16 Jan Ronald Copeland: A Health Culture

As diversity officer at health-care giant Kaiser Permanente, this surgeon looks well below the skin for what makes patients different.

When health-care provider Kaiser Permanente (KP) first started treating patients in the Mojave Desert, during the 1930s, those folks were a fairly homogeneous group, at least in one sense: they were all blue-collar workers.

“California was already highly diverse,“ says Ronald Copeland, senior vice president, National Diversity Strategy and Policy, and chief diversity officer. “Then it became even more diverse [in the 1940s and 1950s] as more African Americans came west to work in the shipyards. Kaiser has dealt with diverse communities—related to culture, ethnicity, gender, language, and belief systems—for 70 years now. So diversity is not a new challenge for us.”

Today, Kaiser Permanente treats roughly 9 million patients in nine states and Washington, DC, and works to serve the ever-diversifying population on both sides of the medical chart. The company has programs like Culturally Competent Care to address the needs of different patient populations, as well as health-care internships for under-
represented college students; education and job training for developmentally disabled students; and dozens of multicultural employee business resource groups. KP’s Latino Association in Northern California was just named one of the top five employee resource groups in the nation by the U.S. Hispanic Chamber of Commerce.

Diversity Woman spoke with Copeland, who originally joined Kaiser as a surgeon before becoming the head of the Ohio Permanente Medical Group and then serving on Kaiser’s National Diversity Council. He reflects on how health-care challenges vary across the United States, his own road into medicine, and how diversity is a lot more than skin-deep.

Diversity Woman: One Kaiser diversity program for staffers is called Cultural Competency. What does that mean, beyond addressing language barriers with patients?

Ronald Copeland: It has as much to do with appreciating and understanding patients’ identities, beliefs, and sexual orientation as it does language: how does that define who they are, how do they define healthy behavior, and how do they want to engage with each provider? To understand, value, and navigate difference, rather than homogenize it, it is necessary to build patient trust in both the practitioner and the system.

So whether it’s a physician or care team members being competent to communicate with patients in multiple languages, we make an investment. For example, we use telephone transmission lines for people who are not bilingual. We also have real-time translation pilots going on, where doctors and patients have virtual translators on a video screen that can hear and translate immediately when the patient is in the room.

DW: What had you learned about diversity before you came to this position? Where does the system break down for folks? 
RC: In my last position, I had looked at our quality outcome data to see if we had any disparities. Patients were getting excellent care, but we still saw differences in outcomes within certain groups.

One area that we targeted two years ago was the African American population and the risk of premature death from cardio disease or kidney failure—due to something as basic as controlling high blood pressure. We identified discrepancies in those areas, and we established teams to begin the pilot interventions. What evolved was a core set of four or five interventions, such as certain medicines, protocols for adjusting medication, and leverage for patient-to-patient support. In Ohio, we eliminated the disparities between African Americans and other populations as to how their blood pressure was controlled.

Another area was colorectal cancer screening for Latino patients, and a lot of the cultural issues that surround having a colonoscopy or exam. We asked, “How do you address those barriers, how do you engage with those communities, and how do you do it in culturally responsible way?” Now, we are implementing some new approaches. The verdict is still out, but we’re seeing improvement already. It’s amazing what you can accomplish.

DW: Why did you become a doctor in the first place?

RC: There were no doctors in my immediate family—my family was from the South and had migrated north. I had seven siblings and was raised in a home where education was a high priority. I had a natural curiosity about life sciences, but also art. I started drawing and painting in school, and one of my teachers paid to send me to an art school over one summer. Until I was 12, I thought I would be an artist, and I even sold my first painting when I was 12. But in the ninth grade I started biology, and the first time I dissected a frog, something changed. I fell in love with the life sciences.

I went to college at Dartmouth to be a biology major, and during my sophomore year, I did an independent research project in Africa. When I was there, I ran into an African American doctor who had trained in London and had a mobile clinic that went from village to village bringing immunizations and basic care. After that experience, something just crystallized, and I came back and declared myself a premed major.

DW: Why did you shift into an administrative role?

RC: As I practiced medicine and as I saw the disparities—some people not having care at all—I felt the pull to have more impact, to do more than direct patient care.

DW: Has it been tough not seeing patients anymore?

RC: It’s my first time in 30 years not seeing patients, and I’m experiencing some withdrawal. I reconcile it by remembering that no matter how high performing I could be as a surgeon, I was still impacting only one patient at a time. I’m a product of the 1960s and 1970s, of the belief in social justice and making a difference in people’s lives. So that makes me feel proud.

DW: What is the biggest misconception Americans have about our health-care system?

RC: That in America we have the best health care in the world—that’s a half-truth. If you need complicated care—brain surgery, a heart transplant—there is no better place to be on the planet than here. But in terms of the entire nation having health care designed to prevent disease, people don’t understand that not everybody has access to that high-end care we tout around the world. From a public-health standpoint, we rank very low in the world. What we’re trying to figure out now, as a country, is how to get the best of both worlds. Health-care reform may not be perfect, but it’s driving us toward asking the right questions.

DW: What happened to your love of art? Do you still paint, or collect, or even just doodle?

RC: All of that! I’m an art collector, and I have tons of sketches. I tell myself that I’ll return to the easel one day. I’m also a jazz fan, which is art for the ears. I listen to jazz and I stay connected to that creative, intuitive side of who I am.

There are a lot of books now about right-brain-dominant people; the qualitative analytical personalities have dominated society for a long time. But these are interesting times—what may be seen as a sideline has a lot more value. The lesson, then, is to be your authentic self. You never know when that skill will be valued.

DW: What books have you read lately that have inspired you?

RC: The Hidden Brain, by Harvard professor Shankar Vedantam. It’s about how we make decisions, how we leverage our brains. One area that has captured my imagination is a dramatic change in what we mean when we say “diversity.” You say diversity and people think race, ethnicity, and maybe gender. Ever since the civil rights movement started, diversity has been aligned with that.

But all of the current research around the brain related to concussion and PTSD has really enlightened us—shattering myths every day about how different we are, how we process behavior. Most things that we had identified before as making people different are pretty superficial. Most of what really makes us different is way below the waterline.DW

Katrina Brown Hunt, based in San Diego, has written for Fortune Small Business and Smart Money.