Thinking About Disparities

    • June 4, 2008

The Goal

Initiate high-level, internal dialogue about the hospital's diversity among patients to begin exploring whether all patients are receiving equal care.

Why It's Important

Approximately one in three U.S. residents is a minority. As the country's minority population continues to increase, hospitals will need to ensure they are providing high-quality, equitable care to all patients in order to succeed and thrive—both in terms of patient satisfaction and financially.

Numerous studies document disparities in the care delivered to White, African-American and Hispanic patients—even when income, education level, insurance status and other demographic and socioeconomic differences are eliminated. Yet most hospitals and health systems deny such disparities exist within their organizations.

How To Do It

The well-regarded Institute of Medicine's Crossing the Quality Chasm report outlined six areas for improving quality of patient care: safety, timeliness, effectiveness, efficiency, patient centeredness and equitability. According to the report, to ensure high-quality care, hospitals must first discover if they are providing equal care to all patients.

Experts agree that assessing whether racial and ethnic disparities in care exist in a hospital requires three core components:

Leadership
Courage
Data

To begin, hospitals should:

  1. Acknowledge that disparities may exist.
    Many institutions' initial reaction is to deny that disparities could exist within their walls, yet few have the quantitative data to support that claim. Hospital leaders must first open their minds to the possibility that disparities in care may exist.
  2. Refrain from making assumptions.
    Due to their geographic location and surrounding community, many of the country's hospitals and health systems have a predominantly minority patient population, with few White patients. Such organizations often mistakenly assume that because most of their patients are African American, Hispanic or Asian, disparities do not exist.
  3. Identify a system for data collection.
    In order to identify and quantify disparities, a hospital must establish an efficient process and suitable electronic system for collecting patient data by race, ethnicity and preferred language.
  4. Move beyond fear of the findings.
    Once organizations have embraced the need to collect this patient data, they should move beyond the fear of what the data may uncover. The fear is that an organization and its leadership, physicians, nurses and other staff will be seen as biased, or worse, racist if disparities in care are discovered. The willingness of an organization to investigate disparities—and depending upon what is found, embrace change if necessary—will likely raise a hospital's standing in the community.
  5. Think through the impact before you start.
    Early in the process of collecting additional patient data, one must ask, “Where will all of the new data lead to, and who may see it?” New patient demographic data may change the information reported to government regulatory agencies, payers and others.
  6. Engage and empower staff throughout.
    Members of hospital leadership play two critical roles in an organization's decision to examine its potential for disparities in care: 1) embracing the process needed to identify such disparities; and 2) supporting and empowering staff so that they do not feel blamed if disparities are found, but instead, are part of the solution to eliminating them.
    • Present the data collection approach to staff, solicit their input and address their concerns. Do you think we can do this? How should we go about it?
    • Return with the learnings. Here's what we found. Let's discuss what we do next.
    • Establish accountability. While there should be no blame for any past disparities in care, there must be staff accountability moving forward. Reducing existing disparities must be a primary focus for everyone—C-suite leaders, physicians, nurses and registration staff.

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