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Create Cultures of Equity

What is this and why does it matter?

Creating a culture of equity means embedding equity into your organization’s core values and daily operations—not just acknowledging health inequities, but actively identifying and addressing the structural and systemic factors that cause them. This requires everyone, from leadership to frontline staff, to recognize inequities as unacceptable and take action to eliminate them.

This work demands honest internal reflection. Your team must examine power dynamics, leadership representation, decision-making processes, and resource allocation through an equity lens—revealing barriers that limit effectiveness and inclusion.

Without this foundation, even well-intentioned health equity initiatives are unlikely to succeed. When equity is embedded in your culture, your quality improvement efforts are far more likely to reduce disparities rather than reinforce them.

How should you work through this component?

Start this component by working through Part 1 of the Create a Culture of Equity (CCOE) and then continue to Part 2.

When does it make sense to work through this component?

This component is an ongoing effort, not a one-time initiative. It becomes especially important when:

If you can influence your organization’s equity culture, begin this work now—regardless of where you are in other initiatives.

Curriculum to be completed for this component:

Create a Culture of Equity (Part 1 of 2)

A training presentation grounding health equity work in critical theory. Covers definitions of health equity, equity vs. equality, and what an organizational “culture of equity” means. Introduces three theoretical frameworks (critical consciousness, intersectionality, relational-cultural theory) and examines systems of oppression — including racism, colonialism, and redlining — as root causes of health disparities.

Part 2 will cover implementation strategies.

RIC – CCOE – Pt. 1 of 2 – 6.2025Download

Create a Culture of Equity (Part 2 of 2)

The action-oriented follow-up to Part 1, presenting five implementation strategies: (1) ground DEI efforts in critical theory, (2) train staff beyond cultural competency to include critical consciousness, (3) strengthen relationships as vehicles for change, (4) empower an implementation team that models equity, and (5) align culture transformation with operational transformation. Includes real-world examples from state teams in Washington, Delaware, and Illinois.

RIC – CCOE – Pt. 2 of 2 – 6.2025Download

Self-Assessment Topics and Questions:

This self-assessment tool will help you identify, anticipate and address common challenges implementing the Roadmap.  Using it will increase your chances of successfully reducing and eliminating health and healthcare inequities. Each Roadmap component will have a set of questions and topics in their respective sections; AHE recommends utilizing the assessment questions in two ways:

  1. Are the team members of the initiative operating from the same definitions of health equity, disparities, inequity, and equitable care?
    • What processes were used to identify and agree upon the definitions?
      • Which team members of the team were involved?
      • How was the community consulted?
      • What resources, if any, were used in creating the definitions?
  2. Is the initiative actively reorienting from individual-level to structural-level root causes of poor health?
    • Recognize that all organizations of the healthcare system function as social drivers of health, including public and private payers, health plans, care provider organizations and regulatory agencies. They are part of the root causes of health inequities and it is imperative for them to act, both inside and outside of the healthcare system, to eliminate health and healthcare inequities.
  3. Is the initiative actively working to recover historical memory to understand the etiology of oppression and understand the lived experiences of those experiencing oppression?
    • If yes, please describe.
    • Note: This requires partnering with the patients, families and members of excluded communities living with and impacted by health inequities to learn their perspectives and experiences regarding the multi-sectoral healthcare system, its organizations, and the roles that they play creating health and healthcare inequities.  
  4. Is the initiative using the recovered historical memory (see #2) to de-ideologize everyday experience by critically questioning the imposed dominant messages regarding health and healthcare equity and why inequities exist?
    • This requires healthcare organizations and individuals within them to self-reflect about their individual, professional, organizational socialization that creates and reinforces racism and white supremacy.
  5. Is the initiative actively working to de-naturalize discrimination and oppression?
    • If yes, please describe how (e.g., the steps being taken by the team).
    • Note: This requires creating strong cultures within the partner organizations that emphasize building the knowledge and skills necessary to identify discrimination and oppression operating outside of and within their work settings. 
    • Note: This includes skills of power analysis and utilizing cross-discipline knowledge, including the knowledge of non-academic communities experienced in social justice and antiracism work.
  6. Is the initiative actively problematizing circumstances that produce poor health?
    • This can include embedding equity into mission, vision, and value statements and holding healthcare leadership through all sectors of the healthcare system accountable for making measurable positive change.
  7. Is the initiative actively seeing marginalized individuals and communities through a strengths-based perspective, valuing their resilience, knowledge, and lived experiences as critical for transforming unjust social structures and imagining new ones?
    • This requires:
      • Recognizing the imperative to partner with patients, family members, and community organizations to identify and eliminate the root causes of health and healthcare inequities;
      • Valuing the lived experience and expertise of patients and communities living with health inequities at least as much, if not more than, those working within healthcare organizations and academic settings;
      • Ceding decisional authority and power to them; and
      • Providing equitable and adequate compensation for their lived experience and expertise.
  8. Is the initiative utilizing critical consciousness to engage in praxis to transform unjust conditions and power dynamics?
    • This requires creating strong and accountable cultures within healthcare organizations that take action to improve internal and external diversity, inclusion, and equity.
  9. Are the members of the initiative and its partner organizations having transparent conversations about the theoretical foundations that guide each partner’s thinking?
    • Diverse transdisciplinary teams grounded in a critical paradigm, which centers on explicit power analysis, will experience less challenges in negotiating worldview differences than transdisciplinary teams that do not share that perspective. 
  10. Is the initiative…
    • Grounding its work in critical theory?
    • Placing a focus on cultural competence with a focus on critical consciousness?
    • Hiring implementation teams that model a culture of equity?
    • Emphasizing relationships as a vehicle for change?
    • Ensuring equity-focused implementation and operations? 
  11. Do all team members and functional areas at partner organizations have the leadership support, authorization, and expectation to identify equity-related challenges and to intervene within the scope of their position?
  12. Does the initiative have:
    • Adequate funding and personnel support?
    • Long-term evaluation periods?
    • Support for experimentation, including failure?

Goal and Objective Setting:

About the Roadmap Goal and Objective Setting Tool

This tool is designed to facilitate goal setting and completion for your team. The tool will allow your team to:

  1. Record goals which align with the various Roadmap components
  2. Record objectives, time frames, and target completion dates, among other important items for each goal
  3. Monitor progress of goals per Roadmap component

Your team is welcome to engage with this tool as much or as little as it would like, and is helpful, in the development, implementation, and evaluation of your health equity initiative. We encourage you to use this tool to ensure clear goal setting and promote consistent communication, accountability, and progress within your team. This tool is designed to be used over time as your team progresses through the Roadmap and your initiative. This is in no way intended to be used one way by all teams. This is meant to help you progress through the Roadmap component(s) on which you are working at a given time and you may reach your goals in any order. We welcome you to consult your AHE TA lead on getting started with this tool.

Each Roadmap component is listed as a separate tab. Navigate to the desired Roadmap component via the task bar at the bottom of the webpage to add, edit, or view goals. Hide certain tabs as needed to narrow your view to specific Roadmap components or the snapshot. Changing the status of a goal will automatically shift the Snapshot view for the specific Roadmap component.