The National Call to Action to Eliminate Health Care Disparities is a partnership among America's Essential Hospitals (formerly the National Association of Public Hospitals and Health Systems), American College of Healthcare Executives, American Hospital Association, Association of American Medical Colleges and Catholic Health Association of the United States. Formed in 2011, the partnership is dedicated to achieving health care equity by working together in three core areas: increasing the collection and use of racial, ethnic and language preference, or REAL, data; increasing cultural competency training; and increasing diversity in governance and leadership.
With the support of the AHA's Institute for Diversity in Health Management, a 2011 survey of the field found that:
- 18 percent of hospitals were collecting and using REAL data to improve care;
- 81 percent of hospitals provided all clinical staff with cultural competency training;
- 14 percent of hospital trustees were members of racial or ethnic minority groups;
- 11 percent of hospital leadership teams were members of racial or ethnic minority groups.
Based on this information, the partnership recently announced a goal to increase collection and use of REAL data to 75 percent; increase cultural competency training to 100 percent; and increase governance and leadership team diversity to 20 and 17 percent, respectively, or to a composition reflective of the hospital's community, all by 2020.
For the field to achieve these goals and to sustain progress and momentum, trustees will need to make equity of care a priority and champion the cause. Commitment from the top levels of hospital leadership will be crucial.
We know equity of care is the right thing to do; trustees also should be aware that there is a strong business and quality imperative for prioritizing the elimination of health care disparities and the promotion of diversity. A focus on health equity brings practical advantages that can improve the quality of care provided to patients and the effectiveness of hospitals and systems.
Racial and ethnic minorities currently make up one-third of the U.S. population and will become the majority of the population around 2050, according to U.S. Census Bureau estimates. As health care leaders seek to provide the best care for their patients, understanding the demographic makeup of their patient base will be critical.
The Quality Case
The collection and use of REAL data play an integral role in understanding the patient population served. Members of racial and ethnic minorities are more likely to experience medical errors, adverse outcomes, longer lengths of stay and avoidable readmissions. By using REAL data, hospital trustees can look for patterns of disparate health conditions and outcomes, and use that data to tailor interventions. These improved care plans can prevent poor outcomes and readmissions and assist with overall quality improvement and better outcomes.
In addition, language or cultural differences can impede communication and be barriers to high-quality care. A hospital committed to making sure its staff understand the cultural and linguistic contexts of the people they treat will be able to deliver better care to all of its patients.
The Business Imperative
Trustees have a special responsibility to pay attention to financial and resource allocation, and equity of care plays a role in good financial stewardship.
In addition to operating in a changing demographic landscape, hospitals are part of a rapidly changing health care delivery system. There is an increased focus on linking payment to value, and reimbursement changes are reflecting this shift. As payment becomes more dependent on outcomes, it is simply not financially viable to ignore persistent poor health outcomes in certain patient populations.
Providing, and being paid for, the highest-quality care can only come about with an elimination of health care disparities. Researchers estimate that eliminating disparities would reduce direct medical costs by as much as $229 billion; clearly, business models should incorporate planning for the reduction of health care disparities.
Diversity, Reflected
Accurately reflecting the community at the board and leadership levels can improve organizational performance. A board that reflects its community can better understand the community's needs. A diverse board can break down cultural barriers and provide connections with the community to aid in improving health and making the hospital a welcoming place to come for care.
Broader engagement with the community is an important role for a board and its hospital. Most hospitals are the leading employers in their communities and, as such, it is incumbent upon them to cultivate deep ties. This builds trust and engagement that further the work of a hospital or system.
In addition, a leadership team that reflects its employees can improve communication. This can lead to better performance and a higher level of employee satisfaction. Those in leadership positions also can mentor those they lead, and support long-term recruitment strategies within a community that promote diversity — this gives an organization an advantage in recruiting the most highly qualified employees.
The Right Thing to Do
While there are practical reasons to address health disparities, let's remember the starting point: equity of care is fundamentally the right thing to do. Good care is not one-size-fits-all; effective communication between patient and caregiver is essential to providing individualized treatments to ensure the best possible outcomes.
The Call to Action is ready to help. Through www.equityofcare.org, the partnership will continue to offer free resources and share best practices to help those on this journey. Addressing disparities is no longer just about morality, ethics and social justice; it is vital to performance excellence and improved community health.
Matt Fenwick (mfenwick@aha.org), writing on behalf of the Equity of Care Partnership, is director of program and partnership development with AHA's Health Research & Educational Trust, Chicago
