Advancing Health Equity at the Harriet Lane Clinic

Mike Ciesielski

Physicians Nakiya Showell and Brandon Smith say it was a little daunting being asked to take the helm of the historic Harriet Lane Clinic, which has provided primary care services to the community in East Baltimore for more than a century. But knowing that their visions for the clinic aligned, they felt confident forging ahead.

Together, they are placing a strong emphasis on increased engagement with patients and families. As a start, the clinic this fall held the first of a new series of patient-family cafes, offering families the opportunity to provide feedback and voice any concerns. Showell would like to form a patient-family advisory council for the clinic to formally solicit feedback and comments on a periodic basis.

“Patient experience surveys are done, but we haven’t been able to meet with families on an ongoing basis and have their voices inform what we’re able to do as a clinic,” says Showell, who in July 2021 became medical director of the clinic. Harriet Lane provides comprehensive health care services for some 7,300 pediatric patients, at least 40% of whom have chronic medical conditions.

The effort dovetails with a research effort they’re involved with, along with researcher Chidinma Ibe, to implement a family collaborative care intervention at the clinic to advance health equity. The work, supported by a $670,000, two-year grant from the Johnson & Johnson Foundation, will fund a community health worker in the clinic. The community health worker will serve as part of the medical team, and will assist with addressing the most pressing social needs for families, bridging communication with providers and facilitating patients’ access to resources. The goal is to expand the pilot to other clinics and federally qualified health centers in Maryland and New York.

“Many of our patients face social resource needs in terms of housing, transportation or employment, which can heavily impact their ability to access care and also their underlying medical conditions,” says Showell. “We’re identifying a real gap in pediatric primary care by bringing this to our clinic.”

Staff engagement is equally important to Showell and Smith. “We definitely want to have a welcoming, supportive environment for our patients and families, but it also should be a great place to work,” Showell says.

The Harriet Lane Clinic last year held an outdoor fall festival with music and food where staff members and clinicians affiliated with the clinic could socialize informally.

“The clinic feels like a family,” adds Smith, who became associate medical director in July 2021 after being a preceptor since 2017. “COVID hit our patients hard, but our staff and clinic hard, too. Holding get-togethers or fun events in the clinic or on a weekend — it’s really important to keep that going.”