Many physicians and leaders in health care are eager to help their organizations address health inequities, but it can be tough to know how to turn those good intentions into concrete, effective actions.
During an AMA STEPS Forward® webinar, Denard Cummings and Rishi Manchanda, MD, MPH, discussed five steps for advancing racial and health care equity at your health care system and talked about examples of places that have successfully begun the journey. Cummings and Dr. Manchanda are co-authors of the “Racial and Health Equity: Concrete STEPS for Health Systems” toolkit, which is designed to help motivated physicians and health professionals in mid-sized and large health care organizations advance health equity.
“It’s not just lip service that is going to be sufficient to advance health equity. It’s not just thinking about these things. It’s about taking deep, rigorous, sophisticated analysis—including an understanding of systems thinking, including an understanding of the data and evidence” of racial inequities, “and translating that understanding into action,” said Dr. Manchanda.
He is president and CEO of HealthBegins, a mission-driven firm that helps physicians and other health care leaders move their organizations upstream to address the social and structural factors that drive health inequity.
During the webinar, Dr. Manchanda and Cummings pointed to a number of examples across the nation where health systems have turned thoughts into action, including one from Cone Health in North Carolina.
In 1963, a federal appeals court mandated the health system end racial segregation by creating access to care for Black patients as well as allowing Black physicians to have privileges in the hospital. It was a landmark case for the nation, Dr. Manchanda noted.
In 2016, Cone Health apologized to the last living plaintiff in the case. The health system has since been working to advance racial equity for their patients and others in the community, creating a more open dialogue with the community about the history of racism and the institutional racism that still exists in many parts of heath care.
“It’s happening in other parts of the country,” Dr. Manchanda said, noting other examples of health systems “driven by data and driven by their mission and, finally, also driven by their connections with community organizations that they serve and that they work with, to improve health outcomes.”
The STEPS Forward toolkit points to several “vanguard examples,” including those below, from health care organizations that have undertaken initiatives to embed racial justice and advance health equity.
The ACCURE trial identified and intervened to improve racial equity in five cancer centers across the country, nearly eliminating inequities in treatment and outcomes for Black patients with early-stage lung and breast cancer.
Northwell Health created the Center for Diversity, Inclusion and Health Equity and leveraged existing departmental structures to help identify health inequities and integrate equity into daily functions across the health system. For example, the center works to improve access for patients with limited-English proficiency. In one year, the system provided more than 260,000 language-interpretation calls.
NYC Health + Hospitals recently launched the Medical Eracism initiative, prompting it to end the use of two race-based clinical assessments—for kidney function and vaginal delivery after C-sections—to help reduce racial biases in care.
University of Washington Medicine formed a multidisciplinary committee to advance health care equity in 2016. The following year, the committee released an enterprisewide Healthcare Equity Blueprint. By 2019, the committee expanded the use of health care equity dashboards systemwide.
“There are many systems across the country that are doing this work and are doing interesting and amazing things,” said Cummings, the AMA’s director of equitable health systems integration. “There is an opportunity to learn from them ... what it is they are doing and how they recognized, and how they have implemented it in a way that has been successful.”
Start here to help your private practice advance health equity.