Best Practices for Promoting Diversity, Equity & Inclusion in Healthcare

Introduction to DEI

While DEI challenges are long-standing, the COVID-19 pandemic increased the visibility of health disparities and the factors that lead to variations in treatment according to NCSL Health Disparities Overview.
 
Health differences among people that are not explained by health status or disease severity often have connections to socioeconomic factors. “Health disparities” is the term often used to describe environmental conditions where people live, work and play, as NCSL explains.
 
Disparities and variations in treatment can result from discrimination based on arbitrary factors such as genetics, access to care, community features, environmental conditions, language barriers and health barriers according to NCSL. For example, the CDC explains that racism is a serious threat to the public’s health.
 
One way that healthcare providers can address these factors is to develop and implement a DEI strategy and training program that directly addresses issues related to their patient and employee populations.

Rationale for DEI Strategy

DEI efforts are critical to improving patient safety and quality of care among vulnerable populations. One of ECRI’s top patient safety concerns of 2021 was racial and ethnic disparities. ECRI found that disparities exist in the frequency of screening for COVID-19 and other conditions. They also found disparities in diagnoses, disease severity, complications, and deaths.
 
To best serve their populations, it is important for healthcare organizations to understand patient and employee demographics and to tailor their DEI strategies accordingly.
 
However, building a comprehensive view of patient demographics can be challenging. While the information collected during the intake process may provide some insight, it often fails to detect every factor and usually does not identify intersecting factors. Shifting community demographics further complicate the endeavor.

Approaches to DEI Strategies and Programs

There is no “one size fits all” DEI program. Your approach must be custom-designed to the meet the needs of your organization and the population it serves. Nevertheless, data collection is a crucial foundation for all programs. Without consistent data collection, health equity problems cannot be described clearly and interventions to address them cannot be assessed well. When data drives interventions, the DEI strategy and/or program can be tailored to the identified needs. Below are examples of three types of programs being implemented by healthcare organizations.

• Diversifying the healthcare workforce – This type of program focuses on building a more diverse workforce with the idea that a diverse team may improve how the healthcare institution interacts with communities. For example, when you recruit people from rural areas to work in rural healthcare settings, there is a greater likelihood that the clinicians/staff will better understand the challenges facing this patient demographic. They will likely have a better understanding of how to use the limited resources of a rural environment to improve the health and well-being of patients. They also are likely to be familiar with key cultural factors and traits that need to be accounted for when communicating with patients.
• Decreasing bias in the institution – These programs work to identify and address any clear biases, especially implicit biases, which exist in the treatment and management of patients. For example, poor outcomes for women with heart disease may lead to the development of an intervention that improves the way cardiology care is offered to women in the community. Health promotion activities may be developed to draw more attention to the existing disparities.
• Increasing interaction with social services – Creating health equity requires targeted investment in marginalized and under-resourced communities, according to APHA.org.  Health entities may find that trusted social service organizations can be key allies in addressing DEI challenges. Establishing a community advisory board with these groups can help healthcare providers understand and address community needs. In addition, partnerships with these organizations may enhance the care provided, so patients’ medical and social needs are better addressed.

For example, according to Housing and Health: Time Again for Public Health Action – PMC (nih.gov), quality of housing is a public health issue. So it makes sense that a hospital’s alliance with an affordable housing organization could feasibly help an economically disadvantaged patient with asthma move to a better environment that decreases the risk of asthma complications that lead to emergency department visits.
 
For more ideas about DEI and community engagement, read: Increasing Healthcare Workforce Diversity: Urban Universities as Catalysts for Change - PMC (nih.gov).

Moving DEI Programs Forward With Patients at the Center

A patient-centered approach is the key to a successful strategy or program. It’s important to note that there is not one best approach for DEI program design. Your strategy must be customized for your culture and community. With that in mind, there are some best practices to consider.
 
The American Medical Association offers a roadmap that includes these five strategic approaches:
1. Embed equity in practice, process, action, innovation, and organizational performance and outcomes.
2. Build alliances and share power via meaningful engagement.
3. Ensure equity in innovation for marginalized and minoritized people and communities.
4. Push upstream to address all determinants of health.
5. Foster truth, reconciliation, racial healing, and transformation.

The Institute for Healthcare Improvement provides ABCDEs of improving organizational equity:
A - Assess workplace equity.
B - Build structural changes from the top down.
C - Commit to equity improvement initiatives.
D - Defend against bias.
E - Evaluate progress.

With patients and their communities at the forefront of DEI programs, success can be achieved slowly, but surely. Improving diversity, equity, and inclusion requires long-term focus and persistence, with a relentless emphasis on improving healthcare for all individuals within a community.

Key DEI Definitions

• Diversity: Understanding the background of employees and patients being served, including culture, gender, sexual orientation, religious beliefs, and socioeconomic status. Also, hiring and retaining a workforce that is representative of the patient population served.
• Equity: Ensuring healthcare workers have what they need to do their jobs and patients have what they need in and out of treatment settings to effectively benefit from best practices in treatment (not to be confused with equality).
• Inclusion: Giving both employees and patients a voice to help provide/receive high-quality care, and encouraging the presence of a diverse healthcare staff in the treatment experience of patients.

Source: Relias.com - Vaughn N. (2020). How Diversity, Equity, and Inclusion Can Influence Healthcare.

This article was based, in part, on the Coverys presentation, “Diversity, Equity & Inclusion: Risk, Safety & Ethical Intersections,” presented by Josh Hyatt, DHS, MHL, MBE, DFASHRM, CPHRM, CPPS, HEC-C.

 
Copyrighted. No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.