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Unless a hospital works to meet the needs of all its communities, it will be irrelevant, says the former chair of Women’s College Hospital (WCH), Michele Landsberg, “No public institution can thrive unless it attracts and helps every part of the population.”
A world leader in women’s healthcare, WCH had to create an entirely new infrastructure, purpose and mission when it de-amalgamated from Sunnybrook Health Sciences Centre in 2006. The board of WCH wanted diversity and equity to be built right into the DNA of the new organization. WCH calls its “commitment to optimal health outcomes for diverse women and their families” its Equity Vision – “While ‘diversity’ is a celebration of all that we are, ‘equity’ is our call to action,” explains former Equity Champion Hazelle Palmer. The Equity Vision incorporates the principles of human rights, anti-racism and anti-oppression, and applies to the entire hospital organization, including patients and staff. And it explicitly mandates the resources necessary to achieve its goals.
Enlarging the board and targeted recruitment led to increased diversity: now thirty percent of board members are ethnic and racial minorities. Community Advisory Panels, reporting directly to the board and including board members, allow the hospital to share ideas, exchange views and collaborate with its broader communities.
According to CEO Marilyn Emery, “Equity is not something we just talk about, it’s something we try to live every day.”
Although women now make up more than a third of the physician workforce and more than half of first-year medical students in Canada, when Women’s College Hospital and Dispensary was established in 1913, women’s access to training and to the profession of medicine was still severely limited.
From the time its first seven-bed facility opened, focusing on women’s health and their special health-care needs, the hospital with its all-female medical staff gave women the opportunity to practice medicine. Relocating to a larger facility two years later, the hospital eventually had x-ray and pathology departments, as well as a women’s venereal diseases clinic. In 1935, the hospital moved again, this time to a modern building near the University of Toronto. It soon became a leader in women’s healthcare.
Women’s College Hospital (WCH) became a fully accredited teaching hospital in 1961. In the same year it changed its all-female doctor policy: if qualified women couldn’t be found, it now allowed men to be appointed to the medical staff.
WCH was amalgamated with Sunnybrook Health Sciences Centre and the Orthopaedic and Arthritic Hospital in 1998, but in 2006 regained independent governance. It is Ontario’s only hospital focusing primarily on women’s health, and the province’s first and only independent ambulatory care hospital. In the fall of 2010, construction began on a new hospital. To be completed in 2016, the 630,000-square-foot building will be home to WCH’s ambulatory care facilities, specialized clinics and surgical suites as well as its prevention, disease management, treatment, research and education programs.
“Right from the beginning we were committed”
When Women’s College Hospital (WCH) was de-amalgamated from Sunnybrook Health Sciences Centre in 2006, its independent governance was restored. “We were trying to create an entire infrastructure from scratch,” recalls Michele Landsberg. The acclaimed journalist and feminist chaired the board during that time of upheaval, and continues to serve as a member today. To build diversity into the new organization, the board took a two-pronged approach: “Change ourselves; enact policy to change the organization.”
“It was a tumultuous time, so there were big challenges,” says Landsberg. “We had to define our whole purpose and mission as well as incorporate the equity and diversity mission.”
“Everything seems to take precedence over diversity unless you’re deeply committed and you keep dragging it to the forefront,” she explains. “Some members who didn’t see the relevance of diversity or felt that it was much more important to get rich people moved on. We weren’t looking for wealth and influence primarily. Because we were starting up a new hospital with a dedicated purpose, we were able to look for people with a deep understanding and commitment to the mission of the hospital and to women’s health, and an understanding of the need for diversity in such an institution.”
“Our board is quite different from many hospital boards,” Landsberg says, laughing. Currently only one board member is male. “Women’s College focuses on women’s healthcare – it’s only right that women be running the show!” But the board felt it didn’t have enough diversity. Adding to its numbers and a targeted recruitment strategy helped change that, and now thirty percent of members are self-identified as ethnic and racial minorities.
While it wasn’t always easy, WCH had an Equity Champion in board member Hazelle Palmer. Palmer worked with other members, senior WCH management, staff, and community representatives to craft the Equity Vision. Adopted in 2007, the plan is Women’s College Hospital’s “commitment to optimal health outcomes for diverse women and their families through community-informed, inclusive and responsive services.”
The Equity Vision details the organization’s commitment to extend the principles and benefits of equity to the entire hospital organization. It is also a commitment to equity in how patients and staff are treated. “I believe [it] is among the most forward-looking models anywhere in the healthcare world,” says Landsberg.
It is important to note that it is “an Equity Vision, not a Diversity Vision,” says Palmer. “While ‘diversity’ is a celebration of all that we are, ‘equity’ is our call to action.” Equity is a guiding principle in hiring, policy development, and advocacy, and the plan’s policies and practices incorporate the values of human rights, anti-racism and anti-oppression. Current champion Marcia Gilbert also heads the WCH Board Equity Committee, which comprises board members and staff, and provides a forum to support, discuss, monitor and evaluate its implementation.
“There’s always a tremendous tension between economics and idealism,” says Landsberg. “Many have thought, ‘We can’t spend any money on that – we need money for a new machine, or a new medically-required thing.’ And that’s legitimate! But I insisted that in the Equity Vision there’s a phrase, ‘with the necessary resources.’ I said, ‘It won’t happen unless we’re committed on paper to spending money on it.’ WCH’s new CEO and president Marilyn Emery “completely understood the Equity Vision and shared our commitment to it, and she has led the way.”
WCH’s patients reflect the GTA’s diverse communities, and so do its physicians, staff and volunteers. All managers, staff, doctors and volunteers – including the board – are expected to be culturally competent. Board education is ongoing, and it has helped to develop a culture that appreciates the intrinsic value of diverse expertise and insight.
Not all new board members have had previous board experience at the hospital or corporate level, so all new members take part in a full day of orientation that includes equity training, learning what will be required of them as governors of a large health-care institution.
To further ensure that services at the hospital are responsive to and inclusive of diverse women and are community-informed, WCH established two Community Advisory Panels (CAPs) – one for women’s health, with members from front-line women’s agencies, and one for active and independent living, with staff and patients from the hospital’s chronic disease management programs. The CAPs provide a framework for the hospital and its communities to exchange views on key health needs, and to collaborate to achieve the most responsive health care for women and their families. Both CAPs report directly to the board and include board members as well as members of diverse communities and agencies, hospital staff and volunteers.
“Equity is not something we just talk about, it’s something we try to live every day. The challenge is to communicate it,” says Emery. Posters featuring representatives of groups – patients, staff, hospital partners and volunteers – now appear throughout the hospital. “The posters begin in a stakeholder’s first language, if it isn’t English, because that’s an important part of equity.” http://www.womenscollegehospital.ca/news/wch-equity-vision.html
Women’s College Hospital has always been a world leader in the development of health programs designed specifically for women, whose healthcare needs are often different from that of men. WCH recognizes the systemic inequalities and barriers that some women face, and continues to advocate for equal health opportunities for all women. Today’s diverse board recognizes that equitable access to health care is just good public policy.
Diversity is “an essential of life in the 21st century,” says Landsberg. “No public institution at this time in our history can thrive unless it attracts and helps every part of the population. Unless we strive to meet the needs of all these communities, we’ll be irrelevant.”
The Community Advisory Panel (CAP) is an innovative way for an organization to build partnerships with its diverse community, and a direct way for the board to hear the concerns of vulnerable or marginalized groups.
Using St. Michael’s Hospital’s CAPs as her model, board chair Michele Landsberg established two CAPs at Women’s College Hospital – one with staff and patients from the hospital’s chronic disease management programs, and one for women’s health, with members from front-line women’s agencies, which she chaired for its first two years. Both CAPs include hospital staff, volunteers, and board members, and a range of health care consumers, patients, and community agency representatives. They provide the framework for these communities and the hospital to share ideas, experience, and expertise, and to collaborate to achieve the most responsive health care possible.
CAPs are “such a rich source of information and guidance for the hospital,” explains Landsberg. They allow WCH to “understand the barriers people in our community face in accessing healthcare services, including language, culture, physical disability and psychological health issues.”And since they report directly to the board and each includes a board member, CAPs “ensure the public’s voice is heard in the board’s deliberations.” She adds, “They are very racially and culturally diverse – a very strong basis to understand better what the public needs and wants.” CAPs also bring up issues that the hospital may otherwise miss. The task force now studying the plight of the people who are in Ontario illegally and have no medical help or the newly-arrived uninsured, for example, “bubbled up from the very grassroots,” says Landsberg. The evidence provided by the women’s CAP “was very enlightening for our hospital,” and WCH is now among the leading hospitals working together with the Ontario Government to come up with solutions.
Our commitment to optimal health outcomes for diverse women and their families through community informed, inclusive and responsive services.
Through its equity vision, WCH commits to
All volunteers, managers, staff and doctors are culturally competent and sensitive.