The post below is a modified version of the foreword Derek Feeley wrote for the new IHI “Achieving Health Equity: A Guide for Health Care Organizations” white paper.
In 2001, the Institute of Medicine described “Six Aims for Improvement” in its influential report, Crossing the Quality Chasm: A New Health System for the 21st Century. The “Six Aims” called for health care to be safe, effective, patient-centered, timely, efficient, and equitable. In the 15 years since the Chasm report, health care has made meaningful progress on five of the six aims (though there is much more work to be done on all).
But progress on the sixth — equity — has lagged behind. Forward-thinking organizations have made strides, and pockets of excellence are emerging, but the lack of widespread progress leads some to call equity the “forgotten aim.”
At IHI, we took steps to keep all six aims top of mind — we even printed them on our hallway walls. Despite this daily reminder, as a leader of IHI, I have to admit to a frustration with our failure to help move the needle on health equity. I know I share this frustration with all of my IHI colleagues, and with so many of you. As part of a broad portfolio of efforts to study and improve health equity, IHI’s Innovation team researched the issue and produced a new white paper: Achieving Health Equity: A Guide for Health Care Organizations. (A more condensed version of the findings from the Innovation team can be found in a recent Healthcare Executive article, written by two of the white paper’s authors.) We hope this paper and the thinking behind it can help lay the foundation for a true path to improving health equity.
Hope, of course, is not the same as a plan. So, the white paper offers practical advice, executable steps, and a conceptual framework that can guide any health care organization in charting its own journey to improved health equity. The framework stresses the importance of making health equity a strategic priority at every level of an organization, especially at the top. The framework emphasizes a systems view of how we’ve arrived at health inequities, and how they can be mitigated. And it urges us to work both within our walls, dismantling the institutional racism and implicit biases that hold us back; and beyond our walls, creating and nurturing new partnerships in our communities that can make an impact on all the social determinants of health.
More than anything else though, the framework described in the white paper and all of the innovative and passionate work described in it demand that we expand our understanding of how health care can improve health equity. Improving only what we’re doing now isn’t enough; real improvement will require broadening and deepening our connections to our staffs, our patients, and our communities.
The United States has a unique history of racism that has resulted in disparate and unjust health outcomes. Indeed, institutionalized racism operates all over the world. At the same time, the more we learn about how race, gender, ethnicity, sexual orientation, age, mental health, disability, geographic location, and other factors contribute to health inequities, the more our determination to make a difference grows. We call on all of you to bring your unique skills, knowledge, passion, and good ideas to those who need them most.
Editor’s note: Look for more from IHI President and CEO Derek Feeley (@derekfeeleyIHI) on leadership, innovation, and improvement in health care in the “Line of Sight” series.
You may also be interested in:
Achieving Health Equity: A Guide for Health Care Organizations
Other IHI Health Equity resources