Even as healthcare leaders embrace health equity as an urgent goal, figuring out how to undo the complex web of systems responsible for America’s serious health disparities is daunting. The work will take years of commitment, and getting started requires a thoughtful roadmap to implement an effective strategy.
Having the right mindset is key. Health equity must not be seen as a new initiative but as a cultural priority embedded throughout the organization. This approach supports other top priorities, such as achieving high reliability care, succeeding in value-based contracts, and cultivating a high-quality workforce.
Collaboration with a wide range of internal and external stakeholders and, in some situations, coalition-building with other organizations will be needed. The leader’s most important role is to keep building momentum.
“We want to see change quickly, but health equity work takes time,” said Portia Newman, PhD, Associate Vice President of Education and Engagement with Chartis Just Health Collective. “You must set up this journey so that leaders understand the time investment, the financial investment, and the strategic action plan that makes sense for the organization.”
Understand Where Your Organization Is on Your Health Equity Journey Today
Health equity has many different facets, so it is important to get clear on your organization’s role and goals for this work. Using specific language will inform the scope and approach that will best serve your organization.
Some goals—for example, increasing equity and inclusion within a health system to improve patient care—can be pursued with the resources of a single organization. Other goals—such as reducing health outcome disparities in the community—may require partnering in new ways with many stakeholder groups, such as community benefit organizations, federally qualified health centers and safety-net hospitals, and possibly other health systems.
Just as important as clearly identifying your specific goals is assessing all processes and systems to understand the current situation. Are you tracking patient health outcomes trends and analyzing for disparities? What’s happening from a health equity learning and development standpoint? Do your recruitment and hiring processes support health equity?
“An assessment gives you the opportunity to explore multiple parts of an organization,” Newman said. “It is a broad investigation of where an organization is on their health equity journey.”
In many cases, this assessment may need to be done before—or in tandem with—identification of your goals. Both tasks require a wide range of input from stakeholders, including staff members, patients, and community representatives.
“To accelerate change, organizations need to understand what’s working for them and against them,” said Tana Watanabe, Senior Managing Advisor with Jarrard Phillips Cate & Hancock, a Chartis company. “An assessment that includes evaluating strategy, operations, and communications is fundamental to finding your starting point.”
The Business Case for Health Equity
Working toward health equity is the right thing to do, but it’s also a wise business strategy. The organizational assessment should identify ways that reducing health disparities can improve financial performance.
One example is increasing access to care. When a patient with housing instability shows up in the emergency department with severe problems that could have been avoided with preventive or primary care, the hospital may need to provide lengthy inpatient care that goes unreimbursed. Helping patients access the right care at the right time to avoid such scenarios is a step toward health equity and measurable savings for the health system.
Part of developing the business case up front is defining success metrics that align with industry best practices and expectations, and measuring how health equity and belonging goals will transform multiple parts of the organization.
Listen, Seek Input, and Get Feedback
Even the best leadership team cannot undo the legacy of health disparities on its own. The way organizational leaders embrace the health equity journey will demonstrate how serious they are about its outcomes. Success requires listening to employees, patients, and communities—particularly those who have not experienced equity in healthcare and may distrust the possibility of change.
“You need to model the outcomes you want to achieve from this process through this process,” said Nathan Hall, Strategy Principal with The Chartis Group.
Intentional listening requires figuring out the most effective way to get input from groups whose voices often go unheard. Next, leaders must report back to the community a summary of what they heard, how they will respond, and how progress will be measured. Most importantly, continuous communication—both reporting out and seeking feedback—must be maintained to keep health equity front and center for the entire organization.
Getting the Board on Board
Board members must be health equity champions, not allowing the work to drop off when other priorities demand attention.
Board members need to recognize that working toward health equity is both a moral and a business imperative. They must understand upcoming regulatory and credentialing changes related to health equity and how the organization, its patients, and its community benefit when health equity—and health outcomes—are enhanced.
As top advocates for health equity, board members will make sure the executive team has appropriate resources to support the work. They also serve as liaisons to community leaders and other external stakeholders, helping to leverage the trust that each group of stakeholders has with its audiences.
Create an Achievable Roadmap
Each organization will have a different roadmap for implementing its health equity strategy, but certain elements are essential.
Clearly defined roles and expectations must be embraced by all leaders, from mid-level managers to the executive suite and board of directors. It may take considerable time to educate these leaders about the need to work toward health equity, the strategy for doing so, and the perils of ignoring it, but it will be time well spent.
Measurable targets should be developed for both process and outcomes. How many staff members will complete a specific training module to advance diversity, equity, inclusion, and belonging? That is a process measure. Did the gap in colorectal screening rates between African American and non-Hispanic whites narrow from one year to the next? That’s an outcome measure. Tracking these measures is helpful when used with a health equity maturity model to show the organization’s progress toward health equity.
Explicit timelines for operational and communications milestones keep the work moving forward.
The decision-making team will include C-suite executives as well as individuals from all levels and all areas of clinical practice and administration. The team must represent the broadest possible range of perspectives. This group will be responsible for defining metrics, providing the resources needed to implement the strategy, and keeping all stakeholders apprised of progress and lessons learned.
A clear communications plan is needed for both internal and external stakeholder audiences. Keeping external stakeholders well-informed may create opportunities for mutually beneficial partnerships. Internally, change often triggers resistance, and health equity work may generate pushback. A good communications plan will anticipate challenges and have strategies lined up to address them.
Achieving health equity will take many years, but incremental progress is possible and must be made visible. “It’s equally important to identify short- and long-term wins and share those successes along the way,” Watanabe said. “By sharing the work you’re doing with the community, you bring people along with you—which can help you achieve health equity outcomes faster.”
How One Health System Started Their Health Equity Journey
When a large integrated health network—with 33,000 employees working in more than 400 locations—wanted to accelerate its diversity, equity, and inclusion efforts and implement a health equity and belonging strategy across the institution, it began with undertaking a culture and climate assessment to inform the work.
That 90-day health equity and belonging assessment and a series of facilitated strategic advisory sessions with the CEO’s cabinet clarified the health system’s current status on a health equity maturity model and what it needed to do to reach its health equity and belonging goals.
That assessment informed the development of a multi-year implementation strategy that included detailed playbooks across vision and strategy, structure and leadership, organizational capabilities, and incentives and accountability. The organization is now on the road to measurably improve health equity and belonging internally and for its community.
Stay Fixed on Health Equity
Best practices for a successful journey toward health equity are similar to those for any major institution-wide initiative.
- Align all leaders, including board members, with the organization’s health equity strategy.
- Create a communications and change management plan that can effectively move this work forward.
- Identify a timeline to assess progress and change.
- Bake transparency with internal and external stakeholders into the strategy.
Although these best practices serve many initiatives, the journey toward health equity requires its own unique perspective. The journey will be long, but the reward is a culture that promotes health for all.
“What's important here is to make sure that achieving health equity is not an initiative,” Watanabe said. “It needs to be ingrained in the culture of who you are as an organization.”