Equity expert says field can end disparities

Boston’s Massachusetts General Hospital, a 2014 AHA Equity of Care Award recipient, is working to ensure that all its patients receive high-quality care, and that the organization reflects the community it serves. The hospital’s Disparities Solutions Center (DSC) offers tools and resources to help identify and address disparities within hospitals and other organizations. The DSC also offers a year-long educational program that has helped leaders from 312 hospitals and other organizations address disparities and deliver more equitable care. AHA News recently spoke to DSC Director Joseph Betancourt, M.D., about the DSC’s work and the AHA’s #123forEquity Pledge to Act Campaign to end disparities in care and promote diversity.

AHA News: What are some of the key takeaways from your work so far, and how has the DSC helped shape Massachusetts General Hospital’s efforts to deliver more equitable health care?

Betancourt: DSC was built on a mission of developing and implementing strategies that advance policy and practice to improve quality, eliminate racial and ethnic disparities, and achieve equity in health care. Our goal was to move beyond research to action – by disseminating models for improving quality and identifying and addressing racial and ethnic disparities in health care nationally, regionally, and locally. We were extremely fortunate in the years leading up to the creation of the DSC to be housed at [Massachusetts General Hospital]. Our leadership, under the direction of our president, Peter Slavin, took the bold step of putting our hospital on a path to addressing disparities and achieving equity – based on the mantra that if the Institute of Medicine found there were disparities nationally, we should assume we were guilty until proven innocent and move to action.

Here are some key things we’ve learned. Policies, structures, expectations and accountability all set the stage. Data is essential.No hospital can know for certain if they have disparities, or deliver equitable care, if they don’t collect key demographic data from their patients that includes race, ethnicity, language proficiency, and education, and if possible sexual orientation and ability and disability. But collecting data is not enough; it must be made meaningful. Stratify quality measures by race, ethnicity, language and other factors at least on a yearly basis. Whether putting together an annual disparities dashboard or equity report, performance measurement in the area of equity is critical to success.

And if you find something, do something.For example,we found disparities in areas such as diabetes management, colorectal cancer screening, influenza vaccination, patient experience and the administration of perioperative antibiotics for Group B strep in obstetrics. This was no surprise to us, but we were prepared to quickly develop strategies to better understand and address the root causes and eliminate the disparities that were identified.

We developed a toolbox that facilitated this process, beginning with open communication with clinical leaders in those areas and focus groups with patients and providers, and moving towards the development of health care coaching programs, navigator programs, clinician education activities and patient information campaigns. Wherever we found disparities we took action and either diminished, or completely eliminated the difference, while improving quality for patients of all backgrounds that have been included in the intervention.

AHA News: Is it important to see equity from the patient’s perspective in order to develop policies and programs that can break down barriers to better health care?

Betancourt: Absolutely. To better understand the perspectives of our diverse patient population, we stratified our patients’ satisfaction and experience with their care by race, ethnicity and language. But we found that many voices were being left out in the dark. An analysis of our response rates clearly demonstrated that those who participated in this surveying didn’t represent the diversity of our patient population.

So we developed and deployed a patient experience survey that explicitly targeted and sought out, using a variety of methods, the experience of our minority populations. We found several key disparities, including how minority patients felt they were being treated compared to their white counterparts at our hospital. So in 2004 we conducted a series of cultural competency educational initiatives for our doctors, nurses and front-line staff. When the targeted patient experience survey was deployed again eight years later, we were pleased to see significant improvements in all the problem patient experience areas we had uncovered. The lesson for us was that cultural competence education matters, and has a direct impact on patient experience.

We’ve also created a multicultural advisory board and include diverse representation on patient and family councils, which inform clinical departments and programs.

AHA News: The AHA’s #123forEquity Pledge to Act Campaign calls on hospitals and health systems to commit to achieving within the next 12 months the following three aims: increasing the collection and use of race, ethnicity and language preference data; cultural competency training; and increasing diversity in leadership and governance. Can the campaign serve as a catalyst for change and advancing health equity as a national priority?

Betancourt: I am absolutely thrilled about the AHA’s campaign. The key components are doable, actionable and there are many models that are publicly available so hospitals don’t need to spend a lot of time reinventing the wheel. I would also say that the goals are fairly modest. Hospitals should be able to collect key demographic data of their patients; they should be able to rapidly deploy cultural competence education to all health care providers and staff; and they should be able to make progress on diversifying their leadership and governance. Achieving equity and diversity in possible and in front of us now, and the #123 Pledge allows us to create momentum, sustainability and national spread. By taking action in these areas, we put ourselves on a path to achieve high-value health care in a time of rapid transformation.

For more on the DSC, click here.  And click here to view a video message from AHA President and CEO Rick Pollack and AHA Chair-elect Designate Gene Woods, president and chief operating officer of Christus Health, on the #123forEquity Pledge to Act Campaignto eliminate health care disparities. To sign the pledge and get more information, visit www.equityofcare.org.