‘The progress that has been made, it’s pathetic’
What has the last 18 months taught us about equity of care issues facing the industry?
The last 18 months have taught us what we should have known for over 50 years— disparities in healthcare are one of the most researched, talked-about topics in academics and in research. Over the past 50 years there have been more Ph.D.s earned on this topic, yet the progress that has been made, it’s pathetic. Perhaps the past 18 months have put a focus on our attention, but still the response is slow.
Why do you think the response has been so lethargic over the years?
I think, on behalf of healthcare leaders, it demonstrates a lack of social responsibility. (They) focus on finances and other areas, rather than looking at the communities they serve and looking for opportunities to address it. … Attention has gone elsewhere from healthcare leaders.
Are you seeing any areas of progress? Places that are doing it right?
There have been some organizations that have been working on this topic all along. And what we’re seeing now, if you go to any medical conference, healthcare conference, this topic is on the agenda, so it’s being discussed.
If you also look at most of the healthcare associations, professional or trade organizations, they’ve all made statements. I want to give a shoutout to the (American Medical Association), which came out with a very strong statement, and then followed it with an acknowledgment of the history of the AMA contributing to the injustice that results in disparities and other issues.
Are there practical things that are working for organizations that maybe the Joint Commission or others could talk about more and get more into the field?
Yes. And that’s the reason why we put out a national competition, the Bernard Tyson National Award for Excellence in the Pursuit of Equity. That’s going to allow us to highlight leading practices, because there are organizations that are doing amazing things. So we do want to educate.
We also want to talk to healthcare leaders that this is a safety issue. It’s not a stand-alone problem. It’s not OK if a woman of color goes to deliver a baby and she has twice the rate of an injury during that delivery. That’s a safety concern. We want organizations to turn to their quality improvement infrastructure to address these problems, not to build something completely new. They have the expertise. They need to look at the data, understand the root causes and move forward.
How is the Joint Commission thinking about health equity from a quality and safety perspective?
“We need to move from talking about the data, talking about the numbers, to apply solutions and being attentive to these issues.”
We’re in the process of evaluating and speaking to experts about the potential of new standards that will ask organizations to assess the disparity issue, identify an opportunity and then address it, without being prescriptive on how it’s going to be addressed.
That’s the first step—to identify a real opportunity. And don’t assume that you understand why that disparate outcome occurs. You really need to work with the community and people of those underrepresented groups to understand what are the true issues that keep an individual either from accessing care, following up through care, or staying within the healthcare arena.
Are there specific conditions you would start to look at, or do you try to do this across the board?
We’re encouraging organizations to identify those opportunities. And they really should not be difficult to identify, whether it’s vaccination rates during COVID-19, (or) we know that (improvements in) maternal infant morbidity and mortality are a huge opportunity.
So the opportunities shouldn’t be difficult to find, but we want the organizations to own them. And they could only own them if they identify them and commit to improving.
Data collection has been a problem for years. Are you seeing improvements on that front?
You have to train your staff to collect the data in an appropriate manner. Without that training— and quality improvement approach toward the collection of data—what you start to collect is numbers that may not necessarily be real.
So the first step is the education and training of all those who are going to collect the data. And then it’s the analysis of the data, which organizations have more experience with, but they lack an expertise in the collection process.
Are there things the federal government can and should be doing to force more work on equity of care?
Absolutely. I think (the Centers for Medicare and Medicaid Services) in particular could help organizations on the accountability side of improvement, require metrics and outcomes, and also use the reward systems—compensate organizations that are really doing excellent work in this area, and work with organizations using their regulatory impact on organizations that are not.
From a leadership view, where do organizations need to start?
I’m a big believer that it always starts with the governing body. And the governing body is instrumental in this effort. It may require resources. It does require leadership. And it requires accountability. The board has to view this again like any other patient safety concern. Whether it’s a central-line infection or it’s a bad outcome because it was a black woman. It’s the same kind of safety concern.
Are you seeing boards taking action?
The conversations I’m hearing are not at this time coming from the board, but more from organization leaders. Individuals who have been working in this space for a while are now getting a platform to be heard and educate others, which is really important.
There’s a difference between education and awareness. Education is the knowledge, you have the facts and then you have the language and all of that. To me, awareness is the application of that education. And that’s where we need to be. We need to move from talking about the data, talking about the numbers, to apply solutions and being attentive to these issues.
And also, looking within our organizations and looking for those structural things that we don’t see every day, that actually are either dismissive to a community or are an impediment.
What’s an example of something like that?
It’s very interesting. I was (in medical) training in a segregated organization in the Northeast. And the white patients were in one wing, the new wing, and patients of color in another. That was a sign of disrespect to a lot of the patients who came in. They did not like to come into the hospital because they felt they were going to be given a second status. And they were.
We have remnants of all of that still around us. And all of us who were educated in that system, that kind of thinking is still hardwired in our minds. And we bring that to work.