Dr. Yeng Yang had a lot of experiences that motivated her to get her title. When she was a child in Laos during the aftermath of the Vietnam War, she watched her father spend a year in pain from an unknown illness before he passed away. Shortly after, she and her family moved to a refugee camp in Thailand. Living conditions were unsanitary, health care was minimal and violence was commonplace. They spent five years there before they could move to Minnesota.

Growing up in Minnesota, Dr. Yang was exposed to the limitations of the American health care system. She saw the inconsistent accessibility. She saw Hmong and Southeast Asian communities receive suboptimal care due to language and cultural barriers. All taken together, her experiences charged her with a feeling of responsibility and a desire to be on the inside making change.

Dr. Yang’s drive has taken her far. Today, she’s the regional medical director of primary care for the northeast south territory, as well as a co-chair and medical advisor of HealthPartners’ Equity, Inclusion and Anti-Racism Cabinet. She joined us on this episode to discuss the areas where she sees opportunities to make health care more equitable. Listen to the episode or read the transcript.

Undoing the unconscious

Dr. Yang’s first big point is that bias isn’t simply a person-to-person issue. She notes that she and many other care providers were educated and trained the same way. They learned the same information and policies from the same institutions – which is the definition of perpetuating a system. If care providers want to serve people better, they have to be willing to depart from what they’re conditioned to.

Take the COVID-19 vaccine rollout. It was known that communities of color had the highest rates of hospitalization and death from COVID-19, but when the vaccine was first rolled out via online scheduling, they weren’t the people who got appointments. Appointments went to more affluent people, people who were native English speakers, who had familiarity with computers and online scheduling systems.

To make sure all communities got access, Dr. Yang and her colleagues couldn’t stay in their conditioned roles, in which they waited for people to seek care. They had to do community outreach and actually meet people where they were. They partnered with local community groups, arranged interpreters and transportation, and sent out specific communications in Hmong, Somali, Spanish and Vietnamese. In about two months, the vaccination gap was closed.

Learning from difference

Another point Dr. Yang makes is that we can’t always rely on similarities – individual or cultural – to carry patient-provider relationships. As a Hmong doctor, Dr. Yang can approach Hmong patients with a strong baseline understanding. She has knowledge about customs and general cultural perspectives, as well as specific nuances like how the Minnesotan Hmong community has both practitioners of traditional Hmong religion and a large number of converts to Christianity. But Dr. Yang can’t be there for every Hmong patient, and the same goes for care providers from other communities.

If a care provider doesn’t have that kind of built-in means for building trust, Dr. Yang says that they need to be open to genuinely learning from their patients. Rather than leading patients along the conditioned American care path of diagnosis, treatment and dismissal, care providers have to be curious. They have to ask questions that will get to the heart of what the patient is looking for and seek additional perspectives for the cultural or personal considerations that need to be accounted for during their care.

Making change from the inside

By being members of HealthPartners’ Equity, Inclusion and Anti-Racism Cabinet, Dr. Yang and our host Dr. Steven Jackson are helping change a health care system in just the kinds of ways Dr. Yang has wanted to see for years. In January 2023, for example, they launched an unconscious bias training curriculum for HealthPartners clinicians.

Even more impactful is the work they’re doing to create pipelines for diverse talent. Despite all of HealthPartners’ commitments to equity and inclusion, our leadership and staff are not as representative of our communities as they could be. To foster a more accurately diverse future, Dr. Yang and colleagues are changing the way we recruit.

Instead of just talking to students near the end of medical or nursing school, we now also invest in creating opportunities for elementary to high school-age kids to learn about health care. Sponsorship, internship and mentoring programs are all giving kids the chance to get experience that they’d otherwise have to get from higher education.

What we see from Dr. Yang is an intuitive understanding of where and how we can be better as a care system. She saw it from the outside and has committed years to making it happen on the inside. As she shows us, the best way to improve patient care experiences is by accounting for patients’ lived experiences, and the best way to improve our care systems is to make them representative of the people they serve. To hear more from Dr. Yang about building trust, different ways of understanding health and the importance of exposure, listen to this episode of Off the Charts.