There is no such thing as high-quality, safe care that is inequitable.
That is the key message delivered in a set of AMA modules on integrating equity into harm-event reporting, with the stated goal of this particular set of modules being to focus on creating safe spaces for physicians, other health professionals and staff to talk about inequities and the way they are manifested in the quality and safety of care.
This includes recognizing that crisis and conflicts in a health care organization can represent opportunity and growth, according to Normella Walker, vice president of enterprise diversity at Mass General Brigham.
“Appreciate that we’re learning, and when we’re in learning mode, we’re going to make mistakes, we’re going to be awkward and clunky,” she says in the third module of the set. “That’s fine. We invite that too, and appreciate pauses, feelings and reflections.”
The “Advancing Equity through Quality and Safety Peer Network Series,” an AMA Ed Hub™ Health Equity Education Center resource, explores these issues in detail. The set of free, online CME activities—offered in collaboration with the Brigham and Women’s Hospital (BWH) and The Joint Commission—builds on work started in 2019 by BWH and the Institute for Healthcare Improvement, which led to the design, testing and implementation of a framework for the work done by the AMA Peer Network for Advancing Equity and Quality.
This first-of-its-kind online curriculum provides comprehensive instruction for integrating equity into quality and safety practices. “Equipping Staff with the Knowledge, Skills and Tools to Create Safe Spaces” is one of the focus areas examined and, in the set of modules exploring this topic, inequities are defined as “systematic, unjust and preventable differences in health outcomes by race, gender, language or other factors.”
Equity has been “largely neglected” in the education and training of physicians and other health professionals, says one module, resulting in the systematic failure to address the root causes of low quality and unsafe care that differentially harms some patients more than others.
“Historically, the approach of the quality and safety field and U.S. health care at large has been to ignore and/or intentionally exclude from consideration how a persons’ identity may contribute to these harm events,” said Karthik Sivashanker, MD, the lead author of this work.
“The unfortunate reality is that unequal treatment based on social factors such as race, class, etc., is the norm and is embedded into every aspect of our society,” Dr. Sivashanker added. “This is especially true as it relates to our health care system and how it is explicitly structured and incentivized to produce unequal care and health, Such denial and avoidance of real issues leads to unreliable and harmful variation in care that ultimately impacts every single person in this country, including and especially historically marginalized patients, staff, and communities.”
In the module, he nudges learners to focus on the root causes of harm at the systemic, social, and structural levels. “The goal isn’t to shame individuals but to build resilient systems around them that prevent harm,” he said.
One strategy is to develop and implement a standardized approach to analyzing inequities. This can be done by embedding equity prompts into core quality and safety tools such as root-cause analysis.
“We’re really trying to enable reliable detection of inequities that can harm our patients and staff members,” said Karen Fiumara, PharmD, vice president of patient safety at BWH.
Physicians and other health professionals are encouraged to consider the power of the stories and narratives of patients and staff who have been harmed.
“There is a level of collective desensitization in healthcare to suffering, especially as it relates to marginalized people,” Dr. Sivashanker notes.
“And while group- or population-level data has an important role, it also serves to distance us from the very real suffering being inflicted on, and experienced by, actual human beings with lives, families, disappointments, and aspirations,” he said. “By centering their individual voices, stories, and narratives of those who are harmed, we are able to enliven and humanize the work of health care improvement. We can then layer on group- and population-level data to note that it’s not a ‘one-time event.’
“It’s a very powerful approach that strategically engages our hearts (and our minds) to build will for effective systems-based improvements,” Dr. Sivashanker added.
The modules acknowledge that conversations can be uncomfortable, but this shouldn’t lead to inaction by those who fear they may stumble and use the “wrong word.”
In another module, Fernando De Maio, PhD, speaks from his perspective co-authoring the AMA Association of American Medical Colleges’ narrative guide and as the AMA Center for Health Equity vice president leading data and research.
“We all make mistakes in this area, but we all have the capacity to grow,” De Maio said.
CME activities within the “Advancing Equity through Quality and Safety Peer Network Series” are enduring material and designated by the AMA for a maximum of either 0.25 or 0.5 AMA PRA Category 1 Credit™️.
The activities are part of the AMA Ed Hub™️ online learning platform that brings together high-quality CME, maintenance of certification, and educational content from trusted sources, all in one place—with relevant activities, automated credit tracking, and reporting for some states and specialty boards.
Learn about AMA CME accreditation.