“We don’t have the resources.”
“It’s too hard.”
“No one wants to talk about this.”
Talking about health equity isn’t easy. Getting support in a health care setting to understand it can be even more daunting. It means questioning whether you can claim to be providing high-quality care if certain segments of your population are persistently the exception.
Despite the challenges, an increasing number of health systems are acknowledging the impact that social determinants of health — including education, economic stability, transportation, access to healthy and affordable food, and discrimination — have on patient outcomes. Digging into the data is crucial for identifying inequities and finding ways to address them.
But how? During the October 25 WIHI, Aswita Tan-McGrory, MBA, MPSH, Deputy Director of the Disparities Solutions Center, and Andrea Tull, PhD, Director of Reporting and Analytics at the Edward P. Lawrence Center for Quality & Safety, Massachusetts General Hospital (MGH), shared some lessons learned from their partnership to lower readmissions rates.
Start with Available Measures
Identifying health inequities doesn’t require collecting data from scratch. Instead, Dr. Tull advised using existing measures. At Massachusetts General Hospital, Tan-McGrory and her team compiled data from billing, electronic health records, and quality measures from the MGH Annual Report on Equity in Healthcare Quality. In her organization, Dr. Tull and other analysts stratify the data by race, ethnicity, and language to identify differences in readmissions rates.
Tan-McGrory cautioned against striving for a perfect data set. “Don’t let the perfect be the enemy of the good,” she warned. “Even imperfect data can tell a story that you can bring to your leaders.”
Get Comfortable Talking about Race
Tan-McGrory insisted that staff must acknowledge race as a social determinant of health. “Race is a sensitive subject, especially today. Many people are more comfortable talking about food security and domestic violence,” she noted. “But race is a social determinant of health — it’s not separate.”
Tan-McGrory stressed the importance of helping staff become comfortable talking about racial inequities. The most effective method, she argued, is getting to know those from different racial, educational, and political backgrounds. “If we’re going to be comfortable talking about race, we need to understand other people,” she said. “We have to be willing to talk about [race] among staff and leadership.”
Engaging staff in these conversations is critical for equipping them to ask patients about their own race. Providers often don’t ask patients about their racial identity, but it’s crucial to do so to collect more accurate data. Training staff how to talk to patients about race is important, but it’s imperative that providers personally engage in the discussion first.
Leadership Support is More Valuable than Resources
Many community health systems worry they don’t have the resources to analyze data at a deeper level, but Tan-McGrory argued that where there’s a will, there’s a way. “It’s not about having [sufficient] resources,” she said. “It’s about leadership buy-in and support.”
Tan-McGrory noted that simply presenting the numbers to executives isn’t enough. Sharing the context of your data will help them better understand health inequities. Connecting it to national trends is more likely to yield action from leaders than providing anecdotes or raw numbers alone.
Identifying leaders at all organizational levels is critical for bolstering the work. Dr. Tull acknowledged the necessity of executive support, but she noted the importance of looking further. “Find [both] an executive and a clinical champion to help you spread the word,” she advised. “This is ongoing work. Just because you don’t find a disparity today doesn’t mean you won’t find one in the future.”
Joshua Eng is a Multimedia Project Assistant at the Institute for Healthcare Improvement.
You may also be interested in:
MGH Disparities Solutions Center Guide to Reducing Disparities in Readmissions
IHI white paper – Achieving Health Equity: A Guide for Health Care Organizations