PROJECT MANAGEMENT PLAN – Development of an Institutional Strategy for Disparities of Care and an Institutional Curriculum in Disparities
Vision StatementBassett Medical Center will have a strategy for understanding the healthcare needs of the population it serves. This strategy will include partnerships with external health and wellness organizations and a plan for education in disparities.
Team ObjectivesOur first CLER visit demonstrated that we had no overall strategy for assessing our populations and no educational program within GME to expose residents to the diversity within our population. The overall objective of the project was to remedy these gaps. Our assumptions differ from those of many of our colleagues. Rural New York state (and rural America outside the South) does not have the racial diversity of the rest of the country. Our disparities lie principally in the socioeconomic and geographic realm. Significant cultural subgroups within our population access healthcare (or not) in different ways. To better understand this dynamic, we invited people from a wide array of populations and healthcare perspectives to serve on the steering committee for this project.
Success FactorsThe most successful part of our work was the collaboration among all of the individual groups (clinical, administrative, research, and education) working on various aspects of our diverse population. Several efficiencies resulted from this cooperative effort, and duplication of effort (which is a common occurrence here ordinarily) was minimized. We organized a multidisciplinary workshop/dinner with a focus on disparities in healthcare (elder care, chronic opioid users, and the transpopulation were the topics of this first workshop) in November 2016. Seventy-five individuals participated, with the majority of the internal medicine residents among them. We were inspired by the enthusiasm of all the stakeholders on the steering committee and the energy brought to the curricular offerings by the entire community and by the internal medicine residents.
BarriersThe largest barrier encountered was competing demands in the residency program. Developing a draft strategy for disparities at the institution and developing a cultural competency/disparities curriculum for the institution were easier than developing an integrated, robust curriculum for the residents. We worked to overcome this challenge by creating elective blocks in the internal medicine residency program so residents could choose an experience in one of several community efforts to bridge one or more gaps in healthcare delivery. Residents are participating in brief block experiences at the Oneonta Free Clinic and the Gender Wellness Center. Experiences are being developed at the New York Center for Agricultural Medicine and Health, Pathfinder Village (a residential facility for people with Down syndrome), and Springbrook (a facility for developmentally disabled people). An experience at the school-based health centers is also being considered.
Lessons LearnedThe single most important piece of advice to provide another team embarking on a similar initiative is to be inclusive and cast a broad net for the steering committee and then assign smaller groups to get specific tasks completed. We could have, should have, and will do more of that going forward. This is a project that has only begun with NI V.