Dr. Michael Kraus: Welcome, everyone, to this episode of Field Notes. I'm Dr. Michael Kraus, the Associate Chief Medical Officer at Fresenius Kidney Care and your host for this discussion today. Here, we interview the experts, physicians, and caregivers who bring experienced compassion and insight into the work we do every day. 

At Fresenius Medical Care, we believe that access to equitable and high quality health care is a fundamental human right. A sign of this key value is our recent commitment to the Zero Health Gaps pledge at the World Economic Forum in Davos, Switzerland. The pledge is part of Fresenius Medical Care's work with the Global Health Equity Network and shows our resolve to achieve clear, actionable steps to make our business economically and environmentally sustainable. At the same time, increasing access to the care we provide in the global communities we serve.

Making health care truly accessible on a global level will take work of governments, industry leaders, local health providers, and community organizations all working together to find solutions. And it goes without saying that this topic is quite complex. There isn't a simple answer, but fortunately, I'm being joined by two leaders who are making changes and driving these improvements at Fresenius Medical Care.

Joining us today to discuss what the Zero Health Gaps Pledge means and what is required of participating organizations is Dr. Amaka Eneanya, Head of Strategy And Operations for the Global Medical Office and Mignon Early, Vice president of Diversity, Equity and Inclusion at Fresenius Medical Care. Welcome to the program.

Dr. Amaka Eneanya: Thanks for having us today.

Mignon Early: Yes, thank you. It's an honor to be here and a great opportunity for us to share our pledge and commitment.

Dr. Michael Kraus: Dr. Eneanya, let's start with you. Part of our responsibilities, I’m sorry, it's part of your responsibilities…you're going to lead the company's efforts to fulfill obligations to the pledge. What exactly does health equity mean to you?

Dr. Amaka Eneanya: So, health equity is a human right that everybody have a fair opportunity to achieve their highest health potential. We know that there's factors globally that affect health equity and that not all people have that fair opportunity. And so really striving in everyday practice to achieve health equity has become a major global goal.

Dr. Michael Kraus: Sticking with you, now that we have a better understanding of what exactly health equity is, what is the Zero Health Gaps Pledge and how did Fresenius Medical Care even get involved?

Dr. Amaka Eneanya: So as you mentioned before, the World Economic Forum is a public, private international organization that brings together political leaders, business leaders, all types of leaders to come and solve basically the world's problems. And this year at Davos, their annual conference, they made this announcement through partnership with Deloitte, a consulting firm that's global, that we were going to be one of 39 corporations to sign this Zero Gaps Health Pledge and the Zero Gap Health Pledge strives to have no differences in the life span of any individual, regardless of their background, including across and within communities.

And so the pledge has ten components, and essentially it's holding institutions accountable, whether they're private institutions, public institutions, but really keeping in mind for various aspects of both corporation activities, care services, employee health, that we will be mindful of all of these on the impact of health and that we will strive to make sure that everyone has, again, a fair opportunity to achieve their highest health potential.

Dr. Michael Kraus: Well, that's pretty impressive. I know that within Fresenius, we certainly held health equity and diversity and inclusion very high status. That's been one of our standing courses. Mignon Early, can you talk to me about what we've already accomplished?

Mignon Early: Yes. So, you know, early in our DE&I journey, and that's how we referred to diversity, equity and inclusion, we recognized the connection between diversity, equity, inclusion and health equity. In essence, DEI supports higher employee engagement, leading to better patient outcomes and experiences, which leads to better business outcomes. So I like to think of it as it's good for patients, it's good for employees, and it's good for business.

We began this journey first with a commitment and a focus on inclusion. The most significant accomplishment to date has been the commitment and awareness amongst our leaders that diversity, equity and inclusion along with health equity, is an essential component of being the organization that we are.

Dr. Michael Kraus: And staying with you for a second, Mignon, what are some of the things that Fresenius Medical Care will do to fulfill its commitment to the pledge, specifically in terms of diversity and inclusion? And have we started some of those activities already?

Mignon Early: We have. We've trained almost 20,000 employees on skills and how to build trust and foster inclusion within their teams. The supporting work has been about building inclusion into the organization, with such things as adding the option of pronouns in emails, building a readily available glossary of inclusive terms for use by all employees in their communication, and then, of course, encouraging our employees to participate in our employee resource groups which connect employees and is aimed at really fostering a more inclusive workplace.

Dr. Michael Kraus: Dr. Eneanya, can you expand on the health equity activities that we've already started, particularly here in the United States and maybe globally?

Dr. Amaka Eneanya: We've done quite a bit. We have a lot to go, but I'm really pumped up to see the momentum across so many employees at Fresenius. So even prior to me joining, a group of stakeholders across the Enterprise came together and formed these United States specific health equity initiatives. Now, this was led by our emeritus employee, Dr. Duggan Maddox, and Dr. Laurien Dalrymple, who is also in the Global Medical Office, who's head of Population Health and Medicine.

And they did a wonderful job energizing and really getting people together to focus on collecting data, accurately ascertaining data that we know has an impact on health equity or tracks very closely with health equity. And a lot of these are social variables. So income, making sure race and ethnicity is accurately and consistently located in the medical record, making sure we incorporate sexual orientation and gender identity and making sure that we're piloting that, and then we'll scale that full time.

What I'm really excited about is the development of a health equity dashboard. And that dashboard actually looks at all of our patient populations across the nation. You can look at certain health outcomes, specifically the proportion or the incidence of home dialysis use, as well as individuals who have been listed for a kidney transplant. And you can stratify that data by race and ethnicity, by language, by gender, by age, and we can really hone in in a very detailed manner down to the city level where we're having the biggest gaps in those very important health outcomes.

And so that's just a snapshot of what we've been doing. And we certainly have a lot of activities that are going on globally to make sure that we can build upon the United States health equity initiatives, start doing the same data collection, and start looking to see if we can form interventions, right, that start to close health equity gaps.

And I think we have a lot to learn because in the United States there's such there's such intense public awareness, in particular because of the impact of systemic racism, the police brutality, the inequities we saw with the COVID 19 pandemic. So, a lot of people are very well versed in health equity. And we know in the United States that these inequities track very closely along racial and ethnic lines.

Now, that's not necessarily the case globally for obvious reasons. There's different types of racial groups, ethnicities, but we also know that certain oppressed groups may track along religious identities or immigration status. And this is what we have to learn in our population that we're serving at Fresenius to see who are the groups that are most impacted. How can we identify those gaps? And then how can we use the data that we're collecting to then intervene on those gaps? So that's just some of what we're doing as part of our global health equity strategic plan.

Dr. Michael Kraus: That's very important. And I've played with the dashboard a little bit because, as you know, I live for growth of both home dialysis and transplantation. And looking at the inequities is eye opening. It is very interesting. It depends which zip code you're at as to what care you'll get, whether it's equitable or not. So we'll continue hopefully to make big strides on that.

Mignon, Amaka has just discussed the efforts with many different employees across countries and within FMC leadership. Clearly, in your mind, this can't be just a US problem, right?

Mignon Early: So, we know, as I mentioned earlier, that higher engagement positively impacts patients and their outcomes. So, every year we run an employee engagement survey and as part of that survey, we include three questions that focus on trust and belonging. These questions are a significant predictor of an employee's satisfaction at work, layering other insights. It gives us a pretty good picture of how our employees engagement and how our employees are engaged with us and really directs many of our actions.

We have targeted programs that we offer, such as intentional inclusion and are in flight to release a program on cultural competency. This, we know, has been widely promoted at least here in the U.S., as one approach to reducing health disparities. We believe, as we understand other segments across the globe, we will be able to customize this training and sensitivities to other parts of the globe.

So our initial support, our goal is to support employees in honing skills on accepting and caring for diversity in all its forms—race, sexual orientation, religion, disability are just a few. We've developed a wide range of networks and rely on grassroots feedback from employees through listening sessions that inform us on how to support. So, in essence, we focus on employee engagement and target actions to meet the needs of our employees, which better prepares them to care for our patients.

Dr. Michael Kraus: So, as you move globally, I assume you're going to have to look at each aspect slightly differently and take different steps in each country just because of the where they're at in today's world. Is that a fair statement, Mignon?

Mignon Early: That is very fair, and we are working now with listening sessions to understand other segments of our employee population across the globe so that we're better informed in how to customize programs to support them.

Dr. Michael Kraus: I love the listening sessions. I think that's clear. That's the only way we'll get collaboration, that's for sure. Amaka while we stay in this global mindset, I noticed this pledge. There's about 40 companies that have taken part of it. Will our actions expand health equity, have a larger impact throughout the world as we participate in this network?

Dr. Amaka Eneanya: Absolutely. And I think that we're very well positioned to not only be active and effective, but to be a leader in this in this pledge with these other corporations. I mean, what other company has the reach that we do for patients with kidney disease? I'm really excited. I've had several people reach out to me from some of the other founding companies that signed this pledge to just early on, let's collaborate. Let's start. And so really pulling together with these other leading corporations is really going to be helpful for us to standardize how we collect data, how we analyze it, and just to share best practices. And Fresenius is already a very collaborative organization within our organization and externally.

And so, this is why I'm very excited about how we move forward with this. And I'll just say to Mignon’s point, like, the diversity inclusion piece is super important because what we do know in the United States that's been studied is that when you have employees of the same background as the population, for instance, that is your consumer base, that you really have really good outcomes for whatever that business is.

And so really thinking about the makeup of our organization all the way from the frontline staff to the executives at our company is how we will truly bring diversity of thought to this organization and really have the best patient outcomes. I'm super excited to work with my friend, Mignon, who has been a huge advocate. Even before I joined just meeting with her, I knew that we would be friends. And so I do want to, you know, give a head nod to Mignon and her team for all the fantastic work they've been doing.

Dr. Michael Kraus: You know, while we’re on this global effort, Mignon, every country is complicated and has different bureaucratic government structures that obviously we're going to be compliant within. How are we working with employees in different countries to enable them to provide the best care to each and every patient?

Mignon Early: So as I mentioned, the biggest thing for us is understanding our employees through employee engagement and then looking at how we help them to hone skills around cultural competency so that they are prepared to take care of patients from many diversities no matter what it looks like.

Dr. Michael Kraus: And Amaka, are we able to assess these individual patient needs within each and every country that they live?

Dr. Amaka Eneanya: Similar to Mignon’s strategic plan, we are also doing a listening tour. We're doing interviews, we're doing ethnographic analyses of the questions that we're asking. And it's been super interesting because, like I said, there's a lot of public awareness about health inequities in the United States. That is not the case everywhere in the world. There are a lot of people that just assume that with universal health care, that everyone's great.

And we know that is not the case. You know, what's been studied here in the United States, specifically, that implicit bias, right, the unconscious biases that we all have really contribute greatly to health care disparities in the U.S. over explicit bias which are conscious and controlled acts. And so, you know, really starting with first, the awareness of what health inequities are using the World Health Organization to kind of educate people or to talk about the social determinants of health, which we know are the conditions in which people work, grow, live, and play that are directly associated with health outcomes.

Using those key terminology and educating people is where we're starting, right? Because we know that access to health care, even the United States, although it contributes to health disparities, it by no means is something that eliminates them. And so again, really learning about the groups that are most oppressed, who have access to the least resources, not just health insurance, but also their social needs, they tend to have very poor health outcomes, especially looking at the studies that have been done in the United States.

And so, we are starting that journey because, again, there's not a lot of multinational organizations that have the type of reach that we do, that have done this work. And so again, partnering with other organizations to talk about lessons learned, to talk about the strategies will really help us align and not reinvent the wheel.

Dr. Michael Kraus: And this global touches and government touch is very interesting. But Mignon, we all know that things happen at the grassroots, at the bedside. What are some of the community organizations we've been working with domestically and how is that working out for us?

Mignon Early: One of the organizations we're working with here is the Boys and Girls Club. The focus of the partnership is on health literacy. So, I'll flip this a little bit. The program actually originated in Asia Pacific. It's called Kidney Kid. So what started as a local edutainment program has grown into a global kidney initiative for us with the help of a superhero character that's known as Kidney Kid, we work to educate children, their teachers, parents, guardians about the kidneys through pretty eye catching and interactive media and other activities.

The program was introduced here in the U.S. last year and is funded by Fresenius. We continue to expand that this year. Additionally, we recognize that addressing these health disparities is not something we can do alone. So we are continuing to seek organizations to partner and collaborate with both here in the U.S. and abroad.

Dr. Michael Kraus: Amaka, I guess we're getting short on time and this could go on forever, but that's great conversation. Do you have any last thoughts you want to add?

Dr. Amaka Eneanya: Yes, I do. And I will just say that health equity is everyone's responsibilities. Now, I know Mignon and I are happy to be here to lead efforts, but everyone should be taking part in the efforts to advance health equity. And I think that doing the work right, like learning about the inequities, is everyone. I put that onus on everyone. So, everyone has homework after this podcast to really start to research this topic. And then I would say work together, because when you try to make this your own thing, you're becoming the barrier. So, we must all work together to advance health equity. We must be humble in our efforts, and that's how we'll achieve that goal.

Dr. Michael Kraus: That's very well said. Mignon, what about you? Any last thoughts?

Mignon Early: Health equity ensures that all have access to what they need to achieve and maintain optimal health. At the same time, and we talked a bit about this, we know that particularly here in the U.S., one of the biggest predictors of one's health is their zip code and that in general, patients are more comfortable with providers when there are providers who look like them on their care team. To Amaka’s point, it is the responsibility of all of us, not some of us, to foster inclusion through the delivery of culturally competent care, which supports our commitment to achieving health equity for all.

Dr. Michael Kraus: Very nice. I think I’ll have to say that this has been one of the more interesting conversations I've had in quite a while. Thinking globally helps take compassionate care to a whole new level. And I'm proud of the work that you're both doing. I'm honored to have you both as guests on this episode of Field Notes and thanks for being here.

Dr. Amaka Eneanya: Thank you so much for having us. This has been great.

Mignon Early: Absolutely. We love sharing the story and engaging others to participate.

Dr. Michael Kraus: Don't stop here. Look for ways to become involved in improving health equity. Every step matters. If you wish more information, reach out to us at Medical.Office@fmc-na.com, and we can provide you a list of resources to begin your journey. If you're new to the Field Notes podcast, you can download past episodes on the Apple Store, Google Play, or wherever you download your favorite podcasts. You may even download them right here at FMCNA.com and while you're there, please remember to subscribe to receive the very latest updates as they happen.

Until next time. I'm Dr. Michael Kraus, and you've been listening to Field Notes by Fresenius Medical Care. Take care, everyone, and let's begin a better tomorrow.