Expert: Work Toward Health Equity, Inclusion Isn't Done Until ‘Every Patient Has Access to the Best Cancer Therapy Possible’

Pharmacy Times® interviewed Kamakshi Rao, PharmD, BCOP, FASHP, chair of the Diversity, Equity and Inclusion (DEI) Committee at the Hematology/Oncology Pharmacy Association (HOPA) and director of the Academic Enterprises and Residency Programs at the University of North Carolina Medical Center in Chapel Hill, NC, and Eric Chow, PharmD, BCOP, MPH, vice chair of the DEI Committee at HOPA and senior medical science liaison at Servier Pharmaceuticals, on some of the accomplishments of HOPA’s DEI Committee in 2022 and its plans for the future.

Pharmacy Times®: What is the goal of HOPA’s Diversity, Equity and Inclusion (DEI) Committee, and when was it established?

Kamakshi Rao: So the HOPA DEI committee—this is actually its inaugural year as a committee—we were initially charged as a taskforce last year, and it really came out of HOPA conducting a survey of its membership and doing an assessment of where the organization stood—not where it stood, but probably more how successful it has been and what members saw as opportunities for HOPA to advance its work in the space of diversity, equity, and inclusion.

It was also the central pillar of the HOPA past president Larry Buie’s tenure, as president, he was really focused on diversity, equity and inclusion. So it was under his leadership that the initial taskforce was charged. It really was aimed at addressing a few different opportunities that I think exist for HOPA as an organization and for HOPA membership.

As an organization, I think the opportunity existed for HOPA to take a central role in equipping oncology pharmacists across the country with educational resources around awareness and opportunities to build health equity and inclusion from a care perspective.

Within the organization itself, there was feedback from membership on opportunities that existed to diversify membership, to increase our capture and our recruitment of people out of pharmacy school into the oncology pharmacy profession, and how to diversify our membership and the leadership of the organization as well.

So the taskforce, initially, and now the committee, is really charged with those 2-pronged aims, one at helping us as an organization grow in terms of our own representative diversity, but also in equipping our membership to practice in a way that embraces equity and inclusion as part of our core tenets of practice.

Eric Chow: Yeah, and I would echo everything that come out yesterday, and just maybe add on a little bit of sort of the historical context too. I think the taskforce was, I think, initially founded in the summer of 2020. And it was really the height of a lot of what was going on that the country was reckoning with in terms of racial inequality, diversity, equity, and inclusion, especially with the George Floyd and some other historical events, that I think really the timing, I think, coincided with what was going on within the organization. I think that's something that really impacted health care, and it's something that we can't ignore anymore. I think there's direct impacts there that we wanted to take a kind of a leadership role within the health care community, along with our other colleagues within the health care community, to really tackle these issues.

Pharmacy Times®: How does the work of HOPA’s DEI Committee and HOPA’s DEI Taskforce coordinate and/or intersect with one another?

Kamakshi Rao: The taskforce was established to sort of be the proof of concept, sort of to take that initial step and say, what opportunity exists here, how could HOPA membership come together and propose steps forward. So the taskforce fell outside of the normal committee and council structure of HOPA. But I think based on the success of the taskforce, based on all the opportunities that were identified by the taskforce, which both Eric and I had the pleasure of serving as members of that taskforce, because of the success of that taskforce, it was converted into an official standing committee within HOPA. And that's with a goal that this needs to be something that will not be addressed in one cycle or in a year or 2, but rather, is something that the organization needs to have consistent, long-term presence and commitment to across its entire structure in order to be successful.

Pharmacy Times®: What has been accomplished around DEI initiatives this past year by teams such as HOPA’s DEI Committee and DEI Taskforce?

Eric Chow: The major accomplishment that really came out of the taskforce besides taking the survey from the membership and really coming out with specific recommendations from that was the generation in the establishment and approval of the DEI statement. I think that was really the North Star for us to really guide future endeavors, whether it be at the committee level for other committees, or whether it be at the committee level within the DEI committee to really guide our activities. And so I think that was really important for us to get alignment, get a board approval, and roll that out to the membership.

Then from there, some of our additional accomplishments were, I think, a significant number, if not all of the taskforce were involved in the generation of a publication detailing our efforts in a submission to a peer-reviewed journal. So we're still in the submission process. So fingers crossed on getting that work out there for other organizations to be able to draw from our experience, whether it be within health care organizations, or other organizations that may be able to adapt to it.

Then for this year, the committee, we've really looked at bringing sort of words into practice. And so we have worked with our membership committee to develop language about a DEI code of conduct for our membership, to be able to hold our members accountable, and to remind them of HOPA’s commitment and responsibility to DEI, both within the organization and even at all the different conferences and any externally facing activities that involve HOPA membership.

I think the next process is to think get board alignment and incorporate sort of an adaptation statement into the membership application for all new members and renewing members to be able to attest to so that way we are holding our members accountable. So those are kind of the ones that come to mind. Kamakshi, fill in if I'm missing anything.

Kamakshi Rao: But yeah, I feel like at the start of the taskforce, we had so much to sort of distill down. I think the one thing that I would point to in addition to what Eric's said about the DEI statement and the publication was really just the thoughtful execution of a strategic plan around DEI.

So we took all the feedback that came from membership, as well as the brainstorming that we conducted as a taskforce, and put forward a comprehensive strategic plan for DEI that crosses over all the councils and committees of HOPA. We sort of did an effort versus impact matrix where we looked at what are those high priority things that we need to chip away at over 5, 10 years, and how do we take those first steps, but also, what are some of those early, easy to knock out, but really impactful ways that we can start to put equity and inclusion at the forefront of the way we do our work.

Some of the things that came out of that were partnerships with groups like Pharm Grad Wish List, partnerships for HOPA travel grants and scholarships for minoritized students and residents to be able to attend the meetings, and those were all some of the accomplishments that came out of the strategic plan that the DEI taskforce put together.

Then one of the things that the committee is now working on to better serve our members is the creation of a toolkit. So HOPA has a plan to launch a new website later in 2023. And our goal is when that website launches to be able to launch the initial version of the HOPA member DEI Toolkit, which should be a living, breathing resource for practicing pharmacists to be able to come to and get educated and learn about advocacy opportunities. So we hope that that becomes part of the year-on-year goal of the HOPA DEI Committee is to make sure that our members have easy access to verified resources that can help them in their pursuit of health equity and inclusion.

Pharmacy Times®: What do you think is the role of the DEI Committee in addressing topics pertaining to implicit bias?

Kamakshi Rao: I would say implicit bias is one of those things that can feel really overwhelming. But I guess one of the one of the ways that I've tried to, and I think the committee has tried to talk about this is that implicit bias is not something to be gotten rid of. Implicit bias is something to raise awareness about. We all have implicit biases. It's not a flaw, it's just a part of being a human. If we can share resources that allow our members to safely explore what their implicit biases are, that is actually the first step in making sure that you're aware of biases so that you can take them into account when you're crafting your approach to practice in a way that counters what your biases are.

So I think from the committee's perspective, I think I speak for myself and Eric when I say education and awareness is always going to be one of the most important parts of our journey in DEI. Every individual is in different place in their DEI journey. And we feel like constantly raising awareness to things like implicit bias, allow individuals to explore how to first learn themselves better, so that they can then serve the patients and colleagues that they serve better as well.

Eric Chow: I think that the whole thing and I thought about adding this on as an accomplishment that we achieved as a taskforce was a couple of our first meetings. We were all embarking on our DEI journeys together and our group was incredibly vulnerable. And people, I think implicit biases can be a little bit fearful at times, right? Because you sort of are afraid of what that might yield. And this group that we really established from the beginning, a very safe and open environment to have those tough conversations. And I think that really enriched the group and really kind of brought us all together, and that kind of small version that, potentially, I hope that we can bring to the membership, those safe spaces to have those vulnerable and tough conversations. Because it was an amazing experience. And Kamakshi, feel free to reflect on that too. It's just I think it's what made that taskforce special. And we were hoping, and I hope that we can kind of continue to bring this forward within the committee's and expand this out to the membership.

Kamakshi Rao: Yeah, I'll echo that. I think the taskforce, we were led last year by Dr. Maurice Alexander and Dr. Britney Brown, and they did such an amazing job of crafting a space that allowed people to practice and make mistakes in front of each other.

We really—even though we all met by Zoom all the time—it felt like you were in a very protected bubble, with people who were willing to offer you grace. And that really, really allowed us, I think, to come out with a much more—I think the DEI statement, when it came into our hands to take a look at—it felt kind of polished, and we just tore it apart and really put a lot of emotion and raw feeling into it. And I think what came out the other side was far more compelling. I know, I was a part of the group that drafted it, but even when we finished it, and then we stopped, stepped back, and looked at it, you kind of got that moment of like, whoa. I think that's what it felt like to be on that group. And I hope we're able to continue that.

I know we've drifted a little away from the implicit bias, but part of it was just really feeling free to acknowledge that each of us is an individual journey, and that if we make mistakes, what we can do is create spaces where we trust the people around us to help us grow as well.

Pharmacy Times®: What are the DEI Committee’s plans for 2023?

Kamakshi Rao: I would say this is a committee who has lots of plans, there's a lot of passion in our group, it really is a thrill to see how much energy goes into it. I think we want to continue the idea of figuring out what resources best align with the memberships’ needs. In terms of education and awareness, we're also working on what are ways to measure diversity and our progress in that space when it comes to committee membership and leadership within the organization.

We have a goal to diversify the leadership and the membership of all of our committees and councils, and that is an initiative that takes years as someone goes through the process of becoming a member, taking on committee roles, and then leading those committees as well. So I think that is a goal for 2023 and beyond.

Eric, other things to add?

Eric Chow: I think we're I mean, you mentioned we're building out the DEI toolkit, that's going to be a tangible kind of benefit for the membership to be able to utilize tools that are available to help them on their journey. I think we're working to not only diversify the committee structure but also even holding our leaders accountable. I think it's important that our leadership reflects our membership. So we're working with the nominations committee to be able to incorporate more DEI efforts into that nominations process to better facilitate, the nomination process for potentially underrepresented members within the community.

Kamakshi Rao: I think the one other thing I would also call attention to is working to identify strategic partnerships that would benefit HOPA from a DEI perspective. I think HOPA is a great organization to support pharmacy professionals in oncology. We don't need to reinvent wheels that other groups have already thoughtfully made, but instead create really strong strategic alliances with organizations that can help us achieve that mission.

HOPA has a new staff member, the director of strategic partnerships, Nicole Watts, and she's joined us on a couple of calls to help us identify what are the priority partnerships that HOPA should pursue that can help us further our causes around diversity, equity, and inclusion.

We've also talked with our media team from the HOPA staff and figuring out how do we make sure that the messaging that we're putting out is thoughtful and that it reflects the values and views of HOPA leadership and the DEI committee. So I think a lot of it is really figuring out how do we build relationships external to HOPA, as well, that can help us on our journey.

Pharmacy Times®: Considering how the focus on DEI initiatives has stepped front and center as an area of focus for health care, what are your predictions for the future of DEI-focused initiatives in oncology/hematology pharmacy in particular?

Kamakshi Rao: Well, I can say that I hope that the attention continues—it is so needed. So, there's a reason that these initiatives and committees are front and center, and it's because it's probably one of the largest gaps that we have. It's not just diversity of the workforce, but it's what that means for access to care for patients and clinical outcomes, inclusion of minoritized populations in research, and what that means for the literature that we read.

So I think our eyes have collectively been opened to all the different ways that DEI is actually having an impact on our work experience, but maybe more importantly, on our patients experience and outcomes. So my wholehearted hope and prediction is that this remains very much front and center for years to come. And truly the work isn't done until we can honestly say that every patient, regardless and inclusive of their background, has access to the best type of cancer therapy possible, and that an oncology pharmacist is front and center as part of that treatment team.

Eric Chow: I mean, I think Kamakshi said it best I mean, it really is it's the impact on the workforce and the impact on our patients. And, even for me, I hope that the push is to be as a push these, this awareness and this education even earlier in our curriculum, is it at the collegiate level, is it at the even earlier than that, as baseline education as we get into some other, kind of political issues with critical race theory and all that stuff. But I think even at the very least a targeted approach, as health care professionals, at the professional school level that we need to really think about social determinants of health and the impact that this has on our patients.

Disclaimer: The views expressed in this interview are the personal views of Eric Chow and Kamakshi Rao and do not reflect the views of companies with which Eric Chow and Kamakshi Rao are associated.