Shift Launches the Healthcare Accountability Learning and Action Network

Co-written by Hena Dhir, Randall Lewis Health Policy Fellow, Sonia Sarkar and Artair Rogers, Shift Health Accelerator co-leads for the Learning and Action Network

Through centering community expertise, the Shift Healthcare Accountability Learning Network aims to create an action-learning space for anti-racism, truth/reconciliation, and political education. The Network is convening healthcare institutions -- including health systems, payors and healthcare technology companies -- that have committed to design and implement health investment, data, and governance initiatives that reflect concrete shifts in power from healthcare to communities, as well as develop a framework for healthcare accountability to community.

The Learning Network experience consists of two phases. The first phase, from the months of September 2022 to December 2022 have been dedicated to learning sessions and action planning. Phase 2 will consist of an action implementation phase from January 2023 to Summer 2023, in which institutions will engage in a community-led initiative and explore recommendations for the sector stemming from their learnings.

    The October session was explicitly focused on institutional assessments, with the goal of understanding individual reflections on positionality and how these concepts can be linked to the deny, distance, distort, and delay framework within the institutions. These narratives were examined based on guest speakers' experiences with governance, data, technology, capital deployment, and the extent to which communities are involved in decision making.

      One pressing issue identified was the need to transition from predatory-designed healthcare institutional systems to ally-designed institutional systems, and eventually to equity empowered institutional systems, in order to redefine community engagement and ownership.  One barrier to this trajectory is the use of deny, distance, delay, and distort narratives that are utilized by institutions, even when those institutions have made verbal commitments to combating structural inequities. 

 Guest speakers in the session reflected on their individual positionality within healthcare settings, and how they ensured that their interests did not take precedence over those of the community.

      Understanding how healthcare systems have been structured historically, was identified as a key factor in reflecting individual positionality. “The healthcare system is not focused on people, it is centered on providers”-  Dr. Pedja Stojicic, Faculty at Harvard T.H. Chan School of Public health shared. Structural racism is a driver in understanding how population health interventions affect different segments of the society. Current institutional power dynamics do not allow communities to play an active role in data narratives. Institutions should take a proactive approach to address the power imbalance between those in power and the most affected communities in order to amplify community voices.  Courtnee Hamity, Senior Evaluation and Data Strategy Officer, Blue Shield Of California Foundation shared “Systems that determine what is valid and what is not valid, at times may not holistically reflect communities”.

    The group discussed potential areas for shifts in healthcare accountability, including: ensuring shared power by carefully analyzing community needs, creating a space to engage community members, and ultimately bridging the gap between what communities want vs what institutions offer. 

    An intriguing aspect that surfaced during the conversation, was the component of the fifth D, namely distraction, in the deny, distance, delay and distort framework. Participants shared that  community needs are seldom prioritized over other issues that are viewed as more time-sensitive. As a result, incorporation of community voices within advisory boards was identified as a critical factor to understand community needs, address them amicably, and further advance the shared-leadership model.

     This session built on a kickoff session of the Learning Network in September, in which participants reflected on their interest in exploring concepts of healthcare accountability. The themes and takeaways from that session are seen here.

The November session evaluated the potential shifts in institutional governance, data technology, and investment in depth. The December and January sessions will concentrate on more defined and focused group work in the governance, data, and investment sectors.