Sara: Duane Reynolds, Welcome to the Growing as Grown-Ups podcast, I'm so excited to bring you on. You and I have known each other for more years than I like to say out loud. We go back to high school music department days, but now you have become somebody that I admire so much professionally. We have both relocated to Atlanta, which is a fun coincidence because we are many miles away from our hometown, but I just really want to learn more about the work that you do and how we can share that with our listeners in a way that will help them learn and grow themselves and so why don't you just start out by telling us - what do you do? What's the work that you do? Why do you do the work that you do?

Duane: Well, Sara, first of all, thank you so much for having me on, and I do have such fond memories of our times back in high school in show choir, and I was so happy when you reached out to me. So I see it as a distinct opportunity to reconnect with a friend and to talk a little bit about what I do. I have been in the healthcare administration space for over 25 years, and I've been in various aspects of the healthcare continuum, from organization development to running faculty practices to management, consulting, and association work. And throughout that process, I think I was finding my voice within healthcare administration, particularly being a minority and seeing and hearing some of the experiences of marginalized individuals going through healthcare, it gave me a unique perspective that I felt I then had a responsibility to try and contribute to a more just and equitable healthcare system and so the Just Health Collective is the name of my organization. We were founded in March of 2020, believe it or not.

Sara: Wow. Great time to start an organization.

Duane: Interesting time to start an organization. I had been working on the plans for it and I said to myself, "Well, this is either going to work or it's going to crash with the rest of the world, but I'm going to go ahead and launch and see where it goes," and you know, it has been an interesting conundrum because we've been extremely busy, which I am grateful, for but on the same token, the work that I do, I wish I didn't have to do, right? When COVID raised healthcare disparities to a national level and the public saw it for the first time, that ignited our work. When the murders of George Floyd and other Black Americans happened and the ensuing social unrest, that ignited our work and so we had this synergy that really set the company up to do what we were founded to do, which was to help create a more just, equitable, and fair healthcare system.

Sara: That's a big undertaking, Duane, and I love that you have taken it on. I'd love to hear more about what you were mentioning earlier about as you were doing the work in healthcare administration, you felt this responsibility to work towards these goals. What was it that really struck you in a way that said, "This is a big enough problem that I need to devote my life in my career and take this risk to start an organization," like, what were the things that really compelled you?

Duane: That's a great question, and I think there are quite a few things, but a few of the stories that stick out to me. I remember in my first operational position, I was speaking to a physician who had been in clinic and was rather irritated that particular day and he mentioned that he had a few patients come in that were clearly drug-seekers and it was the first time that I had even heard the term "drug-seeker", and so I began to sort of pay attention a little bit more to when concerns like that were brought to my attention and oftentimes what I noticed is that it was generally African-American people. I think what was happening was unconscious bias at play. And so it didn't sit well with me, but at that time, I didn't have my voice yet. Even though I was in a leadership position, being a minority in leadership in the organizations that I was in, I was oftentimes the only one and so as you're sitting at a table feeling a little bit out of place to begin with to then sort of challenge the status quo and challenge what people's intentions might be. It just wasn't the time. It took me years to sort of develop my voice, but it was, you know, experiences like that and another experience where I actually had the opportunity to develop a transgender primary care clinic and it was a really exciting endeavor with a physician who was very committed to the cause. We worked together to build out what the clinic looked like, how we staffed it, we met with a prominent member of the transgender community to inform us and we got it off the ground and we're super proud of it. I ended up leaving that organization, but the clinic was still in operation some years afterwards, and I followed back up with that physician to see how things were going, and the clinic was quite successful, and they were actually recruiting primary care patients from different states, which is pretty unheard of as most primary care physicians, you know, they're within probably a 10-mile radius and you certainly aren't traveling state-to-state to see primary care docs. But this clinic was so needed in this part of the country that it was drawing a lot of attention and the physician tried to go to administration and get financial resources to grow the practice - to recruit new providers - and was turned down and this is despite it being a profitable venture. The organization just wasn't ready and it was unfortunate because this community really needed that service, and so it was experiences like that in healthcare where I just saw things that weren't right and that compelled me to think differently. So, being a person of color in the healthcare system and a person who's part of the LGBTQ community, the experiences that I had going through my career were sometimes painful, and I don't regret going through the experiences because it made me a stronger individual. But I also felt as though I needed to do something different to make those who were coming behind me not have to experience what I experienced.

Sara: Are you talking about experiences for you as an administrator watching it or for you actually as a healthcare recipient?

Duane: Actually both. As an administrator watching it and as a leader sitting at the table feeling like I didn't belong. Like, I couldn't speak my voice, I couldn't always be my authentic self for fear of someone ostracizing me, for fear of, you know, people talking behind my back, whatever it was. There were times, there were moments in my career where it was very clear that I wasn't always in a psychologically safe environment.

Sara: Yeah.

Duane: And back then, you know, after growing up trying to figure out who you are, you may not always have the confidence to work against a system that is so strong. Fortunately, things have changed and I found my voice. I found my purpose in this work and so, you know, I focus on health equity, but I also focus on belonging because the thought process for organizations is that you have to get your own house in order first, and you really need to be thinking about how you create a space for your employees to show up as their authentic selves, to be able to do their best work, and to be committed to the organization. To create a space of equity and when you do that, you then are able to lean into the work around health equity because it takes that awareness and knowledge to even begin to look from the lens of health equity and develop different programs and services that are, you know, taking care of your community.

Sara: Wow. That's so powerful and this idea of doing work around belonging, I think it's such an important human psychological need. How do you go into an organization and convince them or inspire them that this is something that they should be spending time on?

Duane: You know, there are many different ways that we enter an organization but one of the key points is we enter and meet them where they are.

Sara: Yeah.

Duane: A lot of times organizations that are coming to us are looking for assistance. So there's some level of willingness to change but organizations and the people within those organizations may be at very different levels. I take the approach of meeting people where they are so that I can then have them come along on a journey towards some type of transformation and awareness. Some of that is related to talking about the business case. Why does this matter from a financial and strategic perspective for health care organizations? You know, payment structures at some juncture are going to change. The Center for Medicaid and Medicare Services - CMS - has said that health equity will be included in payment incentive programs by as early as 2023. Laws are changing in states where it's a requirement for unconscious bias training and anti-racism training for the healthcare workforce. So there is a business case to be made. But then, more importantly, there is a moral and human-centered case to be made and so we start to talk about that and usually what I do is try to meet someone where they can understand their own experience and translate that feeling that they may have had through a bad experience, an unfair-from-their-vantage-point experience and translate that to how another human being might feel in a similar circumstance and so if I can get them to understand that your pain, your hurt, that translates in different ways to different audiences, to different people, and I can build that bridge, then it gives me the opportunity to speak about, well, for instance, if you live in a rural healthcare environment -- the rural community, excuse me -- when I talk about diversity inclusion, it may not quite resonate, but I can talk about health equity from a rural perspective. I can talk about the fact that just living in a rural community, your life span is shorter than those of us who live in urban cities. I can talk about the fact that there aren't specialists or even primary care doctors in rural communities the way that there are in urban core centers, and that means that you have an inequitable experience and so you can resonate with that, right? So then I can go and talk about the person who may be an immigrant in a rural community and not only do they have the issues of physician shortage and lifespan, but now they may have other things such as language barriers, cultural barriers, differences in their cultural beliefs that may be in conflict to how we deliver Western medicine and so it helps people then understand that circumstances are similar, and if you believe that everyone deserves equity and fairness, then shouldn't we be doing something about this other thing as well, right? And usually from that standpoint, we can, again, go on the journey. There's a lot more education and sort of self-reflection that has to happen, but I try to meet people where they are and then go from that standpoint.

Sara: I mean, that's such a powerful approach. That's what we teach in leadership all the time that the way to have influence is you've got to meet people where they are in order to lead them where you want them to go and I love the idea -- I'm big on empathy, like that's one of -- people that listen to the podcast, I talk about it all the time -- but what you're talking about is not only you having empathy to understand and connect with your clients with where they are in their experiences, and then using that empathy you've created with them to help them gain empathy for the people that they're wanting to serve and I just -- I just think empathy, if there was just more of that in the world, if we could learn to really sit and understand each other and think about other people's experiences, I think it would serve us well in this journey to create more equity and understanding and kindness in the world. You focus on the healthcare space and our podcast listeners come from a broad range of organizations but I think all the principles you're talking about can be applied, whether you're working in corporate America or higher education or non-profit work, this idea of creating this impetus to create a place where people belong and consider "How do we make things fair and equal for those people who aren't starting at that point?" So can you tell us and, without having to go into depth of all the things that there are in this work, but what are some of the things that are most important for organizations and leaders to understand or to do as they are trying to grow in this area and create more equitable environments for their employees and their customers and their community?

Duane: I think one of the most important things that leaders can do, that organizations can do, is to elevate the voice of marginalized -- those who have been marginalized. Because if you can create an environment where the least among us, the ones who are under-resourced and underserved and marginalized, can feel that they have a place, that they have value, that they are heard, then you're raising the tide for all boats to rise. And so a lot of what we do is to help people understand the system that we operate in, which is a traditionally Eurocentric culture that was founded based off of racist philosophies and understanding that that still has impact on us today, and it goes beyond just racism, but other forms of discrimination. Helping people understand that perspective, it gives them the ability to think about what they need to do differently in their organizations to create a space where people feel like, again, they're psychologically safe. That they can speak up and challenge the status quo, that they can make mistakes without retaliation or retribution. You know, the work that I do, you know, I couch it in health equity and belonging and by "belonging", I mean the intersection of diversity, equity, and inclusion. But really, what this work is about is humanity and understanding that we all have a purpose in place in this world and if we can liberate ourselves from these confines, these structures that we have created that give us these very rigid boundaries and then we judge people off them, we're limiting the ability for people to truly shine as who they are, and if we can get rid of these oppressive systems and thoughts and allow people to be who they are like, our potential is limitless and the way that we can be connected to one another is strengthened. You know, you talk about empathy. Empathy is absolutely a value of this, and sometimes I couch it in terms of love. Do we have the capacity to love one another in our humanity in all its forms? And if we can create that capacity, what a wonderful world it would be.

Sara: I mean, Duane, right there is, like, can we just tell that to the entire world? How do I get that out of the Growing as Grown-Ups podcast into the world? I mean, it's -- it makes me emotional, "Oh, I wish that was the world we lived in," and I love that you've committed to this work and so I want to ask the key question for me that connected me to what you were doing and why I thought that you would be a great person to bring on our podcast is the type of growth that is needed for people to get to the place that you just described. It's not "I need to learn the rules of engagement and what are the specific things I can say and not say? What are the things I'm allowed to do and not do?" Right? That's like the bare minimum, but that is not going to get to this place where we have this new sense of connectedness and love and humanity, and so the work that we do is teaching people that it is only through leaning into challenges and specifically challenges that contradict our current understanding of the world that the lenses through which we view the world have to change, right? The way that I'm currently understanding the world needs to mature and become more complex or more sophisticated in this realm of equity and diversity and inclusion and creating these connections in what seems like a very fractured world requires us to change the lens through which we are making sense of the world, right? Does that vibe with the way that you see the work that you're doing is helping people see differently?

Duane: Oh, absolutely. It really is about unlearning, the conditioning that we have been taught -- explicitly and implicitly -- and realizing that maybe the world is a little bit different than what we were taught to believe and that we should step back and question some of the things, we should step back and try to look from the lens of someone who maybe is experiencing the oppressive nature of the system we created?

Sara: Yeah.

Duane: Absolutely, though it's imperative that people understand that you have to start to challenge your worldview. Part of the reason that this work is so difficult and complicated is because you create dissonance when you start to challenge the foundation of what someone sees as the nature of who they are and how they were raised, and so you're rocking people's worlds.

Sara: Exactly.

Duane: Yeah, and that's the only way that you'll move to the other side of this is if you're willing, to your point, to lean into that discomfort and try to learn something from a different vantage point.

Sara: Yeah, and for our listeners, we did a whole series at the end of 2021 that unpacked that idea and how, you know, you talk about for the people that reach out to you, they are at least somewhat ready to say, "Help me see differently," but for a lot of people, what the change that you're asking them to make is so big and so scary and threatening -- what some of our guests have referred to is people's "holding environments", the place where they have learned to live and grow and operate, that it's too much and I think about kind of my own journey and, you're right, the last couple of years have just brought so much to the surface and even, you know, just what's going on at the beginning of this year as we've looked at, you know, the anniversary of the Capitol riots and the conviction of the people who killed Ahmaud Arbery and all the stuff that's going on, I've been reminded of the stages of learning -- and I don't know if you're familiar with them but I'm sure you are, even if you've never talked about them in this way -- but people go from being unconsciously incompetent to consciously incompetent to consciously competent to unconsciously competent and I think as a white person, if you would have asked me 10 years ago about racial injustice and, you know, all this stuff. I'd be like, "I have black friends, I like black people," I would never say anything mean and I was unconsciously incompetent of the bigger issues going on in the world, right? And through choosing to lean in, I feel like I've at least moved to this consciously incompetent, right? Where it's like, "I know there's so much more going on in the world than I could possibly understand on my own," and so for people like me who want to learn and grow and figure out how to be advocates for the work that needs to be done, but I have a fear of well, I don't want to just always call my black friends or my gay friends or my Muslim friends and say, "Hey, teach me something," because that's putting a lot of responsibility on the people who always already have to carry so much weight. What are the things that we can do, as we're trying to learn and grow in this area that we can find these new lenses in these new mindsets, to see the world in a bigger way? How do you help people through this journey when they at least know they have work to do?

Duane: You bring up a very important point about not putting the burden of teaching about oppression and discrimination on the groups or individuals that have experienced that, because it can retraumatize them.

Sara: Yeah.

Duane: That's not to say that some of us don't want to take the opportunity to teach. I teach it, but I teach it for a living, right, and I teach it when I'm in a space that I'm comfortable with my friends, but it shouldn't be an obligation. So in the absence of that, I think number one, you have to go on a self-learning journey and that is reading books, watching movies, watching podcasts. Doing whatever you can to educate yourself and get a different perspective on what the system that we're operating in might be. One of the books that has gotten a lot of press is Cast. I think it's by Isabel Wilkerson and it's really about the systems of oppression that have existed, particularly in the United States, but comparing them to other countries and understanding what they do to the collective. There's another book, How to Be an Antiracist by Ibram X. Kendi that I think is very helpful for individuals. So there are all types of these resources that are out there. But I also don't think that it does take conversation, but the conversation should be among white people more often, right? Those of you that have come to a place of greater understanding should have conversations with those who may not be as far along, and understand that you're not going to change someone overnight, and understand that you may not change some people at all. It's not about them. It's about the people that we can impact and the people that want to go on the journey, and we hope that we tip the scales with those of us who see the world a little bit differently and want to create a space of liberation for everyone. But I think it is really imperative that white people come together to solve a problem that white people created, and we have to just accept it for what it is, right?

Sara: Yeah.

Duane: We're not going to get out of it unless white people are at the table helping to solve the collective issue.

Sara: Yeah. I think that's so true, and I think it's such an unsettling thought to so many people. So I would encourage our listeners to sit with this and think about it and talk to people. Duane, you've given so many good pieces of advice and wisdom. Is there one thing that you would say above all else, if you could give a word of advice or encouragement or challenge to our listeners, what would be the one thing you want them to hear?

Duane: Be patient with yourself as you go on this learning journey. Be empathetic with others. Give grace, and ultimately, think about the way that you want to be loved in the world and imagine if we could create a space for everyone to feel that same type of energy. Is that the world that we want, and if it is, then you have to go on a journey to get to the other side.

Sara: Man, I can't imagine people who try to follow your advice and don't see growth and benefit and joy come out of that. It’s going to be hard, but totally worth it.

Duane: It is, yeah. It is heart work, and oftentimes I also, as I am working with individuals, talk about "what is your why?" and, inevitably, the "why" always leads back to "I want a better place for my children -- a better world for my children," or "A better world for my grandchildren," and if that is truly what you want and you have the power to change that, what are you going to decide to do?

Sara: Yeah. People can't just sit by and want somebody else to do the change that they are hoping for, right? We all have to learn to take responsibility for what we can take responsibility for, fight for the things that need to be fought for, love the people who need to be loved, and just try. I love it so much, Duane. Let me ask you as we kind of wrap up, what is going on in your world that you are really excited about?

Duane: Well, there's so much. I think one of the really exciting engagements that we have going on is with a large healthcare system that is in the second phase of the journey with us. So we started with an assessment of the organization and now we're to a point of implementation. So, we're thinking about the change-management strategy. We're thinking about performance and quality improvement with the health equity lens. We're standing up governance and operating models so that it becomes embedded in the system. You know, we're creating incentives that will move people towards creating a different type of healthcare system. That, to me, is transformative work and it's challenging, very challenging, but when an organization and its leaders commit to doing that, that gives me such hope for what healthcare can be in the next iteration of the system itself.

Sara: Yeah, the fact that it's not just, "Let's just train our people to think and feel differently, but we're going to set up the systems that reinforce it and support it," I think is so powerful and so important and so needed in reinforcing all of this. So proud of the work that you're doing, Duane. Where can people find you, find more about the work that you're doing? How do people learn more?

Duane: Well, the easiest place to go is my website, which is justhealthcollective.com and I'm also on LinkedIn and Instagram, so you can certainly find me by searching my name, Duane Reynolds and, yeah. You can find me through those locations and then there are many other opportunities to get involved with Just Health Collective, whether it's working with us, being a part of our newsletter, being on the podcast -- through our Centering Health Equity podcast -- many, many different avenues that we can engage with different folks.

Sara: All right. We will, as usual, put all of those links and resources on our website so people can follow you and stay up with what you're doing. Duane, thank you for your time, thank you for your friendship, thank you for the work that you are doing. I just, I wish you all the best and I hope that you continue to make such a big difference in healthcare and in the lives of the people who are a part of the work that you're doing. So thank you so much for all of that.

Duane: Sara, thank you, and I appreciate the opportunity to be a part of this podcast and a friend of yours.