Create Cultures of Equity
What does it mean to create cultures of equity, and why is it important?
A culture of equity refers to the environment and culture of an organization that:
- identifies inequities; and
- takes responsibility for eliminating those inequities by applying an equity and anti-racist lens to make systemic policy and procedural changes that dismantle discrimination, biases, and disparities.
Creating a culture of equity means embedding equity into your organization’s core values and daily operations. It’s not just acknowledging health inequities, but actively identifying and addressing the structural and systemic factors that cause them. Creating a culture of equity 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. You are far more likely to reduce disparities rather than reinforce them when equity is embedded in your organization’s culture and all of its quality improvement activities. When equity is embedded in your organization’s culture, your quality improvement efforts are far more likely to reduce disparities rather than reinforce them.
Creating cultures of equity continues even after specific health equity initiatives end. It requires ongoing effort, not a one-time glance. A strong and healthy culture of equity will energize and help sustain nearly every other organizational goal and objective. Any initiative will have a higher chance of succeeding when team members feel included, valued, and have equal opportunities to exhibit their strengths and receive recognition and support. The Advancing Health Equity team has learned that health equity initiatives that take place within organizations with a strong culture of equity are more likely to succeed compared to equity initiatives launched in organizations without strong cultures of equity.
When should I create cultures of equity?
Activities to create a culture of equity should begin as soon as possible. Even though creating a culture of equity is in many ways its own initiative, it is a critical component of all work to advance health and healthcare equity.
The Time Estimate chart below provides a high-level overview of the steps as well as the approximate number of meetings for which to plan. The estimates will vary from team to team. Ideally, the work of creating cultures of equity will eventually involve gaining the buy-in (if needed) of organization leaders. Also, the work might move outside of your immediate health equity team because it will involve organization-level objective and goal setting, and strategic planning.
| Key Activities | Time Estimate: ~13+ Hours |
|---|---|
| Review and discuss Create Cultures of Equity: A Critical Approach To Understanding Systems of Oppression | 2 one-hour meetings |
| Review and discuss Create Cultures of Equity: Transforming Operations and Culture to Advance Health Equity | 2 one-hour mtgs |
| Review and discuss Best Practices for Institutionalizing Fair and Inclusive Health Care Practices and Measuring Progress. Note which of the activities for each of the five elements might be a good fit for your organization or team. | 2 one-hour mtgs |
| Reflect on the team policies and procedures of your organization(s). | 2-3 one-hour mtgs |
| Brainstorm ideas and make a tentative plan or proposal to begin creating or improving cultures of equity. | 5-6 one-hour mtgs |
| Share the tentative plan or proposal with key stakeholders, begin earning stakeholder buy-in, finalize the plan, and begin implementation. | Ongoing. |
How can you create cultures of equity?
As a team first review the Create Cultures of Equity: A Critical Approach To Understanding Systems of Oppression presentation as a team, below. Then, the team should review the Create Cultures of Equity: Transforming Operations and Culture to Advance Health Equity presentation. The team should be given plenty of time to discuss the concepts and ideas in both presentations.
Note: The presentations can bring-up conflicting world views amongst team members or within an organization that they might need to work through. It can be difficult to acknowledge and discuss these differences. An neutral facilitator from outside your organization(s) could help your team review and discuss the material.
Next, review Best Practices for Institutionalizing Fair and Inclusive Health Care Practices and Measuring Progress (from the Institute for Healthcare Improvement’s Advancing Health Equity: An Approach to Systematically Identify and Evaluate Health Disparities). This resource provides high-level guidance to create a multi-year strategic plan for advancing a culture of equity for healthcare sector organizations.
Resources to Create Cultures of Equity
Create Cultures of Equity: A Critical Approach To Understanding Systems of Oppression (Presentation)
A training presentation that grounds health equity work within critical theory. It covers definitions of health equity, equity vs. equality, and what an organizational “culture of equity” means. It 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.
Create Cultures of Equity: Transforming Operations and Culture to Advance Health Equity (Presentation)
This action-oriented follow-up to the presentation above presents five implementation strategies:
- Ground diversity, equity, and inclusion efforts in critical theory
- Train staff beyond cultural competency to include critical consciousness
- Strengthen relationships as vehicles for change
- Empower an implementation team that models equity
- Align culture transformation with operational transformation.
This presentation includes real-world examples from multi-organization collaborative teams in Washington, Delaware, and Illinois.
Best Practices for Institutionalizing Fair and Inclusive Health Care Practices and Measuring Progress from the Institute for Healthcare Improvement’s Advancing Health Equity: An Approach to Systematically Identify and Evaluate Health Disparities; Appendix B).
This resource guides organizations in developing a strategy to maximize the chances of successfully identifying, reducing, and eliminating health and health care inequities. Implementing the strategy and tracking progress will provide key data to organization leadership regarding the status of the organization’s equity efforts.
In addition to addressing the advancement of equity for patients and health plan participants, this practical guidance also addresses equity, inclusion, and belonging for the organization’s employees.
Assessing and Improving Activities to Create Cultures of Equity
This tool will help teams assess:
- Alignment between the team and the organization key stakeholders
- Common root causes of problematic relationships with surrounding communities and patients living with inequities
- Assumptions that might impact the team’s or organization’s work to advance health equity
About the Roadmap Goal and Objective Setting Tool
Use the Roadmap Goal and Objective Setting tool to facilitate and document the development, implementation, and evaluation phases of your health equity initiative. It will help your team realize your vision to reduce and eliminate health and healthcare inequities by providing a centralized resource to:
- establish process goals that align with each Roadmap component;
- document task status, identify project champions, and maintain detailed notes;
- monitor progress across multiple Roadmap components simultaneously; and
- promote consistent team communication, accountability, and progress.