Health Equity in the Pediatric ED with Dr. Cherrelle Smith
Growing up in a small, rural community one hour away from the nearest in-network physician, Cherrelle Smith, MD was aware from an early age of limitations on access to health care. She also grew up with a strong understanding of the importance of historically black colleges and universities (HBCUs) thanks to her parent’s teachings. Those two experiences converged at Meharry Medical College, an HBCU, where she continued to foster a passion for pediatrics and the ability to serve as an advocate for her patients and their families.
Now assistant medical director of the Stanford Pediatric Emergency Department (ED), Dr. Smith has focused her efforts on expanding access to care as well as mitigating the behaviors and microaggessions that can marginalize female and black physicians.
How did the experience of attending an HBCU for both undergraduate and medical school influence how you practice medicine?
In college and medical school, I went from being a minority to being in the majority and saw women and minorities in leadership positions and as professors, physicians, academic chairs, and deans. I was able to grow into the understanding that I don't have to be unsure of myself or my capabilities, because I look or sound different. And without the fear of bias or prejudices of others, I was able to truly focus on learning medicine.
Meharry was just a beautiful, nurturing environment that showed me what type of excellence I could achieve, and also bring back my community, to help other people who look like me. I think community service and giving back have always been important to the minority community and a focus for HBCUs. It’s something of a hot topic in medicine now and I feel part of my role is to make sure this isn’t just a fad. How do we move beyond conversation to facilitate care for the underserved? How can we make sure that our staff represents our patient population, and that our patients can see themselves in the people who take care of them?
How does inequity in access to health care shape your worldview?
As a minority, I felt I was aware of health inequity because of geography or lack of resources. But in medical school, I began to understand inequity caused by cultural differences where a doctor may not understand a patient’s needs, circumstances or communication nuances if they don't come from a similar background.
At Meharry, we were affiliated with the city hospital, but I also spent time at other academic institutions in Nashville and was able to see the contrast between patient care at one institution versus another, and inequities across the board when it comes to socio-economic status, racial-ethnic status, or location.
Tell us about your work at Stanford on health equity and microaggressions.
I’ve been focusing on equity for our low acuity visitors. These patients create a high volume and tend to have a longer length of stay resulting in lower patient satisfaction. One of the biggest things we can do is address language barriers. If we can improve access to interpreter services, either remotely by phone or iPad, or in person, we can make a difference in how we care for these patients. We have also strategically provided double attending coverage during high volume times, developed specific guidelines on MD and RN workflows, and utilized low acuity documentation aids, templates, and pathways to align nursing and patient access services to help reduce the length of stay for these patients.
Throughout my career as a young, black physician I’ve experienced a spectrum of micro- and macro-aggressions. As part of the department’s gender equity initiative, I’ve been involved in developing tools and resources to help my colleagues recognize microaggressions they experience or witness and address them in a way that moves us toward progress and a positive, supportive culture.
How did you develop your leadership style?
At Meharry, I served on the executive board of our student government in roles which involved budgeting, planning and working with university leaders. And as Miss School of Medicine, I was charged with coordinating community service for the School of Medicine by engaging with community partners and arranging different advocacy projects and outreach experiences. It was a great opportunity to build my skills in leadership, communication, and planning.
Now as an assistant medical director at Stanford’s Pediatric ED, I work with various hospital sections and leadership groups on process improvement and optimizing our workflows so we can provide the best care as efficiently as possible. I help to prioritize what's important for our group and where we need support as well as administrative duites. It's a steep learning curve, but it has been exciting and challenging to integrate how we practice in the Pediatric ED with the other players involved in care for our patients, including the admitting teams at Lucile Packard Children’s Hospital, other subspecialty services, and our essential ancillary staff at Stanford.
How does Stanford support you in achieving your goals?
It seems like whenever I have a question, I can be directed to someone who can get to the answer. Whenever I want to learn more, my department encourages my growth and even supports additional training. And it’s really refreshing to have those assets and that backing. The changes that can improve access to care for different populations might not be happening next month or even in the next six months, but my hope is that we'll be able to greatly improve the management of ALL of our patients. With Stanford being the innovative place that it is, I expect to glean from these resources and make that aspiration our reality.