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Foundational Activities

Create a Team Charter

Once a team has made the commitment to advancing health equity, more often than not, the next question is, “Now what?” The next logical step might be writing a team charter to solidify the motivations, methods, and goals of the next phases of the work. Depending on the size and complexity of the organization or multi-organization collaborative, there may be a need for more than one team charter.

For example, one team might create a team charter to focus on the work needed to create a culture of equity. Another team’s team charter might address the Roadmap components of Identifying a Health Equity Focus, Conducting a Root Cause Analysis, Prioritizing Root Causes, and Designing a Care Delivery Transformation.

Adopting a team charter puts the team on the right path to achieving lasting results. A team charter defines the team’s vision as well as the reasoning behind where they invest their time and energy. Additionally, it serves as a consistent reminder of the team’s priorities and goals, so all team members can map where they are in the change process and remain engaged actors.

Creating a team charter can be as simple or complex as an organization makes it. There are, however, key elements that each charter needs to reflect to ensure an effective outcome. During the initial planning stages, think deeply about the charter’s core purpose and the roles each team function would ideally play within it. For example, what responsibilities would administrative staff have in enacting a culture of equity and how would it differ from other team members? Are the other teams with vital roles in the organization, such as maintenance and support staff, equally addressed and included in the charter? If not, why not?

Also consider the accountability structure for the team. Map out how the team(s) will correct course when a problem or inequity is brought to their attention as well as the preferred method for suggesting new ideas or discussing issues when they arise. In addition to solidifying the preferred decision-making methods, it may be helpful to jot down some ideas for ensuring there is equity in how feedback is given, from whom, and in what spaces. When team members feel empowered and heard they are more likely to remain engaged and contribute to the overall team mission, no matter their role in the organization.

Finally, team members need to be aligned on the mission and goals. Take the temperature of the room. Are there elements of the charter that some members are uncomfortable or disagree with? What elements are team members most excited about and why?

It’s important to remember that the team charter is a living document. As time passes, some aspects of the charter will need to be updated or eliminated as your team puts those initial ideas into practice. Be sure to review and update the team charter and the team’s core functions every 2-4 months to ensure that the team operates with a sense of high mutual accountability and urgency. Reviewing the charter more often also makes certain that new team members are well-oriented to team goals and ready to incorporate them into their new job functions. Creating a team charter can initially be a heavy lift, but it is an important step that solidifies a clear focus, plan, and way forward in the road to achieving (or improving) a culture of equity.

Conduct A Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis

The purpose of the Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis is to take inventory of an organization’s current working climate and the resources related to quality improvement and advancing health equity. After the charter is drafted and agreed upon by team members, it’s time to take a moment to think about what the organization does well, where it could improve, and what could challenge or support the organization’s efforts to create a culture of equity.

There are many factors, internal and external, that impact a SWOT analysis. It’s important to pick several to get a more accurate and well-rounded result that is specifically tailored to your organization or team.

Internal factors can be controlled by an organization. It can range from the tangible to the intangible, from the common to the unique. Every organization may have people, use data, or have a company culture, but they all look different when put into practice in everyday life.

Think about who in the organization has the potential to be champions for equity work. Who might potentially create roadblocks? What are the levels of investment that can be realistically expected from volunteers and patients, staff, patient care team members, or administrative leadership? Thinking of specific team members might naturally lend itself to conversations about company culture, the organization’s skill in implementing quality improvement measures, or its attention to diversity and inclusion. There are many internal factors to consider in a SWOT analysis, all of which can positively influence the end result. See below for a non-exhaustive list.

PeopleWhat human resources are available?
Consider all levels within the organization from volunteers to leadership.
DataHow is data on race, ethnicity, or language collected? Is it stratified by multiple factors or just one or two?
Consider how complete the data is, its relative quality, and what improvements can be made.  
CultureHow strong is the organization’s culture of quality improvement?
Consider how the organization addresses issues of diversity or inclusion.  
FinancesWhat is the organization’s payer mix or their reimbursement policies?
Consider any notable financial challenges or assets the organization may have.
AgilityHow nimble is the organization or team in pivoting when changes need to be made?
Consider how to use the SWOT analysis to create an environment in which adaptability is at the center of team dynamics.
PartnersWhich organizations would be reliable health equity partners?
Consider how expanding partnerships at the local/community, regional, and national level could advance efforts to achieve a culture of equity.
UniquenessWhat does the organization offer that isn’t available anywhere else in the marketplace?
Consider how to leverage that uniqueness to attract health equity partners, engage and inspire team members, and create a stronger culture of health equity.

Once the team has discussed internal factors, it’s time to think about the external factors that impact the organization.

External factors are those elements that an organization cannot control. They can be national or local in scope, or even internally specific. For example, political and economic trends can have a significant impact on the service a healthcare organization provides. On the local level, social norms relating to cultural or linguistic differences also impact how care is administered. When conducting a SWOT analysis on external factors, it’s important to understand why something may be out of an organization’s control as well as what can be managed. See below for a non-exhaustive list of external factors.

CompetitionHow are other practices in your market similar or different?
Consider to what extent those organizations compete for resources and how often your patient may overlap.
DemographicsWhich communities does the practice serve? Are those communities represented among employee ranks?
Consider how the demographics might be changing and how the organization will adapt to those changes.
InfrastructureIs the organization connected to a larger network or system?
Consider how the policies in an external system impact your own.
PartnersHow well do your partners priorities align with your organization’s?
Consider how well your organization is regarded among current and potential partners.  
Social TrendsWhat are the social norms regarding health and healthcare in the surrounding community?
Consider how demographic changes brought on with the arrival of new populations may impact those norms.  
PoliticalWhat is the political climate in the surrounding community?
Consider how that political climate impacts the well-being of patients and the work accomplished.  
EconomicsWhat major economic issues exist or are on the horizon that could impact the health or healthcare of the community?
Consider how agile the organization is and how well it would respond to those potential issues.  
TechnologicalWhat IT services are available to help your organization do its work to the best of its ability?
Consider what IT services are needed to provide the most optimum level of care.  
Policy  To which federal, state or local programs, payor requirements (e.g. Medicaid), or other policy regulations is the organization beholden?
Consider how those policies may impact your patients and the care they receive.

Conducting a SWOT analysis is a valuable exercise in the journey to meaningfully address health equity. It’s important not only to catalog what the organization has, but also what it might be missing. Teams should review and update their SWOT results every 3-6 months. External and organizational environments are always changing and new team members bring new perspectives that can reframe aspects of the SWOT, ultimately helping the organization move forward.