Robust Data Collection, Careful Review Key to Preventing Disparities
By Dorothy Brooks
Through a $40 million initiative called United Against Racism, the Mass General Brigham system in Boston has launched an array of programs aimed at eliminating disparities and promoting antiracist care.
While the initiative is credited with narrowing some gaps in care between white and minority populations, health system leaders stress there is much more work to be done in this area. Nonetheless, this pioneering work has been hailed as a national model for other health systems that are struggling with their own efforts to promote equity on the front lines.
Nadia Huancahuari, MD, a medical director for quality, safety, and equity, says one of her chief concerns is ensuring patients from minority groups who present for care are treated with the same respect and given the same experience as white patients. To make progress in this area, she suggests leaders recognize medical distrust persists because of perceived ongoing inequities in care.
“Patients who have that fear and/or mistrust need a healthcare system that is willing to rebuild that trust, be transparent, be willing to apologize, and implement processes to improve patient care and experience,” Huancahuari explains. “Inequities in the patient experience are not unique to emergency care. However, certain elements specific to emergency care environments, such as limited patient care team interactions, fear of the unknown, and loss of control — to name a few — may exacerbate patients’ mistrust.”
To make changes, develop multiple ways to capture where disparities exist, work to understand these disparities, and target improvement efforts.
“Our organization has established many systemwide processes by which care team members as well as patients can share concerns regarding possible bias or discrimination impacting the care all patients receive,” Huancahuari says. “Our team then reviews these concerns to better understand the experience.”
For instance, Huancahuari’s team analyzes any cases that have been flagged for discrimination or bias. “Our patient and family relations specialists promptly connect with the patient to better understand the experience and provide support,” she explains. “We then work with the local departmental or clinical unit leadership to identify the vulnerabilities raised from this encounter, and develop process improvements to strengthen our system.”
When such case reviews are completed, Huancahuari’s team typically will reconnect with the patients involved, through letters, in-person meetings, or virtual meetings.
“We then thank them for their willingness to discuss their difficult experiences and emphasize how their feedback helps us to create a more equitable care environment within our healthcare system,” she says.
Huancahuari acknowledges openly addressing inequities in the care clinicians provide is a new and uncomfortable space for many. “However, once we have raised awareness of these inequities and follow a systematic approach to review these cases, there is significant engagement and support for this effort,” she says. “Furthermore, during our reviews, we emphasize that most often patient harm associated with widespread inequities is due to long-standing broken systems, policies, and practice, and not due to one individual’s behavior.”
While it can be difficult to make the case for improvements to skeptical colleagues, Huancahuari says one effective way to engage leaders and team members around this work is to share the data, along with patient stories.
“To increase your institution’s awareness of potential structural, institutional, and interpersonal biases that impact the care patients receive, it is critical to include patient demographics in every case analysis,” she says. “Explicitly acknowledging the patient’s age, gender, race, ethnicity, preferred language, and insurance provides a deeper understanding of patient factors that may contribute to adverse events and to poor patient experiences.”
Huancahuari adds humanizing the data with a patient’s personal account will create a better picture of inequities experienced.
For emergency medicine leaders who may be starting similar efforts, Huancahuari suggests developing a system in which administrators can reliably receive feedback from the care team and patients regarding inequities in care and/or experiences.
“I would recommend [that people] carefully review their patient satisfaction data, disaggregating it by demographic factors, and identifying vulnerabilities and trends,” she says. “For instance, in emergency care, some high-risk areas and moments in which inequity in patient experiences may show up include waiting room times, hallway care, language barriers, and a mismatch of expectations in regard to testing or disposition.”
As clinicians and administrators implement these new processes or educational initiatives to address these vulnerabilities, their success can be measured through future positive patient experiences across all demographics, Huancahuari observes.
A Boston health system has launched a multimillion dollar program aimed at eliminating disparities and promoting antiracist care.
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