Dr Tonicia Freeman-Foster of LEIDOSWEL On 5 Things We Must Do To Improve Patient Outcomes for Underrepresented Populations
Examine Your Mindset. Healthcare providers must start with the person in the mirror. Asking themselves questions and answering honestly. What do you believe about your patients from historically marginalized and underrepresented populations? What do you believe about their ability to achieve premier wellness? What do you believe about your role and partnership with the patient as the first expert and participant in their healthcare? What actions and commitments are you willing to take? Each of us has a suitcase that we carry throughout our lives. It contains perspectives we inherited from loved ones, information obtained through our experiences, religion, social networks, and the experiences of others. Our suitcases become the lens through which we filter our interactions and experiences with others, for the good and the bad, if the information in our suitcase is faulty or incomplete. It is important that we take time to inspect and unpack our suitcases continuously.
Healthcare disparities continue to affect underrepresented populations, leading to unequal patient outcomes. Social, economic, and cultural barriers often hinder access to care, appropriate treatments, and equitable health services. How can we bridge these gaps and ensure that all patients, regardless of background, receive the highest standard of care? In this interview series, we are talking to healthcare providers, policy makers, community leaders, researchers, and anyone who is an authority about “How We Can Improve Patient Outcomes for Underrepresented Populations”. As a part of this series, I had the pleasure of interviewing Dr. Tonicia Freeman-Foster.
Dr. Tonicia Freeman-Foster is the CEO and Co-founder of LEIDOSWEL, a healthcare and human services consulting firm specializing in leadership development and organizational culture. With over 20 years of experience, Dr. Freeman-Foster empowers organizations and leaders nationwide to enhance their skills and amplify their impact to ignite positive change that transforms their organization and the lives of their team members, clients, communities, and ultimately the world.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?
This is a topic that is near and dear to my heart. I have done a significant amount of research and work on this topic throughout my career in HIV, mental health, substance use, and wellness. I understood early in my career the power that leaders had on staff and patient/client belonging. One story that still resonates with me to this day is one where I promised a client that I would call her back to follow up on the status of her request by the end of the day. I did not have the opportunity to work on her request, but I still contacted her to let her know I had not forgotten about her. She began crying and stated that most people would not have called her back. This situation led me to understand the power that my work, words, and actions have on the lives of clients, especially those who have been historically marginalized and mistreated.
My passion is to support and walk alongside leaders as they navigate how they show up in the workplace, lead others, and cultivate a culture of thriving. Being a leader is highly rewarding, but it can also be a scary and lonely role. Leaders make deposits and withdrawals in the lives of others, but the goal is to make more deposits than withdrawals. This requires coaching, mentoring, strategic partnership, and a space where leaders can be vulnerable, ask questions, receive constructive feedback, and be celebrated. There have been times throughout my career when this was missing, and I longed for these spaces and opportunities. Instead of dreaming about it, I decided to take action and create it. Our mission at LEIDOSWEL is to ensure leaders have the support they deserve and need to learn well, lead well, and live well.
Can you share the most interesting story that happened to you since you began your career?
Being diagnosed with cancer. I am a cancer warrior who has experienced medical providers, facilities, and treatment modalities. I feel blessed to have had a great experience with my medical team and work alongside them to improve my health outcomes, survival, and recovery. I know my experience is not everyone’s experience, but it should be. My experience gave me hope that premier healthcare is possible. Patients should feel seen, heard, believed, and understood. These elements provide a sense of relief for patients, which is healing within itself. My journey with cancer taught me the importance of proactive self-care and quickly exiting situations and workplaces that are toxic. Readers can learn more about my story in my book, Navigating Rough S.E.A.S. — Soul Eroding Assimilation-forcing Systems: A Playbook for Navigating Workplace Trauma and Reclaiming Power, Wellness, and Joy.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
Breath= Life = Opportunity. An opportunity to do better and be better humans. Leaders and humans, in general, are often put in boxes. Sometimes, we place ourselves in boxes and convince ourselves that we are too young, too old, or too set in our ways to change. Each of these mindsets is furthest from the truth. We don’t have to be who we were last year, yesterday, or even a few minutes ago. We have the power, and I believe a duty, to evolve into the best version of ourselves continuously. This inspires me to become UNstuck daily, strive toward the best version of myself, and constantly evolve.
How would you define an “excellent healthcare provider”?
Based on my personal experiences, I would define an excellent healthcare provider who takes pride in their patients’ health, strongly desires to see them well, and takes actions that align with this mindset. A provider who fosters a caring and compassionate partnership with their patients. One based on asking curious questions and listening intently to understand what it must be like to navigate the world in your shoes with this condition or disease and not judge because they know, as the patient, you are the first expert on your body. Based on my experiences and research, the biggest theme for patients was being seen as a human being, beyond their diagnosis. The second was a provider who treats them, speaks through a lens of hope, and believes their patients can and will get better. Lastly, I believe spirituality plays a huge role in being an excellent healthcare provider because it holds the provider accountable to a higher power and to serving others well for reasons beyond themselves.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
One of the primary things that inspires me to be a better healthcare leader is my relationship with God. I am clear on the fact that I was placed on this Earth as a vessel for a purpose that is bigger than myself. This holds me accountable for learning, growing, evolving, and striving to prioritize my self-care in the process. My spirituality and faith are my compass, and they help to keep me grounded and my joy intact, even when the journey becomes overwhelming or uncertain.
The second is being in communities with great people. Every leader needs great and supportive communities. I specifically use the word communities because communities are unique in the types and level of support they provide, so leaders need multiple communities. I immerse myself in several communities, and each of them enriches my life in different ways. I am engaged in a community for business owners, a book club community to enhance my learning, a Zumba community for wellness, and a community specifically for Black women leaders where I can show up fully and unapologetically as my authentic self. I am a better human being and leader because of my communities.
Are you working on any exciting new projects now? How do you think that will help people?
Yes, I recently wrote a bestselling book, Navigating Rough S.E.A.S. — A Playbook for Reclaiming Power, Wellness, and Joy. It details my workplace experiences as a Black woman leader and provides lessons learned and strategies that center on the needs of Black women leaders. Conversations and coaching, in addition to quantitative data, confirmed the importance and need for support for leaders to thrive, especially Black women leaders. Ironically, Black women are often isolated, marginalized, and mistreated in the workplace, even when they work in industries whose missions are to take care of people and promote wellness.
As a result, I decided to curate authentic and psychologically safe spaces for Black women leaders who work in healthcare and human services industries to learn, grow, and thrive in a community with women who see, hear, and believe them and celebrate their authenticity.
I also made the decision to work with organizational leaders to enhance their leadership skills so they can promote thriving among their staff, clients/patients, and communities. Through our consulting and coaching experiences, LEIDOSWEL focuses on leadership development and organizational culture. We pride ourselves on not taking the quick and topical route or facilitating touch-and-go assessments. Instead, we work with organizational leaders to dig to the roots of the challenges to identify actions and viable strategies for long-term success and thriving.
Ok, thank you for that. Let’s now jump to the main focus of our interview. What are the primary barriers that underrepresented populations face when seeking healthcare?
Barrier to accessible and affordable premier healthcare services. Feeling disrespected, unseen, unheard, undervalued, not believed, and misunderstood by their medical providers and personnel. These things exacerbate the patient’s feelings of overwhelm, anxiety, and distrust and ultimately contribute to poor health outcomes because people wait until they get very ill before seeking care.
How can healthcare providers build trust with patients from diverse backgrounds, especially in communities that have historically experienced medical neglect or discrimination?
First, I believe the focus should be placed on being a trustworthy provider and becoming a provider that patients desire to trust. This starts with the provider and how they show up with their biases, beliefs, experiences, prejudices, and the stories they tell themselves about their patients from diverse backgrounds. These things manifest in how people are treated (or not) and the quality of care they receive.
Next, healthcare providers must immerse themselves in learning the historical and present-day atrocities experienced by their patients directly, vicariously, and intergenerationally. Healthcare providers must be intentional in creating opportunities for patient feedback, listen intently to identify the ways they may be contributing to neglect and discrimination, and take positive action swiftly. These things, along with time, will aid providers in building trustworthiness.
What role does cultural competence play in improving patient outcomes, and how can medical professionals be better trained to meet the needs of underrepresented groups?
Cultural competence is only a fraction of what is needed to improve patient outcomes. Cultural competence frequently appears as a checklist of actions or a series of trainings that providers complete to receive a certificate and CEUs. On its own, cultural competence will not improve patient outcomes. Cultural humility is essential. Cultural humility involves transformation, lifelong learning, addressing power dynamics, and taking action on inequities. Cultural humility results in evolution and a change in mindset. Cultural humility is who individuals become or what they do differently as a result of their training and development.
Can you share any successful strategies or programs that have been implemented to reduce health disparities and improve outcomes for underserved communities?
First, diversity attracts diversity. In my experience, diverse peer support staff have always been conduits for engaging diverse clients and patients in healthcare services. Individuals with lived experience can speak authentically based on their experiences and lessons learned. They are extremely resourceful and can build trust and rapport with clients fairly quickly and engage them in healthcare services. They give patients and their loved ones hope.
Second, accountability and consequences are necessary incentives to promote healthcare services that improve outcomes for underserved individuals and communities. Funders must be diligent about flagging healthcare providers who continuously demonstrate poor access and treatment outcomes among underserved populations. On the other hand, funders must also be diligent in adequately funding healthcare providers who are making great impacts and demonstrating improved outcomes, but are underfunded.
Third, healthcare providers must engage their front desk staff in cultural competence and cultural humility training. These individuals are the front door of the organization. They facilitate the first interaction with patients, and many times, they are the last to receive ample training and continuing education opportunities. Front desk staff can create a positive and engaging patient experience or a negative and traumatizing experience. Front desk staff are valuable members of the team.
How can technology and telemedicine be leveraged to reach underrepresented populations who may face geographic or financial barriers to traditional healthcare services?
Increasing access to telehealth services for preventive care and treatment services through expanding mobile health and neighborhood health services can support individuals experiencing geographic barriers to healthcare services. Free and income-based, high-quality healthcare services can support individuals experiencing financial barriers to healthcare services.
As a “healthcare insider”, if you had the power to make a change, can you share 5 changes that need to be made to improve patient outcomes for underrepresented populations?
1 . Examine Your Mindset. Healthcare providers must start with the person in the mirror. Asking themselves questions and answering honestly. What do you believe about your patients from historically marginalized and underrepresented populations? What do you believe about their ability to achieve premier wellness? What do you believe about your role and partnership with the patient as the first expert and participant in their healthcare? What actions and commitments are you willing to take? Each of us has a suitcase that we carry throughout our lives. It contains perspectives we inherited from loved ones, information obtained through our experiences, religion, social networks, and the experiences of others. Our suitcases become the lens through which we filter our interactions and experiences with others, for the good and the bad, if the information in our suitcase is faulty or incomplete. It is important that we take time to inspect and unpack our suitcases continuously.
2 . Measure What Matters and Evaluate It. Healthcare providers must look at their data and ask curious questions. Critical questions are: Where are we currently with patient outcomes? Where would we like to be with individual underrepresented populations and collectively? How do we plan to get there? If each healthcare provider reviewed their data and took positive actions, it would create a ripple effect that would significantly reduce and eliminate healthcare disparities. Words without action are just words. Improved patient outcomes must be prioritized, adequately funded, and effective action steps must be developed alongside the individuals and communities most impacted.
3 . Healthcare providers must model the way by treating their first customers exceptionally well. The first customer is employees. Patients often connect and engage better with individuals who look like them and understand their cultural experiences. Data demonstrates a significant correlation between the race and ethnicity of the provider staff and the race and ethnicity of those electing to receive services. The healthcare disparities among underrepresented populations mirror the disparities in the healthcare workforce. This means there’s a great chance that disparities in patient outcomes are connected to disparities in diversity in decision-making roles within the organization.
4 . Peer support staff are critical to engaging with patients. Providers should hire and equitably pay diverse members from their communities and employ them at various organizational levels.
5 . We must remove racism and oppression from our healthcare system. There are no workarounds or exceptions. The data demonstrates healthcare disparities for persons based on race, gender, religion, and culture. A deeper dive is necessary to identify effective strategies for working with diverse populations. This is most effective when listening sessions and focus groups are facilitated with individuals receiving services and community members. Healthcare leaders must look at the data to identify the providers and personnel who are presenting challenges and take swift action.
What specific steps can be taken to ensure that medical research and clinical trials are more inclusive of underrepresented groups, and why is this important for improving overall patient outcomes
Trustworthiness is critical. People often focus on trust, which gives a pass to those making decisions and places the responsibility on those with the least power in the relationship. Which is often those who have been historically marginalized and oppressed. When patients are not treated well, the first thing they desire is to get their urgent needs met as quickly as possible and leave. The last thing they desire is to stay longer than necessary for anything, including medical research and clinical trials. Healthcare providers must prioritize being trustworthy in their actions, decisions, and words. Only then can we look at more inclusive medical research and clinical trials.
Additionally, healthcare providers should thoroughly explain the purpose, benefits, and any known adverse side effects of their medical research and clinical trials using language that is easy for elementary school students to understand. Most patients are not fluent in medical jargon, creating barriers to engagement. The process for medical research and clinical trials should provide clear pathways for asking questions and be transparent about the utilization of human specimens and the dissemination of medical data. There should also be diverse opt-in cohorts where participants can connect and converse with other participants who look like them throughout the process. Adequate compensation to individuals for their participation, expertise, time, and transportation is also extremely important.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
My movement would focus on addressing barriers at the roots and cultivating organizational cultures where staff, clients, patients, and community members thrive. Many people focus on leadership development, which is awesome. However, addressing organizational culture and the root causes of challenges is critical. Otherwise, we will continue to plant good seeds in poor soil and tap our shoes together in anticipation of beautiful and thriving flowers. We will continue to see the status quo: distrust for healthcare providers, healthcare disparities, unnecessary suffering, and premature deaths. Patients should see, feel, and experience their provider’s vision and mission statements when they interface with the organization, virtually or in person. What do premier healthcare and equitable outcomes for underserved communities look like, sound like, and feel like? How do patients know it’s present when interacting with your organization?
How can our readers further follow your work online?
I would love to connect with the readers! The best way for readers to follow my work is by signing up for our newsletter: https://www.leidoswel.com/join-our-community.
Readers can connect with me on LinkedIn: https://www.linkedin.com/in/toniciaff
I am also offering a special gift for readers who are interested in learning more about our programs and services to book a free 20-minute strategy consultation with me: https://www.leidoswel.com/contact-us
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.
Dr Tonicia Freeman-Foster of LEIDOSWEL On 5 Things We Must Do To Improve Patient Outcomes for… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.