Equity in Healthcare – Equity is the ability of everyone to access and receive high-quality health care. It is based on the principle that no one is disadvantaged due to race, ethnicity, gender identity, sexual orientation, nationality, socioeconomic status, or geography.
Health systems must treat quality equity as a core strategy to achieve quality equity. They can do this by directing some of their financial investments to community initiatives; offering career-development opportunities for employees, some of whom live at or near the poverty level; carefully weighing options about where to build facilities; and striving for ethnic, racial, and socioeconomic diversity in all of their decision-making.
1Understand the Issue
Health equity is a complex issue that affects the lives of many people. It is a matter of access and quality, influenced by socioeconomic and demographic factors and the social determinants of health (SDOH), such as poverty, violence, unsafe living conditions, and environmental health risks.
Healthcare providers and systems can improve health equity by focusing on the social determinants of health and improving access to and quality of health services. This multidisciplinary approach requires leadership commitment, resources, and infrastructure.
In addition, it is necessary to address unconscious bias and make equity a core value. This requires training on the issue and participation in learning forums.
Identifying, understanding, and responding to equity issues should be a priority for all leaders. This is a challenging and time-consuming task but a worthwhile endeavor. It can also be an opportunity to strengthen organizational culture and commitment.
2Develop a Plan
To achieve quality equity in healthcare, organizations must choose a strategy that aligns with their goals and values. This can be a complex process, but there are many ways to start working toward a more equitable healthcare system.
The first step is to make equity a leader-driven priority. Senior leadership must articulate the vision, act on it, and build it into all high-level decision-making.
Moreover, leaders must allocate financial and information resources to the work of advancing equity, as well as create structures and processes that support it. At Henry Ford Health System in Detroit, for example, leaders have established a Center for Healthcare Equity under the stewardship of a senior vice president.
Achieving equity in healthcare requires that organizations engage other sectors to address the social determinants of health, such as access to transportation, housing, and education. It also involves the creation of a social risk stratification and adjustment framework that identifies potential disparities across multiple domains (e.g., race, gender, socioeconomic status, and so on).
Once this foundation is in place, data can help identify potential gaps. For instance, a system may incorporate nonmedical vital signs into its health assessment process and partner with community organizations to connect underserved populations with the services they need to be healthy. It also might create a systemwide care coordination program to help people stay in their homes.
3Implement the Plan
Health equity aims to deliver quality care that does not differ by race, ethnicity, or other personal characteristics. It is an essential quality pillar identified by the Institute of Medicine in its landmark report Crossing the Quality Chasm: A New Health System for the 21st Century.
Healthcare delivery systems must do much work to reduce health disparities, but it’s more complex. It requires a broad commitment across multiple aspects of a plan, and leaders must engage the communities where they provide care.
In addition, it requires that they prioritize equity in healthcare and support that effort with investments in infrastructure and staff training. The delivery system must also be transparent about its goals and how they align with broader plans for improving quality and safety.
Another vital support is governance attention to equity, especially at the board level. This includes holding the CEO accountable for achieving precise and quantifiable equity goals. It may also mean modifying executive compensation to ensure a meaningful portion of the total is connected to equity metrics.
Increasingly, health plans use data to identify and close equity gaps in delivering quality and safety services. This is a critical step to help improve care delivery and increase the effectiveness of programs designed to reduce health disparities. This strategy involves collecting and analyzing race and ethnicity data in a standardized format so that this information can be used to drive improvements.
4Monitor the Plan
Equity in healthcare requires a sustained commitment by all levels of the organization – delivery systems, quality improvement and safety teams, leadership, and the board. It also involves investment in infrastructure, including data systems and training on unconscious bias.
One way to monitor the plan’s progress is to include equity in all existing quality dashboards. This could mean creating an equity lens or incorporating equity into existing unit-, department-, entity-, and board-level quality dashboards. It should also ensure that equity is a common component of all financial and balanced scorecards.
Healthcare organizations can also track the outcomes of their health equity initiatives by tracing the social determinants of health (SDOH). Tracing SDOH allows healthcare professionals to understand how specific adverse SDOH lead to health disparities and provides insight into how to improve healthcare access and outcomes in communities.
The COVID-19 pandemic has demonstrated that pervasive and often deadly health inequities persist for Black, Indigenous, and people of color (BIPOC). The healthcare system can be a critical catalyst to improve these outcomes by addressing both within and outside the healthcare system through partnerships with other sectors and establishing a measurable and transparent racial equity agenda.