Move From Comfort to Courage


At one of our most recent patient advisory board meetings, the agenda included an update on Medicaid expansion. One of the representatives said, and I quote, “Yes, we need to talk about that. I’m mad.” Those words resonated with the other members of the board, as well as those of us who are receiving daily updates on the advocacy efforts for Medicaid expansion. Our patient advisory board is comprised of individuals who have no insurance or have coverage through Gateway or Medicaid; many of whom have health care issues that require routine doctor visits. After the historic vote in August 2020, to approve Medicaid expansion in our state, our advisory board representatives were hopeful for a chance to have new or expanded access to health care coverage.

As I continue to watch this academic exercise taking place in the legislature over whether to fund Medicaid expansion, it raises a big question for me: “How are we centering and responding to the voices of people most impacted in our work?” A clear majority of voters (53%) approved expansion. However, there is a small group of people who insist they know what is best for the community, though it stands in direct opposition to how the people voted. This fight for expansion is following an all too familiar pattern, where organizations convene groups of community members for feedback, yet fail to act on the wisdom of experience shared in these conversations. It should come as no surprise then, as a result of this fractured trust, the community is “mad.”

The biggest silver lining I have observed over the past year is that our region is crying for more courageous leaders who are willing to move out of their comfort zone. The community needs leaders courageous enough to create space for those most impacted to join the conversation and be a part of the decision-making process. As we move through our transition and strategic planning process at the RHC, our patient advisory board members and other community partners are pushing us to shift from our comfort zone and courageously center the people with first-hand knowledge of the barriers we seek to address in our efforts to advance, catalyze, and bring about systems transformation. PrepareSTL has been a great example for us to follow. While it was created in response to the pandemic, it has shown us the value of leaders collaborating and strategically using their influence to create space for the communities who have borne the disproportionate impact of Covid-19 to lead the change.

At the RHC, we are committed to leaning more into this charge of centering those most impacted, and we invite other leaders to join us. Examine your policies and practices to see how you are engaging residents and patients in leadership roles in your work; work to create an environment that weights the data of experience as highly as the quantitative data we diligently examine. If we really want to see justice in our lifetime, we need more leaders who are willing to engage in radical listening and partnership that shares power with community.

Angela Fleming Brown

CEO, St. Louis Regional Health Commission

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