In the early 1990s, at the dawn of what we thought would be a golden era of health reform, I worked at a hospital which did a great deal of outreach in diverse urban communities by developing relationships with community health centers and other community based organizations to serve their patients and clients. We developed relationships with clinicians so they could follow their patients in the hospital, something that allowed greater continuity of care -- which is still a goal in managing chronic conditions.
We learned these strategies from the wise leader of a local bank that had enhanced its reputation and its business by opening branches in neighborhoods throughout Boston where it was hard to find an ATM, much less an actual financial institution. The executive we consulted with told us that it was possible to do well in business by doing good. His approach, which we modelled, was to grow our business by serving the entire community, not just pre-approved portions of it.
I was reminded of this recently when I was talking with the chief of medicine at a large public medical school in a very red state. She had invited me to her school to give a talk on how to reach out to lesbian, gay, bisexual, and transgender (LGBT) patients. The state in question was not one in which you would expect to find anyone other than the most committed activists doing outreach to LGBT people. And yet this doctor, who had no personal connection to the LGBT community that I was aware of, had taken the step of not just inviting me to lecture on the topic to her colleagues via Grand Rounds, but of paying me to do so.
I asked her what her motivation was. She told me that she was concerned about feedback the hospital had received from LGBT patients criticizing care they had received. Health care providers were being accused, she said, of letting personal anti-LGBT bias interfere with their ability to provide competent care to LGBT patients. Some of those who were complaining, she added, were prominent members of the LGBT community.
The doctor's response was to do what any good leader would do: listen to the complaints, determine if they had merit, and then take steps to solve the problem. As a clinician, of course, she was engaging in "population health": after identifying the health needs of the community, she had taken action to ensure that young clinicians were well trained to meet those needs.
But she was also acting as a business leader. Her actions will not just benefit the LGBT community with better care. Her place of employment will -- eventually -- see a financial improvement as a result of her actions. In competitive markets -- and today every health care market is a competitive one -- minority communities, including the LGBT community, pay close attention to the word of mouth reputations of hospitals and health care centers. If a receptionist, nurse, doctor, or other clinician engages in behavior that is disrespectful, they have not just alienated that one patient. They have alienated that patient's close friends and families and even, in some cases, that patient's broader social network. As more and more people who were previously left out of the health care system because they did not have insurance are enrolled under the Affordable Care Act -- with LGBT people chief among those -- no health care institution can, quite literally, afford to engage in discriminatory behavior anymore.
As we consider strategies nationwide to expand affirmative health care to all, we should not shy away from making the case that competent care is not just about doing good. It is also about doing good business.