Creating a Culture of Equity

Roadmap Step 2: Creating a Culture of Equity

Even the most well-intentioned effort to reduce disparities is less likely to succeed if it’s not part of a broader culture of equity. When staff recognize that disparities exist within the organization and view inequality as an injustice that must be redressed, that organization has a strong culture of equity.

While fostering a culture of equity can be challenging, it can have significant benefits for an organization. When an organization values a culture of equity, the staff shares a definition of equitable care and places high value on its delivery, which can yield concrete benefits.

Similar to a culture of quality (which lays the foundation for quality improvement), a culture of equity will be essential to the success of quality improvement that seeks to reduce disparities.

What is a Culture of Equity?

Finding Answers Spotlight:

We’ve seen that recognizing disparities within an organization can often be a challenge, especially through the work of one of our Finding Answers grantees. When researchers at Harvard Vanguard Medical Associates assessed provider awareness of disparities, they found that 60% of providers surveyed believed that quality of care differed by race at the organization--but only 40% thought that difference applied to their own patient panel.

Does this sound familiar? Have you seen similar situations at your own organizations?

A culture of equity is made up of two parts:

  • You identify the problem, and
  • You take responsibility for addressing it.

In other words, disparities are openly recognized, staff and providers are motivated to reduce them, and everyone knows their role in the process.

It’s not enough for people to know that disparities are a problem in general; they need to recognize that disparities exist among their own patients.

It’s important to get everyone on the same page. Ideally, people throughout an organization, from leadership to front-line staff, share a common definition of equitable care and place high value on its delivery.

For example, Aligning Forces for Quality, a regional multi-stakeholder quality improvement collaborative, implemented the Expecting Success program to reduce racial and ethnic disparities in cardiac care in hospitals around the country. One of the program’s participating hospital CEOs showed his support for the program by publicly endorsing it to staff throughout the organization, including management, providers, housekeeping, and valet. In addressing them, he emphasized that they all play an integral role in providing high-quality, equitable care, and made sure they understood they had specific roles and responsibilities for reducing disparities.

Sometimes even staff or providers who are motivated to address disparities may feel discouraged. Vulnerable patients face significant challenges outside the clinic and it can feel like the problem is out of our hands. Later on in this this Road Map step, we’ll talk about ways to help providers and staff feel empowered to make a difference.

Why is a Culture of Equity Important?

When equity is an integral element of organizational values, these programs are more likely to be successful. A culture of equity is key to both jump-starting your activities and to maintaining them. Your program may be more likely to get the money and staffing it needs if the organization has prioritized disparities reduction.

We realize that this may seem like an abstract ideal. But a strong culture of equity will not only build the foundation for ongoing success: it can help to secure tangible resources, like money and time.

Culture change can be challenging because it is gradual and difficult to gauge, but there are concrete actions you can take to make it happen. Next, we’ll explore strategies to establish a culture of equity.

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 Race, Ethnicity and Language (REL) data with all of your staff and community advisory board (CAB) 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 can be challenging because of the sensitive nature of the issues involved.  Some helpful techniques are to:

  • Start by talking about more comfortable issues. Language and literacy are often good starting points.
  • Recognize and validate the challenges staff face when dealing with these issues.
  • Avoid blaming individuals. Most people are well-meaning, and often, the system is the underlying problem.
  • 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, Diagnosing the Disparity, when we discuss doing a root cause analysis.


Take Responsibility

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

Making Equity a Priority

Harvard Vanguard Medical Associates' Board of Trustees added equity as a core component of their QI strategy, which was an indication that the organization was ready to implement the Finding Answers equity program.

Similarly, Baylor College of Medicine opened an Office of Health Equity and created a new position: Chief Equity Officer, which sent a message throughout the organization that equity is a priority and a part of organizational culture.

Explicitly prioritize equity 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, equity can be codified as part of an official QI strategy, or an organization can establish an Office of Health Equity.

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

Anticipate the effect of quality improvement 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. You will 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. This document can be helpful tool in convincing leadership to support the program, and foster leaders’ buy-in.

Identify and publicly recognize equity champions

Identifying Your Equity Champion

The following quote is from staff at the Fund for Public Health New York:

“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.”

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.

Be sure to look for equity champions at all levels of staff. As the Fund for Public Health New York noted (in the sidebar), 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. When implementing equity-focused quality improvement, you can serve as an example for each other and to future sites undertaking this work. But Finding Answers can also get you started with stories of grantee success — hearing their experience 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. And if they can’t fully participate, keep them informed.
  • 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.

Establish a diverse community advisory board

Establish and maintain an active community advisory board that is representative of your patient population. Read this important document for tips on how to develop a successful CAB.

Develop relationships with community-based groups and organizations

Develop and maintain strong, working relationships with community-based groups and organizations who serve priority populations.

Formalize your commitment to equity

Make sure all staff understand the role they play in reducing disparities in your organization. Make equity a part of job descriptions. Also, track the organizations efforts, and document its successes – that information can be useful in soliciting private donations or when applying for grant funding.

A culture of equity is an essential component of a successful equity program, a generalized understanding of the importance of reducing disparities. Roadmap Step 5, Securing Buy-in, focuses on how you can secure the commitment of staff, patients and the community, to your specific program.

*Click here for a printable PDF version of Step 2*