Pursuing Equity: The Role of Health Care - IHIapp.ihi.org/.../Presentation_D3_E3_Pursing_Equity_Reid.pdf · Pursuing Equity: The Role of Health Care Session D: 9:30 –10:45am Session

Pursuing Equity: The Role of Health CareSession D: 9:30 – 10:45am Session E: 11:15 – 12:30pm

Berny GouldJulie OehlertAmy ReidMichelle Schreiber

D3/E3

Agenda

• 15 mins Framing & Overview

• 10 mins Case Study 1: Vidant Health

• 10 mins Case Study 2: Kaiser Permanente

Hospitals and Health Plan

• 10 mins Case Study 3: Henry Ford Health

System

• 15 mins Panel Conversation

• 15 mins Open for Questions & Discussion

2

Session Objectives

• Identify opportunities and develop next steps for

improvement in how your organization can

impact health equity

• Develop strategies for engaging leadership to

advance equity

These presenters have nothing to disclose.

3

Welcome

4

What is Health Equity?

When all people have “the

opportunity to attain their full health

potential and no one is

disadvantaged from achieving

this potential because of their

social position or other socially

determined circumstance”.

CDC

What is Health Equity?

“A particular type of health difference that is

closely linked with social, economic, and/or

environmental disadvantage. Health

disparities adversely affect groups of people

who have systematically experienced greater

obstacles to health based on their racial or

ethnic group; religion; socioeconomic status;

gender; age; mental health; cognitive, sensory,

or physical disability; sexual orientation or

gender identity; geographic location; or other

characteristics historically linked to

discrimination or exclusion.”

Healthy People 2020

A difference or disparity in

health outcomes that is

systematic, avoidable,

and unjust.

CDC

What is Health Equity?

Institutionalized racism: differential access to goods, resources, and opportunity by race.

Phyllis-Jones. Levels of Racism: a theoretical framework and a gardeners tale. AJPH

What Is Health Equity?

Framework for Health Care Organizations to Improve Equity

Wyatt R, Laderman M, Botwinick L, Mate K, Whittington J. Achieving Health Equity: A Guide for Health Care Organizations. IHI

White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2016. (Available at ihi.org)

Partners: Participating Health Care Orgs

1. HealthPartners

2. Henry Ford Health System

3. Kaiser Permanente Hospitals & Health Plan

4. Main Line Health

5. Northwest Colorado Health

6. Rush University Medical Center

7. Southern Jamaica Plain Health Center, Brigham &

Women’s Department of Medicine

8. Vidant Health

Introductions

VIDANT HEALTHPursuing Equity Journey

Julie Kennedy Oehlert, DNP, RNChief Experience Officer

Patient & Team Experience•Brand•People

•Leadership•Equity & Inclusion

Operational Excellence: the Value ImperativesQuality Experience Finance

1. Make health equity a strategic priority• Demonstrate leadership commitment to improving equity at all levels • Secure sustainable funding through new payment models

2. Develop structure and processes to support health equity work• Establish a governance committee with internal and external stakeholders to oversee equity work • Dedicate resources in the budget to support equity work

3. Deploy strategies to address multiple determinants of health • Health care services• Socioeconomic status• Physical environment• Healthy behaviors patient and team members

4. Decrease racism within organization (patient and team facing)• Physical space: Buildings and design• Health insurance plans accepted by the organization• Reduce implicit bias within organizational policies, structures, and norms, in patient care and within team members

5. Develop partnerships with community organizations• Leverage community assets to work together on community issues related to improving health and equity

Kaiser Permanente Presentation for IHI Equity Session

December 2017

Berny Gould RN, MNA

Sr. Director Quality and Equitable Care

Page 17

KP’s Journey to Eliminate Disparities

• Executive leadership commitment and sponsorship secured

• Decision to collect R/E/L member demographic data

• Equitable Care Health Outcomes (ECHO) group formed - infrastructure

• HEDIS data stratified to determine gaps

• Radical transparency of progress

• Goals set

• Shared learning and spread

• Financial incentives deployed

Page 18

How many of you have data on disparities?

▪ Is it stratified by:

– Age

– Gender

– Race ethnicity

– denominators

Think globally – act locally

Think global, act local is a common principle that is applied to organizations, business, education and

governance. It asks that employees, students and citizens consider the global impact of their actions.

Incentive goals/Annual goals

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Use of Heat Maps

22

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Current Diabetes Project

Focus on three inter-related components:

• Leadership

• Leadership interviews

• Manager focus group

• Patient focus groups

• Community

• Surveys

• Questionnaire data on health and well being

• Clinical outcomes

• Glycemic control in Hispanic/Latino members (HgbA1c

<8.0%)

Page 24

Learnings

▪ Leadership counts (at all levels)

▪ Empower with knowledge/skills and enable with technology

and infrastructure in order to scale improvement

▪ Celebrate progress, but reward outcomes

▪ People tend to co-own that which they help create

▪ Transparency creates opportunity

▪ Fail fast and learn quickly

▪ All points of view matter, but some will actually make a

“breakthrough” difference

▪ Align and embed the work into core business and operational

practices

▪ Commit to excellence and strive for greatness

▪ It’s a journey!

Henry Ford Health SystemIHI Equity Forum

December 2017

Longstanding & Award-winning Commitment• 2015 AHA Equity of Care

winner

• 2017 Excellence in Supplier Diversity

• 2017 Top Health System in Diversity and Inclusion (DiversityInc Magazine)

• Diversity Inc Top 10 list of hospitals and health systems for diversity and inclusion since 2000

Equity embedded across the organization

• Office of System Diversity & Inclusion

• Multiple Employee Resource Groups (ethnic groups, LGBTQ)

• Annual Diversity Hero Award

• Systemwide Healthcare Equity campaign

• Supplier diversity

• Cultural Humility Training (LEARN)• Listen to other perspectives• Explain your own perspectives• Ask and Acknowledge differences• Recommend• Negotiate plan sensitive to patient needs

Equity a key feature of all quality work

• Equity and Quality working together

• System quality dashboard includes Equity following a STEEEP format

• Numerous systemwide initiatives• Community Health Workers to

reduce diabetes disparities

• Readmission reduction ESRD

• Community partnerships such as Gleaners Food Bank

• Select metrics evaluated using REaLcriteria (Race, Ethnicity and Language)

Healthcare Equity Scholars Program

• AAMC Learning Health System Award

• Launched in March 2014

• 20 employees annually chosen from multiple business units

• Meet half day per month for one year

• Equity project sponsored by senior leader

Infant Mortality Initiative

• Intervention for women at risk for poor pregnancy outcomes

• Collaboration of multiple healthcare organizations

• Use of Community Health Workers and group visits

• Support and education for women at risk

• Over 400 live births with zero infant mortality

Thanks for attending today’s session

• Dr. Kimberlydawn Wisdom• SVP Community Wellness and Equity

• HFHS Gail & Lois Warden Endowed Chair in Multicultural Health

• [email protected]

• Dr. Michelle Schreiber• SVP Chief Quality Officer

• Breech Endowed Chair in Healthcare Quality

• [email protected]

Panel Discussion

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Q&A

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