A new report from the Institute for Healthcare Improvement (IHI) offers a framework for healthcare organizations to continue health equity efforts amid politicization.
The report was based, in part, on a literature review and extensive interviews with 27 participants across health systems and community organizations. The report identified appropriate policies that support ongoing health equity initiatives and created a framework for maintaining equitable care.
“I want leaders to take away the understanding that there’s still opportunity and space and reasons and importance around continuing to do this work,” Camille Burnett, Ph.D., vice president of health equity at the IHI, told Fierce Healthcare.
In recent years, diversity, equity and inclusion (DEI) efforts have come under scrutiny during the Trump administration. Corporate and academic institutions alike have pared back their initiatives or entire departments.
The report cited several such examples within the government, such as the Centers for Medicare & Medicaid Services (CMS) pulling information on health equity for the Medicaid and CHIP programs through Section 1115 waivers. Health equity plans were also removed from the CMS’ Enhancing Oncology Model, while the National Institutes of Health canceled grants that touched on DEI and LGBTQ+ health, and a CMS committee on health equity was disbanded.
Though DEI programs are not illegal, the report said, and health equity is not the same thing as DEI, “the relationship and misuse between the terms and related programs have caused uncertainty.”
The difference between DEI and health equity, per the report, is that DEI refers to workforce initiatives. Health equity is about the ability to access healthcare without variation in quality because of personal characteristics. While both efforts are somewhat related, the IHI report focused solely on health equity work.
The framework included the following recommendations:
- Publicly acknowledge continued commitment to health equity
- Reframe equity as a strategic imperative
- Identify and address differences in health outcomes
- Provide health equity training
- Communicate potential language and role changes with employees
- Establish places to share experiences
- Provide historical perspective, past lessons learned and a view of the future
A major way to reframe health equity is to think of it as integral to patient safety and quality improvement, per Burnett. Quality of care is a bipartisan issue. “The heartbeat of the work really does sit within quality improvement work that health systems are required to do anyway,” Burnett said. “It was just a matter of adaptation.”
The Joint Commission renamed the Requirements to Reduce Health Disparities program to Excellent Health Outcomes for All, though the certification still supports identifying differences in outcomes. That type of work, per the report, could be supported by centralizing population health data or co-locating population health with quality improvement.
However, making public-facing changes to language could make it look like organizations are going back on their commitments. That is why it’s crucial to continue communicating with affected communities, assuring them of commitment and explaining reasoning, the report said.
It’s worth keeping in mind that regional differences play a role in how organizations are responding to external pressures. Those in the northern parts of the U.S. have largely been able to work with their attorneys general to come up with a game plan on how to navigate the president’s executive orders, the report highlighted. Those in southern regions or those predominantly governed by conservative leaders often have their hands tied. Additionally, an organization’s funding determines what decisions it makes, such as whether it depends on government money or independent donors.
Social benefit efforts may gain more traction when organizations emphasize their financial benefits, per the report. Organizations that make the business case for health equity may find it easier to maintain support from leadership and board members. Being communicative about forthcoming changes and offering spaces to discuss moral injury experiences can also support well-being and boost morale.
One could look at the disruption happening in a positive way, Burnett noted. The incumbent healthcare system was designed in such a way that results in major inequities. “This is a moment in time when we can redesign it, and we can reimagine it,” Burnett said.
Burnett’s sense is that health systems remain committed to health equity, though the moment now demands more of leaders. As long as the work continues, Burnett is less worried about how the language or framing changes.
“I would rather see adaptation, than to see people not doing the work,” she said.