To date, 1,656 organizations, 51 state hospital associations, and 11 municipal hospital associations have signed onto the American Hospital Association's (AHA) #123forEquity Pledge to eliminate healthcare disparities. That means every state, and nearly 30% of our nation's hospitals, are represented in the movement to improve health equity. But the road between pledging good intention and effecting actionable change can be poorly marked, and dotted with unseen obstacles. In this post we'll review the key tenets of the AHA's Equity of Care Campaign, rationale for participation, and key actions hospitals and health systems can start to focus on today.
Four areas of focus: data collection, cultural competency training, diversity in leadership, and community partnerships
Health disparities in America are a well-documented reality, associated with immense human and financial costs. Many health equity advocates argue that the improvements we have seen to date have been too slow to come, that we need not more research to tell us that our time for action is now. To this end, the AHA launched the #123forEquity pledge campaign in 2015 with the purpose of stimulating concrete actions aimed at accelerating progress in the following areas:
- Increasing data socio-demographic collection (e.g.; race, ethnicity, language preference, etc.)
- Increasing cultural competency training
- Increasing diversity in leadership and governance
- Strengthening community partnerships
Leaders in these areas are honored each year at the AHA Leadership Summit with the Equity of Care Award. Quality Interactions is proud to have had two clients stand out in this field: 2017 Honoree, Moffitt Cancer Center, and 2014 Award Winner, Massachusetts General Hospital.
Key drivers for participation
The #123forEquity pledge campaign "asks hospital and health system leaders to begin taking action to accelerate progress" in these four areas of focus. The key word for many here? Asks. Beyond the prestigious annual Equity of Care Award, there is no immediate incentive or mandate attached to participation. Thus, is is hard to determine how successful the campaign has been in producing concrete results. As one of our clients said about the pledge, “It’s nice PR but it doesn’t mean anything if you aren’t doing it. We’ve started improving our diversity at higher levels of leadership. We’re trying to push up from within, but we are looking for roots, which is cultural competency training.”
The AHA recognizes how challenging it is to devote the time and money necessary to realize the goals of the #123forEquity pledge. From their site:
In addition to being the right thing to do, eliminating health care disparities is vital as our health care system moves from a volume to a value-based payment structure. As payment becomes more dependent on outcomes, it is not financially viable to ignore persistent poor health outcomes in certain patient populations. Associated with health care disparities are increased costs of care due to excessive testing, medical errors, increased length of stay and avoidable readmissions. Pay-for-performance contracts are beginning to include provisions to address racial and ethnic disparities.
Here are a few key things to know:
- Between 2003 and 2006, 30.6 percent of direct medical expenditures for African Americans, Asians and Hispanics were excess costs due to health care disparities (Joint Center for Political and Economic Studies, 2009).
- Eliminating health care inequities associated with illness and premature death would reduce in direct costs by $1 trillion.
- Researchers estimate that eliminating disparities would reduce direct medical expenditures by as much as $229 billion.
- Eliminating health care disparities gives hospitals and health systems a competitive marketing edge when trying to attract or retain patients and employees.
Everyone who works in healthcare is acutely aware that time is a scarce resource. And many organizations struggle to find the budget for programs that may be seen as nonessential. Cultural competency training can appear to be a drain on precious resources. But in fact, cultural competence can actually save clinical time. And, as the AHA outlines, cultural competency training is an investment that yields significant financial returns.
Taking action, setting roots
Cultural competency training is an essential investment in your organization’s future. But knowing that doesn’t solve the difficult task of deciding how it can and should be done. There are many cultural competency training programs out there, so which is the right one for you? And how will you carve out the time and money for training?
This common dilemma is precisely why we developed our Jumpstarter Award for cultural competency training. Originally designed for organizations who have taken the #123forEquity pledge, the Jumpstarter Award provides you with capsule training at a fraction of the market price. It gives your organization an opportunity to build momentum, prove value, and solicit buy-in without a large upfront investment or a long-term obligation.
While cultural competency training isn't panacea to the challenge of health disparities, it is certainly an essential component of the solution—the roots of a larger initiative. The AHA's Equity of Care Toolkit is packed with useful resources for building a #123forEquity strategy, and the upcoming 2018 AHA Leadership Summit in San Diego will include a #123forEquity Training that features Dr. Joseph Betancourt, Quality Interactions Co-Founder, and Director of the Disparities Solutions Center at Massachusetts General Hospital.
The time is now
As recent headlines show, we are experiencing a cultural uprising that demands equal and just treatment for all people. Nowhere is this more important that in healthcare, where equity can be a matter of life and death. Health disparities are a real and growing problem. From the stark statistics on black maternal and infant mortality and income-based health inequities, to increased vulnerability for LEP (Limited English Proficiency) patients, we cannot afford to wait.
We hope you will share your stories with us on your journey, and invite your comments below, or at firstname.lastname@example.org.