How Diversity Fuels Mount Sinai’s Award-Winning Health Equity Work

Gary Butts, MD, remembers a time when it would’ve been uncomfortable or even risky to mention race in a hospital. Now the chief diversity and inclusion officer for the Mount Sinai Health System, Butts said his organization’s work in health equity has created a climate much more poised to affect change.

“When I was an intern and when I was earlier in this work, if you mentioned the term race, you were looking over your shoulder,” Butts, who is also the Dean for Diversity Programs, Policy, and Community Affairs at the Icahn School of Medicine at Mount Sinai, told PatientEngagementHIT in a recent interview.

Butts has been with Mount Sinai since the 1980s, and in 1998 took the mantel of overseeing diversity, equity, and inclusion efforts starting first with the medical school and then moving into the entire institution. In that time, Butts has been able to support efforts to increase medical student and researcher diversity and guide Mount Sinai as it continues its work to support all patients.

The difference between then and now is substantial, Butts said. This year, 30 percent of the Icahn School of Medicine’s incoming medical students are from traditionally marginalized groups, as is 16 percent of the organization’s residents. This is a key step in supporting greater health equity and diversifying the medical workforce.

But perhaps more important is the change Butts can’t quantify.

“The fact that we can talk about race and racism relatively publicly with some degree of comfort—that is not easily measurable, but it’s a point of impact that most institutions still aren't at,” Butts stated. “I can have one-on-one conversations or we can have group conversations at the most executive level about racism.”

It’s that cultural change that led to Mount Sinai being awarded the 2022 Carolyn Boone Lewis Equity of Care Award by the American Hospital Association’s Institute for Diversity and Health Equity. Mount Sinai said its Road Map for Action played a big role in receiving the honor, as it details the organization’s entire plans to change and eliminate racial health disparities and racism in medicine.

Butts said he remembers the day they decided to embark on the roadmap; it was Monday morning and it came in response to the social unrest spurred by George Floyd’s murder. What was intended to be a few weeks’ worth of work assessing the structures at Mount Sinai enabling racism in medicine and carving out a path forward, turned into a six-month endeavor.

The framework looks at how Mount Sinai can use recruitment and training of Black and other underrepresented staff and faculty, build partnerships to boost antiracism work, and advocate for new approaches to dismantling structural racism in the organization. The framework is notable because it acknowledges that Mount Sinai cannot overnight undo the damage from centuries of slavery and a century more of legal institutional racism; it was designed to build lasting structures and to be sustainable.

It was also built by a cadre of people with differing perspectives and priorities, something that can often be amiss in health equity work. Often, and especially when Butts was starting out in medicine, this work fell to those directly impacted by inequity.

Of course, it is crucial for health equity work to incorporate the voices of the most marginalized, but having the work rest solely with Black people—or other racial minorities or LGBTQ+ people or women—will not support change across the entirety of the institution.

“It's not my bucket to carry alone,” Butts emphasized. “I have a role, as do other leaders across our system, and all the staff have to be engaged. If we can't agree to a successful endpoint or two along the way for every one of us staff, even including the most invisible, then we're not there yet. That's the point.”

“There's only so much pioneering a single individual can do and frankly, folks shouldn't agree to it,” Butts added. “And just because you are Black or Latinx, or LGBTQ and an issue or policy might affect you directly, doesn't mean that you should be the one expected to lean and lean forward while everybody else gets a pass.”

That mindset has been critical to Mount Sinai’s success in supporting health equity work. When building the Road Map for Action, Butts made sure it was a plan that could be carried by the more than 40,000 staff and students at Mount Sinai and the Icahn School of Medicine.

“We needed the folk who needed it done yesterday, and we needed others who said, ‘wait a minute. We can't implode in doing it,’” Butts said. “We still have the business of Mount Sinai to support and then, of course, work needs to be integrated.”

That all-hands-on-deck approach means Mount Sinai needs to be a safe place for everyone to voice their opinions, going all the way from the leadership down to the medical students and residents. Butts said Mount Sinai and the Icahn School of Medicine are dedicated to changing the climate of medical education, which is notoriously rigorous, and preventing quit rates among historically marginalized folks.

For Butts, that means taking on a particularly big mentee load, including kids all the way down in middle school and into medical school. That lets him center their voices as these young people become involved in—and in many cases drive—the organization’s health equity work.

After all, supporting diversity, equity, and inclusion in medicine requires both a bottom-up and top-down approach, Butts advised, and it needs to be designed as a long-haul investment.

“This should not be the work of a single individual or the people of color or the women or LGBT individuals. It's everybody's,” he concluded.

“Everybody has a responsibility that needs to be made here. It is to become part of our work to do. It's our work to do over time and this is where we will begin. We'll make this commitment and structure ourselves and identify the specific strategies and the ventures over time that we will commit ourselves.”