Hospitals aim for equity of care
AHA-McKesson Quest for Quality Prize winners are recognized for making impressive strides toward the Institute of Medicine’s (IOM) six quality aims of safe, effective, efficient, timely, patient-centered and equitable health care.
But achieving more equitable care can be a challenge even for the cream of the hospital quality crop, says Gary Yates, M.D., chief medical officer for 2004 Quest for Quality prize winner Sentara Health Care in Norfolk, Va., and chairman of the Quest for Quality prize committee.
“We see a number of organizations that are trying to understand the best ways of approaching” equity of care, says Yates, who adds that the committee is looking for more hospitals to accelerate their progress on that quality aim.
“I think it’s a combination of historically thinking about it as a standalone program or initiative and a concern about finding good practices that can make them more efficient and effective in advancing health equity,” he says.
According to IOM, the equity of care aim is focused on “providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location and socioeconomic status.”
What makes it so challenging is that there are “factors outside of the clinical care environment that are difficult to control, yet often have an impact on the outcome of the services provided,” says John Duval, CEO of 2014 Quest for Quality Prize winner VCU Medical Center in Richmond, Va. “There are many social determinants of patients’ health status that require a health system to modify its delivery models to achieve the desired health outcomes.”
VCU’s “complex care.” A survey of the costs associated with Virginia Coordinated Care, the hospital’s program to serve 30,000 un- or underinsured residents, found that 10% of patients with significant health problems accounted for 80 to 90% of the cost of the program. The hospital created a “complex care” program for 500 of the costliest patients, assigning each to a multidisciplinary team that included a doctor, social worker and a clinical psychologist.
The health system partners with other organizations to provide a full range of health-related services to homeless people in the greater Richmond area. And its Medical Respite program provides short-term residential care so they can rest in a safe environment while accessing medical care and other support services.
Hospitals “need to acknowledge where opportunities exist around equity of care and dedicate the resources to address the issues,” Duval says. While urgent, he says “it may be one of the more challenging issues for organizations that are struggling with ever increasing economic pressure as they advance the exceptional care they are striving to provide.”
The 2015 Quest for Quality prize winner, Children’s Colorado Hospital in Aurora, sees the pursuit of more equitable care as part of its continuous journey toward performance improvement.
School-to-Work programs, like Medical Career Collaborative and Project Search, provide opportunities for economically disadvantaged students to pursue careers in health care, with many hired by the hospital after completing the programs. Also, the hospital recently appointed Nita Mosby Henry, its senior vice president of human resources, as its first chief inclusion officer, as part of an effort to make the hospital’s workforce look more like its diverse patient population.
“Our commitment to broadening diversity is there, but the results may take time,” says Dan Hyman, the hospital’s chief quality and patient safety officer. “They just won’t happen overnight.”
Fostering a “culture of equity.” Providing more equitable care means “baking equity into all six of the IOM quality aims,” says Tomás León, president and CEO of the AHA-affiliated Institute for Diversity in Health Management. “Quality and equity are two sides of the same coin. We can’t achieve the Triple Aim of health care and transform health care without eliminating disparities in care.”
The “culture of equity” has to be an organization value, he says. “It takes purpose-driven leadership to be intentional about setting equity as a top priority and integrating it into your strategic planning process and leadership recruitment,” he says.
León finds that “purpose-driven leadership” at 2015 AHA Equity of Care Award winning Henry Ford Health System (HFHS) in Detroit and Robert Wood Johnson University Hospital (RWJUH) in New Brunswick, N.J.
HFHS was the 2010 Quest for Quality prize finalist. Among other achievements, the six-hospital system was recognized for a campaign to establish equity as a key, measurable aspect of clinical equity. To address the needs of the large Arab-American population in the Detroit area, for example, the hospital partnered with a community services organization to establish the Arab Community Center Obstetrics Clinic and the organization hired Arabic-speaking female staff to encourage women to seek care. The African-American Male Health Initiative promotes prevention and early disease intervention by reaching out to the community – such as through churches, barbershops and community centers – to provide health screenings and education.
Efforts to increase diversity in HFHS management has led to a 57% increase in minorities assuming leadership roles and a 44% increase in women in top leadership positions over the past five years.
“Diversity is in our DNA,” says health system CEO Nancy Schlichting. “It is who we are and who we serve.”
Rather than attempting to train everyone on every cultural competency, Schlichting says it’s “much more important to train them to ask patients questions … to learn from their patients, because often the patients will be the ones who will help them understand what those needs are.”
Making patient data guide your strategies. RWJUH gathers data on patient race, ethnicity and language to help identify ways of improving minority health care. It has increased the use of interpreter services and instituted transitional care for low-income patients to close the gap between patient discharge and their follow-up visit to their primary care physician. As a result, the hospital’s 30-day readmission rate dropped from 13% in 2013 to 5.2% in 2014.
“We are committed to living diversity as a value – modeling it internally, among our employees and patients – and externally,” says RWJUH President and CEO Stephen Jones, who appointed himself to the position of chief diversity officer from 2011 to 2014.
IFD’s León says the key to success in achieving more equitable care is leadership, community engagement and “stratifying the [patient demographic] data, analyzing the data and using it to inform care strategies and eliminating disparities.”
He also sees an economic imperative in pursuing the IOM’s equity of care aim. “Healthier communities, healthier workforce, healthier economy,” he says. And that is the vision of the AHA – creating healthier communities that help individuals achieve their optimum health.”