Across the nation, state agencies are focusing more intentionally on efforts to advance health equity and prioritizing strategies to address gaps in health outcomes and access. Agency staff are increasingly being charged with leading health equity efforts within and across their agencies. While tasked with leading these transformational change efforts, these leaders face unique challenges related to building coalitions, securing buy-in, and adeptly responding to resistance, all while having few national networks and professional development opportunities.

The Center for Health Care Strategies spoke to Quyen Huynh, DNP, FNP, ARNP, FAAN, a current Medicaid Pathways Program participant, health equity champion, and family nurse practitioner, to share her approach to leading health equity efforts across the Washington State Health Care Authority (HCA). Dr. Huynh is in her second year as the first Health Equity Director at HCA.

Q: What does addressing health equity mean in your current role in Washington State?

A: I provide strategic direction to move the needle on health equity through our policies, programs, and our services – requiring cross collaboration between all 18 divisions in our agency. Unfortunately, our country’s divisiveness on so many issues disproportionately impacts those who are already most vulnerable and disenfranchised. For example, Black and Indigenous populations continue to have some of the worst health outcomes, no matter how resilient they are as people. The system is stacked against them, so health equity is absolutely essential in today’s climate.

Q: How can becoming a more inclusive leader – one that values the diversity and lived experiences of staff and is open to multiple perspectives – support your health equity goals?

A: Studies repeatedly show that a diverse and inclusive workplace is better for morale and business. In health care agencies, like mine, we are responsible for the health and well-being of all people in our state. To fully understand and serve well, we need to have an inclusive and diverse staff and leadership who have lived experiences. We can more effectively advance health equity when we reflect the people we serve, whether this means race, religion, sex and gender identities, housing, or education status.

Q: Do you have examples of where you were able to enhance support and collaboration – internally and externally – for your agency’s health equity goals?

A: When I first started at HCA, I created an internal health equity policy. Part of that policy requires us to change the job descriptions for all 1,500 employees to reflect equity being a central part of our job. Policy alone isn’t enough without more guidance, so our equity team, composed of experts from various divisions in our agency, created an equity lens toolkit.

We also created a network of health equity liaisons from all 18 divisions at HCA. The health equity liaisons collaborate on several projects, including a brand-new inventory database and dashboard report that collects all the equity-related work in the agency. Staff can search this dashboard to find projects or programs of interest, and if others have done similar work in the past, they can connect with those teams and collaborate, preventing a waste of duplicative resources and time.

Externally, all five health and human services agencies (HHS) in our state collaborate on key areas, such as workforce, data equity, and community engagement. We connect on what our agencies are going through and learn best practices to bring back to individual agencies. Another example of HHS’s collaboration is the recently formed Sex and Gender Identity (SGI) Workgroup, which is making changes to systems and processes.

Q: How does resistance to equity show up in your work? How have you dealt with it? 

A: Everyone is on board with equity in principle, but there is resistance to change. The system was not built for equity and that makes this work draining for everyone. It’s draining for me – a person pushing it. It’s also draining for people who are receiving it and for those who are starting their equity journey. We’re being challenged to work in new ways, reframe our thinking, and release past assumptions. We can combat resistance through continued education, open-minded conversations, creative thinking, innovation, and resourcing our efforts appropriately so that we have the capacity to build out this work.

 Most recently, we hosted our first annual Health Equity Retreat where key leadership at HCA spent half a day training on human solidarity. We explored the common ground in all of us regardless of where we are in our equity journey. It allowed us a chance to share diverse perspectives, listen to understand, and reflect on the toxic groundwater that permeates our systems and culture. We then spent the second half of the day applying this new lens to address concrete work at HCA through creating a 3-year equity strategic plan. 

Q: Building resilience in equity work requires us to care for ourselves, too. How do you practice this?

A: First, we must take an extra moment to breathe, slow down, and recognize and validate everything our bodies and minds tell us. If we don’t, we’re going to fall into this cycle of exhaustion and eventually burn out.

Second, find your “cabinet.” I love my cabinet, which includes several people internally, and a whole lot of people externally. They are mostly experts, who are on the same difficult journey, or who may be a few steps ahead or “behind.” They are people I can trust and depend on to talk through difficult issues. For example, I have 30-minute monthly calls with the equity director from another state. We discuss the challenges of our work – and sometimes we just need to complain about the weather together!   

Third, find your passion and fill it. I’m a clinician. I’ve spent most of my career working with diverse immigrant and refugee populations, and I continue to see patients a couple times a month. I refill my cup by connecting with my patients and with the communities that we serve.

Fourth, and finally, find your roots. Find what grounds you. That’s my family. I am a Vietnamese political refugee. I come from the communities that we serve. I connect with my family, like snuggles in the morning with my children or dinner with my parents. They remind me to slow down and enjoy my cup of tea, which my husband and kids often make for me each morning.