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Facing up to inequities in your organization is painful, but necessary to achieve the Triple Aim for all.
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Health Equity Starts When Your Organization Gets Uncomfortable

By Andrea Werner | Wednesday, October 24, 2018
Oct 29 revised photo

Sometimes when you describe a process for working toward improvement, it can sound deceptively easy. When explained to others, the steps can seem simpler and more painless than they really were.

This is worth noting when sharing lessons learned about addressing health equity. I can tell you there were many times when we at Bellin Health were squirming in our chairs during our equity discussions.

We asked ourselves many hard questions:

  • “What is institutional racism?”
  • “What does it really mean to be inclusive?”
  • “Is our care less equitable than we assumed?”

It’s deeply uncomfortable when you find that the demographics of your workforce are not at all reflective of your community. It’s distressing when you realize that your orientation platforms are only in English. We’ve learned that the hard conversations you need to have to address such disparities must be in the context of overall improvement and without judgement.

Moving from Commitment to Action

Over the last 10 years, Green Bay, Wisconsin has become increasingly diverse. The Wisconsin Collaborative for Healthcare Quality (WCHQ) recently recommended utilizing four measures of stratification of data in order to evaluate health disparities among member patient populations: race, ethnicity, Area Deprivation Index, and primary payor. This commitment has incited excitement and momentum within our state.

In health care, we are community leaders and positioned well to make a proactive positive stance to invite the community to move forward. We have many partners in the community who acknowledge the existence of disparities in Green Bay and are willing to work together toward improvement.

The concept of equity as it relates to overall health and wellbeing is not foreign to Bellin Health, but it was our work as members of the IHI Leadership Alliance and the development of the Achieving Health Equity Call to Action that compelled us to move from commitment to action.

Our initial act was to make health equity a strategic priority for our system. Each year, word by word, our leadership team reevaluates our mission, vision and strategic objectives. Applying the Call to Action helped us ensure that these statements contained the language that made it crystal clear that we will make our strategic intentions a reality for all persons.  

Next, we recognized a need to educate ourselves to better identify opportunities to improve health equity as a senior leadership team. Bellin reviewed and disseminated literature, including the IHI white paper: Achieving Health Equity: A Guide for Health Care Organizations. We used the white paper’s assessment with several internal groups including frontline teams, leaders, and subcommittees (which contained community members and members of our Board of Directors). We shared results, identified gaps, and achieved organizational commitment. We formed a dedicated team and identified an operational lead and executive sponsor.

Applying Improvement Experience to Equity

As we continue our equity journey, we will create a compelling aim statement, develop a system of measurement, and develop a driver diagram. We will prioritize the work in the context of our 120-day improvement cycle, and we will work methodically on our plan.

We will incorporate health equity into a range of improvement initiatives. We will co-design with our community members.

We will fail, we will get back up, we will test another theory, and we will hardwire the changes that show demonstrated results. We will stay true to our mission and vision and learn from our colleagues within the IHI Leadership Alliance Equity Workgroup. At the end of the day, we will empower individuals, groups and communities with the knowledge and the tools necessary to achieve Triple Aim results for all.

Andrea Werner, MSW, is Bellin Health Vice President, Heart, Lung & Vascular Services.

Learn more about the IHI Leadership Alliance work on pursuing of health equity:

How to Achieve the Triple Aim for All

Lesson from Kansas: Start Addressing Health Equity in Your Own Backyard

Go Upstream to Pursue Health Equity

You may also be interested in:

IHI white paper — Achieving Health Equity: A Guide for Health Care Organizations

Equity is a featured track at this year's IHI National Forum.

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