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How do you establish a culture of equity?

A culture of equity involves identifying the problem and taking responsibility for addressing it. This page contains tips and best practices for organizations looking to cultivate a culture of equity.

Identify the Problem

How can you concretely help your organization identify the disparities issues it faces?

Share Data and Discuss Openly

Share your stratified REL data with ALL your staff and community advisory board members.

Facilitate an open discussion about the documented disparities and people’s reactions to the data.

Facilitating an open discussion about racial and ethnic disparities issues is challenging. Some helpful techniques are to:

  • Start by talking about more comfortable issues. Language and literacy is often a good starting point.
  • Recognize and validate the challenges staff face when dealing with these issues.
  • Provide opportunities for anonymous input, for those who may not be comfortable speaking up in a group.
  • Be sure patients’ point of views are represented, either through a CAB or some other mechanism.

It’s important to respond to people’s reactions in a productive manner. In fact, you should leverage that discussion to build momentum for your equity program.

Identify Priorities

Once you’ve gathered feedback, you’ll want to identify priority areas for disparities reduction. We’ll talk about this more in Road Map Step 3, Planning for Equity, when we discuss doing a root cause analysis.

Take Responsibility

What are some strategies to help your organization take responsibility for its documented disparities?

Explicitly reflect equity as a priority in organization mission and goals.

Members of the organization should agree upon a definition of equitable care and goals for disparities reduction; these should be explicitly stated in organizational mission statements and charters.

For example:

  • Part of official QI strategy
  • Office of Health Equity

Let’s look at a few examples from FA grantees:

  • Harvard Vanguard’s Board of Trustees added equity as a core component of their QI strategy. This was an indication that the organization was ready to implement the Finding Answers equity program.
  • Similarly, Baylor Health Care System opened an Office of Health Equity and created a new position: Chief Equity Officer. This sent a message throughout the organization that equity is a priority and a part of organizational culture.

If you need more information on crafting mission and value statements, see our resources list.

Anticipate the effect on Disparities

In Road Map Step 1, Linking Quality and Equity, we showed how quality improvement can close -- or widen -- the disparities gap. As you plan your quality improvement work, ask yourself—and prompt your practices to consider—how it might affect patients differently.

Gain Leadership Buy-in

Gain general leadership buy-in to disparities reduction. You’ll find more information about getting buy-in to a specific idea or project in Road Map Step 5, Securing Buy-in. But to start, you need general buy-in to making equity a part of the organizational culture. Your practices’ participation in this initiative is a good indicator of this buy-in, but you need to make sure that buy-in is secured across the organization’s leadership—not just from one enthusiastic member of management.

We’ve created a product called “The Case for Equity” that explains various rationales for investing in disparities interventions.

Designate Accountable Leaders

Designate specific leaders that are held accountable for disparities reduction. Note the plural here. Having more than one leader on board is key to share the burden of work and maintain momentum when someone is on vacation or leaves the organization. And when hiring new leaders, include equity priorities in their job description.

Identify and publicly recognize equity champions

These champions will have a natural talent for team-building, leadership, and advocacy. Our Finding Answers grantees have repeatedly told us that equity champions are key.

An equity champion is a person with a strong personality who takes pride in his or her work. S/he often works at the level of nurse or care coordinator and is seeking ways to demonstrate talent beyond his or her prescribed duties. In our experience, the equity champion is self-identified, but it is important that supervisors also approve of their role.

—staff at Fund for Public Health in New York

They described the characteristics of an equity champion:

  • A strong personality
  • Pride in his or her work
  • Self-identified but also approved by a supervisor

Be sure to look for equity champions at all levels of staff. As New York noted, this can often be a nurse or care coordinator.

A champion can sometimes be recognized as that person who spends a few extra minutes with a patient or goes out of their way to accommodate the patient’s family.

Empower Staff

Sometimes even those who are motivated to address disparities may feel discouraged, because vulnerable patients face significant challenges outside the clinic. So how can we help providers and staff feel empowered to help these patients?

  • Give examples of success in similar clinics. You all can serve as those examples for each other and future sites undertaking this work. But we can also help connect you to grantees or other organizations that have made a difference—hearing their stories can be motivating for staff just getting started.
  • Take a field trip to a nearby clinic that’s done well already. Hearing and reading stories of success is one thing—but seeing how another clinic operates drives home the message that this is possible.
  • Invite staff and providers to join your Equity Team—those working on this Initiative. And if they can’t fully participate, keep them in the loop.
  • Share your plan for equity with the whole staff. They’ll feel inspired if they are purposefully included from the beginning and have an ongoing role to play.

Strive for a Diverse Workforce

Strive to recruit and maintain a diverse workforce that reflects the population you serve. This demonstrates to your patients that you’re committed to the issue and may also lead to improved patient-provider communication.

Tie compensation to disparities reduction

Tie compensation to quality goals that include disparities reduction. This is a big one and not entirely well understood. If you’re interested in learning more about this strategy, we can give you materials from our grantees and the literature.

Establish a diverse community advisory board

Establish and maintain an active community advisory board that is representative of your patient population.

Develop relationships with community-based groups and organizations

Develop and maintain strong, working relationships with community-based groups and organizations who serve priority populations. CHCS will be able to help you identify and build relationships with these organizations as part of their Community Scan.

Mention the community scan?

Questions:

  • last part of page two is a bunch of short laundry-lists: accordion, or group?
  • Where to break the accordions on page 2?