2. AMAT FALL MEETINGS AJ Johnson, CPTC Senior Organ Recovery Coordinator Sierra Donor Services THE PDSA ENGAGE AND CHANGE: A MULTI-DISCIPLINARY PROCESS MODEL TO SERVE AFRICAN AMERICAN FAMILIES

3. N EED A CKNOWLEDGED But Not Addressed THE WHY MULTIDISCIPLINED PROGRAM APPROACH

4. THE WHY: NEED ACKNOWLEDGED, BUT NOT ADDRESSED “ I know the benefits minority role models and mentors bring in helping a health-care workforce to flourish. From them I learned how to ease the burden of the inequities and disparities that my patients from racial/ethnic population groups suffer unjustifiably. Diversity and inclusion should be the foundations for our interactions with each other, our patients and our communities, as well as for our research and education programs.” David Acosta, M.D., FAAFP Associate Vice Chancellor, Diversity and Inclusion University of California Davis Health System Sr. Associate Dean for Equity, Diversity & Inclusion Health Sciences Clinical Professor UC Davis School of Medicine

5. THE WHY: NEED ACKNOWLEDGED, BUT NOT ADDRESSED Approximately 134,430 men, women, and children are awaiting transplant in the U.S. 108,667 are awaiting a Kidney Transplant 37,229 African Americans are awaiting a Kidney Transplant U.S. Department of Health and Human Services, HRSA, Organ Procurement and Transplantation Network, August 2014 Registrations.

6. THE WHY: NEED ACKNOWLEDGED, BUT NOT ADDRESSED

7. THE WHY 2013 NATIONAL DECEASED DONORS RATES BY RACE

8. THE WHY 2013 DECEASED DONOR RATES BY RACE IN CALIFORNIA

9. THE WHY SIERRA DONOR SERVICES (SDS) DSA POPULATION BY RACE

10. In 2010, Sierra Donor Services (SDS) African-American consent rates were 23%. In 2011 the following year showed increased gains, but still were only 40%. THE WHY AFRICAN AMERICAN CONSENT RATES IN SIERRA DONOR SERVICES (SDS) DSA

11. On June, 2 nd 2013, a prominent African-American Minister in our DSA chided us for what he felt was an egregious expectation of a family on the heels of learning the worst news of their lives. “Ideally, a person should not hear about nor discuss donation for the first time at the deathbed of their loved one. This discussion should take place NOT where a person DIES, but where they LIVE…!” THE BEGINNING: CALL TO ACTION A CCEPTED The Case That Started It ALL

12. THE BEGINNING: CALL TO ACTION A CCEPTED “…People LIVE In Communities…” “…This Is Where Your Message Should Be Heard First!”

13. THE BEGINNING: LISTEN TO THE NEEDS OF THE COMMUNITY It was CLEAR something NEEDED to done! But what exactly?! Before we took ACTION to respond to the assumed NEEDS, we first went to the community and LISTENED! What we HEARD was WHAT the NEEDS were and HOW the community wanted these NEEDS addressed!!! And then - - -! WE took ACTION!

14. P lan D o S tudy A ct A M ulti- D isciplinary A pproach COMPLEX PROBLEM? SIMPLE SOLUTION!

15. COMPLEX PROBLEM SIMPLE SOLUTIONS

16. BUILDING THE FRAMEWORK AND THE TEAM In order to support the GOALS of this initiative, a TEAM of ONE CLINICIAN and ONE OUTREACH coordinator was created with the support of SDS local and corporate leadership, with myself in the role as the CLINICIAN carrying the BULK of the WORKLOAD. The PDSA cycle officially began on October 19, 2013 with the COMMUNITY OUTREACH PIECE and the CLINICAL PIECE began December 17, 2013 and came to a close on August 26, 2014. The PDSA Team was co-chaired by two team leads (one CLINICIAN and one COMMUNITY OUTREACH COORDINATOR from SDS). These leads were essential in helping to maintain momentum and move the project forward and in ensuring the EFFORT remained on task. The leads also met with the Executive Director and the Leadership of the SDS once a week to report on the progress of the project.

17. PLAN DO STUDY ACT: KEEP IT SIMPLE! A TWO PART STRATEGY Community Outreach and Engagement/Establish Brand Recognition and Brand Trust Clinical Response/Consent and Approach

18. Sierra Donor Services (SDS) otherwise known as the DONOR BRAND was either alien or unknown at best, and vehemently despised at worst by the targeted community. From October 2013 to August 2014, the PDSA reached over ONE HUNDRED THOUSAND people in over NINETY community events!!! Engaging, Dialoguing, and Registering HUNDREDS of NEW registrants! From the PDSA the FEARLESS MESSAGING MODEL of community engagement was created! COMMUNITY OUTREACH AND ENGAGEMENT/ESTABLISH BRAND RECOGNITION AND BRAND TRUST Banana Festival 15000 Reached!

19. African American Ambassadors who were NOT previously engaged or utilized by SDS were recruited and TRAINED to tell there stories to the community- - - FEARLESSLY!!! Outreach to the African American Community ALWAYS included a DONOR FAMILY MEMBER, A RECIPIENT, A CLINICIAN, and A COMMUNITY OUTREACH COORDINATOR! This was done to address REAL PROCESS concerns in REAL TIME by the community from someone who had an GREAT EXPERIENCE with the DONOR BRAND and a PERCIEVED SUBJECT MATTER EXPERT! Teams with the COURAGE and PASSION to TACKLE any subject matter! Even RELIGION! COMMUNITY OUTREACH AND ENGAGEMENT/ESTABLISH BRAND RECOGNITION AND BRAND TRUST FEARLESS MESSAGING!!! Grant Union High School 3000 reached!

20. No SUBJECT or PLACE is out of BOUND for ENGAGEMENT of the COMMUNITY! Including Funerals, Homegoing Celebrations, and Memorials! Since the PDSA began, I have been invited to four Funerals and Homegoings, and managed to REGISTER fifteen people at one Funeral. These OPPORTUNITIES have played a MAJOR part in OUR BRAND RECOGNITION in the community! COMMUNITY OUTREACH AND ENGAGEMENT/ESTABLISH BRAND RECOGNITION AND BRAND TRUST FEARLESS MESSAGING Homegoing Celebration!

21. Partnered the DONOR BRAND with BRANDS the targeted community trust, such as Churches, and other organizations with long standing historical tactile involvement in the community with proven service resulting in community trust. Received invitations and endorsements from organizations at their sponsored functions. Organizations such as the National Council of Negro Women, NAACP, ACTS, and many, many others. COMMUNITY OUTREACH AND ENGAGEMENT/ESTABLISH BRAND RECOGNITION AND BRAND TRUST FEARLESS MESSAGING Sacramento Valley Section of NCNW Christian Woman of the Year Gala! Reached Over 30 AA Churches!

22. Cultivated relationships with COMMUNITY PARTNERS to GROW a VESTED INTEREST from within. Even if that means FIVE MILES OF STREET CLEAN UP IN THE HOT CALIFORNIA SUN!!! COMMUNITY OUTREACH AND ENGAGEMENT/ESTABLISH BRAND RECOGNITION AND BRAND TRUST FEARLESS MESSAGING CXD Foundation Clean Up!!!

23. JUST A FEW PARTNERS AND CONNECTIONS California Medical Association NAACP Sacramento Valley Section of the National Council of Negro Women Sac Hub William Jessup University ACTS City Pastors.net Northern California Clergy Association UC Davis Medical Center Calvary Christian Center-45,000 members Center of Praise Molina Healthcare Arthur A. Benjamin Health Profession High School City of Elk Grove, Multi-Cultural Outreach CXD Foundation Sisters Of Nia

24. CLINICAL RESPONSE/CONSENT AND APPROACH The CLINICAL PIECE of the PDSA began December 17, 2013 and ran CONCURRENTLY with the WORKLOAD of the COMMUNITY OUTREACH PIECE and the RESPONSIBILITY of maintaining the DUTIES of an “ADJUSTED” call schedule! The strategy of LIKE REQUESTOR was adopted for this EFFORT, but was RIGHT REQUESTOR was also A BIG PART of it’s SUCCESS! FEARLESS MESSAGING in the confounds of the “ROOM!” The Consenter places no topic or subject OUT OF BOUNDS in this DISCUSSION of DONATION unless the consenting party does so. In other words, no assumptions are made about the limits of the discussion. It’s a matter of being “PRESENT and HUMBLE!”

25. Referral Data collected and maintained by one source. Discussions in real time with potential donor families- Experiences, Testimonials, providing REAL and usable information for FUTURE engagements. CLINICAL RESPONSE/CONSENT AND APPROACH Referral Followed By One PersonPDSA ONLINE INTAKE FORM

26. CLINICAL RESPONSE/CONSENT AND APPROACH RESULTS

27. CLINICAL RESPONSE/CONSENT AND APPROACH RESULTS!!!

28. The African American PDSA has demonstrated that customization of the message to the targeted community in concert with the appropriate message and messengers can not only increase the BRAND EXPERIENCE of the community, but most importantly that of the DONOR FAMILY in Real Time. This Approach/Consent Protocol has demonstrated the Like Requestor, Right Requestor aligned with FEARLESS MESSENGING techniques are EFFECTIVE and should be considered for those DSA’s with large disenfranchised communities of color.

29. CLINICAL RESPONSE/CONSENT AND APPROACH RESULTS!!! Results far exceeded expectations, and the ONGOING partnerships and outcomes continue to be sustained due to the focused effort of PDSA staff despite the formal cessation of action. Education and communication (formal and informal) along with the cultivation and development of EXTERNAL PARTNERS and ongoing engagement that have helped to “solidify" the improvements made by the PDSA in this transition period. In addition to the overwhelming GOOD WILL that our BRAND now enjoys in this community there have been collateral benefits that contribute to the continued success and sustainability of this EFFORT!

30. LESSONS LEARNED: A FEW THINGS TO CONSIDER Reflecting on this partnership, there are a number of lessons learned that others may find helpful when considering such an initiative. Developed clear and concise goals and constantly evaluate their efficacy. Spending time cultivate, and understand each individual’s and organization's perspective, culture and values, to promote the sharing of a common vision and commitment to follow-through to save lives through organ and tissue donation. Using the PDSA model for improvement as a framework for developing, testing, learning and refining processes as it relates to present and future engagement of communities of color. Focusing on process issues as well as tasks to enhance inter-professional collaboration.

31. Always keeping the NEEDS of THOSE WE SERVE and their families at the forefront of what we do. Engaging organizational and senior leadership support to help reduce barriers and obstacles that may occur. Focusing on strategies to facilitate the spread and sustainability of this EFFORT. LESSONS LEARNED: A FEW THINGS TO CONSIDER

32. Let’s create a Consortium of Leaders across the nation to replicate and build on what we have started. Reshape it or remodel it FIT the NEEDS of your COMMUNITY! HELP is HERE! And that HELP is YOU!!! LASTLY: A RENEWED CHALLENGE Let’s Talk About It!!!

33. REFERENCES Racial Microaggressions in Everyday Life, Implications for Clinical Practice May–June 2007 ● American Psychologist 271 Copyright 2007 by the American Psychological Association 0003-066X/07/Vol. 62, No. 4, 271–286 DOI: 10.1037/0003-066X.62.4.271 Clinicians’ Implicit Ethnic/Racial Bias and Perceptions of Care Among Black and Latino Patients ANNALS OF FAMILY MEDICINE ✦ WWW.ANNFAMMED.ORG ✦ VOL. 11, NO. 1 ✦ JANUARY/FEBRUARY 2013 The State of Research on Racial/Ethnic Discrimination in The Receipt of Health Care May 2012, Vol 102, No. 5 | American Journal of Public Health Shavers et al. | Peer Reviewed | Framing Health Matters

34. THANK YOU JESUS!