After stratifying all core quality metrics by race, ethnicity, and language data, leaders identified disparities in health outcomes for specific patient populations. Of those disparities, the Center for Diversity and Health Equity chose to address the metrics that were scalable and already had existing quality improvement initiatives deployed. The metrics selected include:
- Central line-associated bloodstream infection (CLABSI)
- Rescue events
- Missed appointments/no shows
Understanding that significantly reducing or eliminating disparities can take years, Seattle Children’s set short-term and long-term goals for reducing disparities for each of the three metrics. For their short-term goals, leaders selected goals that were low cost, required fewer resources, and were achievable in the near-term. These short-term, achievable goals helped engage staff by demonstrating the meaningful impact they can make in their patients’ lives. The hospital’s long-term goals aim to address the root causes of disparities, and thus take more time and effort to achieve. These long-term goals are more transformational in nature and align with Seattle Children’s Hospital’s vision statement.
Short-term goal: Improve access to interpreter services to reduce disparities in missed appointment rates and rescue events
Seattle Children’s data analysis revealed that missed appointment rates were higher among non-English speaking patients. Leaders set a goal to reduce missed appointments by more reliably providing an interpreter to all patients who requested one. They also set a goal to increase interpreter use throughout the hospital stay to reduce inequities present in rescue event metrics.
To increase access to language services, Seattle Children’s leaders shifted towards a blend of in-person and video-based interpretation on iPads. Staff also translated appointment reminder texts into the top seven languages spoken for care at Seattle Children’s, and sent patients tailored texts in their spoken language. Additionally, staff increased interpreter use on rounds when feasible and implemented a process to access an interpreter prior to and during a rescue event.
The Center for Diversity and Health Equity is working with a community led taskforce and family advisors to develop meaningful interventions that meet the needs of patients and families.
Long-term goal: Address clinician bias to reduce disparities in CLABSI rates
Seattle Children’s found that certain patient populations may experience a CLABSI more frequently than others. Leaders recognized that improving disparities in CLABSI rates would take time because the root causes of these disparities likely include racism and implicit bias. While a difficult barrier to address, addressing implicit and explicit bias is essential in eliminating outcome disparities. Seattle Children’s Hospitals launched the Anti-Racism Organizational Change (AROC) strategic initiative, which includes the implementation of an organization wide Health Equity, Diversity and Inclusion Council (HEDI). Larger departments and divisions have also launched HEDI/Anti-Racism committees to align with the AROC and HEDI goals. Seattle Children’s is focused on policy change, evaluation of clinical standard work with an HEDI and anti-racism framework, and HEDI and anti-racism training.