As the U.S. moves toward a pay-for-performance quality and safety model, addressing care for vulnerable populations is vital. Hospitals must now find an effective way to manage both medical and non-medical factors for their patients. However, these non-medical factors are also some of our most pressing social issues: poverty, race, geographic location, and ethnicity and language barriers.
Every day across our country, people experience the harsh reality of the often inadvertent inequities in health care. Imagine not being fully aware of your health condition or not receiving necessary care due to a lack of access to providers, bias, low health literacy, limited English proficiency or at worst, racial stereotypes. Imagine having to choose between getting your insulin or feeding your family. Imagine having limited access to transportation and the closest grocery store is more than 30 minutes away.
It’s true that addressing health disparities can feel overwhelming, for a number of reasons: not knowing where to start, a lack of resources, personal and cultural bias, and multiple other priorities. The good news is many hospitals now include health equity in their system's strategic plans and are seeing some success. In addition, across the board, we have opportunities to engage more hospitals and dive deeper into improving health equity efforts.
To improve quality, hospitals must address equity
The Institute for Diversity and Health Equity defines health equity as everyone having a fair and just opportunity to be as healthy as possible. Addressing differences or gaps in health care among certain populations must be on the agenda for every health care organization, not only because of increased morbidity and mortality rates in disadvantaged populations, but also as a result of the predicted U.S. population shift. Statistics show that by the year 2060, the U.S. will be a minority majority country – meaning the population will shift to be 56 percent minority and 44 percent white.
As organizations work to meet the needs of their patients and staff, they must hear from and engage patients, families and staff in order to better serve them. Diverse voices and representation must be present to gather ideas and feedback from all of the populations that are served. Organizational leadership also should reflect the communities served in order to include a diverse perspective on decision-making and policy implementation.
Collecting data such as race, ethnicity and language (REAL) components and then stratifying quality outcomes by REAL has shown many hospitals opportunities for improving care in particular populations. For instance, one system found significant disparities in African Americans who readmitted with pneumonia. The African American readmission rate for patients with pneumonia started at 17 percent, compared to white patients who readmitted with pneumonia at a rate of 13 percent. The hospital team conducted a comprehensive review of medical records, looking at numerous clinical and socioeconomic data elements, and identified opportunities to address the disparity. They formed work streams to implement targeted interventions related to discharge, home visits, access to care and awareness; and the rates decreased to 11 percent and 9 percent, respectively.
One of the keys to this hospital’s success is having their chief diversity officer included on the executive leadership team. The hospital team’s work has created a framework for addressing disparities in other quality metrics across the system. It serves as a great example of prioritizing health equity and improving care for all patients.
The Centers for Medicare and Medicaid Services is also heavily involved in addressing the health equity issue. Their Partnership for Patients Initiative is centered on making care safer, improving care transitions and increasing safety across the board. Safety Across the Board (SAB) means a hospital has a culture in place that avoids harm across all conditions, specialties and units; it means the system of care is safe. One of the principles of SAB is addressing health disparities.
The Institute of Medicine includes equitable care in its Six Domains of Health Care Quality along with safe, efficient, patient-centered, effective and timely. The power to begin to close the gaps in health care begins with conversations and dialogue we can have to start to change perspectives. I encourage hospitals to include health equity as an organizational goal and priority and supply resources to implement needed changes throughout the organization in addressing health disparities. Let’s all continue to work toward providing safe, equitable care for all patients to live their best lives.
Vizient has been engaged in helping hospitals address health disparities and become more equitable in their care. To learn more, contact Ashley Neal.
About the author. In her role at Vizient, Ashley Neal coaches HIIN participants, facilitates the Rapid Adoption Network (RAN) improvement methodology, and manages HIIN members in transformation networks to assist them in improving patient safety and quality of care in their institutions. She has also served as a planner and committee member on the Knowledge Network Series Steering Committee. Prior to joining Vizient, she served as a clinical nurse leader, where her accomplishments in the hospital setting included Top 10 Nurse, Mosaic Award for Diversity and Inclusion, and Chairman’s Award Circle of Excellence.