DHA 733 Week 5 Leadership for Equity and Trust Example

Earning Back Trust: Leadership for Health Equity After a Community Forum in Rural Northeastern North Carolina

[Student Name]

University of Phoenix

DHA/733: Contemporary Leadership Issues

Week 5 Assignment

[Instructor Name]

[Date]

The health network, the forum, residents' comments, data and plans are composites written for a model paper; research findings come from the sources cited.

At a community forum in the region's largest county, residents spoke for two hours. A retired teacher described waiting four hours in the emergency department while white patients who arrived later were seen first. A young mother said a nurse assumed she used drugs. An older man said he would not go to the hospital because he did not want to be experimented on. Several said they drove an hour to another system rather than use their local hospital. The regional vice president left with pages of notes and a clear, painful message: many Black residents did not trust the hospitals. This paper examines why and what leaders must do.

The Region's Disparities

Data confirm what residents described. In the region, Black adults have higher rates of diabetes and high blood pressure than white adults, are more likely to be hospitalized for complications and less often name a regular primary care clinician. Black patients' emergency department waits were longer on average, and their patient experience scores were lower. Maternal complications were more common among Black mothers, a pattern seen across the state and the nation.

Historical Abuse and Mistrust

Mistrust has deep roots. Alsan and Wanamaker examined the effects of the 1972 public disclosure of the Tuskegee study, in which the US Public Health Service observed hundreds of Black men with syphilis without treating them, and found that disclosure was correlated with increases in medical mistrust and mortality and decreases in physician visits among older Black men; they estimated that life expectancy at age 45 for Black men fell by up to 1.5 years, about 35% of the 1980 gap between Black and white men (Alsan & Wanamaker, 2018).

What the Historical Evidence Means

The man at the forum who feared experimentation was not irrational. His fear reflects a documented history, and it has measurable consequences for health. Leaders who dismiss mistrust as misinformation misread both history and evidence. The region has its own history too: its oldest hospital kept separate wards for Black patients until the 1960s, and older residents remember being sent to a basement entrance. Those memories are passed down in families and churches, and they shape decisions about where to seek care today.

Bias in Clinical Judgment

Mistrust is also sustained by present experience. Hoffman and colleagues found that half of a sample of white medical students and residents agreed with at least one myth about how Black and white bodies differ, such as a belief that Black people have thicker skin, and that trainees holding such myths judged a Black patient to be in less pain and chose treatment less accurately (Hoffman et al., 2016). The teacher's wait and the mother's treatment are what historical mistrust looks like in the present.

Structural Causes

Individual bias is only part of the story. Bailey and colleagues describe structural racism as the ways societies foster racial discrimination through mutually reinforcing systems, including housing, education, employment, income, credit, criminal justice and health care, and review evidence linking it to health inequities, along with interventions such as place-based, multisector efforts (Bailey et al., 2017). In the region, decades of segregation and disinvestment shaped where people live, their incomes and their distance from care.

From Mistrust to Trustworthiness

Framing matters. Asking communities to trust institutions that have not earned it places the burden on those harmed. The leader's task is to make the institution trustworthy: honest about the past, competent and fair in the present and accountable for results. Trust follows trustworthy behavior over time; it cannot be requested, advertised or bought. The region should expect trust to return slowly, and only if residents see changes in how they are treated at the front desk, in triage and at the bedside.

What the Forum Taught Leaders

The forum revealed that leaders had been measuring the wrong things. Overall patient experience scores looked acceptable because they averaged across groups, hiding the gap. Complaints from Black patients were resolved one at a time without anyone looking for patterns. And no senior leader had attended a community meeting outside the hospital in years. Leaders were not seeing what residents saw every day.

Action One: Stratified Data

Every quality and experience measure, including waits, pain treatment, readmissions and patient experience, will be reported by race, ethnicity, language and county, reviewed monthly by leaders and shared with the board.

Action Two: Workforce and Training

The region will recruit from local communities through partnerships with historically Black colleges and community colleges, include community members on hiring panels for leadership roles and provide training on bias in clinical judgment, paired with practical changes such as standardized pain assessment protocols.

Action Three: Clinical Practices

Standardized triage audits, pain treatment protocols and review of any restraint or security call will reduce opportunities for bias to shape care. Maternal care will receive particular attention: every obstetric unit will use standard protocols for recognizing hemorrhage and high blood pressure, and patients' reports of symptoms will be documented and answered, since dismissing a patient's concerns is one of the most common complaints Black mothers describe.

Action Four: Access and Language

The region will extend evening clinic hours, add transportation for patients without cars and provide professional interpreters for Spanish-speaking patients rather than relying on family members. Several forum speakers said they avoided care because clinics closed before they finished work, a barrier that falls hardest on hourly workers.

Action Five: Community Partnership

A community advisory council, with members from churches, civic groups and neighborhoods, will review data, hear complaints and advise on priorities. Members will be paid, and the council will meet in community settings, such as churches and libraries, not the hospital boardroom.

Action Six: Acknowledgment

The network will acknowledge publicly the history of discrimination in medicine and in the region's own hospitals, including their segregated past, as a step toward accountability.

Resistance and Risks

Some staff may hear stratified data and bias training as accusations. Leaders will present the work as a quality problem the whole organization owns, share results openly and recognize units that close gaps. There is also a risk of symbolic action: a statement without changed practice would deepen mistrust. Every commitment will therefore have an owner, a date and a measure.

Accountability and Measures

Measures include disparities in wait times, pain treatment, readmissions, maternal outcomes and patient experience, the diversity of staff and leaders and community trust, measured through an annual survey. Results will be reported at a public forum each year, in the same community where residents first spoke, so they can see whether their words changed anything.

Conclusion

The residents' stories reflect real disparities, a documented history of abuse, persistent bias in clinical judgment and structural inequities. Evidence shows mistrust has measurable health consequences. Leaders must make their institutions trustworthy through stratified data, workforce change, clinical safeguards, community partnership, acknowledgment and public accountability.

References

Alsan, M., & Wanamaker, M. (2018). Tuskegee and the health of Black men. The Quarterly Journal of Economics, 133(1), 407-455. https://doi.org/10.1093/qje/qjx029

Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: Evidence and interventions. The Lancet, 389(10077), 1453-1463. https://doi.org/10.1016/S0140-6736(17)30569-X

Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences, 113(16), 4296-4301. https://doi.org/10.1073/pnas.1516047113