Healthcare Inequities Can Be Resolved with Anti-Bias Training, Data-Driven Systemic Change

There’s a disproportionate burden of negative healthcare outcomes for black and brown communities. Now, what do we do about it?

Championing health equity in healthcare leads to a focus on cultural competency, where providers offer services that meet the unique social, cultural, and linguistic needs of patients.

Even without the specter of a pandemic, healthcare systems can find serving diverse communities a challenge, but a few daring visionaries are proving that a focus on diversity and inclusion training and comprehensive assessments can help healthcare systems improve. “This current environment that we’re in is actually creating much needed attention to health inequities,” says Maria Hernandez, President and CEO of Impact4Health. “We’re finally looking at some of these structural issues that we knew long ago needed to be addressed.”

Championing health equity in healthcare leads to a focus on cultural competency,(1) where providers offer services that meet the unique social, cultural, and linguistic needs of patients. The proliferation of cross-cultural awareness can fundamentally alter how healthcare systems work. The ability of healthcare providers to offer services that meets the unique needs of patients has been the subject of countless reports showing key benefits of culturally competent care. Adopting this approach leads to better care for diverse populations, higher employee morale, better problem solving, and better employee retention.

The key to accomplishing this goal, according to Hernandez, is the collection of key data on health outcomes among diverse populations. One example is Sutter Health, which adopted the Health Equity Index(2) to measure health outcome disparities. The organization—company wide, including executive leadership and the board of directors—embraced a commitment to identify, quantify, and address inequities in the care they provide. It also made a significant commitment to engage staff and physicians in anti-bias training.

Some barriers to health equity are based on structural or systemic racism, while other challenges are often based on individual bias, conscious or unconscious. These biases about others enter into a myriad of decisions about how a patient is treated in both subtle and significant ways. Learning about these issues improves the quality of care and creates opportunities for improved staff performance.

“We need to think about every step,” says Dr. Stephen Lockhart, Sutter Health CMO. “How can we, as an organization, employ techniques to get equity or equitable results in the care we provide?”(4)

“COVID-19 ripped the band-aid off of the structural inequalities that exist not only within our society but also our healthcare system,” says Dr. Lockhart. “When you consider Black Lives Matter and the George Floyd murder, it becomes a perfect storm. We know that there’s a disproportionate burden of negative outcomes for black and brown communities. Now, what do we do about it?”

Impact4Health addresses these challenges in a holistic way, examining each healthcare organization in its entirety. First, detailed statistics, case studies and other examples drawn from real life situations help demonstrate to physicians, caregivers and other providers that inequity is real. Secondly, the organization provides training not just to physicians but also administrative staff using a strategy dubbed “The ACE Mindset,” or Attention, Connection and Empathy. Simply helping doctors put themselves in someone else’s shoes can change how they act, leading to better outcomes. This work must also take into account the real challenge of “diversity fatigue,” (3) as some of these factors have become more polarizing across the nation in recent years.

These are big ideas to absorb, so we know there’s no “magic bullet” to change the healthcare industry. Sutter Health’s approach is just one example of building a playbook for health equity, though. Identifying and quantifying the effects of health inequities and assessing a hospital’s approach to these challenges with a tool like Impact4Health’s free Inclusion Scorecard for Population Health is a place to start. As healthcare organizations seek to develop a culture of inclusion, including fostering a workforce that more closely represents the communities they serve, health outcomes improve. As physicians and other healthcare professionals embrace a more thoughtful consideration of each patient, whether they’re affected by ethnicity, poverty, past experiences or other cultural factors, not only do outcomes improve but costs also decrease. “You must integrate equity into all elements of healthcare delivery,” says Hernandez. “Health systems need to look at how diverse patients experience care the minute they walk in the door. Every interaction, every diagnosis, every treatment, every step—can be designed to promote health equity and better outcomes.”

Healthcare systems across the nation are working exceptionally hard to address the pandemic and the inequities it has exacerbated. That work requires a true assessment of all factors that can advance quality of care for all. “Those who are taking a hard look at how to provide culturally competent care, training providers on unconscious bias are making strides. The next step is to work in partnership with vulnerable communities to solve key challenges together.” says Hernandez.

About Impact4Health
Impact4Health is a multidisciplinary team of community psychologists, public health researchers, physicians and health educators who promote health equity, working in partnership with hospitals, public health departments, and healthcare insurance providers. Strategies employed include training in cross-cultural health, inclusive leadership, and implementing the Inclusion Scorecard for Population Health. Impact4Health is also a leader in the development of health-related Pay For Success initiatives to address asthma-related emergencies for children living in vulnerable communities. For more information, please visit us as http://www.Impact4Health.com.

1.    Centers for Disease Control; “Cultural Competence In Health And Human Services”; npin.cdc.gov/pages/cultural-competence Accessed 20 JAN 2021
2.    Pressman A, Lockhart S, Petersen J, Robinson S, Moreno M, Azar KMJ (2019) Measuring health equity for ambulatory care sensitive conditions in a large integrated health care system: the development of an index, Health Equity 3:1, 92–98, DOI: 10.1089/heq.2018.0092.
3.    Chronicle of Higher Education; “Diversity Fatigue is Real”; chronicle.com/article/diversity-fatigue-is-real/ Accessed 20 JAN 2021
4.    Centering Health Equity Podcast Interview with Dr. Stephen Lockhart anchor.fm/centeringhealthequity/episodes/Major-Health-Systems-Respond-to-the-National-Call-for-Health-Equity-Part-1-emvksq

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