Dr. Anjali Bhagra of Mayo Clinic

Driving Equity, Inclusion, and Diversity in Healthcare: A Discussion with Mayo Clinic’s Dr. Anjali Bhagra

January 5, 2021 – By Jared Mueller, Director – Mayo Clinic Innovation Exchange

Last autumn, Anjali Bhagra, M.D. was designated as the new medical director of Mayo Clinic’s Office of Equity, Inclusion, and Diversity. A clinical investigative internist and professor of medicine at Mayo Clinic’s campus in Rochester, Minnesota, Dr. Bhagra also leads an active research program, focused on enhancing resilience; decreasing stress and anxiety; healthy aging through optimism and happiness; leadership and resilience; work-life balance; and stress reduction in women, healthcare professionals and trainees.

Dr. Bhagra’s research into sex-specific differences in stress aims to establish an effective intervention based on the construct of resilience to address the risk of future cardiovascular disease in women experiencing moderate levels of stress. She co-founded a leadership development conference that promotes inclusivity — Growth, Resilience, Inspiration and Tenacity for Women and Men in Medicine, or GRIT.

Dr. Bhagra also is a director and an executive board member of the American Medical Women’s Association Ignite initiative, a program that explores issues encountered by women in training and throughout a career in medicine.

Q: What are some of the central goals of Mayo Clinic’s Office of Equity, Inclusion, and Diversity (OEID)?

AB: This summer, in the aftermath of the tragic death of George Floyd, Mayo Clinic announced a new $100 million commitment over the coming decade to combat health disparities and racism — while advancing equity and inclusion within Mayo itself. In addition to being medical director of OEID across Mayo Clinic, I am also the medical director of the Rochester campus’s team working on operational planning and implementation of that $100 million commitment.

Mayo Clinic is committed to addressing disparities in care and opportunity in the Arizona, Florida, and Midwestern communities that surround Mayo’s largest physical campuses. Enhancing the diversity of the patient population Mayo Clinic serves is among our major priorities. Our Education and Research shields also have ambitious goals to support diversity, equity, and inclusion. As Mayo Clinic prioritizes diversity among its leadership ranks and its student and staff cohorts, Mayo also plans to double down on supporting research programs that will help narrow disparities in care among communities in the U.S. (and within and between countries across the world).

The Mayo Clinic Center for Digital Health, Mayo Clinic International, and the Mayo Clinic Platform are all teams that are working to enable Mayo to serve patients of all backgrounds, anywhere in the world. Importantly, Mayo Clinic is also committed to supporting diverse and under-represented entrepreneurs through its Supplier Diversity Program.

Q: Your research program has focused on strengthening the resilience of Mayo Clinic patients as they confront illness — but also, on supporting your fellow healthcare providers themselves with resilience throughout their careers. What are key resilience lessons?

AB: Every human brain struggles with focus, fatigue, and fear. Often when our brains wander, we focus on what isn’t perfect in our lives. The engineering of the human brain is very survival-based. This engineering causes us to worry about our finances, our careers, our health, and our families. The pandemic has only exacerbated these challenges.

Our brains do a ton of mind-wandering every day — and our capacity to pay attention and focus erodes over the course of the work day. Fatigueability is real. The demands of healthcare mean that medical culture must acknowledge these struggles. Our brains hunger for vital needs, which we sometimes summarize using the acronym R.U.M.: our brains need rest, uplifting emotions, and motivation.

However addressing these needs holistically is usually more challenging than simply grabbing candy, or otherwise seeking instant caloric gratification, snacking habits which can themselves cause health challenges down the road. Patients, physicians, and nurses will all benefit if we develop a culture that allows a provider to say “I’m fatigued, I’m looking for some uplifting emotions,” when she or he is six hours into a challenging day and needs a mental boost before consulting with the next patient.

Q: How do stressors and cultural expectations impact individuals across gender identity, in terms of mental and physical health?

AB: One extraordinary finding in recent years emerged from a study evaluating levels of salivary cortisol in women who work part-time, as I have for parts of my career. Cortisol analysis found that study participants experienced higher average levels of stress during the hours when they were at home than the hours when they were at work.

It can be impossible to separate stressors at home from one’s work life, and work stressors from one’s home life. This spring, we published a paper in Current Cardiology Reports outlining the distinct burdens borne by male and female physicians when it comes to work-life integration, gender and maternal bias, and childcare policies — all factors that tend to differentially disadvantage women in medicine.

Employers and society alike need to develop norms and practices that help preserve women’s and non-binary individuals’ health in culturally competent ways. We each have a role to play in reducing health-threatening career stressors to more manageable levels. Preserving the resilience of providers during this pandemic (a necessity to protect both caregivers and their patients alike) is even more important, and a topic that several Mayo Colleagues and I analyzed in Mayo Clinic Proceedings this summer.

Q: What breakthrough innovations in healthcare delivery or technology excite you most?

AB: When it comes to artificial intelligence (AI), I’m excited about innovators who are working to ensuring the healthcare sector invests as much care in de-biasing AI algorithms as it does in developing and implementing the algorithms. Any digitalized tool has multiple entry points for bias, biases that can critically impact their performance. Just last month, there was a finding that pulse oximeters over-report oxygenation in Black patients. So escalation of care happens late (and often too late) for Black patients suffering from COVID-19 and other serious illnesses.

At the core, we need to innovate to expand the accessibility of care. How do you make certain the healthcare workforce is ready to provide culturally competent care to all patients? For the workforce to be ready, we need to keep up with unconscious bias training: these include asynchronous and synchronous delivery formats, and individualized training plans based on what an individual’s blind spots are — rather than a one-size-fits-all unconscious bias module.

We can also consider how to build equity and inclusion into performance management practices. Many corporations rely heavily on balanced scorecards as performance tools. We could create scorecards that ask: are you truly a well-rounded provider, incorporating an equity lens? How diverse are your patients, with whom do you publish research, and how interprofessional and multi-disciplinary are you within healthcare?

Healthcare is ripe for innovation, both when it comes to tools and processes that will ensure delivery of equitable care to patients of all backgrounds, and the cultivation of a thriving, diverse workforce within the healthcare sector itself.