Ala Stanford: Six things health systems can do to build better relationships in Philadelphia

Weeks into the COVID-19 pandemic in 2020, Ala Stanford rented a van, filled it with medical supplies, and headed to Philadelphia.

Stanford, a Montgomery County pediatric surgeon who grew up in Philadelphia, couldn’t stand the stream of news stories detailing how Black people were at greater risk for COVID-19, yet far less likely to get tested or vaccinated.

Stanford parked her van outside churches and SEPTA stations, and in vacant parking lots in some of the low-income Philadelphia neighborhoods that were among the hardest hit. Within weeks, lines of people waiting to be tested and vaccinated stretched around the block of wherever the Black Doctors COVID-19 Consortium, as Stanford and her peers began to call themselves, set up for the day.

Stanford chronicles her pandemic experience and subsequent efforts to address health disparities in her new book, Take Care of Them Like My Own, available Aug. 6.

In it, she talks about the secret to her success: Trust.

“The biggest element is trust. Period,” she said in a recent interview with The Inquirer. “It takes a while to build trust — it’s not one touch, it’s multiple touches.”

The Black Doctors COVID-19 Consortium reached Philadelphia residents who weren’t connecting with the city or its leading health systems. The group’s work won national accolades, and in 2022 President Joe Biden tapped Stanford to lead regional operations for the U.S. Department of Health and Human Services.

She stepped down from the position last year to return her focus to the health clinic she founded, Dr. Ala Stanford Center for Health Equity, in a part of North Philadelphia where life expectancy is 18 years shorter than in the city’s wealthier, majority-white neighborhoods.

Reams of research have found that a positive relationship between providers and patients is key to improving health outcomes, particularly in communities of color, where deep-seated distrust of medical providers may discourage people from getting needed care.

Stanford urged Philadelphia’s leading health players to consider taking the following steps to build trust within the communities they serve.

Pop-up clinics, free health events, and vans that can provide on-the-go cancer screening are beneficial because they can help people get needed services without traveling to a medical facility. But they are temporary.

Health systems that want to send a message that they are truly invested in a community should set up permanent health clinics and services, so people can easily get care they need any day of the week — not just on special occasions, she said.

Weekend and evening hours can significantly improve access for people who are not able to take time off from work to go to a doctor’s appointment.

Extending hours can help build trust by demonstrating that the health system understands its patients’ needs.

A kind welcome from the receptionist or intake nurse can go a long way toward putting patients at ease, especially if they haven’t been to an appointment in a while or are nervous about their visit.

Doctors often stand while talking to patients because it is efficient — they’re short on time and can type into an electronic medical record during the conversation. But standing to talk to a patient who is sitting establishes a power dynamic that may not be conducive to relationship-building.

“When you sit down, even if it’s for two minutes, it says to the patient that you are here and there’s nowhere else you need to be,” she said.

This can be particularly meaningful to people of color, who are more likely than white patients to say they don’t think their doctor listens to them and may have been talked down to by doctors in the past, she said.

Patient navigators are valuable liaisons between health systems and patients, and don’t need advanced degrees – just good people skills.

Patients who come to an appointment after years without medical attention may have a backlog of needed tests and services that can feel overwhelming to them.

Following up to make sure they schedule and complete appointments may feel like a level of hand-holding that’s outside a health-care provider’s responsibility, but it can help establish a lasting relationship that keeps patients coming back.

“Especially the patients who haven’t been to see you in a while — those are the ones you really have to hold on to,” she said.