We recently hosted webinars for providers in Canada, the United Kingdom, the Middle East, Australia, and Asia Pacific on strategies to reduce disparities that occur during patient interactions and elevate health equity as an enterprise-wide priority. (Click here to view the presentation in full and download the PDF.)
Around the world, patients with marginalized identities (e.g., racial and ethnic minorities, LGBTQ+ communities) experience longer lengths of stay, higher rates of readmission, shorter life expectancy, and higher disease prevalence than their non-marginalized counterparts. While these are symptoms of broader institutional and historical failures, hospitals and health systems can—and must—address the inequities that occur within their four walls.
Over the last year, our members have increasingly requested for health equity research. Many Advisory Board research teams pivoted to address the need and, through dozens of interviews with health system leaders and extensive literature reviews, we identified eight dimensions of a comprehensive health equity strategy. These include:
- Social needs and community outreach;
- Data collection;
- Data analysis;
- Staff knowledge, skills, and attitude;
- Culturally sensitive care delivery; and
- Workforce diversity, equity, and inclusion.
However, despite the clear need for a multifaceted approach to improving health equity, many organizations focus solely on increasing workforce diversity and staff training. While they are good starting points to providing more culturally sensitive care, these strategies alone won't solve systemic issues. Clinical leaders are uniquely positioned to help their organizations tackle systemic challenges.
Leveraging influence to assign (or assume) responsibility over health equity
One unique opportunity for clinical leaders is to define and/or advocate for executive accountability over health equity goals.
Progressive organizations typically have a designated health equity role that is accountable to the CEO or Board (e.g., Chief Health Equity Officer or VP of Social Determinants of Health). These roles are exclusively dedicated to aligning the organization's strategy to address specific disparities and ensuring that each department's strategic plan supports system-wide equity goals.
At very progressive organizations, such roles may even have the authority to hold the CEO accountable to delivering on diversity, equity, and inclusion goals. During our webinar, we discovered that about 45% of our participants have a dedicated leader for health equity.
While delegating these responsibilities to a single owner creates a clear accountability structure, it could also lead to disengagement and siloing. Other leaders and staff may disengage from health equity issues because they feel it is no longer their responsibility or within the scope of their roles.
Additionally, organizations risk making equity its own siloed strategic pillar—rather than taking an equity lens to every part of their strategic plan. To counter this, organizations must ensure that clinical leaders have a close partnership with the organization's equity leader and consider equity in every aspect of their strategic plan.
Workforce diversity is important. But it's only part of the solution to addressing disparities in health care.
Alternatively, the CNO and CMO at organizations without a dedicated role can form a leadership dyad to set strategy and coordinate implementation.
About 36% of our webinar participants do not have a dedicated health equity officer. Absent a dedicated leader, the CNO and CMO are uniquely positioned to lead health equity efforts because of the potential impact on clinical quality, patient safety and experience.
Common barriers to executive accountability
Other roles could theoretically oversee health equity strategy if they are senior enough, receive enough funding to carry out initiatives, and have the authority and bandwidth to make meaningful progress on goals.
However, most clinical leaders tasked with advancing health equity in addition to their day jobs are unable to give it sufficient attention. At best, they are only able to address one-off issues rather than systemic barriers.
Carving out new roles or expanding the scope of existing positions is a significant undertaking that typically doesn't have an immediate ROI. As such, building a business case for such an investment is challenging.
However, clinical leaders can leverage their authority and influence to implement or advocate for this—and other—solutions to the disparities that occur within organizations.