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On the Path to Equity: The Partnership to Advance Tribal Health

Health care delivery systems in the United States, like many other institutions, have not yet realized equitable outcomes — or even equity — in the processes of delivery or payment of care, but for my entire career I’ve witnessed valiant efforts to those ends. Over the past three years, Comagine Health (as HealthInsight) has been the lead organization for a contract with the Centers for Medicare & Medicaid Services (CMS) to engage with the Indian Health Service (IHS) to improve health and health care for American Indian and Alaska Native people. The Partnership to Advance Tribal Health (PATH) has been engaged with 24 CMS certified and IHS administered hospitals across seven states. We have incredible partners in three Quality Innovation Networks (Mountain-Pacific Quality Health, Stratis Health, and Great Plains Quality Innovation Network) and with the Oklahoma Foundation for Medical Quality.

I am absolutely certain that every single member of the PATH team, those employed by Comagine Health and those from our partner organizations, hold dearly close the goals of decreased health disparities and increased health equity. I wish I could tell you I’ve learned the secrets to making this happen, but I haven’t. However, I have picked up a couple of strategies along the journey.

When I first worked on the Navajo Nation, it was with all the eagerness and fresh optimism characteristic of a young idealist. I had a new, complicated uniform of a Public Health Service officer and shoes that I shined with military precision. I was fresh out of graduate school with requisite hospital and public health nursing experience to provide a foundation for the challenges awaiting me.

One of my first referrals was an elderly woman who had fallen at home and declined a visit to the hospital. When I went to see her, she was herding her sheep and goats. She wore a long skirt and purple velvet shirt clasped at the neck with a large turquoise and silver squash blossom brooch. Her silver bracelets and bold-colored headscarf completed the complex uniform of a grandmother. Her granddaughter translated that I was there to see her and why. She asked me to first help her corral her sheep and goats. Responding to her request as well as to something innate from time helping my own grandmother on her farm, I obliged. Twenty minutes later I reported back to her with muddy shoes and clothes and the unpleasant smell of sheep lanolin all over me. Through her granddaughter’s translation, amused at the quick transformation from public health officer to shepherd, she then informed me that I was welcome to come back sometime in the future to check her out, but she was fine today since she had gotten help. This began my practical education about listening and partnering with people to address their health care needs. Lesson one: Keep showing up.

The PATH team’s experience with the Indian Health Service and those served by this agency is broad. Some get care at IHS, some have worked for IHS, lots have some other link or experience, and some have no direct experience. This team’s professional experience is broad, too: they bring a variety of clinical, leadership and quality improvement skills to the work. However, all the formal education, credentials, training and experience will not make anyone an expert on the lives, communities or even health care needs and context of others. The expertise gained through professional endeavors is only applicable to a willing partnership with the end users of health care. To understand the plight of others, one has to set their own knowledge aside long enough to listen with a sincere intention of hearing and not responding. The PATH team is very skilled at this crucial task. Lesson two: Humbly listen.

To keep showing up and humbly listening are strategies that foster successful partnership of the highly skilled PATH team and the institutions and people we serve. Simple bits of wisdom do impact inequity.

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