How Clinical Leadership is Helping Shape More Equitable Kidney Care | The Clinical Compass
For Dr. Bourne Auguste, kidney care is about more than disease progression. It’s about addressing inequities in care and partnering with communities to improve access and outcomes.
When kidney disease progresses, access to timely and appropriate care can significantly affect health outcomes. Yet not all people in Ontario experience kidney care in the same way. Black people in Ontario are disproportionately affected by chronic kidney disease (CKD) and have a 35% higher rate of dialysis use compared to the rest of the population. Disparities in access and outcomes continue to affect many communities across the province.
Addressing these inequities is a key focus for Dr. Bourne Auguste, nephrologist at Sunnybrook Health Sciences Centre and Provincial Medical Lead for Health Equity and Chronic Kidney Disease at Ontario Health. Through his clinical leadership role, he works to support equitable, timely access to care for people living with kidney disease.
Understanding the Impact of Chronic Kidney Disease
For Dr. Auguste, his work is deeply informed by his clinical experience. In practice, he observed differences in how patients accessed care and experienced outcomes.
It was by witnessing these disparities in health outcomes for racialized groups that motivated me to pursue this clinical leadership role.”
These observations led him to explore how health equity could be advanced through both clinical care and system-level change.
“As a clinical lead, I use data collected across the province to identify inequities,” he explains. “This includes examining information by postal code, race and socio-demographic factors.”
Their findings confirmed many of the concerns raised by patients; however, data alone is not enough.
Clinical leaders also bring direct patient care experience into system planning and decision-making. When developing initiatives focused on health equity, Dr. Auguste and other clinical leaders recognized the importance of ensuring that patients and communities help inform the conversations and decisions that would ultimately affect their care.
One example of this approach was by organizing several community engagements hosted by Dr. Auguste and his team, which provided an opportunity to hear directly from patients.
With advancing health equity identified as a formal strategic objective of Ontario's kidney care system, the plan is designed to help ensure that more patients receive care that reflects their individual needs, experiences and circumstances. Through a greater focus on cultural safety, patient partnership and reducing barriers to access, the plan will help guide health care providers to create a more equitable kidney care system for underserved populations across Ontario.
Helping to Create Trust Between Clinicians and Patients
Improving kidney care also requires building trust between clinicians and the patients they treat. Dr. Auguste says that listening to patients and acting on their feedback is essential to strengthening these relationships.
Trust in the health care system is not experienced equally. Historical and systemic discrimination has contributed to mistrust among some communities, particularly when patients feel their experiences are not reflected in their care.
“Trust-building requires honest and transparent conversations about why engagement is happening, what concerns exist and what the team hopes to achieve,” says Dr. Auguste. “It’s also important to acknowledge past harms, as overlooking them can perpetuate mistrust.”
Culturally safe care is one way to strengthen trust. Dr. Auguste believes that delivering care must reflect the unique contexts of each patient.
“Culturally safe care begins with recognizing that each person’s context is unique,” he adds. “Whether it is how they receive care, the foods that are part of their daily lives or their experiences navigating the health system, these factors can vary widely, and I believe care should be tailored to reflect those differences.”
By engaging directly with communities and recognizing diverse experiences, clinicians can create stronger relationships and more equitable approaches to care.
The Role of Clinical Leadership in Advancing Equitable Care
According to Dr. Auguste the role of a clinical lead should centre on two priorities – caring for patients and advocating for them.
“Advocacy comes from listening to patients, understanding their lived experiences and using clinical encounters to help shape policies that affect those patients,” he says.
While his work focuses on kidney care, Dr. Auguste recognizes that advancing equity is a shared responsibility.
You don’t have to be a clinical lead to make a difference clinicians at all levels can contribute by engaging with their patients and communities to better understand barriers to care.”
Whether through data analysis, community engagement or culturally safe care, clinicians can help identify and address inequities across the health system. For Dr. Auguste, success means ensuring that no one is excluded from the conversations and decisions that shape care.
As Ontario continues to work toward a more equitable health system, he hopes more clinicians will adopt his principles of listening to patients, following the evidence and ensuring that care reflects the diverse communities it serves.
Last Updated: August 14, 2026
