Q&A with Elizabeth Howell

TEDMED: In your TEDMED 2018 talk, you mentioned that one way for hospitals to improve the quality of care around childbirth is to implement a bundle program as advised by the Alliance for Innovation on Mental Health. What infrastructural resources are needed to adopt such a program, and who at the hospital should be driving this change? 

Elizabeth Howell: Some of the Alliance for Innovation on Maternal Health patient safety bundles are easier to implement than others and some require little infrastructure or resources. All require sponsorship from individuals within the hospital or healthcare settings. Leadership can come from nursing, physicians, midwives, or hospital administration.

TM: While social determinants of health contribute to racial and ethnic disparities, there remains a component of racial bias in health care. What are some steps that we can take to dismantle providers’ racial bias? Does this happen during medical education or elsewhere?

EH: Addressing providers’ racial bias is important and some medical schools have begun implicit bias trainings for faculty and staff. However, a complex web of factors contributes to disparities. I suggest we tackle disparities brick by brick:

1.  Measure racial disparities in pregnancy outcomes and address them through quality improvement activities in hospitals.

2. Hold hospitals and healthcare organizations accountable for their performance on outcomes.

3. Teach medical students and trainees patient-centered communication strategies, shared decision-making skills, and actions to address implicit bias.

4. Address who institutions are admitting into medical schools and residency programs in an effort to diversify the workforce.

5. Ask how healthcare systems compensate and reward physicians within the system. Make compensation linked to performance on reducing and addressing disparities.

6. Challenge institutions to continually ask themselves whether they are doing everything they can to reduce disparities.

TM: How aware are pregnant women and new mothers of the risks and signs of maternal mortality or morbidity? What is the best way to educate these women on the risks that they face, so that they can take informed steps to protect their health?

EH: Women with obesity, hypertension, diabetes, and other chronic illnesses are at higher risk for complications during pregnancy.  It is important for all reproductive age women, especially for women with chronic illness and these risk factors, to seek healthcare before they become pregnant and receive education about the best steps to protect their health.

TM: If every hospital across the country adopted the highest quality of standard care around childbirth and maternal health, do you think we would still see racial disparities in maternal morbidity and mortality, or do you think that disparities would remain due to other uncontrolled factors?

EH: I believe a meaningful portion of the disparity gap can be closed by improving quality of care across the care continuum and improving standards across all hospitals.  While addressing the larger societal issues that drive racism is important work for scholars from every field, it is not an excuse for delayed action on these tangible steps.

TM: What was the TEDMED experience like for you?

EH: The experience crystallized for me the importance of storytelling in communicating important truths. As a scientist we frequently communicate through tables, data, and graphs but the emotional connection to the problem is often what motivates action.

TM: At TEDMED, we like to think about each talk as having a “gift” –  that thing that reveals new perspectives and profoundly influences our own, or our collective, health. What is the gift you’d like people to receive when watching your TEDMED Talk?

EH: We can save the lives of thousands of women who die or experience severe complications from childbirth every year if we raise standards in EVERY hospital and provide high quality healthcare for ALL women before, during, and after pregnancy.

TM: What was the highlight of your TEDMED experience?

EH: A highlight for me was being introduced by Michael Painter from the Robert Wood Johnson Foundation as a “nice radical… For Liz, there is no division between her passion and her compassion.”