Title IX to Health Equity: Power of Mission (10:44)

“It is a crisp, cool day in September 1975, as I and other freshmen try out for the women’s rowing team at Yale University. At the helm are Captain Chris Ernst and Anne Warner, silver medalists in the World Rowing Championships that past summer. They are goddesses to us. We want to be just like them. We will soon learn that, in many ways, we are. Although Title IX had passed [about] 4 years earlier, there were no sports teams for girls in my high school. The Yale coach assures those of us with no prior experience that it’s okay: ‘We will teach you to row at Yale.’ And with those words, my love affair with rowing begins.”

Mary O’Connor, Director of the Center for Musculoskeletal Care at Yale and a former Olympian rower, tells the story of the 1976 Yale Women’s Crew protest.

Each afternoon, her team would ride the crew bus 30 minutes from campus to their Derby, Connecticut boathouse to practice. “When the water is calm, the river embraces us and the rowing is magnificent, but when the water is rough the river punishes us. Instead of clean catches of our blades in the water, oftentimes, each stroke assaults us with cold, sometimes freezing backsplash. We’re often soaked,” she recalls.

“We dock, put our boats away, and go to the bus, shivering in the fall New England air. There, we wait somewhere between frosty and frozen. Why? Because while we sit on the bus, the men’s team takes nice warm showers and puts on clean, dry clothes in their locker room. We, on the other hand, have no locker room or shower at the boathouse and arrive back at campus cold, wet, and smelly, racing to the last open dining hall for dinner.”

Plans to build a locker room for the women’s team were scrapped due to lack of funding. And by March 1976, some of the rowers had become ill. The team decided to act.

“Before practice, we meet in the locker room at the gymnasium on campus to prepare. There, we strip and write Title IX in Yale blue marker across our bare chests and backs. We don our prized Yale Women’s Crew sweats with nothing underneath. Nineteen of us march up five flights of stairs to the reception room of the director’s office for women’s athletics at Yale. We are serious and determined.”

A Yale Daily News student writer and a photographer accompanied the crew team. When the director emerged, the 19 women took off their sweats and stood wearing nothing but Title IX written on their skin.

Ernst then read a statement. O’Connor recalls the beginning: “These are the bodies that Yale is exploiting. One a day like today, the ice freezes on the skin. Then we sit for half an hour as the ice melts and soaks through to meet the sweat that is soaking us from inside.” When Ernst finished reading, the team dressed, returned to the gym to change into workout clothes, and went to practice.

“Within a few days, our story is picked up by the New York Times and international newspapers. The university is embarrassed into action. We have our locker room the following spring. Our protest sends ripples through athletic departments across the country and in years to come is applauded as the first stand against gender inequality in college athletics.”

“We were just looking for a locker room, but what we got as a team was so much more,” says O’Connor. “A deep team connection was born that day in the athletic director’s reception room, as we individually and collectively wanted to make something that was wrong, right.”

The team went on to win national championships over the next 4 years and saw several of its members, including O’Connor, qualify for national and Olympic teams.

O’Connor sees parallels to this story every day in the world of health care and shares three lessons she learned that are important for health care leaders motivating teams.

An Unjust Distribution of Services Leads to Poor Outcomes

“The naked truth about our nation is that some of us get good health care, and some of us don’t,” says O’Connor. She likens this to how the men’s crew team had hot showers while the women’s team caught pneumonia.

“I do not believe that a person’s zip code should predict their life expectancy or their gender influence the quality of care they receive, yet they do,” she says. Women and people of color suffer more from disabling joint disease than Caucasian men, and they get lost — particularly low-income individuals — in the chaos of untreated joint disease and the comorbidities that develop from immobility: obesity, hypertension, diabetes, heart disease, and depression.

“Instead of the pneumonia my teammates got, these patients get chronic pain, wheelchairs, and an early death.”

Leaders Must Recognize Disparities and Aspire to Do the Right Thing

“My Yale team embarrassed the university into recognizing and then addressing the inequity in facilities at the boathouse. We did not feel our voices were heard by university leadership, and frankly, we didn’t trust them to do the right thing,” says O’Connor.

“As health care leaders here today, we need to listen to our patients and teams and communities, and we need to be trustworthy. We have to recognize that health disparities are real and commit to the bold vision of a better and more just health care world.”

The Voice of Many Is Much More Powerful Than the Voice of One

This is the most important lesson, says O’Connor. “Individuals alone cannot create the level of change needed to improve the health of our nation. If our Captain Chris had demonstrated alone, as badass as she was, the impact would probably have been negligible. Nineteen of us took action together, and I learned how a highly motivated team can produce what seemed to be an impossible outcome.”

“Imagine the power of leadership in medicine if we collectively unite to eliminate disparities. We would revitalize our communities and our nation,” O’Connor says.

How can we do this? Start by re-envisioning the concept of health care teams, says O’Connor, and create teams that reach beyond the traditional walls of medicine. These teams include not only health care providers, but the broader medical team, along with members from community and church centers, social service agencies, insurers, urban planners, and policymakers.

“Health starts in the home and community, not in the doctor’s office or hospital,” she reminds the audience. “Then, we [need to be] fearless in motivating our teams to success, giving our teams a vision and mission that truly engages them on a deeper, emotional, and spiritual level, that inspires them to have grit, that will unite and motivate them.”

“We were 19 different women that day who demonstrated, but we were united by our sense of injustice,” O’Connor says. “Let us be unafraid to inspire our teams so that they, too, can produce what seem to be impossible outcomes.”

For the past 8 years, O’Connor has chaired Movement Is Life, an innovative, multi-stakeholder coalition of health care providers, community and religious leaders, and others committed to eliminating musculoskeletal disparities. “The work is hard, but we are making progress,” she says.

For example, the Operation Change community-based program for African American and Hispanic Latino women increased their physical activity and lowered their joint pain without drugs or surgery. “Teams extending beyond our traditional walls can produce nontraditional results,” she says.

In closing, O’Connor acknowledges Sister Generose Gervais, who served for decades as an inspirational leader at Mayo Clinic. She famously said, “No money, no mission.” But talking about margin and financial performance is the easy part. Sister Gervais’ full quote continues, “No mission, no need for money. Dollars do not feed the soul.”

“A sense of mission now more than ever must drive us in creating and motivating innovative, diverse, and groundbreaking teams in health care,” says O’Connor.

From the NEJM Catalyst event Essentials of High-Performing Organizations, held at the University of Michigan’s Institute for Healthcare Policy and Innovation, July 25, 2018.

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