Dr. Roderick K. King believes in transformational moments—and he believes that when it comes to achieving health equity and building healthy communities, we’re in the middle of one right now.
As the health disparities expert told the audience at The Albert Schweitzer Fellowship (ASF)’s annual conference last October, we’re in the midst of “an unprecedented confluence of drivers for change, including our country’s changing demographics and pressures to improve quality of care and reduce cost.”
As one of the newest members of The Albert Schweitzer Fellowship (ASF)’s Board of Directors, King is working to help Schweitzer Fellows, Fellows for Life (alumni), and other emerging and established professionals leverage this moment in ways that improve health and well-being in vulnerable communities.
King is Senior Faculty at the Massachusetts General Hospital (MGH) Disparities Solutions Center and an Instructor in the Department of Social Medicine at Harvard Medical School (HMS), as well as President of Next Generation Consulting Group. Among other roles, he has served as the Director for the Health Resources and Services Administration, Boston Regional Division and as a Commander in the US Public Health Service, US Department of Health and Human Services.
We spoke with King about his personal journey, his belief in results-based leadership models, and the steps emerging professionals can take to help achieve health equity without burning out along the way.
ASF: Can you tell us a little bit about what initially drew you to pediatric medicine as a career, and then about what drove you to work to effect change in health and health care at the systems and policy level?
RK: Initially, when I was in medical school, I was interested in orthopedic surgery. But after doing my pediatrics rotation, I realized that I really loved taking care of kids, and that I was interested in working more closely with families, specifically through the clinical encounter, to help them achieve better health in their communities.
I soon began to run into many families with the same set of pediatric issues—for example, children struggling with very difficult chronic diseases like asthma. It was out of that clinical experience that I began to see the differences in health outcomes between kids of color and kids not of color, and I soon made a deep connection with a theme from my childhood: what is the role of the provider in the community, and what are the broader issues that underlie the disease you’re treating?
My father was a general practitioner in Brooklyn, New York—a very underserved area in the early 1960s—and I grew up in that context. We were a mom-and-pop shop, so I saw my mom and dad deal with those underlying issues—for example, my mom worked to get parents aware of and connected to the importance of the SATs and the PSATs. Clearly, it wasn’t just the disease that was the issue at hand; my parents were really interested in the overall well-being of the family and the success of their children. My pediatric experiences brought me back to that original interest and exposure.
ASF: How can Schweitzer Fellows and other emerging professionals help to leverage the transformational moment you described at our annual conference in October?
RK: I think the first step is to get as clear as you can about what your passions and interests are. They may change—but what are they now? What really excites you? Are you most interested in issues around improving quality of care and health care access? Are you most interested in transformational change and, perhaps, health care reform administration? Each individual has a particular passion and interest; the way to be most impactful is to align that passion and interest with the opportunities that are available.
Once you get clear on your interest, the second step is to gather as much information and learn as much as you can around that particular topic. That process may involve reading the literature, searching the internet, going to conferences, and so on—in a sense, becoming a well-informed expert in that arena.
The third step is to pursue hands-on practical experience and exposure to that issue. Learn the hands-on piece of what you’re passionate about—because in order to be part of this transformation, you have to understand both the context (which is step 2) and have the experience of actually doing it.
Out of those three steps, what will start to emerge are windows of opportunity that align with your passion—windows of opportunity where you can make a difference.
ASF: Once you’ve identified that passion and found your niche, and followed these steps to become well-versed in it and figure out what your path will be, how to you stay motivated, find some semblance of balance, and avoid burnout—especially if you’re seeing a lot of things that make you feel like you’re downstream from the problem?
RK: By making sure that you take care of yourself, whether it’s physically, mentally, or spiritually. By doing things that will nourish you and continue to feed you, because addressing disparities is long-term work that requires you to maintain a certain capacity to continue that work.
The second thing is really developing a great support network—your friends, family, mentors, peers—and carving out very specific time to connect and engage authentically with them, whether it be time with your family, regular check-ins with your mentor(s), or regular convenings with your colleagues. Any of those things are important because they offer you balance—and informally, they will help you to put what you’re experiencing into context. Doing this kind of work can sometimes feel lonely. You can start to feel like you’re the only one. But connecting with this network will remind you that many are supporting you or are in the same battle with you.
The third way to sustain yourself is to continually evaluate the alignment between your interest and passion and what you’re doing—because as we mature and grow, we change. The things we learn might push us in different directions. You have to constantly reevaluate, ‘Is what I’m doing a good alignment between my values and passion, and the opportunities that exist?’
ASF: In your capacity with MGH Disparities Solutions Center and the Institute of Medicine, you have published numerous landmark papers and calls to action regarding health disparities. You also continue to mentor and lecture on leadership in minority health policy at Harvard. Are there any related trends or initiatives that you’re particularly excited about?
RK: Historically, we’ve had a very clear separation between health care and public health—health care meaning the management and treatment of disease, public health being the prevention of disease and improving population health. The trend I’m seeing now is that the two are finally, actually merging. People are starting to realize that in order to improve individual health, you have to engage strategies to improve population health.
I’m seeing this realization in the current literature, which shows that despite efforts to improve quality of care in the hospital setting, things that appear to work are outside the hospital setting and require working as a community—community health workers, visiting home nurses, “health navigators” who actually go out and help people navigate the system. What works is going outside the health care system in addition to strategies within health care.
Additionally, there’s a clear signal being sent through health reform that, if we want to control costs in health care, it’s going to require institutions to be accountable for maintaining overall good health. In other words, hospitals no longer can just be financed and paid for the treatment of disease, but now are going to be compensated based on how healthy their patients are. The unsaid message is that in order to keep people healthy, you may have to go beyond the exam room and into people’s communities and homes. Organizational incentives will now be based on achieving the result of keeping people healthy.
The other trend that I’m particularly excited about is the increasing realization that in order to improve population health, it’s going to take multi-stakeholder collaborations. [King’s recommended reading on this front: “Leading Toward Population Health” from the November/December 2011 issue of Health Care Executive and “Collective Impact” from the Winter 2011 issue of the Stanford Social Innovation Review.]
There is no one institution, there’s no one hospital system, there’s no one social service program that will singlehandedly improve the health of populations. It’s the collaborative efforts of multiple leaders across multiple sectors—health care, business, housing, education—that will have to come together to develop strategies to improve and maintain good population health. A lot of my current work is moving in that direction: how do you support and align leaders to take collective action for impact?
I’ve been trying out a number of different models over the past seven to ten years. The one that I have really been focusing on is called Results-Based Leadership (RBL). It was created by one of my colleagues in Washington, DC, Jolie Bain Pillsbury. It pulls together various leadership skills, including skills around collective impact, accountability, and group decision making. I’m now trying to see how I can use this model in the Caribbean—pulling together leaders in Trinidad to see how to use the model to develop strategies to address chronic diseases, because they’re realizing that they have to manage and control the non-communicable chronic diseases (e.g. diabetes, hypertension, heart disease, etc.) that are now the number one killer in the Caribbean. But their health systems are not built to address these things. What I’ve proposed is that they look at the RBL model as a way to engage multi-sectoral leaders to come up with strategies to address chronic diseases.
This approach is something that I’m really passionate about, and I’m seeing more and more communities start to form these collaborations across the country, and more and more hospitals now being willing to be part of collaborative efforts in communities. So there’s this growing trend and interest around multi-stakeholder collaboratives, but the part that’s so revealing for me is that most people realize that this is what needs to happen, but don’t necessary have the leadership skills to do it. What I’ve been exploring is: what are those key skills that people need to have to do this effectively and move from talk to action?
ASF: What does being a Board Member of The Albert Schweitzer Fellowship mean to you? How do you hope to see the organization grow?
I’m excited to be a Schweitzer Fellowship board member because I really believe that our ability to address future challenges in health care will depend on the training and support of the next generation of leaders.
Being on the Schweitzer board gives me the ability to support those future leaders—to be able to identify ways we can best mentor them, guide them, coach them, and provide opportunities for them to be change agents. It gives me a very concrete way to support the next generation of leaders.