As I recently read AHRQ’s 2016 National Healthcare Quality and Disparities Report with the patient safety team here at IHI, a phrase kept running through my mind: “Demand more.” A bicycling advocate from my Boston neighborhood of Dorchester uses the hashtag #demandmore when tweeting about improving safety for pedestrians and cyclists. Jonathan Fertig (@rightlegpegged on Twitter) does for his cause what many health care improvement innovators and early adopters do for quality and safety.
More specifically, Fertig uses data, questions the status quo, shares information about best practices, and visits places that are getting it right. He is vocal at meetings, and rubs some people the wrong way. In short, he is relentless. He demands more and tells us that we should, too.
So how — and why — should we demand more in our fight for health equity?
Good News and Bad News
Let’s first look at the positive findings in the report that brings national attention to the successes and failures of health care quality and safety in the United States. The good news includes an impressive decline in hospital-acquired conditions (HACs). With a 17 percent reduction in HACs, an estimated 2 million harmful events were avoided between 2010 and 2014. AHRQ estimates that these efforts saved 87,000 lives and $20 billion in health care costs.
However, for about one-third of patient safety measures, high-income households received better care than poor households. (Similarly, a recent article in JAMA notes an association between higher income and greater longevity.) The AHRQ report also notes that whites received better care for about 20 percent of patient safety measures than blacks and better care for about 30 percent of patient safety measures than Asians.
The question is clear: How can we close those gaps?
Using QI to Attain Equity
The same measurement tools and QI methods we’ve used to achieve life-saving reduction in HACs can and should be used to eliminate disparities. The AHRQ Report should spur organizations to take local action. As Ron Wyatt, Medical Director and Patient Safety Officer at The Joint Commission, wrote recently, “health care organizations, across the continuum, must begin to analyze existing data sets, stratify the data by race, ethnicity, geography, socioeconomic status, insurance, status, income, and employment to better understand where to begin the work to improve outcomes and become adaptive learning organizations.” Without shining a bright light on disparities, we cannot claim a serious commitment to equity.
Addressing health inequities will require persistence, bravery, and creativity. But so did dramatically reducing HACs that were once common. To improve, we took matters into our own hands.
That’s what Fertig did, too. Like our colleagues in the IHI Leadership Alliance, he even broke a few rules. In September 2015, after a devastating fatality at a busy intersection, Fertig used potted plants and orange traffic cones to create a bike lane along one of the deadliest stretches of road in Boston for cyclists. Since then, he’s used a bike trailer, donated flowers, and publicly available data to make more protected lanes where cyclists most need them.
What small tests of change can we run? What rules might we need to break? Let’s use the tools we have to close the equity gap and produce the best outcomes we can for everybody, all the time. When better, safer outcomes don’t yet extend to all of us, and there are still inequities determined by race and income, we must confront the hard truth that our progress has not gone far enough.
Joelle Baehrend is IHI Fellowship Director and a content developer for IHI’s Patient Safety Focus Area.