A common saying in emergency medicine is that we are an extension of our surrounding community. Its members come to us out of necessity, often at their worst, as a last resort, and as the only option in some cases.
EPs strive to meet all patients where they are and deliver optimal care despite the circumstances; this mutual relationship makes the emergency department a community health resource. The hidden demand in this relationship is that it extends beyond the doors of the ED and far beyond the ambulance bays. A health equity position requires understanding, prioritizing and building up the members of our community.
Community engagement has traditionally been seen as a separate mission from the emergency, often owned by the parent medical system or through the discrete actions of individual providers (often with active searches, initiatives, or pre-existing community connections). A high degree of overlap is present with diversity, equity, justice and inclusion, and the ideals almost emphasize community buy-in and participation. Suffice it to say that the relationship between community engagement and DEI is more partial than silo versus silo.
EPs and department heads must recognize community engagement as an integral part of the DEI spectrum as we strengthen our specialty-wide commitment to DEI. Without this, DEI initiatives and the results of the DEI strategy will not be sustainable. Here are some ways to illustrate the value that community engagement improves the quality of our emergency services:
Overview and Membership: The modern emergency department has evolved from a single-function entity to a multi-use health care access point. Departmental leaders have assumed this role for the most part. However, EPs have a poor idea of how the communities they serve perceive their department; this affects the delivery of care and can lead to negative health outcomes.
Attempts to understand these dynamics often involve deep dives into Press Ganey scores and analysis of trends in emergency service use. These methods are inaccurate because selection bias (in Press Ganey) and a myriad of confounding factors (in usage) significantly distort the picture. Direct engagement with community members is essential for real insight, and recognizing community members as stakeholders builds trust and lays the foundation for restorative justice.
In practice, this could mean forming a community advisory board, inviting community members to participate in monthly work-in-progress or operations meetings, forging strategic partnerships with local organizations, and involving departmental representatives in board meetings. local council.
Recruitment and retention: Departments that elevate community-engaged projects or champion them through funding and sponsorships are more likely to recruit and retain diverse EPs, a commonly cited challenge in DEI conversations. At the basic level, it is about understanding the hidden parameters of distance traveled and social responsibility, facets honored by committed work in the community.
PEs from historically marginalized backgrounds place considerable value on engaged work in the community, as it is often integrated into their medical journey and amplifies the purpose of practicing medicine. Giving back to a community is also an unspoken responsibility or part of a social contract for many diverse applicants. The decision to integrate a group or an institution is multifactorial, but various perspectives pay particular attention to the departmental culture. In fact, it can be as serious as compensation packages, growth opportunities, and clinical workload. Thriving community programs and projects are an indirect measure of departmental culture and can inform perception and final decisions.
Improved data collection: Precision medicine is the latest supernova in emergency medicine. However, equity blind spots exist in the precision medicine method, especially in data collection. The identification of these blind spots depends on the contributions, that is to say the collection of broad perspectives and experiences, particularly within the department. But when community engagement is harnessed appropriately, the nuances of the end-to-end patient experience emerge along with the range of identities tied to those experiences.
Any previously obscured issues in the delivery of care can be openly addressed and refined. This approach forces transparency (i.e. EDs share the quality improvement process with patients), highlights inclusiveness (i.e. recognizes patients as stakeholders in the ED care ecosystem) and results in improved tools, actions and policies influenced by better data. The short-term victory for community engagement is in stronger, more accurate data sets, but over time, this translates into better health outcomes for neglected populations.
Medical centers have survived on the false narrative that being the direct health resource for a surrounding community makes them part of the community. In reality, many care centers are no more part of the community than other businesses that exist in the space and extract resources without giving back directly to its members. A true commitment to the principles of diversity, equity, inclusion and justice requires community engagement and investment. PEs need to think deeply about this dynamic and challenge our departments to hold the communities we serve accountable.
Dr. Brownis an emergency physician and assistant professor of social emergency medicine at Stanford Hospital. He is also the Impact Director of TRAP Medicine, a barbershop-based wellness initiative that leverages the cultural capital of barbershops to address the physical and emotional health of Black men and boys. . He has also worked with ABC News’ medical unit and contributed articles on health equity and wellness. The New York Times, USA Today, GQ, and The root. Follow him on Twitter@gr8vision. Read his past articles onhttps://bit.ly/DiversityMatters-EMN.