CASE STUDY: Cone Health's Innovative Education Requirements for Improved Physician Training
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CASE STUDY: Cone Health’s Innovative Education
Requirements for Improved Physician Training
Cone Health | Greensboro, N.C.
Overview
Cone Health serves residents in several counties in
and around Greensboro, N.C. The not-for-profit health
care network is comprised of more than 100 loca-
tions, including five hospitals, 1,300 physician part-
ners and a total workforce of 13,000 employees. In
2020, Cone Health received the Carolyn Boone Lewis
Equity of Care Award from the American Hospital
Association for efforts that include integrating health
equity practices into its physician-training curriculum
and within the governance of its board of directors.
Throughout its long history, Cone Health’s mission
has been to meet its community’s evolving health
care needs, including on the equity, diversity and Moses Cone Hospital in Greensboro, N.C.
inclusion front. Today, all its physicians with privi-
leges are required to complete continuing medical Not only was Cone Health challenged with getting
education (CME) pertaining to the social and racial administrators and staff to buy-in on a wholesale
influences of health care. Furthermore, to ensure culture change, it also faced earning back the trust of
high equity of care levels for all patients, Cone Health African American community members by distancing
collects race, ethnicity and language preference itself from a past rooted in discriminatory policies.
(REaL) data using patient-centered interview tech- In 1963, nine African American doctors successfully
niques, which include electronic medical records that brought legal action against Moses Cone Hospital
also capture patients’ preferred language. to join the medical staff and desegregate care for
However, implanting this requirement of CMEs did African American patients. This lawsuit resulted in a
not come easy. Cone Health significantly overhauled landmark federal decision and was a precedent for
its culture after a revealing look at how its own staff numerous similar lawsuits throughout the country.
perceived the organization’s values. The process began Decades later, community perceptions of the hospital
more than 10 years ago with health care leaders needed to change.
asking a simple question: Who do we want to be?
In 2010, Cone Health conducted an internal assess- Impact
ment that asked staff what they thought were the
main drivers and core values. What administrators Following the 2010 assessment, Cone Health’s
learned was that employees thought Cone Health leaders launched a significant effort to address
mostly focused on cost controls and patient volume. diversity, equity and inclusion. Eventually, a Physician
“That was not inspiring to anybody,” said Paul Council for Health Equity was formed, and that group
Jeffrey, president of Cone Health’s Wesley Long went to work on several early initiatives to demon-
Hospital. “The organization was accepting that it was a strate the need for more training among physicians.
good health system, but not one aspiring to be great. When the medical executive committee (MEC) first
We worked on who we wanted to be — a patient-cen- received the request for physician cross-cultural
tric health care organization, focusing on improving education in 2016, it pushed back and turned it down,
different areas of quality and patient experience.” offering only to establish minimal training. Then
© 2021 American Hospital Association www.aha.org | March 2021
something happened that became a turning point for Lessons Learned
Cone Health.
Six months after the MEC’s decision to reject In developing new cultural competency training for
cross-cultural education for physicians, Cone Health’s clinicians and staff, Cone Health realized that educa-
CEO, Terry Akin, offered a public apology to the last tional offerings had to be flexible in order to meet
surviving plaintiff of the original 1963 desegregation everyone’s scheduling needs. Required courses are
lawsuit. “It was a really big deal, locally,” said Dr. Alvin now offered in a variety of ways to fit within changing
Powell, chief health equity officer for Cone Health. “It work schedules.
was an opportunity for Cone Health to separate itself “Physicians have flexibility to select training that
from its past, develop trust works best for them,” said
within its community and Laura Vail, Cone Health’s
move forward with a new director of health equity.
initiative of health equity.” “Pre-COVID-19, some
The community’s courses were made avail-
reaction to the candor and able in person. We offered
courage by Cone Health’s a social determinants of
top leader, coupled with health series as lunch and
health care disparities learn sessions. In the COVID
identified in patient data, era, we have adapted and
helped the committee are offering more courses
reconsider its decision. through digital platforms. Our
Through collection of physicians have attended
REaL data, the hospital racial equity courses and
could show the MEC bias courses over the last
that real racial disparities Cone Health CEO, Terry Akin, apologizing to the last year. Cone Health’s physician
of care existed. After surviving plaintiff of the Simkins v. Cone lawsuit. practice group has developed
reviewing the data and webinars on various topics
learning more about the reality of unconscious biases including interpreter services, empathy and discrim-
affecting patient care, the MEC unanimously decided ination in patient services. Online courses are also
to mandate cultural competency training. available for physicians on-demand.”
With the committee’s endorsement, Cone Health Another eye-opening development stemming
made education a key driver for underscoring equi- from Cone Health’s focus on health equity and
table care as a priority. It adopted new physician cultural competency education are the questions and
training methods and updated patient-data collection positive conversations that were being generated
standards to ensure high-quality care for its patients by the staff. As clinicians learned more about their
and within its surrounding communities. patients’ lived experience, their perceptions of the
“Courses and trainings are required of all physi- medical field, and about their patients’ social and
cians throughout Cone Health’s system,” said Powell. economic determinants of health, they became more
“We felt that if we really wanted to impact health aware of many patients’ points of view.
equity within our community, it had to be led by the Vail added, “Physician feedback has been positive
physicians.” and the physicians said the training raised awareness
All physicians at Cone Health are required to of many important issues, such as racial justice, crim-
take two courses for each reappointment cycle. inal justice disparities, as well as health care dispar-
Medical professionals earn two CME credits for each ities and issues that touch on equity in health care.
2-hour completed course and have great flexibility It has helped ‘create the conversation’ and that’s
in choosing which cross-cultural topics they’d like to powerful. Training has raised awareness and people
learn more about in order to best serve their patients. are talking about it. It’s a good thing.”
© 2021 American Hospital Association www.aha.org | March 2021 | 2
Because these conversations were already Dr. Powell pointed to Cone Health’s innova-
taking place among the staff before 2020, Vail tive patient data collection methods and how it’s
believes equity was at the forefront as the COVID-19 important to pair that effort with advanced tech-
pandemic quickly materialized. As the national nology so patients at all connection points within the
conversation began to shift toward social, economic system may benefit. “Now we are able to measure
and health inequities, Cone Health had already a lot of these things system wide. Our data analytics
addressed inequity issues in driving its new organiza- teams can accurately measure disparities. When we
tional culture. “It’s really good that our culture was in look at health equity, we have to be very intentional in
place before COVID happened,” she said. “When we doing this work to unwind institutional and systemic
began to see these inequities arise, we quickly began processes that result in disparities.”
to partner with the faith community. We went to Furthermore, Dr. Powell notes a culture of health
historically African American churches and said we’d equity, diversity and inclusion must be sustainable.
like to offer COVID testing and partner with you.” Maintaining a successful future entails reaching out
Vail also said Cone Health teamed up with its beyond hospital walls and making better connections
Hispanic and Latino organization partners to offer the with people in Cone Health’s communities.
same services and provide translated information “We need to think about continuing to create
through fliers and radio advertising. a culture of equity. We’re also continuing to look
at health inequalities outside of our institution and
Future Goals in communities of need. We are building a mobile
strategy to go into these communities and brick and
As Cone Health’s leaders look to continue a primary mortar facilities for long-term access to care closer
focus on health equity, they realize that it’s important to home. We also recognize that there needs to be
to remember where things started in order to move diversity with respect to who are the caregivers
ahead. within your institution. The caregivers need to mirror
“There was a time when we were not the community for which they are caring.”
patient-centered, when we weren’t looking at
every patient through a lens of equity,” Vail said. To hear more about Cone Health’s physician
“There’s been a culture shift in our organization training innovations for building a culture of
which really had to occur first for this health equity health equity, listen to this AHA Advancing Health
work to take root.” podcast. All IFDHE podcasts are available here.
© 2021 American Hospital Association www.aha.org | March 2021 | 3You can also read
