Elbe was quite famous in her day, so we relied on her own writings and news accounts from the time.”

The opera Lili Elbe, in addition to being acclaimed for its artistry, is a significant milestone. It stars Lucia Lucas, a baritone, in the first grand opera for and about a person with trans experience. The Grammy Award-winning composer Tobias Picker, who is married to Dr. Stollman, befriended Lucia when he cast her in Don Giovanni in a Tulsa Opera production—the first time a transgender singer had played the leading role in an American opera. Mr. Picker, Dr. Stollman, and Lucia wanted to collaborate on an original project, and the story of Lili Elbe was chosen.

Tobias Picker, left, and Aryeh Lev Stollman, MD, taking a bow after a performance of the new opera at the Theater Saint Gallen in Switzerland. “This resonates with our work as physicians, health care workers, and support staff, because behind our work is love for humanity,” says Dr. Stollman. “We serve people, no matter their physical appearance, their background, or gender identity. And we do it through all types of difficult times and situations.”

“Tobias asked me to write the libretto—or the story and lyrics,” Dr. Stollman says. “But I worked very closely with Lucia as the dramaturg, to gain the insight of her experience and authenticity.” This is the second time Mr. Picker and Dr. Stollman have collaborated. The first was the inspiring opera Awakenings, based on the story of Oliver Sacks, MD, and his efforts to treat patients with sleeping sickness. That opera opened in June 2022 at the Opera Theatre of Saint Louis.

“Like Awakenings, we wanted Lili Elbe to have a mythic undercurrent,” Dr. Stollman says. “In Awakenings, we used the story of Sleeping Beauty. In Lili Elbe, the myth of Orpheus leading his lover, Eurydice, out of the underworld is a motif that reoccurs. I believe that myths have a strong emotional truth. In the myth, Orpheus is saying, ‘Don’t look back, you cannot return to your old life, but you are coming into a new life.’ And our characters are always moving to the future, to a new life, a new realization. And that’s the mythological underpinning.”

Lili Elbe discovers her true nature as a woman when her wife, Gerda, asks her to stand in for a female model who was delayed for a painting session. Gerda is entranced with the beauty of her husband, then called Einar Wegener, and it is she who bestows the name Lili. And as Lili embraces her identity, she says, “When you paint me now, I feel I have always been her.” Lili becomes a muse to Gerda, whose paintings of Lili win acclaim. But Gerda wrestles with how much space to allow Lili in their marriage. At first, she insists that Lili transition back to Einar in the evening. But as Lili makes her true identity known among their circle of friends, Lili wants to experience all the feelings of womanhood, including marriage and motherhood. And even though their marriage is annulled and they become involved with other lovers, their love for each other endures.

Lili becomes engaged to Claude LeJeune, a young man whose passion is creating perfumes from flowers through a delicate process called enfleurage. The symbolism of the flowers living on becomes a motif as Lili dies as a result of complications of one of her surgeries. And the life and story of Lili Elbe still resonate today.

“The opera is more than about love with a transgender person,” Dr. Stollman says. “It’s about love and transcending difficulties. It’s about a tragic heroine’s journey that starts with self-knowledge. And it’s about loss, because Gerda loses Lili. But also because Lili dies in the end, as many tragic heroines do.”

The staging and choreography of the opera are innovative, witty, and symbolic. As Gerda exhibits her paintings of Lili, they are symbolized by actors suspended above the stage, swirling in evocative poses. The prominent German newspaper Die Welt gave it an enthusiastic review, calling it “emotionally gripping, a delicate work of musical theater that unfolds as an Art Nouveau arc, amidst a bright, symbolist stage.” A leading Austrian paper, the Voralberger Zeitung, called it “an emotionally charged masterpiece.”

Dr. Stollman related the theme of love transcending all to the mission of Mount Sinai, which was founded to care for underserved people and is home to the Center for Transgender Medicine and Surgery, a world leader in gender-affirming care. “This resonates with our work as physicians, health care workers, and support staff, because behind our work is love for humanity. We serve people, no matter their physical appearance, their background, or gender identity. And we do it through all types of difficult times and situations.”

Preparing Physicians to Treat the LGBTQI+ Community With Dignity as It Ages

Noelle Marie Javier, MD, left, with Roy Noy, MD, during Dr. Noy’s four-month observership at Mount Sinai to learn more about LGBTQI+ medicine and geriatrics.

The field of LGBTQ+ medicine has slowly been developing over the past decade, but a crucial intersection with a subspecialty has often been overlooked—geriatric medicine.

Throughout history, LGBTQI+ medicine has been underdeveloped and under-prioritized for several reasons, among them being that few people were historically willing to disclose and seek care as LGBTQI+ individuals, and that many members in the community lost their lives to the HIV/AIDS epidemic during the 1980s.

“There have been gaps in training at medical schools, residency, and fellowship training programs from the past until now,” says Noelle Marie Javier, MD, Associate Professor of Geriatrics and Palliative Medicine, and Medical Education, at the Icahn School of Medicine at Mount Sinai.

Across the majority of MD programs throughout the country, the average time devoted to training in LGBTQI+ medicine is about five hours in total across the four-year program, as cited in a 2011 JAMA paper. “That’s simply not enough,” says Dr. Javier.

These days, with increasing acceptance and awareness of diverse sexual orientations and gender identities in society, and modern advances in medicine, LGBTQI+ people are growing older and living longer—some with unique health concerns and disparities. These could include how older adults living with HIV are aging, or long-term effects of having received marginalized care or faced barriers to care. “Now, more than ever, we need to be prepared as physicians and allied health professionals to take care of them in a way that’s culturally humble, sensitive, and responsive,” Dr. Javier says.

The Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai is committed to providing inclusive and affirming care for older LGBTQI+ adults, which includes training and education for staff, students and trainees. Inspired by this work, the leadership at the Tel Aviv Sourasky Medical Center (Ichilov) reached out to the Mount Sinai LGBTQ+ Medicine Fellowship program to arrange a pilot program where a resident in geriatrics could gain knowledge and training through an observership for the care for older LGBTQI+ adults. During the fall of 2023, Roy Noy, MD, chief geriatrics resident at Ichilov, collaborated with Dr. Javier in expanding his geriatrics skills and developing a curriculum that he could use to train staff back in Tel Aviv.

Read more about Dr. Noy’s observership at Mount Sinai and the importance of focusing on geriatric LGBTQI+ medicine.

Dr. Noy is helping the Tel Aviv Sourasky Medical Center (Ichilov) set up an LGBTQI+ clinic for older adults. He spent four months at Mount Sinai observing various models of care in geriatrics and LGBTQI+ medicine.

How did this program come about?

Dr. Noy: We are trying to establish an LGBTQI+ service for older adults in our hospital at Tel Aviv. The head of the program, Roy Zucker, MD, was the inaugural fellow at the Mount Sinai LGBTQ+ Medicine Fellowship. He came up with the idea of trying to establish an observership for me to learn more from Mount Sinai about what is needed to start such a specialized service.

Dr. Javier: I was invited to be a plenary speaker at GLMA: Health Professionals Advancing LGBTQI+ Equality last year when Dr. Zucker and I first got acquainted. He wanted to set up a collaboration for one of his residents in the hopes of expanding his medical knowledge and clinical skills to take care of older LGBTQI+ adults.

What went into this observership?

Dr. Noy: The program had several parts to it.

  • On the broader geriatrics side, I did a lot of observing with different doctors and other team members working in the Brookdale Department Geriatrics and Palliative Medicine, and I joined them on their daily rounds. I also got to join the departmental educational programs.
  • For the LGBTQI+ medicine side, I observed Antonio Urbina, MD, Medical Director of Mount Sinai’s Institute for Advanced Medicine, in the HIV clinic. I got to train in Mount Sinai’s Center for Transgender Medicine and Surgery with Joshua Safer, MD, who is Executive Director of the Center. And I also got to shadow Angela Condo, MD, Assistant Professor of Geriatrics and Palliative Medicine, in the geriatrics clinic for people living with HIV.
  • In addition, I was connected with people and organizations who play an important role in LGBTQI+ health, such as SAGE, an advocacy and services group for LGBTQI+ elders, and MJHS Hospice and Palliative Care.
  • On the training side, I was connected to Mount Sinai’s Office for Diversity and Inclusion, to see what they are doing for new and current employees, how they are implenting sexual orientation and gender identity data gathering, and how the Health System connects with the LGBTQI+ community.
  • There was also an academic side where I got to work with Dr. Javier on writing a chapter focused on affirming care, and we have an ongoing project concerning educational training programs.

Dr. Javier: The idea was to expose Dr. Noy to different models of care within the geriatric and palliative medicine landscapes—not just inpatient geriatrics and palliative care, but also neurology and memory care, outpatient clinics, urgent care, and chronic illnesses. By the time we were done with the observership, we had developed several deliverables, including submitting a chapter titled “Affirming Care for LGBTQ+ Patients” to Clinics in Geriatric Medicine that is currently in process for publication, and a scoping review research project titled “A Scoping Review Protocol of Educational Training Programs in Medical and Health-Related Professions Caring for Older LGBTQI+ Adults, November 2023 to Present.”

What were your takeaways?

Dr. Noy: Now that we’re starting our own LGBTQI+ older-adults service here in Tel Aviv, having been at Mount Sinai has helped us figure out what we need to focus on, as well as what are topics unique to us.

One big thing I learned is about communication in the way we address the community. It is important for everyone in the medical field, but it’s especially important in geriatrics because we do need to see the full picture of the person sitting in front of us and understand where they’re coming from. That involves knowing what are things that had been problematic, the history of what had been in the way of them getting treatment, and you can’t do that without good communication.

I also learned that connection with the community is important if we are going to be successful. The way community organizations work with health care in New York, I want us to be able to work as closely knit with them like that too.

Dr. Javier: I like mentoring people who want to be trained in LGBTQI+ medicine and health care. But just as I had helped Dr. Noy with his training, he had helped me too. Prior to this observership, I had several ideas in mind about developing a curriculum, but when Dr. Noy arrived and we started talking about what the program should look like, it helped to create more concrete ideas. I learned a lot from him in terms of what the community is like in Israel and what health services are available to them.

The amazing thing that came from this was: I want this same enriching experience for my fellows here in the department. We have 30-plus fellows in the department and are the largest ACGME-accredited fellowship program in geriatrics and palliative medicine in the country, but creating a LGBTQI+-focused curriculum had been on the back burner for quite some time. There is no formalized curriculum as of yet. This observership catalyzed the need to start working on this curriculum and make it a priority. In some serendipitous way, I got the outcome—a formalized program—before I got the template, and now I’m tracing our steps back of what we did and achieved in this pilot trial.

Why is it important that we focus on training physicians to care for LGBTQI+ older adults now?

Dr. Noy: Similar to the United States, in Israel, older LGBTQ+ people were less likely to identify as such than younger people. And we know that the LGBTQ+ population tend to face more barriers to accessing health care than the general population—this could include avoiding seeking treatment because of previous bad experiences, or even just from stigma.

As they age, the problems could accumulate, and they might end up needing more comprehensive treatment, when they could have preventive treatments earlier. There are general things like cancer, hypertension, or diabetes surveillance that could be done earlier, but there are also conditions more likely within the LGBTQI+ community, such as depression and mental health, that could get ignored.

Then there’s the fact that thanks to advances in medicine, we now have people with HIV living to old ages—even into their 80s and beyond. There’s still so much we don’t know about how they age, such as cognitive decline, frailty, effects of polypharmacy, and more. It’s not just about managing their medication, but also understanding their wellness as a whole. It’s important that we start integrating that training from medical school onwards. And also that we work with the community to show that we do exist—we’re here for everyone in the community.

Dr. Javier: When I was training as a fellow, I was not trained in LGBTQI+ medicine. Even today, that’s still not the case in many institutions. We need to change that and fast. The fellows in my department are knowledgeable enough to be able to take care of the needs of patients and be culturally responsive, but competencies around optimal LGBTQI+ medical care is not a requirement for them to graduate. The integration of LGBTQI+ care should be reflexive in geriatrics and palliative care curriculums across the country.

There continues to be a lot of disparities and inequities in care, especially for older LGBTQI+ adults and people of color. According to the 2015 U.S. Transgender Survey, 40 percent of respondents have attempted suicide in their lifetime. There are many other unique health concerns in the community, and if you did not ask about the sexual orientation and gender identity of a person, you can miss out on the big picture of why they’re seeking care in the first place while being clouded by our own biases and prejudices in helping them.

Read more about how Mount Sinai is empowering health care for LGBTQI+ communities

The Importance of Affirming LGBTQI+ Health

How to Find an LGBTQI+ Experienced Medical Provider and Why That’s Important

Two Employee Resource Groups, Mount Sinai Interfaith and Islamic Community at Mount Sinai, Hold a Silent Vigil

Rowaida Farraj, PharmD, left, and Rabbi Jo Hirschmann, BCC, FACHE

The Mount Sinai Interfaith and the Islamic Community at Mount Sinai employee resource groups gathered to hold space for collective grief and to express their shared humanity, love, respect, and understanding on Wednesday, January 10.

About 90 Mount Sinai employees, students, and trainees joined the virtual vigil held via a Zoom call.

The event, titled “Our Shared Humanity: A Silent Vigil for Mourning,” was led by Rabbi Jo Hirschmann, BCC, FACHE, Senior Director of Education, Center for Spirituality and Health at the Icahn School of Medicine at Mount Sinai, and Rowaida Farraj, PharmD, Executive Director of Pharmacy, Mount Sinai Downtown.

“We spend so much of our lives talking. We wanted to create a quiet space where we could connect with ourselves and each other,” said Rabbi Hirschmann. “Together, we made space for our grief and for the hope and comfort that can come from simply being together. It was very meaningful to do this as Mount Sinai colleagues.”

Dr. Rowaida shared similar sentiments.

“It is clear many people are hurting during this difficult time,” she said. “We all needed a safe space to be together to feel that pain but also feel the presence of our community at Mount Sinai Health System which acknowledges that pain, respects all people, and hopes for a better future. We are so grateful we were able to create this space for everyone.”

GOALS Employee Resource Group Explores Environmental Racism and How It May Appear In a Work Atmosphere

The Growth in Operations, Administration, and Leadership Society (GOALS) employee resource group hosted its quarterly meeting, bringing together about 20 Black men from across the Mount Sinai community to discuss environmental and systematic racism and how it affects the work atmosphere.

The session was held Wednesday, December 6, at the Annenberg Building on the campus of The Mount Sinai Hospital. Anthony Smalls, MBA, Financial Analyst and Program Manager at the Icahn School of Medicine at Mount Sinai, organized the event.

The GOALS employee resource group aims to address issues that can affect change and meets quarterly to discuss various topics and provide networking opportunities for its members. Members have the opportunity to meet with those with experience and longevity at Mount Sinai Health System, which is vital to fostering mentorship.

Christopher W. Bland, MPH, AE-C, was the keynote speaker and led the discussion. He presented at Mount Sinai Health System’s Diversity, Equity, and Inclusion Summit in October 2023 on climate change and environmental racism.

Christopher W. Bland, MPH, AE-C, talks at a meeting of the Growth in Operations, Administration, and Leadership Society (GOALS) employee resource group.

“The word ‘system’ derives from the idea of placing together in an organized and arranged form,” he said.  “Thus, a system isn’t something that occurs but is a well-thought process to achieve a specific outcome. Unfortunately, the communities that house the Black and Latino populations are affected worst by some systems that are in place.”

Mr. Bland discussed the effects of health insurance and health care, food deserts, pollution, and trash pickups in Black and Brown communities.  He said that Mount Sinai has continued to serve the community with the highest form of medical care and fosters community relationships with organizations like One Hundred Black Men Inc.

Still, more work needs to occur to end these systematic cycles, he said, adding a quote from Martin Luther King, Jr.: “Injustice anywhere is a threat to justice everywhere.”

Added Mr. Smalls: “From redlining to income gaps to predatory lending to home loan discrimination to the racial wealth gap, our communities have had so many obstructions in our paths that if they were ever to be removed permanently from our course, we might hit levels that most could not fathom.”

Retention of staff of color is essential to diversity. With GOALS, members get an opportunity see others from our communities at different levels within Mount Sinai. A motto of One Hundred Black Men is “They will be what they see.”

To learn more about the GOALS ERG, email GOALS@mssm.edu or visit the website GOALS (Growth in Operations, Administrations and Leadership Society).

Pin It on Pinterest