Leadership Lesson – April 2023: Health Equity Is Everyone’s Job

Words of advice from leaders on the front lines.
This month’s leadership lesson is from Rosa Abraha, MPH, health equity lead at Alliant Health Solutions.

Health Equity Is Everyone’s Job

The COVID-19 pandemic presented unprecedented challenges and exacerbated longstanding systemic health disparities, pushing the conversation around health equity from “why is this important?” to “how do we do this?” As a result, addressing health disparities has become a priority of the White House, Department of Health and Human Services (HHS), CMS and the Joint Commission leadership. Effective July 1, 2023, the Joint Commission has even elevated Standard LD.04.03.08, which addresses health care disparities as a quality and safety priority, to a new National Patient Safety Goal (NPSG), Goal 16: Improve health care equity, and moved to NPSG.16.01.01 for all hospitals, ambulatory health care organizations, behavioral health care and human services organizations, and critical access hospitals. The NPSG standard and six elements of performance increase the focus on improving health care equity as a quality and safety priority. This prioritization presents Alliant with a critical opportunity to be at the forefront of supporting hospitals, nursing homes and community partners to build more resilient communities and address longstanding social determinants of health (SDOH) across readmissions, opioid misuse, diabetes, and other critical chronic diseases.

In honor of National Minority Health Month, I want to share three critical action steps Alliant is taking to promote systematic integration of health equity across our work. The first step is allowing our data to tell the stories of health disparities. In alignment with the CMS Framework for Health Equity, Alliant has ensured that our hospital and nursing home PowerBI dashboards display any known disparities across race/ethnicity, gender and disability status by facility and community. This data has allowed us to prioritize areas where we say the greatest need for improvement in health equity across the facilities and communities we serve and take strategic action on addressing health disparities. But we know this demographic disparity information across race, ethnicity and language (REaL) data doesn’t tell us the whole picture, which has led us to innovate as the first QIN-QIO contractor to develop an SDOH mapping tool. With expected completion in the fall of 2023, this mapping tool will allow us and our providers to drill down into the deeper social needs disparities at the county level, including food insecurity, housing instability/homelessness, transportation and more. Given that a patient’s care journey is 80% dependent on these non-clinical factors, we need to account for them in our data to drive the change we want toward health equity.

Capitalizing on the REaL and SDOH data we’ve gathered, our second action step is developing evidence-based interventions to address these disparities across our quality measures. This includes conducting coaching calls and train-the-trainer sessions with facilities and providers to identify and embed imperative SDOH questions in their intake/admissions and readmissions processes and evaluate over time (i.e., monthly, quarterly, annually) the top social barriers in their facilities. As hospitals and nursing homes continue to experience staffing and resource shortages, Alliant’s support has alleviated the overwhelming burden of addressing all the disparities at once and granted them clear direction on which social needs should take priority. We’ve also conducted rigorous research and identified proven interventions for our facilities to employ across various quality measures to address SDOH barriers that impair their patients’ health outcomes. For example, our interventions would detail how to address the lack of transportation as a driving force in recurring readmissions and practical strategies to address gaps in health literacy for uncontrolled diabetes through cultural and linguistically appropriate standards (CLAS). We’ve even developed a bite-sized learning series on health literacy on our YouTube and completed numerous health equity trainings alongside CMS and our learning and action networks events. We are also launching Alliant’s first health equity bite-sized learning series and a website featuring creative and easy-to-use resources and tools for employing health equity strategies in nursing homes, hospitals and community settings.

Lastly, Alliant is clear that the role of health equity does not lie on one individual, facility or community. It is, in fact, everyone’s job. Most hospitals and nursing homes do not internally house the resources needed to address healthcare-related social needs issues, making our partnerships for community health networks a necessity for filling these critical gaps. Addressing health inequities requires a coordinated community response where health systems and community partners within our PCHs are actively partnering to address disparities, especially for the most disproportionately impacted. In turn, Alliant has developed a symbiotic framework for clinical and community partnership whose heartbeat lies in genuine and authentic engagement, co-authorship, and buy-in in enhancing the health of our communities. We must expand our understanding of what creates health and think outside the box on the role of community partners within clinical settings to help address social needs. Engagement must go beyond physical attendance in meetings and work together to generate innovative alliances, contribute to decision-making, and reasonably distribute organization resources to support the clinical gaps in addressing patients’ social needs. For many patients experiencing co-morbid conditions and more than one social need, we must develop cross-sectoral partnerships that connect different social determinants of health for a more comprehensive understanding that addresses a patient’s total health.

Ultimately, health inequities did not start overnight and will not be solved overnight. Still, if we all come together to take targeted action on moving this important work forward, we can create a culture of health equity for everyone that is both scalable and sustainable.