Dr. Mark Schuster of Kaiser Permanente Bernard J Tyson School of Medicine: 5 Steps We Must Take To Truly Create An Inclusive, Representative, and Equitable Society

I’m not sure that a truly inclusive, representative, and equitable society has ever existed, but it’s certainly something worth striving for. This is of course a huge question and I could go in many directions. Many leaders with much greater expertise than I are speaking and writing right now about the need to change our conceptualization of race, our mischaracterization of history, and our legal system’s differential impact on people from different backgrounds.

As part of our series about ‘5 Steps We Must Take To Truly Create An Inclusive, Representative, and Equitable Society’ I had the pleasure to interview Mark Schuster, MD, PhD, the Founding Dean and CEO of the new Kaiser Permanente Bernard J. Tyson School of Medicine.

Mark Schuster MD, PhD, Founding Dean and CEO of the new Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, CA, is an internationally recognized leader in research on child, adolescent, and family health concentrating on topics such as racial and ethnic health disparities, sexual and gender minority health, paid family leave, obesity prevention, and quality of health care. Previously, Dr. Schuster was the William Berenberg Professor of Pediatrics at Harvard Medical School and Chief of General Pediatrics and Vice Chair for Health Policy in the Department of Medicine at Boston Children’s Hospital. Dr. Schuster has co-authored two books, including “Everything You Never Wanted Your Kids to Know About Sex (But Were Afraid They’d Ask),” and more than 250 journal articles. He is an elected member of the National Academy of Medicine and a recipient of the Joseph St. Geme, Jr. Leadership Award from the Federation of Pediatric Organizations, the Barger Excellence in Mentoring Award from Harvard Medical School, and the Richardson Award for lifetime achievement from the Society for Pediatric Research.

Thank you so much for doing this with us! Before we dig in, our readers would like to ‘get to know you’. Can you tell us a bit about how you grew up?

Thank you for having me, Tyler. I grew up in Baltimore, Maryland. I was one of those kids who really liked school and idolized their teachers, and my interests in school were wide-ranging. I picked topics for my research papers at school that seemed odd to people at the time: capital punishment, the Lumbee Tribe, and chimpanzees learning American Sign Language. These don’t seem so odd now, but I think my teachers thought I marched to a different drummer. As I say that, I guess I did march to a different drummer. I realized I was gay when I was 12 years old and spent nearly a decade trying to hide that. Also, I’ll add that in seventh grade, my parents sent me to a very academically rigorous school across town. I have many fond memories from there but allowing Jewish students to attend wasn’t something that everyone supported. I learned all sorts of slurs for Jews there, and one time had my head stuffed in a toilet while being called rabbi. What’s remarkable now was how open a lot of it was.

Is there a particular book that made a significant impact on you? Can you share a story or explain why it resonated with you so much?

Night by Elie Wiesel made a huge impression on me as a child. It’s a memoir of Wiesel’s experience as a teenager surviving Nazi concentration camps in Poland and Germany. That book taught me a blunt lesson about the atrocities people can inflict on each other, and it also taught me about people’s capacity for resilience and determination. It brought home what I was generally aware of, since I lived in a community where some parents, grandparents, and teachers had their concentration camp numbers tattooed on their wrist. It may sound silly now, but in high school, when I was facing a challenge, I would think about people who had survived so much terror and remind myself that my trials were trivial by comparison.

Another book that comes to mind is one I also read as a teenager — Maya Angelou’s I Know Why the Caged Bird Sings. Her bravery in revealing her rape was startling and felt like such a generous act of sharing her experience to help and educate others. The idea of helping others benefit from your experiences was powerful to me. And her ability to survive such a trauma was inspiring — maybe it’s similar to the effect that Night had on me. Of course, she went onto become a national icon after my childhood and her work had even more impact on more people.

I gave several of my favorite books to my now-husband nearly three decades ago as a gift not long after I met him. I guess it was my version of a mixtape. Both of these books were a part of that gift.

Do you have a favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life or your work?

I’d pick, “What goes around, comes around.” I’ve tried to have that at the fore when making all sorts of decisions and responding to people. That doesn’t mean I always succeed at it, but I try to. And I’ve found it to be true. There have been people I’ve done a favor for or helped out in some way when there was no likelihood of them ever being in a position to reciprocate. And yet, even years later, our paths have sometimes crossed again — maybe in a professional setting, maybe in a social setting — and they’ve remembered whatever it was long after I’ve forgotten and been incredibly helpful back. I’ve really been struck by that. I also always try to remember times when people have been generous to me.

How do you define “Leadership”? Can you explain what you mean or give an example?

I can tell you about my approach to leadership. As the leader of a medical school, I try to convey my enthusiasm and commitment to the school’s mission, vision, and values. I aim to make myself accessible and to hear multiple points of view — both ones that immediately make sense to me and ones that initially seem like a stretch or impossible. After hearing different perspectives, I often make a different decision from where I started. That’s why it’s been so important to surround myself with people who have different ways of looking at things and who can challenge me to see things from other vantage points. I also have learned that I need to make the best decision I can with the information available. I can’t always do a study or spend a year looking into things. Learning to make decisions with imperfect information has been a really important lesson. I am ultimately responsible for some decisions at our school, but others are really about working with a team and building consensus. I also think leadership includes mentorship and sponsorship, helping people to pursue fulfilling careers, to build skills, and to develop themselves and prepare for a future job. I’ll end by saying that a leader can set the tone for a group — they can raise morale, they can excite people and inspire them. I think any of us who are in leadership or managerial positions seek to do that.

In my work, I often talk about how to release and relieve stress. As a busy leader, what do you do to prepare your mind and body before a stressful or high stakes meeting, talk, or decision? Can you share a story or some examples?

I eat chocolate. I guess that’s not the answer you want from a physician. I also overprepare! Before a big meeting, I tend to channel my nervous energy into planning and preparing. I think of all the possible questions or issues that could come up, and I jot down bullet points on how I might address them. I might not predict anything that actually does come up, but having tried makes me feel more comfortable.

Ok, thank you for all that. Now let’s move to the main focus of our interview. The United States is currently facing a very important self-reckoning about race, diversity, equality, and inclusion. This is of course a huge topic. But briefly, can you share your view on how this crisis inexorably evolved to the boiling point that it’s at now?

Our nation’s current self-reckoning is the result of centuries of anti-Black racism and oppression. This crisis isn’t just now reaching a boiling point — it has been boiling over for decades and centuries. But I agree we’re going through another period as a country where more people are aware of the need for a reckoning and seem more interested in engaging. Why right now? That will be for historians to shed light on some day, but I would say that social media and the ability for anyone with an iPhone to be a videographer have made it possible for information to travel so quickly and for documentation of atrocities to spread — and for people to educate each other more easily. And there has been so much shocking news in such a short period of time — George Floyd, Breonna Taylor, Ahmaud Arbery, and many, many more people, in addition to so many people whose names never make it into broad consciousness — and during a pandemic that has been devastating to so many that I think the general public has been more inclined to notice and react and care. We’ve had times earlier in our country’s history where a single book or article or a photo shocked people into action, at least for a little while. As information is becoming more democratized, I think that has enabled the latest examples in a long history of acute and chronic mistreatment and abuse of people based on the color of their skin or their ancestry to get broader attention than in the past.

Can you tell our readers a bit about your experience working with initiatives to promote Diversity and Inclusion? Can you share a story with us?

I learned a lot about promoting diversity and inclusion as an undergraduate. Students at my college were predominantly white, and our school newspaper was also pretty homogenous. I was assigned to cover what was called the “minority beat.” Working on stories on Chicano students and Asian-American students and others helped me see things from a new perspective. I learned a lot. I covered and also got involved in efforts to increase accessibility for people using wheelchairs. I thought I was just learning to be a journalist, but really, I was also learning about the breadth of communities all around me.

At our medical school, diversity and inclusion are at the core of our purpose. We’ve sought to incorporate equity, inclusion, and diversity into every aspect of the school, from our curriculum to our approach to recruitment of students, faculty, and staff, and even to the recruitment of our Board of Directors. We use a holistic admissions approach, where we look at each applicant’s entire life experience and challenges they’ve faced in the context of other data, and it’s yielded two classes that are among the most diverse medical school classes in the country. And we’re always seeking feedback to find out how we can do better on issues of diversity of inclusion. It’s a process of constant learning and adjusting, and we’re lucky to have students, faculty, and staff who are passionate about these issues and are working together to advance our mission. Our students have been so helpful in pointing out ways that certain medical concepts and practices incorporate biases. Our curriculum undergoes an equity, inclusion, and diversity review where we have a team of faculty and staff look to increase representation and mitigate bias in our materials. We had built sessions into the curriculum on microaggressions, the history of racism in American medicine, implicit bias, and more. But we hadn’t focused on genomics and race specifically, and so at our students’ request, we added additional material and thereby improved the curriculum. We also work on pathways programs to provide role models and guidance for high school and college students. In addition, I try to use the platform that being a dean sometimes gives me to promote equity and inclusivity in commentaries, presentations, and panels.

This may be obvious to you, but it will be helpful to spell this out. Can you articulate to our readers a few reasons why it is so important for a business or organization to have a diverse executive team?

I’ll start by saying the most obvious reason, which is different perspectives and experiences can lead to multiple ways of looking at opportunities, challenges, and decisions. Diversity makes it more likely, I think, to avoid mistakes and to prevent missing the chance to do something really well because you have too narrow of an understanding of how your customers, employees, patients, or students might feel about things. When everyone is alike, there’s such a greater possibility of everyone reinforcing each other’s biases and deficiencies in clear thinking. I feel it’s become a truism that diverse teams lead to better outcomes. But let me go beyond that. Beyond benefit to the organization in having a diverse team, there’s also a benefit to our children. I think it’s terrible for children to grow up seeing doors closed to them based on their race or ethnicity or orientation or gender or any number of characteristics. In healthcare, children dreaming of becoming physicians or nurses or pharmacists will be more likely to pursue their dreams if they see evidence that they can make it, and that evidence often comes in the form of people like themselves.

Ok. Here is the main question of our discussion. You are an influential business leader. Can you please share your “5 Steps We Must Take to Truly Create an Inclusive, Representative, and Equitable Society”? Kindly share a story or example for each.

I’m not sure that a truly inclusive, representative, and equitable society has ever existed, but it’s certainly something worth striving for. This is of course a huge question and I could go in many directions. Many leaders with much greater expertise than I are speaking and writing right now about the need to change our conceptualization of race, our mischaracterization of history, and our legal system’s differential impact on people from different backgrounds. I’ll try to add some additional thoughts to the discussion from the perspective of someone who has spent most of my career as a pediatrician who does policy research and will start with how we can move in an inclusive direction starting with children. I think of universal childcare and paid family leave to support working families. I think of high-quality primary education to give all our children a chance to learn to the best of their abilities and to open rather than close opportunities for their future. I think back to your previous question on the importance of diverse leadership teams, and so also believe we should work to create role models for them to consider a wide array of possibilities, in terms of where they work, where they live, what family or social environment they create for themselves. Particularly on my mind right now is that everyone should be able to vote freely and easily. And finally, I think of radical action on climate change, without which we won’t even have a society to make more inclusive, representative, and equitable, especially since those hit hardest by climate change will be those already facing the most discrimination and precarious circumstances around the world. Until someone invents a magic pill that takes away all discriminatory bias and instincts (and that eradicates the practices that institutionalize them), these are elements that I think would contribute to creating the environment that I think many of us want.

We are going through a rough period now. Are you optimistic that this issue can eventually be resolved? Can you explain?

Our society is constantly evolving. When we look back to previous generations, there are always things that are shocking about the values and practices from earlier eras. Some of our values and practices today that are just now being recognized as potentially harmful or discriminatory might be viewed in fifty years as unequivocally discriminatory. And then there will be others that we’re rather self-satisfied with at the moment that will later be recognized in a new and disparaging light. So yes, I am optimistic that things can get better and better over time, that we will develop a more and more equitable society and world. Maybe not in a linear manner, and almost certainly not for everyone in the foreseeable future. I do feel optimistic, but I don’t want to be naïve. There’s a lot of work to do, which is going to take an openness to new ideas and self-reflection for individuals and groups and societies. As soon as we resolve the inequities we are conscious of now, we will begin to recognize other societal values and practices in which we have not been inclusive and equitable. This work is ongoing, and there is always room for improvement.

Is there a person in the world, or in the US, with whom you would like to have a private breakfast or lunch, and why? He or she might just see this, especially if we tag them. :-)

Oh, there are dozens and dozens of options…

I would love to sit down with Pete Buttigieg, both as an admirer and as a policy nerd. I remember 30 years ago debating a friend who believed that we would see a gay person in the cabinet in our lifetime. I was certain that was impossible. We were standing in West Hollywood, still one of the only places at the time to have elected an openly gay person to office. How wrong I was! So, I’d like to thank Secretary Buttigieg. I’d also want to discuss the important influence that transportation has on health, as it affects access to health care; pollution and its health consequences; the integrity of neighborhoods, often ones that serve primarily people of color and people with limited financial resources, when land is taken by eminent domain to build a highway; and on and on. I think our decisions for transportation, as well as policy issues in general, should take into account the health consequences.

And an even bigger stretch for you to arrange a lunch meeting, I can’t resist saying Barack Obama. Every time I read something he has written or listen to him speaking on a tough issue, he is so good at acknowledging the complexity and conveying an appreciation of the nuance and making a clear case for the path forward that he sees.

And here’s a person with whom you definitely can’t arrange a lunch, because she’s long gone, but I feel like our country needs a meeting with Rachel Carson. She transformed our appreciation of the environment and how we were damaging it. She activated people, and as I understand it, she got their attention so quickly. I’d want to see if she has any insights into how to get our country to take climate change more seriously. A subset of the population is clearly engaged, but nonetheless, we have not been able to enact the policies and make the changes that we need.

How can our readers follow you online?

Readers can follow me on Twitter @DrMarkSchuster, find me on LinkedIn, or visit our school’s website at medschool.kp.org.

This was very meaningful, thank you so much. We wish you only continued success on your great work!