Create Cultures of Equity
Even the most well-intentioned effort to reduce health and health care inequities is less likely to succeed if it’s not part of a broader culture of equity. Having a strong culture of equity goes beyond staff simply recognizing health inequities among the communities they serve exist; they also must view those inequities as unacceptable and in need of remedy. Creating and sustaining a culture of equity takes time, teamwork, and continual attention. In a culture of equity, all employees, both individually and collectively, identify and reflect upon the organizational dynamics that reproduce health inequities and actively work to transform those dynamics.
Fostering a culture of equity can be a difficult undertaking, but the benefits outweigh the challenges. When an organization values and promotes a culture of equity, staff learn to value it as part of the care they administer. Organizations that value health equity also explicitly respect and value the diversity in life and experience of their workforce. Often, organizations attempt to address health inequities through general quality improvement, related to the idea that “a rising tide lifts all boats.” Yet improving quality while ignoring demographic differences in process and outcome measures does not address equity. It’s not enough to know that inequities are a problem in general; one must be aware of which inequities exist among their own patient population.
A culture of equity is essential to the success of a quality improvement program aimed at reducing differences in health care and health outcomes.
To enact a culture of equity, organizations and employees therein have two major tasks:
- Identify the problem
- Take responsibility for addressing it
Yet creating a culture of equity is not simply an external undertaking. It is important to pay attention to internal organizational dynamics, as well. Using an equity lens to create an internal culture of equity might shine a light on power inequities between teams that reduce overall effectiveness. It is impossible to create a culture of equity when those involved feel disempowered or disenfranchised. For example, if an employer creates an employee-only portal chock-filled with important information about benefits and company news, that’s equality. It’s equity, however, when that employer ensures the portal is disabled accessible, with text that can be enlarged, images that have clear descriptions for a screen reader, and colors that are visually distinguishable from one another.
Linking Quality and Equity
Nearly everything in life can be viewed through an equity lens. Using an equity lens means that in addition to making sure every person has equal access to health care, care is taken to allocate the right resources according to a person’s (or group’s) specific needs. It is a common misconception within healthcare that equal care is synonymous with equitable care. Yet research has shown that even when access to healthcare is equal, patients of color are more likely to receive lower quality care than white patients.
Quality care is the right care administered at the right time to the right person. Even when quality improvement efforts improve outcomes across a patient population, among racial and ethnic and other demographic groups, those outcomes can stay the same, worsen, or not improve as quickly. Equitable care is not a one-size-fits-all approach. Rather, equitable care centers the individual and ensures an optimal outcome regardless of background or personal circumstance.
When attempts at health care reform focus only on access or overall outcomes for the entire patient population, they miss addressing a crucial piece of the health equity puzzle: gaps in quality. At its core, health equity is possible only when quality and equity are aligned. Quality health care is:
These pillars of quality miss the mark if they are realized inequitably across the patient population. Health care that links quality and equity takes into account racial and ethnic differences as much as it does other demographic factors. It can’t be high-quality care if that care is significantly less effective for some populations and not others. Therefore, organizations must continually revisit their efforts to create a culture of equity, strengthening and improving those efforts when necessary.
Creating a culture of equity is, first and foremost, a process of nurturing. Even highly motivated staff or providers may feel discouraged in their attempts to address disparities. Vulnerable patients face significant challenges outside the organization’s walls and it can feel like the problem is too big for one person or organization alone to solve. Cultural change is often gradual and can be difficult to gauge, but when equity is an integral element of organizational values, those initiatives are more likely to be successful and ultimately, rewarding.