The Time is Now: The Accelerated Importance of Just, Equitable Healthcare
With an end in sight to the trauma of the COVID-19 pandemic, hospitals and health systems must begin determining how to recover from both financial losses and the trauma faced by staff, achieve a more resilient framework for future crisis response, and chart an increasingly efficient and equitable way forward for care delivery. This latter point may well become the defining challenge of our time, both within healthcare and in this larger American moment.
What are We Hearing?
While the efforts and sacrifices of care professionals must be recognized and uplifted, it is also crucial to examine how the pandemic response really impacted the communities they serve. It is common knowledge that underserved, vulnerable populations were disproportionately affected, with the CDC reporting that Black, Latino, and Native people were about three times more likely to be hospitalized by COVID-19, and at least twice as likely to die from related complications; these numbers reflect larger trends related to access, quality of care, and outcomes across disadvantage populations. In a time when American society is growing far more aware of the costs of discrimination, bias, and lack of political representation it is of the utmost importance that this conversation extends to the healthcare space. Fortunately, the rise of value-based care, the increasing sophistication of population health and risk analysis, and expanded interrogation of the social determinants of health have given providers a fuller picture of their communities and more robust tools for supporting them.
There is a clear recognition that more diverse workplaces are better prepared to support more diverse customers, and healthcare is no different – employees and especially leaders who can draw on shared experiences and empathize with underserved patient populations can more proactively and effectively address some of the gaps in understanding and trust that stand in the way of access to care. According to polling by the Undefeated and the Kaiser Family Foundation, Black adults report more instances of discrimination, more difficulty finding healthcare providers who treat them with respect, and dramatic challenges finding clinicians who can empathize with their lived experiences; fully 70% of Black respondents indicated that they believed the American healthcare system regularly treats people unfairly based on their race. This extended to a large number who had not personally experienced discrimination, and according to the authors, the pandemic is exacerbating mistrust.
We have written before about the importance of placing a greater focus on inclusion and equity in a healthcare environment, but the pandemic has placed these concerns in even sharper relief. Our recent peer-to-peer sequences involving Grand River Hospital, Cottage Health, and Northwell Health – driven in part by the Driven by the AMA’s Communication Climate Assessment Toolkit (C-CAT) - identified a number of core best practices aimed at better serving a diverse patient population, including the establishment of strong community partnerships, which help keep a pulse on what matters most to the people with the greatest need, helps to educate and build trust in the system, and creates a potential pipeline for more diverse hiring. Other components included better language access, greater cultural competency among clinical staff, leadership that appreciates both the moral and financial implications of more equitable care, and perhaps most importantly, stronger data capture, aggregation, and analysis. This begins with configuring the EHR to facilitate easy demographic data collection at the point of care, cross-referenced with diagnoses and outcomes. Our recent series of Virtual Think Tanks centering on building DEI principles into healthcare provider culture and business strategy have only reinforced the importance of more intentional use of data, backed by clearly defined budget outlays and the sustained engagement of leadership.
America is at a crossroads of racial reckoning, and the institutions that bear the greatest responsibility for helping to bridge this gap, education and healthcare, are at the center of the storm. The time is now for healthcare leadership – comprised of some of the most capable, intelligent, and well-educated people in the country – to build the structures, policies, and processes necessary to begin leveling the playing field. Our research indicates a shift in this direction, with more than 60% of healthcare leaders expressing interest or participation in DEI policies for internal staff and greater commitment to equitable care delivery. Establishing mechanisms that ensure provider demographics more accurately reflect their communities is absolutely necessary, as is building a more consistently enforced commitment to enabling diversity of thought within the organization – this requires hiring practices that prioritize a range of experiences, skillsets, and backgrounds; cultures that are open, safe, and designed to uplift new and innovative perspectives; and leaders who recognize the long-term value of these changes and who are willing to model the behaviors it takes to achieve them.
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