Advancing Equity: The Power of Measurement to Drive Change
Why It Matters
How do you center equity in a measurement system? Asking three foundational questions can help.
What gets measured gets done. — Attributed to Peter Drucker
There can be no quality without equity. — Institute for Healthcare Improvement (IHI) President and CEO Kedar Mate
What happens when we bring together these two ideas? What might it look like to have a measurement system that moves the US health care system closer to equity? We already had daunting equity gaps across many conditions before COVID-19. The effects of the pandemic — including widening equity gaps — have made asking and answering these questions more urgent.
In response to these realities, the Rise to Health Coalition [convened by IHI, the American Medical Association (AMA), Race Forward, and many other partners] strives to center equitable measurement in health care. To meet the moment, we seek measures to help understand and improve equity in service of the Coalition’s vision of “...a transformed health care ecosystem where all people have the power, circumstances, and resources to achieve optimal health.” Fernando De Maio, Vice President, Health Equity Research and Data Use in the AMA’s Center for Health Equity and I (co-chairs of the Rise to Health Coalition Measurement Steering Committee) shared our experiences to-date in a commentary in Journal of Health Care for the Poor and Underserved.
Partnering with the Coalition’s Measurement Steering Committee and a broader group of advisers, we have offered three foundational questions to center equity when choosing how, what, and why we measure:
- Will these measures help us see if change occurs? To track progress, this requires (at minimum) having accurate data and data we can stratify (for example by race/ethnicity) to understand the current state of inequities and learn about progress.
- Are we measuring only what is easy to measure or what is meaningful? To ensure accountability, it is essential to discuss what data are meaningful and will show change. We also recognize that it is easy to swirl in conversations about what those data are, how to obtain and share them, and how to reconcile differences in the ways that similar concepts are measured. We must push through that swirl and have important conversations with those most affected by inequity while moving towards meaningful action.
- Which measurement choices will hold a diverse set of institutions together? To inspire and sustain collective action, we must clearly connect measures to a meaningful aim in ways that keep us accountable to those most affected by inequities. Measures must also be relevant to an array of actors in the system (e.g., health care organizations, payers, professional societies, pharmaceutical/biotech/research companies) and be collectable within each institution or organization. Balancing these considerations is no easy feat, especially since transformation often takes years.
Spoiler alert: We do not yet have all the answers, but we have identified some steps forward. And in keeping with the continuous improvement that IHI practices, we offer these in the spirit of shared learning towards meaningful improvement and transformation.
We recognize and appreciate that this work is hard, but it is essential. As noted in the commentary, “If we are not asking ourselves the tough questions, we will inevitably fall into traps we could have anticipated or that others before us have confronted. However, if we are not taking seriously the challenge that we can find a way forward — both in action and in measurement to track and learn about that action — we will never, ever get there.”
Marianne McPherson, PhD, is an IHI Senior Director and Improvement Advisor. Learn more at session C17: Measuring for Equity: Methods and Examples for Identifying and Prioritizing Meaningful Measures at the IHI Forum (December 10–13, 2023).
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