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The Vital Role of Hospitals in Tackling Health Inequities

Hospitals and health systems stand at the forefront of advancing health equity and carry the heavy responsibility of treating illness while promoting wellness and reducing disparities in health outcomes.

Many people face health challenges 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 wellbeing, and make it difficult to manage chronic conditions, recover from illness or maintain overall good health. Rural and urban hospitals and health systems stand at the forefront of advancing health equity and carry the heavy responsibility of treating illness while promoting wellness and reducing disparities in health outcomes of their communities. 

To effectively fulfill the role of convenor, healthcare organizations (HCO) like hospitals and health systems must foster internal cultural shifts that prioritize diversity, inclusivity, 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 drive impactful systemic change for individuals and communities. By aligning their internal values and practices with the needs and strengths of the populations they serve, HCOs and their care providers can become catalysts for health equity, ensuring that all individuals have full and equal access to opportunities that enable them to lead healthy lives.

Lessons learned 

In March 2021, the country was 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 system raised issues around feeling disconnected to the organization and were interested and concerned about the care that they felt patients received and didn’t receive. In response, the associate chief nursing officer of academic patient care clinical trials and health equity research was instrumental in launching and leading a DEI program that focused on health equity. 

What the academic health system quickly realized was the need to address workforce inequities to help solve patient and healthcare inequities. The health system applied a human-centered design approach to addressing the concerns of their Black employees and allies. They took a concerted effort to fully understand the lived experiences of their employees, in and outside of the workplace. This included everything from what they were going through, what they were seeing, what they were hearing, and what they were experiencing.

Fast forward three years, the health system has progressed strategic projects and programs within their workforce equity team while implementing bold moves to the paradigm. One example is that they implemented an equity award, whose foundation is in identifying and appreciating when equitable care is delivered, when there’s an opportunity to highlight someone for doing the right thing.

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

The bright spots of health equity

Health equity should be embedded in every aspect of the healthcare organization because it’s impossible to achieve quality or safety without it, and it must impact the entire organization to succeed.

Before one California public health system could move forward with driving and influencing their community, their chief health equity officer, needed to gain the trust of their CBOs and partners. They knew that their county has a lot of disinvested communities due to its rural geography, and they were being overlooked. The health system made a strategic decision to invest $20 million in their community and started 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 of demographic data gathering in public hospitals can play a vital role in achieving health equity. Over the past five years, the chief health officer of a different West Coast institute, has worked to nearly double its collection of self-reported data, including sexual orientation and gender identity (SOGI). This data availability has enabled them to spot disparities and determine where to concentrate efforts to lessen them. Moreover, they have observed their systems starting to engage, contribute, and delve into difficult conversations to understand how to restructure organizational frameworks.

Shared wisdom

Alone, HCOs and CBOs cannot address all the health-related social needs that influence the health of their patients and communities. Collaboration is key and being committed 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 that may need support. It’s also important to always consider the end goal and be intentional in the structural changes and the quality improvement changes that need to be addressed.

Wherever there is influence, there should be decisions to have diversity. While difficult, the best way to diversify a 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’s value in leaning into discomfort because a lot of health equity work is uncomfortable.

To effectively execute external health equity initiatives, it is vital to equally focus on strengthening internal health equity efforts. It’s important to deconstruct some of the existing infrastructure and collaboratively design and re-construct a healthcare delivery system that aligns with a shared vision and meets the needs of patients. Also, health equity should not be viewed as the responsibility of a single individual but rather as an integral aspect of an entire organization’s operations. 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 wish to see in healthcare.

Photo: wildpixel. Getty Images

Bryan O. Buckley, DrPH, MPH, MBA (He/Him/His) is the Director for Health Equity Initiatives at the National Committee for Quality Assurance (NCQA), where he supports NCQA’s Health Equity strategy across multiple departments to better integrate health equity concepts into existing programs and projects. Dr. Buckley serves as an Adjunct Assistant Professor at the Georgetown University School of Medicine, where he teaches, coaches, supports and supervises graduate students at 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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