Jarret Patton MD
Take these steps to get more equitable health outcomes in your organization.
The Institute of Medicine (IOM) states that healthcare should be safe, effective, efficient, patient-centered, timely, and equitable. Our pursuit of better healthcare drives us towards all of these hallmarks of quality health care. As difficult as it is to keep the first five in balance, ensuring equitable care can be very difficult. Areas of health disparities are well published in the medical literature. Asthma, diabetes, cancer, and hospital readmissions are just a few examples from institutions across the country with differences in care. This article will explore some best practices that an organization can undertake in order to practice more equitable medicine.
Collecting, stratifying, and planning strategy based upon REAL(april-06th-2017.html) data are three important steps in which one takes to further equity within an organization. In essence, using REAL data can be the foundation in which all programmatic changes can be made. If you don’t collect REAL data, you must start doing so.
However, collecting the data is not enough; encourage your peers to examine existing quality, customer satisfaction or safety metrics with REAL stratification. There will be different information gained from these reports than the stand alone reports. Once an ongoing analysis is done on the new data, there could be additional programs or interventions implemented to help close the gap on any found disparities. It is important to remember that while looking for disparities, you will likely find them.
Continuing self-directed education is another well studied intervention. Although one can never be culturally competent, many work towards cultural humility. This implies that one is open to develop an understanding about another culture while maintaining one’s own. Respect for difference is a key to cultural humility. Keeping an open mind while making the effort to see a different perspective can go a long way. There are many proprietary and free resources on the web that can provide additional education. This education should be provided at all levels of an institution. It is equally important for the board of trustees to understand these concepts as the front line staff. DoctorJarret can provide educational programming to your institution or small group.
Another basic tenet, communication, must be clear and concise. Primarily, communication must occur in the preferred language to the patient. In a nation founded upon immigrants, we have the fortune of working in an environment with its own vernacular (i.e. code blue, code pink, stat, H&P, I&D, NPO, wRVU, IVF etc.) within a macrocosm that includes many different languages. Every healthcare outlet should have different options for interpreter services. This can include live and cross-trained interpreters, telephonic interpreters, and remote video interpretation, which includes American Sign Language.
Understanding, urges us to seek meaning from cross cultural interactions and be aware of things that can lead to tension during healthcare encounters. In doing so, one learns about another culture and perhaps learns about oneself or tendencies (i.e. bias bias-affects-everything-we-do.html) For instance, timeliness is one that we can all relate to. Does the person base their life on chronological time (like doctor’s appointments) or event based time (i.e. the party gets started whenever I arrive)?
Engagement is a strategy that can be used to negotiate a treatment plan or help when cross cultural conflict arises. A provider can realize what is important to the patient while explaining their own point of view. Using engagement, an acceptable care plan can be developed while achieving mutual goals. The end result is a more satisfied patient encounter which increases the satisfaction of the clinician and the patient.
These strategies can help discover health disparities and begin the elimination of them. What are you waiting for?
1 Institute of Medicine. Unequal Treatment: Understanding Racial and Ethnic Disparities in Health Care. National Academies Press. 2002
2 Health Research & Educational Trust. Rising above the noise: Making the case for equity in Care. HRET. Chicago. 2013. www.hpoe.org
3 Health Research and Educational Trust. Improving Health Equity Through Data Collection AND Use: A Guide for Hospital Leaders. Chicago: Health Research & Educational Trust, 2011. pp 11-12
4 Wilston-Stronks A et al. One size does not fit all: Meeting the health care needs of diverse populations. Oakbrook Terrace, IL. The Joint Commission. 2008