Health Equity, Diversity and Inclusion

Quality Oversight, Health Equity and the Community Board’s Role

Four core areas can be leveraged to institute meaningful change

By Brad Clarke

The imperative for health care providers to strive for health equity for their patient populations and communities accelerated this year as new regulations and standards issued by regulatory and accreditation agencies, including the Centers for Medicare & Medicaid Services, The Joint Commission and the National Committee for Quality (NCQA), took effect.

Within the complex realm of quality oversight, the community board plays a pivotal role in shaping policies, strategies and initiatives that drive the pursuit of equitable health care, in which all patients achieve the highest quality outcomes possible, regardless of their gender, race, age, socioeconomic status or other factors. This article focuses on four core areas — leadership, strategic planning, data and community partnerships — where the community board’s work aligns with many of the themes of these directives and offers suggestions for board consideration.

Leadership

A community board should ensure that its organization has a leader with dedicated responsibilities for identifying and implementing actions aimed at improving equity. Each of the organization’s leaders should be focused on improving health equity. However, designating an internal leader whose role specifically addresses health equity initiatives sets the tone throughout the organization that the work is essential and core to the organization’s mission.

Leadership is an essential component of quality improvement activities — management-level leadership, physician leadership and team leadership — have been consistently associated with successful quality improvement projects. Just as the board’s decisions can drive the allocation of resources toward equity-focused projects that have the potential to reshape health care delivery, identifying an individual to lead the organization’s activities to progress health equity helps establishes clear lines of accountability and helps ensure that staff have the support necessary to implement successful initiatives.

Equity leaders are pivotal in helping establish a strategic vision for the approach the organization takes to tackling equity in partnership with the board, driving cultural transformation, education and staff training within the organization, developing and reviewing policy, and collecting and reporting equity data.

Strategic Planning

The community board should be involved in developing a health equity strategic plan. Developing a strategic plan will elevate health equity goals across the organization and unify commitment to understanding the need for and enacting change to improve quality of care and health outcomes for all patient populations. A plan will include metrics that set a framework and will stipulate key resources that must be designated for achieving these goals.

A board that is involved with the strategic planning process sends the message that the board, the CEO/executive leadership team and health equity leader are truly united in creating a future health equity direction for the organization — a message that is important within the organization and community.

To further demonstrate commitment to health equity, the plan should incorporate input from stakeholders across the organization and from the community, such as local business and civic leaders, nonprofit representatives and academic partners.

Fundamentally, a strategic plan will proclaim the importance of health equity within every department and establish accountability for leadership to deliver on equity commitments by tracking results and demanding transparency.

Data

The community board can create a shared understanding of health inequities through quality data. Data serves as the foundation for informed decision-making and targeted interventions, especially when it comes to advancing health equity initiatives. Regulators and accreditors are requiring a deeper dive into patient population data to determine where health inequities exist. Data, therefore, needs to be stratified by various factors (e.g., race, ethnicity, gender) that reflect the demographics of the patient population.

Collecting accurate and comprehensive data enables hospitals and health systems to identify disparities, assess the impact of interventions and tailor strategies to address the unique needs of underserved or structurally marginalized populations. There are a myriad of data sources that can be used to analyze equity, but it is helpful for community boards to consider the following questions:

• As we aspire to provide quality health care for all, do we look at our quality metrics by demographic groups across the various services lines?
• How do our patient satisfaction scores look when stratified according to race, ethnicity and language (REAL) and sexual orientation and gender identity (SOGI) demographics?
• What are our facility access rates for different patient demographic groups? How do they compare to general community demographics?

Community Partnerships

Promoting health equity requires a concerted effort that extends beyond the walls of health care facilities. Community boards can help to link their organizations with those within the community to maximize their organization’s health quality efforts.

Hospitals, as cornerstones of their communities, possess a unique opportunity to drive change by collaborating closely with local residents, community organizations and advocacy groups. By forming a strong partnership between hospital boards and the community, a comprehensive approach to achieving health equity can be realized.

While hospitals and health systems have a lot to contribute to tackling equity, often the challenge is “being invited to the community table.” The ambassadorial role members play within the communities in which they live is one of the great advantages of community boards. The board can champion collaborations with community organizations, governmental agencies and other stakeholders to collectively address health care disparities. These partnerships can lead to initiatives that tackle social determinants of health, provide education and outreach to marginalized populations and enhance access to care.

Community board members can help by:

• Lending their names to increase the credibility of the project.
• Commit organizational resources, including funding and staff support, through governance decision-making processes.
• Help attract potential additional partners and/or external funding sources.
• Help overcome any roadblocks that emerge along the way.
• Champion health equity projects among policymakers and elected officials.

Guiding Meaningful Change

The board’s role in promoting equity in health care is essential, influencing every facet of the organization’s operations, from culture to strategy. By fostering designated leadership, making strategic decisions that prioritize equity, valuing and expecting stratified data, collaborating with stakeholders and assigning accountability (especially to itself), the community board can guide the health care organization toward meaningful change. The pursuit of health care equity is a collective endeavor, and the board serves as a catalyst for transformation, working to ensure that health care is accessible, effective and just for all individuals, regardless of their background or circumstances.

Brad Clarke, MPH, (bclarke@viahcc.com) is a senior consultant at Via Healthcare Consulting, based in Carlsbad, Calif.

Please note that the views of authors do not always reflect the views of the AHA.