As a 4th grader in Jackson Mississippi, Ivor stood outside a hospital room and listened to her father scream, “Let me go…let me go…” as three men held him down for a spinal tap. In that moment, she made her decision to become a physician, “I didn’t want to feel that disempowered again,” she states. Her decision to work as a health communication researcher evolved from this experience as well, “I didn’t want other kids, I didn’t want any patients … I didn’t want any other families to feel that way either.”
Dr. Ivor Horn’s journey from Jackson to Washington, DC and to an Associate Professorship in Pediatrics at Children’s National Medical Center and George Washington University School of Medicine included hardship and courage. Only in medical school did she discover that her family had been homeless at one time, “the fact that no one told me I was poor or homeless …gave me the freedom to not put boundaries on what I could do,” she writes.
This is why Dr. Horn maintains a clinic in one of the poorest areas of Washington, DC: Ward 8. Some facts highlight the need in this area of DC: the obesity rate in Ward 8 is 42%, even higher than Jackson Mississippi and the average family income is $10,000 per year. “The families I see experience challenging home lives a lot like that which I experienced growing up; I can look a kid in the eye and say with conviction that I know exactly what he is going through….” At her community health center, no one is turned away because they can’t pay.
As a physician, Dr. Horn is tested by her clinic’s schedule, “Our schedule allows 10-15 minutes per patient with a little extra time for complex patients…. those with multiple medical conditions that need multiple services.” So she empowers her patients with her four rules: “1) Sit down. 2) Listen, 3) Let them know we are in this together.” And her final, the “doorknob rule- “You can stop me anytime during the visit, even if my hand is on the doorknob.”
Pediatricians need strong partnerships with parents. What she has learned in her practice and her health communication research is that, “patients are more likely to follow a health plan they helped develop than one dictated to them.” Her experience tells her that, “Managing a chronic condition like asthma is about what you do every day, not just during a crisis. Give patients and caregivers tools that make management part of their routine. That means asking about THEIR routine,” she says.
Now she is sharing this knowledge with health care innovation designers in what she calls ‘Inclusion by design.’ She defines ‘inclusion by design’ as “A conscious effort to include the minorities who need disruption of health care, IN the innovation, development, and design process.”
To Dr. Horn, it’s really a no-brainer. As she points out, “Minority communities are actually early adopters of technology. They own more cell phones and are greater users of social media.”
Yet she is frustrated that, even though there is a wide variety of health IT out there, much of it is not reaching minorities or the underserved. In a presentation at the Healthcare Experience Design, 2013 conference, Dr. Horn gave a step-by-step description of just how to reach more of the underserved with innovations. For example, she pointed out that personal connections are key and active listening is necessary. Developers need to communicate and collaborate with minority communities on innovation solutions. “Trust and listening matter in health…and they matter in the design process,” she says. “Companies need to look to minority developers and Health Care Providers who are in the community already,” Dr. Horn states.
Dr. Horn recommends that designers start small or locally and then scale up. When HIT designers bring up the barrier of cost or money, she makes the important point that bringing innovations that help those who need it most will, in the long run, reduce health care costs for everyone.
Dr. Horn practices what she preaches, “When my patients see me in their neighborhood, it matters,” she says. When she recommends apps for teenage patients with asthma “Their eyes light up and they feel empowered. I’m on their turf.”
Knowing where her patients are coming from makes a huge difference. “I know what it’s like to have your phone or your electricity turned off.” And being a role model is important. “I know how important it is for my patients to see someone who looks like them and who tells them, I’ve been where you are and there is no excuse for you to not reach for the best.”
And that’s just what Ivor Horn has done since that fateful day in Jackson, Mississippi.
Presentation at HealthCare Experience Design 201 Conference