PAYERS
We’ve Got to Be in the Room “Where It Happens”
As COVID-19 continues to infiltrate communities across the country, I’ve done my best to keep my distance socially. One of my primary activities during this time has been online streaming services, discovering new and rewatching beloved movies and shows.
A few years ago, I was fortunate to see Hamilton on Broadway, and when it was released last summer for streaming, I dove in. What can I say? I love everything about that musical—the songs, the talent, the storylines, the intention and the diversity in cast and perspective. It left its mark on me: the power of how to reimagine structures, the beauty of perspective, the importance of inclusion.
But this time it was more than just being a fan…something about it hit deep when I watched it in 2020. I experienced it against the backdrop of growing social awareness and action against our society’s injustices. I watched it while mourning the many who have lost their lives to systemic racism and discrimination in criminal justice, health care, employment, housing and other social structures.
And in that context, the song, “The Room Where it Happens” became an earworm for me. It underpins the critical nature of diversity, equity and inclusion in all we do—especially in health care. The song depicts a dinner where Alexander Hamilton, Thomas Jefferson and James Madison have closed-door negotiations, each walking away with what they wanted:
“….No one really knows how the parties get to ‘Yes’
The pieces that are sacrificed in every game of chess
We just assume that it happens
But no else is in the room where it happens”
This refrain commands the push and pull of policies, programs and decisions developed in a vacuum. It is the experience of communities that have been historically marginalized, that are on the receiving end of work that occurs in the “rooms” that are often closed to their participation, will, experiences and concerns. Historically and in present day, many communities are acutely aware that they are not in the room when it happens.
As I write this, the health care industry is going through a wave of changes, steeped in awareness that equity cannot be only an “add on” to health care solutions. I applaud this! We’re having conversations, making pledges and presentations across the industry on embedding equity, diversity and inclusion into the standard practices of health care. And at NCQA, Accreditation standards are changing to enhance equity, revamping how
demographic data is captured to reflect the diverse needs of communities, enhancing the allocation of SDOH.
Yet, with all this growth, past mistakes continue to be made. As I sit in rooms where changes are being considered, the familiar faces and voices still don’t reflect people who have been affected by
inequity, discrimination and disparities. Often, I’m the only minority in the room. Why?
Equity in health care requires diversity. It requires looking at issues through multiple lenses and experiences and including them in solutions. It requires intersectionality of opinion, experiences, cultures and lives. Most critical and essential, it requires the voice of the community in order to effect true change and develop solutions that work. This is something every organization can do.
As Aaron Burr says (via Lin-Manuel Miranda):
“We want our leaders to save the day
But we don’t get a say in what they trade away
We dream of a brand new start
But we dream in the dark for the most part
Dark as a tomb where it happens
I wanna be in the room where it happens”
When you are in a room where decisions are being made, ask yourself who’s missing—who has been traditionally excluded? Then, make the change.
We all need to be in the room where it happens.