HealthWorks CEO on the Importance of Cultural Competency, Treating Patients Like Family
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Voices from the field

HealthWorks CEO on the Importance of Cultural Competency, Treating Patients Like Family

Tonya Adkins, MD, knows all too well what it feels like to be challenged by the health care system. During the second trimester of her first pregnancy, she complained to her doctors about severe pain. They didn’t hear her. Complications from severe preeclampsia almost ruptured her liver, and at just 21 weeks pregnant, Adkins gave birth but lost her child shortly after delivery.

Since then, Adkins, an OB/GYN, has devoted much of career to caring for women with high-risk pregnancies, people of color, people with low incomes and the undocumented. These are the “unseen” as she calls them.

Last year, when Adkins stepped into her new role as CEO at HealthWorks for Northern Virginia, she ushered in a new goal for helping patients feel seen. “It’s all about the small things. When you walk in the doctor’s office, did someone smile or greet you when you came in, were there providers who could speak your language, did someone help you schedule a new appointment if we had to cancel? You don't always have to give people medicine to care for them. We can do a lot of good by just showing people they matter.”

Dr. Adkins spoke with the Northern Virginia Health Foundation about her vision for HealthWorks and the steps the organization is taking to make patients feel more like family. The conversation was edited and condensed for clarity. 

The approach of treating patients like family, “like they matter,” feels like something that every healthcare organization sets out to do. Something that HealthWorks would say it does, too. What’s different about this vision? This whole thing is about enhancing the work that we’ve always done. The difference is in the mindset. Our patients are more than patients, they’re more than people who just might be sick or hurt. My vision is for everyone to buy into the mindset that the people walking through our doors could be our moms, dads, cousins, siblings. You’re going to treat this patient like you would treat a family member, because who else do they have? We are it. We are the safety net. If they don't come here, they're going to the ER or the urgent care, and they're going to get a bill.

What’s driving this more intense focus on treating people like family? We want people to feel seen. Our patients are the unseen patients. That's what I say. Some are undocumented, so they get no benefits. They don't qualify for Medicaid. They work in jobs where they get paid under the table, and they get no time off. They might live in multi-family dwellings. So you might have three families sharing a two bedroom or three-bedroom apartment, there's no privacy. They deserve the same standard of care that everyone else gets.

Because English is not the first language for many of our patients, that means they might not understand what's going on with their bodies, because no one talks to them in their language and helps them understand disease processes. If I had a patient who comes in and she's bleeding, I need to talk to her about why she's bleeding. I'm not going to just say to her, "This is what we're going to do to fix it. Take this medicine and be gone.”; That's not fair. I wouldn't talk to my patients who spoke English like that. I would take the time to explain everything that was happening.

We have resources. We have prescription services. We have a food pantry. We have all these services that will help patients get the care that they deserve. We have staff who assist with filling out their charity care applications and help them navigate their bills at Inova, or Reston, or wherever they go. We live in the wealthiest counties in America, and there are these pockets of deep, deep poverty that most people don't even know exist.

Is it true that you got your job at HealthWorks by accident? [Laughs] Yes, you could say that. When my family moved to Virginia, I knew this was going to be our last move since we had been in Okinawa, Japan and San Diego, California, for several years before that. I said, ‘What do I want to do with the rest of my life?’ I knew I loved community medicine so, I thought, ‘let me call the Health Department and see if they're hiring.’ I called what I thought was the Health Department, and it was HealthWorks. The Human Resources director at the time said, ‘Oh my gosh, we are not the Health Department, but we're looking for an OB/GYN. Our OB/GYN left three months ago.’ And I said, ‘Okay, sign me up.’

Just like that? Yep. At the time, my kids were still in middle school and elementary school. I wanted a part-time job where I could work when I wanted to work and not work when they had school field trips and things like that.

What were those first few years like? After being the part-time OB-GYN for a while, my first day of work as the Chief Medical Officer was the day we got our first COVID patient. My two years in that position was spent really running the clinical part of the organization and managing that COVID reaction. The executive leadership team met seven days a week for an hour every day because things would change. The beginning of the week, we'd start out with this policy, and by the end of the week, the policy would need to be changed.

That first day I thought, ‘How can I do this?’ Immediately my mind just went into overdrive and I started making decisions and plans that eventually got us through the COVID pandemic. I said, Okay, we're not using this space down here. We're going to have an acute care clinic downstairs on the first floor before sick patients get up to the second floor. We're going to close one of our locations because they didn't want to have COVID patients in that building due to the many other organizations in that location. That way we'll have extra staffing. There were all these things we put in place.

That sounds like a lot to take in at one time. What did you take away from that experience? It was crazy! But I realized I really like this leadership thing. I liked being busy, I liked being with the people. I really liked it and I would've probably stayed in the CMO role, except when Carol Jameson [former CEO of HealthWorks] was putting in her note of retirement, I thought, what would it be like to just do the administrative stuff, which I really love and give up some of the patient care responsibilities. There was a nationwide search, I applied, and it came down to myself and another candidate and they chose me to be the CEO. And that's kind of how I got here.

Although there has been a formal declaration of the pandemic’s end, masks, vaccines and social distancing continue to help reduce the number of people flooding doctors’ offices with COVID-19 infections. Given that, are there other challenges that stand out for you now? Mostly, what we're seeing now are the long-term repercussions of the pandemic: staffing issues, the “Great Resignation”, difficulties in hiring. All of that affects how we work. The pandemic made us more aware of the disparities in healthcare. That means now we’re making sure that our patients have access to care, making sure that we are identifying those patients who, pre-pandemic, may have been able to pay for their $35 medical appointment, but now they can't and making sure we still see those patients anyway.

The pandemic also ushered in what some consider a racial reckoning in healthcare, a call for the field to not only diversify but also to prioritize care that’s culturally competent. Are you navigating that with your staff, too? We’re navigating both of those things, even as an organization with a patient population that’s roughly 80% Spanish-speaking or from other countries. To do this type of work well, as we must do, it has to be done in a culturally competent way, even something like scheduling. 

How so? One time, I needed to cancel my patients on a Wednesday. I was supposed to go to a meeting in Richmond with a senator. I don't like to cancel my patients because our patients work hourly jobs, they don't have time off. So when they have an appointment, often they take the whole day off. I realized that the culture of many workplace environments is that if I say, ‘Oh, I have a meeting,’ then the next step is simply cancel the patient.

And I said to the staff, that is not what we want to have. Canceling a patient should be the very last thing we do. And when we do cancel them, we have to call every single one of those patients and say, 'Your provider is not here today. How can we make this right for you?' That means we find them an appointment. If they feel like they need to be seen that day, we find an appointment for them that day. If it's something that can wait, we can reschedule them to next week. But every single one of those patients that we talk to, we make sure they understand that they are our number one priority.

A lot of our staff, our mission-minded staff, they'll tell me, ‘Dr. Adkins, that was me. I remember we came to this country, and we didn't have anything. And we came to a place like a HealthWorks, and they took care of us.

How else are you factoring in cultural competency? Again, healthcare is not just health, it's everything. So when I talk to patients about very intimate things, there are culturally sensitive things that I can't tell them to do because, in their culture, they're not going to do that. One of the examples is long-acting reversible contraception. When we put an IUD in, or NEXPLANON, and they stop having periods, if we don't educate them appropriately, they will have it taken out, because they think not having a period means that all that blood is being accumulated. And where does it go? So you have to be able to really educate your patients.

And in the whole language thing, while we have translation services in every single language, sometimes patients feel it's just easier to go in there and try to get through an appointment without an interpreter. Well, that's not good. Your patient doesn't understand what you're saying, and that's not cool. So, we have to make sure that we have mission-driven staff who are as concerned with the patient getting the message as I am, and making sure they're not leaving that room until the patient understands everything they just went over with them. That's hard to find.

What’s next for HealthWorks? We’re opening two new sites. We have a Herndon dental site that we're building out right now, and it should be ready this February. And then we have a Sterling site that's co-located in the Loudon County building at Ridgetop Circle in Sterling, Virginia. We used to see patients there for mental health and substance abuse one day a week on Wednesdays. The county said, ‘What if we built you an office here and you could see patients five days a week?’ We said ‘Yes.’ So they're building an office for us down on the first floor now that's going to be our space. We'll have one provider there every day, and we'll be open five days a week.

I also really want to make sure that our staffing is in place so that we can be successful. It makes no sense to have a building if we have no one to staff it. But now, instead of just having staff, I want to find more mission-driven staff. I want to find bilingual, culturally competent staff. It makes the search harder, but it’s worth it to take that extra step to find these mission-driven and linguistically and culturally competent staff members.