How equity impacts the patient experience

Health equity has significant impact on the patient experience, which is an essential tenet of health care value. As part of a four-part series examining how health equity influences health outcomes, finances, and affects the length and quality of our lives — Priya Bathija, vice president of AHA’s The Value Initiative, and Duane Reynolds, president and CEO of the AHA’s Institute for Diversity and Health Equity, address how equity impacts the patient experience.

AHA News: How can clinicians work to improve the patient experience in a more equitable way?

Duane Reynolds: In order to improve the patient experience, clinicians must acknowledge that variability exists in how individual patients perceive clinical interactions. Some of these perceptions are formulated well before an actual clinical interaction.  

As a result, the patient may present with certain biases about the clinician and vice versa. Biases are not innately negative but can create discordant interactions based on conflicting cultural beliefs, assumptions about individual behavior and propensity to change.   

Clinicians should investigate their own biases by completing the Implicit Association Test.  

Awareness of one’s own biases are important to developing new patterns of thought and to dispel beliefs that may prevent trust building and empathy during clinical interactions. Clinicians also should request their patient satisfaction data be stratified by race, ethnicity, language, sexual orientation and gender identity as available in order to understand differences in patient experience. 

Priya Bathija: Clinicians must prepare for sensitive conversations, invest in cross-cultural training and professional medical interpreter services, among other efforts. The AHA’s screening for social needs tool can be helpful here.

Baylor Scott & White Health’s Community Advocates Program is a great example of social needs screening done well. The program trains undergraduate student volunteers to screen patients for their medical and social needs and link them to existing resources in the community. As a result, the 30-day readmission rates of enrolled patients dropped by 87.5%.

Also, we need to flat-out ask our patients what they want — and do it in ways that are comfortable for them.

We might not always like their responses but knowing what matters for patients will allow hospitals and clinicians to better design solutions and care plans. 

For example, hospitals participating in the Age Friendly Health Systems movement use the 4Ms Framework to address the needs of older adults. Developed by the John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, caregivers focus on What Matters, Medication, Mentation and Mobility to increase patient satisfaction, improve health outcomes and reduce costs. Anne Arundel Medical Center used the 4Ms in various ways to ensure better care coordination. As a result, they gave back 10.23 years of patients’ time, reduced readmission rates by 8% and length of stay by 26 hours, all contributing to improved patient experience.

Lastly, it’s important to remember that equity starts at the top, and it’s ultimately up to leadership to champion these efforts and to fight for increased access to care among diverse populations.

AHA News: How does an improved patient experience impact value?  

Priya Bathija: More equitable patient experiences promote better outcomes and ultimately lower costs, which spurs value.

For example, Boston-based Brigham and Women's Hospital tested a low-cost care model by treating patients in the comfort of their own homes, which has boosted value and resulted in fewer clinical interventions for patients. This makes care more affordable for a wider variety of patients and has saved money and improved outcomes. 

Duane Reynolds: Value is derived when we improve experience, outcomes and reduce costs. Experience applies not only to patients but also to the community and employees.  

Patients’ assessments of care are often based on interactions during the process and whether they recovered from their illnesses. That experience can help or hinder recovery and impact whether or not patients understand and choose to follow a clinician’s plan of care.   

Understanding patient experience from various demographic lenses allows providers to improve experience for all and not solely based on the majority population. The demographics of our country are steadily moving toward a majority-minority makeup. As a result, it is critical for hospitals and health systems to get ahead of the curve, understand and strategize methods for engaging and building trust with minority and underserved populations for which we are increasingly being held accountable for care and outcomes. 

Priya Bathija is vice president of AHA’s The Value Initiative and Duane Reynolds is president and CEO of the AHA’s Institute for Diversity and Health Equity.