| Oct 20, 2022

Shifting the Paradigm: Curing Healthcare Inequities One Job at a Time

During the pandemic, healthcare inequities were making life difficult for valued members of our team. We decided not to stand by and allow this to amplify the crisis already underway. Here's how we acted to ensure that health equity was available to our frontline heroes.
By Jim Dunn , Kinneil Coltman, DHA |

4 minutes

In the summer of 2020, as the global pandemic intruded and a national reckoning on racial justice tore through many of our communities, a few leaders at Atrium Health were engaged in some soul-searching alongside members of our board.  Health equity was already integral to our organizational DNA; we were surpassing most health systems in this space, and we had even won some of the nation’s top awards for our efforts. But none of these efforts had dislodged the deeply rooted structural inequalities that were determining who lived through the pandemic and who didn’t.

No Frontline Inequities on Our Watch

We watched our providers on the front lines, fighting a grueling battle on various fronts – on the one hand combating pandemic surges, and on the other, struggling with the exhaustion and burnout borne of keeping our patients alive and healthy. Such vigilance inspired us to articulate a mission to draw a line in the sand when it comes to the dramatic health inequities that plague far too many of the communities we serve at Atrium Health.  Our mantra?  “Not on our watch.”

But where to begin?  Research tells us that healthcare only accounts for about 20 percent of health while the other 80 percent is driven by social factors well outside our control as a healthcare system.  As we scrutinized data from our own community health needs assessments, it was easy to feel overwhelmed – the inequities ran deep, the seeds of which had been planted generations ago.  Too many families, particularly in communities of color, lacked good jobs and were struggling to keep a roof over their heads and food on their tables.  In the same way that the pandemic flooded and overwhelmed us, poverty seemed to relentlessly tear away at parts of our communities, exhausting and degrading their ability to thrive.

We wanted to attack the disease of poverty at the roots and cure it for generations and, to that end, we needed to make a powerful paradigm shift. We needed to recognize the limitations of our role as a healthcare provider in addressing these issues.  As the largest employer in North Carolina and in most of the communities we serve, we wondered whether our role as an employer might be the key to healing our communities.

Their Problems Become Our Problems

We had to be honest with ourselves – this was not just about giving someone a job, as we had been doing that for a long time.  If we hoped to truly embrace our teammates and support them in addressing the social issues interfering in their ability to stay healthy, we needed to drill holes in the traditional employee-employer relationship.  We needed to understand the practical dimensions of our teammates’ deeply personal struggles: Were they having trouble affording groceries?  Were they worried that their utilities were about to be disconnected? Were they at risk of being evicted? Were their families experiencing a crisis?

In late 2020, as we waded into what would become one of the most significant surges of the pandemic, we surveyed our teammates across certain income bands to get a sense of how they were doing.  We inquired about personal struggles as well as their overall mental health. Most importantly, we wondered aloud if they could use our help.

Although it was difficult to hear our teammates detail the challenges they were facing, their answers led us on a journey that continues to this day. With the support of our board, we launched a social impact strategy intended to eliminate the gaps in life expectancy in our most underserved communities, and our own teammates are a priority focus.  We now have a comprehensive strategy to support our teammates’ social needs through our teammate social impact framework, which includes myriad programs and initiatives.

Early Solutions: Community Partnerships and Career Development

First, we established our Teammate Help NOW program, which includes key partnerships with community safety-net organizations and a Community Health Worker assigned to assist our teammates with ongoing social needs through connections to those partners. We have also designated various locations for our teammates to pick up emergency food supplies as needed. Although the program started just over a year ago, it has already furnished over 500 teammates with financial, food, housing, and internet resources.

To guard against displacement and gentrification in our community, we have invested $10 million in several naturally occurring affordable housing (NOAH) properties to maintain rent rates at between 30-80 percent of an area’s median income. Each property has an allocation of units for our own teammates through our Housing Opportunities Promoting Equity (HOPE) program, and quite a few teammates have already accessed affordable housing through this program, with numbers climbing weekly.

We founded a separate non-profit called the Caregiver Heroes Teammate Emergency Fund, which provides financial assistance to our teammates in crisis situations. Through this fund, we have distributed over $1 million to support over 700 teammates who have suffered house fires, major illnesses, deaths in the family and other unexpected challenges.

To support the long-term economic mobility of our teammates, we established our own Career Development Center, which is now engaged in supporting over 600 teammates through outside-in programs to connect community members to jobs at Atrium Health, and our inside-up programs for teammates in entry-level roles to grow their career with Atrium Health. Our goal is to expand the reach of these programs to 2,000 teammates by 2025.

But even as we foster the career growth of our teammates, we must not be blind to the economic disincentives for growth these initiatives present for some teammates. “Benefits cliffs” can impact anyone whose career advancement exceeds his or her income eligibility for public assistance programs. In response, we launched a pilot program with the Federal Reserve Bank and the Goodwill Industries of Southern Piedmont to mitigate the effects of benefits cliffs among our teammates. We have also calibrated our health insurance, retirement plans and other benefits to ensure they are uniquely beneficial for teammates in entry level roles.

These are some of our initial efforts, but we’re not stopping here.


Celebrating Every Win

One recent morning, a manager discovered that one of our teammates was going to be homeless by that evening.  Within hours, a community health worker at Atrium Health had secured temporary housing for several days for that teammate and immediately got to work on longer-term solutions. These are the kind of stories that are starting to pour in routinely.

While we haven’t figured it all out yet, we know we are on the right path to healing our communities – one job at a time.


Co-author: Kinneil Coltman, DHA
Jim Dunn
Executive Author

EVP, Chief People and Culture Officer, Atrium Health

Jim Dunn, PhD, DHA, DAST, FACHE, is EVP and chief people and culture officer for Atrium Health, one of the most comprehensive and highly integrated not-for-profit healthcare systems in the U.S. view profile


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