Why and How Health Care Systems Are Making Equity a Priority

The COVID-19 pandemic and the tragic murder of George Floyd placed a spotlight on the deep disparities and inequities that have long plagued our health care system. At United Hospital Fund’s virtual Quality Leaders Forum on June 23, three of New York City’s leading quality experts discussed how these events triggered a focus on equity leading to deep introspection and action, both for them personally and within their institutions. “Historically many of us have left the equity domain to policymakers and population health researchers and haven’t taken it upon ourselves as a burden that we need to bear,” said Ilseung Cho, MD, MSc, chief quality officer at NYU Langone Health.

In addition to Dr. Cho, the event’s panelists included Yvette Calderon, MD, MS, chair of the department of emergency medicine at Mount Sinai Beth Israel Hospital, and Eric Wei, MD, MBA, senior vice president and chief quality officer at NYC Health+Hospitals. UHF president Anthony Shih, MD, served as moderator. 

Panel members, clockwise from upper left: Ilseung Cho, MD; Eric Wei, MD; Anthony Shih, MD; and Yvette Calderon, MD

The panelists all identified leadership engagement as essential to the culture change required to create greater equity in the delivery of health care and within health care organizations. “The critical part of cultural change is for leaders to see the need to acknowledge that structural racism is embedded within their institutions,” said Dr. Calderon. The need for dedicated support, such as protected time and resources, was also noted.

Education was another important theme. All three panelists said their organizations are conducting staff training related to unconscious bias, and emphasized that such training requires an ongoing commitment. There may be opportunities to explore other ways of learning, Dr. Wei said, such as small group simulations that go beyond typical learning modules. The panelists stressed the need to learn from the next generation of medical, nursing, pharmacy, and allied professionals.

The three organizations have also developed plans to address inequities, involving staff at different levels, and identified areas to work on immediately. Dr. Wei shared the example of Health+Hospitals’ medical “eracism” initiative to remove race-based calculations in diagnostic tests, and a commitment to consider the role of bias in cases discussed at risk management meetings. Dr. Cho discussed NYU Langone’s quality improvement goals related to equity, set by each department, while Dr. Calderon described the use of dashboards by Mount Sinai Beth Israel to identify disparities in care, and to assess whether the organization’s workforce represents the communities being served. 

One of the biggest ongoing challenges, the panelists agreed, is collecting accurate data on Race, Ethnicity and Language (REAL) Data and Sexual Orientation and Gender Identity (SOGI). Currently, much of the data are missing or categorized in ways that are not useful. Panelists said their organizations are working with staff to educate them on why this data is important, and how to collect it appropriately and sensitively while being mindful that patients have good reason to be skeptical about its use. For example, historical racism in medicine is behind much of the hesitation toward COVID-19 vaccinations among those affected by its legacy. It is important to “build trust that we will do the right thing with the data and address the problems we discover,” Dr. Cho said.

“We’re all learning together and need to keep the conversation going,” said Dr. Wei. Everyone agreed that the journey to greater equity will take time and commitment, and Dr. Calderon emphasized that sharing best practices and ongoing challenges could be very beneficial. Dr. Cho aptly quoted from Maya Angelou to end the evening: “Do the best you can until you know better. Then when you know better, do better.”

Participants in the Quality Leaders Forum, organized in collaboration with Greater New York Hospital Association (GNYHA), included alumni from the UHF/GNYHA Clinical Quality Fellowship Program and honorees from UHF’s Tribute to Excellence in Health Care. Members are invited to network and discuss current issues in health care quality with nationally recognized quality leaders and to pursue opportunities for sharing best practices. Past Forum summaries can be found here. The next Forum will be held on September 22.

UHF is grateful to Elaine and David Gould, whose generosity supports the Quality Leaders Forum.