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Effective July 1, 2023, The Joint Commission is elevating health equity to a new National Patient Safety Goal (NPSG) for health care organizations. According to The Joint Commission, “The new NPSG increases the focus on improving health care equity as a quality and safety priority, but the requirements for accredited organizations are not changing.”
The equity-focused NPSG will bring new considerations and potential challenges for health systems and health care leaders. To help navigate the new guidance, we interviewed Taj Mustapha, MD, Chief of Equity Strategy for M Health Fairview, and Lou Hart, MD, Medical Director of Health Equity for Yale New Haven Health. Both serve as faculty for the Institute for Healthcare Improvement’s Leadership for Health Equity Professional Development Program and have extensive experience as equity leaders.
What does this updated guidance mean? The new NPSG makes it clear that health systems need to prioritize and operationalize equity within their organizations. “At its most basic,” Mustapha says, “the new guidance says we can really get to work at a national level to address health equity. If we don’t have equity as a goal, it’s easy to just pay attention to the majority or plurality of a population because improving health in that population is going to make overall [health outcomes] numbers look great. When we start to highlight that equity is important as well, then suddenly smaller populations matter in a way that they haven't to date by the national regulations.”
Creating a consistent set of measures as part of the equity-focused NPSG will also help health systems advance their equity work. The NPSG, says Hart, “gives us a clearly aligned national framework where [health systems] can all begin to measure from similar playbooks as opposed to every institution creating their own metrics. It’s at least a first attempt at creating a benchmark so that we can begin to learn from each other.”
In response to the new guidance, health systems can be proactive in making sure they have the right resources devoted to advancing health equity in their communities. “It’s no longer ‘nice to have’ someone who’s paying attention to health equity, it’s a must have,” says Mustapha. “[The new NPSG] raises the floor a bit in terms of what is required to operate. Instead of one person analyzing health equity data, integrate [that function] into your quality, safety, and operations mechanisms so that [data analysis] can actually result in real change for your patients.” Centralizing equity within a health system will help ensure historically and currently under resourced populations do not continue to experience worse outcomes.
“By presenting health equity within a quality improvement and patient safety framework,” notes Hart, “we can utilize quality improvement systems that are already in place. This new guidance [establishes] baseline operations of what we can do today, tomorrow, and going forward to continue to improve patient outcomes and do better by our patients each and every day.” You do not need to reinvent the wheel. Use existing systems and leverage resources to connect your quality, safety, and equity infrastructure.
The new NPSG is a great first step. However, Mustapha notes, “This is a floor, not a ceiling. The next step would be to establish increasing requirements to not only address racial disparities but also to specifically narrow them, and include guidance around how we should collect and analyze racial disparities data.” Having the weight of The Joint Commission behind these changes will help influence health systems to make health equity a priority, yet there is more work to be done.
Advancing health equity requires establishing a culture of equity just as health systems have established cultures of safety and quality. Mustapha asks, “How do we create a better system to achieve the outcomes we need? The challenge as we start to uncover inequities is to apply a just culture approach and not have the discomfort of knowing inequitable outcomes [exist] keep us from addressing the root issues. We need to [view] inequity as a system-level problem and then apply a quality and safety approach as well as a just culture approach to [improve] it.”
Mustapha and Hart both share steps that health care leaders can take now in response to this new NPSG to advance equity:
- Make equity a systemwide commitment at every level and department of your organization. Ensure that all leaders and staff are aware of your organization’s equity goals and get everyone involved in the work — that includes safety and quality teams, senior leaders, finance teams, clinicians, and regulatory and compliance teams as well. Require everyone in your organization to have the skills and competencies to advance equity and hold everyone accountable for achieving equity goals.
- Leverage the new guidance as an opportunity to create real change for health equity. Take this opportunity provided by the new NPSG to unite around the reasons why you are doing this work: ultimately, it is for the benefit of your patients and communities, and they should always be centered in the work. Establish groups like community wisdom councils to ensure that you are keeping the community voice active in decision-making processes.
- Double check that your data accurately reflects your population. Using data to identify health disparities is great, but if your organization is not collecting data from patients in a meaningful way — and if the population you treat is not reflected in that data — then it all falls apart. Take the time to make sure that the foundational data structure is correct so that you can leverage these NPSG regulations to achieve equity.
Elias Miranda is an IHI Project Manager.
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