If 2020 was the year of a collective reckoning on racial injustice across the nation, then 2021 was the year of laser-like focus on how to redouble our efforts to advance equity and become more anti-racist. As Healthforce Center at UCSF will celebrate our 30th anniversary in 2022, we are taking extra time to review where we've been and where we are going.

For three decades, our research and convenings have helped health care leaders and policymakers better understand the health workforce and develop successful improvement strategies and policies. Our dynamic leadership training programs have touched thousands of people who continue to make significant and meaningful change in health care.

All of this work has been shaped by the recognition that achieving equity is essential for healthy communities. This past year, like many of you, Healthforce Center focused on examining how our organizational structures, processes, and people do or don't contribute toward equity. This included investing in training and educating ourselves, creating a pipeline for diversifying our staff, and redesigning our operations with the goal of removing structural barriers to equity.

In 2021, our research and convenings promoted practical ways to talk about the generational impacts of racism on health, build capacity that increases leadership diversity, and craft policies that can result in greater numbers of diverse and language concordant health professionals.

• To increase providers' understanding of how structural racism impacts health across generations, and how health care organizations can work toward becoming actively anti-racist, the California Improvement Network, one of Healthforce's flagship programs, held a workshop with experts in the field. Health care leaders shared strategies and reflections as they grappled with how to ensure equity by dismantling organizational policies that perpetuate inequities and integrating equity into efforts to address social needs that impact health.
• Safety-net institutions such as health centers and clinics are crucial to accessible and quality care for poor and underserved populations. To promote health equity and achieve real systems change in health care requires investments in leadership development in all sectors. A formal evaluation of the Clinic Leadership Institute, which Healthforce Center ran for more than a decade, showed that our proven methods of leadership development have borne fruit among its 258 graduates.
• Language concordance between care providers and patients is critical for establishing trust, ensuring patient satisfaction, and, ultimately, improved clinical outcomes. Unfortunately California has long had a dearth of trained health professionals who can provide care in languages other than English. We partnered with Mathematica to identify long-term and near-term policy strategies, including expanding pipeline programs, to train more health professionals who reflect California's diverse population.
• Health systems are uniquely positioned to advance health equity in communities by ensuring their workers are well, resilient, and equipped to deliver high-quality care. The COVID-19 pandemic has shown how work environments in health systems affect the well-being of workers, whose capacity to deliver safe, patient- and family-centered care plays a central role in achieving health. We guided recommendations for future investments with the potential to identify health worker supports, strategies, and efforts to promote well-being.
• Dental therapists (DTs) are a globally used workforce model that reduces educational barriers to improve workforce diversity while also safely expanding access to primary dental care. Introduced in the US in 2005, DTs have now been adopted in 13 states and several Tribal nations. Our study found that health equity is a driving goal for dental therapy adoption, including community engagement, implementation and dissemination, and access to oral health care.
• Health care quality improvement efforts may actually worsen health disparities for people systematically marginalized, if not carefully planned. We gathered strategies and tools from national leaders on ways to implement QI projects that intentionally advance health equity in primary care.

At Healthforce Center, we envision an effective and responsive system in which organizations across the health care ecosystem are prepared with the knowledge and leadership skills to drive progress toward more effective health care delivery and more equitable health outcomes for all. And as part of the University of California, San Francisco, the leading university dedicated to advancing health worldwide, our collective mandate is to advance health care quality and equity.

"Creating a more equitable, accessible, and inclusive health care system won't be easy, but we already know what works," UC President Michael Drake recently wrote. I couldn't agree more. Watch this space next month to hear about the projects Healthforce Center will tackle in 2022.