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Sun. Jul 14th, 2024

The critical role of hospitals in addressing health inequities

By Vaseline May30,2024

Many people face health problems due to unmet social needs, such as food insecurity, unstable housing or lack of transportation. These social factors, or health-related social needs, can reduce a person’s well-being and make it difficult to manage chronic conditions, recover from illness, or maintain good overall health. Rural and urban hospitals and health care systems are at the forefront of advancing health equity and bear the heavy responsibility of treating disease while promoting well-being and reducing disparities in health outcomes in their communities.

To effectively fulfill the role of convenor, healthcare organizations (HCO) such as hospitals and healthcare systems must foster internal cultural shifts that prioritize diversity, inclusion, and equity (DEI), while simultaneously building intentional external partnerships with community-based organizations (CBO). This dual approach of institutional internal cultural evolution and strategic community collaboration can create impactful systemic change for individuals and communities. By aligning their internal values ​​and practices with the needs and strengths of the populations they serve, healthcare organizations and their providers can become catalysts for healthcare equity, ensuring that all individuals have full and equal access to opportunities that enable them to live a healthy life.

Lesson learned

In March 2021, the country had been dealing with a full year of the Covid-19 pandemic, economic inequality and increased concerns about social injustices. During this time, Black employees at a leading academic health care system raised issues around feeling disconnected from the organization and expressed interest and concern about the care they perceived patients were and were not receiving. In response, the Associate Chief Nurse Officer of Academic Clinical Trials in Patient Care and Health Equity Research was instrumental in launching and leading a DEI program focused on health equity.

What the academic healthcare system quickly realized was the need to address workforce inequities to help solve patient and healthcare inequities. The healthcare system applied a human-centered design approach to address the concerns of their Black employees and allies. They went out of their way to fully understand the lived experiences of their employees, both inside and outside the workplace. This included everything from what they experienced, what they saw, what they heard and what they experienced.

Three years later, the health system has moved forward with strategic projects and programs within the workforce engagement team while implementing bold steps toward the paradigm. One example is that they have introduced an equity award, the basis of which is identifying and valuing when equitable care is delivered, when there is an opportunity to highlight someone for doing the right thing.

Additionally, the healthcare system has restructured its data system to obtain demographic information to better understand patient populations. As a result, they have begun to identify health disparities across all their quality and safety metrics. They are also working to boost access to communities of color in their clinical trials.

The bright spots of healthcare equity

Health equity must be embedded in every aspect of the healthcare organization because without it, quality and safety are impossible and the entire organization must be impacted to succeed.

Before a California public health system could make progress in engaging and impacting their community, their Chief Health Equity Officer had to earn the trust of their CBOs and partners. They knew that their province had many disinvested communities due to its rural location and that these were being overlooked. The health system has made a strategic decision to invest $20 million in their community and launched an Equity Partnership, which leverages public, private and nonprofit organizations to drive health equity initiatives that are aligned and collaborative.

Addressing and overcoming the challenges associated with collecting demographic data in public hospitals can play a critical role in achieving healthcare equity. Over the past five years, the chief health officer at another West Coast institution has worked to nearly double its collection of self-reported data, including sexual orientation and gender identity (SOGI). This availability of data has allowed them to identify disparities and determine where to focus efforts to reduce them. Additionally, they have seen their systems begin to engage, contribute, and delve into difficult conversations to understand how to restructure organizational frameworks.

Shared wisdom

On their own, healthcare organizations and CBOs cannot address all health-related social needs that impact the health of their patients and communities. Collaboration is key and a commitment to cross-sector collaboration should be the gold standard. That said, communication and collaboration take time. Start small and identify grassroots initiatives that are already happening within organizations and that may need support. It is also important to always keep the end goal in mind and be intentional about the structural changes and quality improvements that need to be addressed.

Wherever there is influence, decisions must be made to achieve diversity. While this is difficult, the best way to diversify the workforce is to diversify the C-suite, and the best way to diversify the C-suite is to diversify the board. It may be uncomfortable at first, but there is value in leaning into discomfort because a lot of health justice work is uncomfortable.

To effectively implement external health equity initiatives, it is critical that we also focus on strengthening internal health equity efforts. It is important to deconstruct some of the existing infrastructure and jointly design and reconstruct a healthcare system that aligns with a shared vision and meets the needs of patients. Also, health equity should not be seen as the responsibility of a single individual, but rather as an integral aspect of an entire organization’s activities. This approach ensures that everyone within the organization can articulate and contribute to health equity goals. After all, patients and their families deserve a system that embodies the ideals we all want to see in healthcare.

Photo: wildpixel. Getty Images


Bryan O. Buckley, DrPH, MPH, MBA (He/Him/His) is Director of Health Equity Initiatives at the National Committee for Quality Assurance (NCQA), where he supports NCQA’s Health Equity strategy across multiple departments to better advance health equity integrate concepts into existing programs and projects. Dr. Buckley is an adjunct assistant professor at Georgetown University School of Medicine, where he teaches, coaches, supports and mentors students in the School of Medicine and Biomedical Graduate Education. He is a board member of the American Public Health Association, American Heart Association Greater Washington, DC Region, and Food & Friends.

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