"There have been standards, minimum expectations for an organization — things you must demonstrate when a surveyor comes to your door. What I’m saying is that’s just not enough." Ron Wyatt, MD, is Medical Director in the Division of Healthcare Improvement at The Joint Commission, and he's a former IHI Fellow.
There’s been a lot of work at The Joint Commission on what to do about inequity and disparity. There have been standards, minimum expectations for an organization — things you must demonstrate when a surveyor comes to your door.
What I’m saying is that’s just not enough.
Or let me put that in another way: People who are not white are treated differently in the health care system. People who have a different sexual orientation are treated differently in our health care system. People who can’t speak perfect English are treated differently in our health care system. And I do not see a concentrated effort coming from anyone to say this has to end.
Moving from Monitoring to Action
There’s very sparse evidence in the research literature and in multiple comprehensive reports that health disparity and equity has made any significant improvements, in decades. It is time to say to health and health care leaders that this is urgent and can no longer wait.
As I've talked about these issues with lots of organizations, I’ve said, "Maybe it's time to think about how we can hold health care leaders accountable." I continually hear from leaders, “This is [a] huge [topic], Ron. What can my organization do?"
The Joint Commission is collaborating with organizations around the country to look at the potential impact of measuring health literacy and stratifying data by race and ethnicity to develop real solutions. This approach will likely result in meaningful and sustainable change. Other examples of what an organization should begin to address include:
So, what do we do next?
First, we have to think back to how we regulate equity and disparity. We go back to Title VI of the Civil Rights Act of 1964 that says you must provide equal health care. You cannot discriminate against anyone in the US, based on ethnicity or race. That language has been there since 1964, and we still see problems, severe problems.
Organizations will have to ask themselves, “What are we doing? Who are our language interpreters?” It’s not going to be enough to just say, “Well, we don’t speak this language. Can your son or daughter help us interpret?” You need to use appropriate interpretive services. For instance, in Illinois, where I’m living, there are over 100 different languages spoken. In California, I think now is over 200. I believe there are six to eight states now where minorities are the majority. What are we in health care doing to prepare for that population when they come to our doors and say, “I need your help”?
One of the things that we want to do is encourage organizations to look at disparity and inequity in a different way, in a real way, in a meaningful way. What are the data sets in your community, in your organization, that mean the most? What are you actually measuring? Do you know who your community is? Do you know how your community is performing compared to the best?
The Business Case for Equity
There’s lots of good research going on. There’s lots of good people doing stuff. We talk the talk. I’m not convinced that we walk the walk when we say we must eliminate this problem. If you look at the business side of it, and quite frankly there are folks who will say, "What’s the business case, Ron?" The business case is this: If you look at the harm done by delivering unequal treatment, direct costs, indirect costs, readmissions, harm done, it’s over a trillion dollars. That’s the business case for this. That’s real money that can go to improve communities, improve populations. There is a business case for this that we cannot ignore any longer.
So, if the first step is a national goal to solve health inequities, then I say so be it. That’s a goal that applies to the entire world. We have to start looking at the things that are going to make a difference in a society that’s going to look very different in 2040 than it does now. We have to start thinking about big goals in a big way – and that’s what a national goal would do.
Editor’s Note: Keep an eye out for the second part of Dr. Wyatt’s three-part blog post series coming soon.
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