Use Case 2. Initiating antiracism work within one learning network

The All Children Thrive Learning Network in Cincinnati, OH (ACT) is a learning network launched by Cincinnati Children's Hospital (CCHMC) and more than 30 other organizations to apply the science of quality improvement to some of the toughest, most complex problems affecting community health. ACT convenes improvement teams including members of the healthcare system, community organizations, the public school system, and parents from the community. In Spring 2019, at the biannual learning session, a gathering of network members to accelerate progress of the improvement teams, those with lived experience, including parents, challenged all people present to recognize and meaningfully address the influence of racism in achieving the goals of every improvement team. This call to action served as a catalyst for the development of antiracism work within ACT. The antiracism team convened to initiate the antiracism effort, which included members of ACT who had expertise in Critical Race Theory and/or lived experience with racism. Prior to starting the antiracism work, the members of this team had many conversations about racism in general as well as how it impacted the goals that ACT is working to accomplish as well as our daily interactions at work. These conversations were opportunities to practice interrogating and naming their participation in and/or experiences with white supremacy, white privilege, and racism and increased the team's comfort in doing so. Supported by the call to action and this foundational relationship, the antiracism team established a global aim to create an antiracist environment within the ACT network and an initial SMART aim to increase awareness of and willingness to address racism at all levels of the organization as measured by the Racial Equity Map (REM) by June 30, 2021. The REM was developed by the Racial Equity Learning and Action Community as a measurement tool for organizations to identify their place on the racial equity journey, catalyze conversation, and identify actions steps to advance racial equity together. 49 The team subsequently worked to build a theory of change (Figure 3). Other components of the anti‐racism work included creating a stakeholder diagram based on two categories: (1) level of support for anti‐racism work and (2) importance of buy‐in for the success of this work. The team also conducted informal interviews with a variety of internal ACT network members (eg, those members who also work at CCHMC) to inform where to start the antiracism work, learn about the historical context of antiracism work in the network, and build will for the effort. Collectively, these efforts led the team to testable interventions. Based on this process of developing our theory of change, conducting a stakeholder analysis, and conducting informal interviews, the antiracism team learned that internal members of the ACT network did not know how to talk about racism nor where to start to address racism. The antiracism team therefore developed a meeting series focused on antiracism‐related education and capacity building. In this series, the team created brave spaces 50 of learning in which a volunteer group of ACT network members were able to have open and honest dialog regarding racism and its impact on both their personal and professional lives. The team chose the term “brave spaces” intentionally to set the expectation that the team could not promise the comfort many associate with “safety” (eg, safe spaces). Instead the group (eg, the volunteer group and the antiracism Team) would have to lean in to the challenging nature of these conversations. 50 Additionally, we emphasized the importance of embracing failure. The group was there to provide critical feedback with the understanding that critical feedback is an investment in another's continued improvement. The group then worked together to develop a common language by defining terms including race, racism, white privilege, and white supremacy. The antiracism team, led by the needs of the group, also provided education about the historical impact of racism, and the group worked together to identify and name the influence of racism on the work of ACT. Building on this foundation, the group used case studies to identify and then practice addressing racism in the work and the work environment. Our early experience in the antiracism work has affirmed that this work is hard, and resistance to this work shows up both at the individual and institutional levels. The following are learnings based on our experience about how to do this equity work within our network—generalizable principles that could be applied to equity within Learning Health Systems. First, our experience affirmed that time, space, and access to resources, including subject matter experts and measurement tools, are critical. Dismantling structural racism and other forms of systemic oppression that thrive on mutually reinforcing inequitable systems requires time. 51 While quick wins are important for building early will, long‐term support is necessary to achieve sustained change. Second, the experience affirmed that it is essential to include diversity in race, ethnicity, age, gender identity, role within CCHMC, and perspective. Working in an echo chamber decreases a team's ability to identify blind spots. This is particularly important when working to identify and dismantle white supremacy within a system built upon white supremacy. Third, our early experience affirmed the need to create an environment in which team members can call out hesitations and motivations, examine and discuss root causes, and openly contemplate whether or not their efforts are producing the desired outcome. We are now working to scale this intervention to other groups across CCHMC.