Disparities Dialogue

Awareness: First Step Toward Eliminating Disparities
Expecting Success helps hospitals begin discussing and addressing disparities

A topic frequently cited in health journals but rarely mentioned in America's hospitals is sparking discussion among the 10 Expecting Success sites: how to identify and address racial and ethnic disparities in patient care.

Ann McAlearney, Sc.D., M.S., spoke with 200 clinicians, managers and executives at 10 hospitals about how they identify disparities, discuss gaps in care with staff and make reducing disparities part of a hospital's culture. Information from her interviews is part of an ongoing Institutional Readiness for Change (IRC) assessment Expecting Success is conducting to help hospitals identify and address disparities.

"All hospitals want to think that disparities cannot possibly exist in their institution," says Dr. McAlearney. "This mentality makes it challenging to identify changes that may be necessary. But there are hospitals that are looking at data and talking with staff about the possibility of disparities in care. This then makes everyone more aware of both the ethnic and cultural diversity within their patient populations and possible differences in the care they receive."

She says hospital leaders who acknowledge the possibility of disparities within their patient populations largely attribute disparities to factors such as a patient's income level or lack of insurance, or to preconceived judgments about education levels, cultural differences or language barriers. But even when leaders are aware of disparities, there can be reluctance to implement changes.

"There is a real distinction between an organization's readiness to change for quality improvement purposes, and its readiness to change in order to address racial and ethnic disparities," says Dr. McAlearney. "However, a few managers are starting to talk about bold steps to make changes."

To that end, Dr. McAlearney asked the hospital leaders about their willingness to incorporate performance measures for reducing disparities into their 'balance scorecards,' the metrics they use to gauge organizational performance. In response, some reported that they were seriously considering incorporating new metrics. The majority, however, were more resistant to this change and emphasized that broader quality improvement initiatives already in place should be sufficient to address the disparities issue.

All Hospitals Can Begin the Discussion

Any hospital can raise awareness about the possibility of disparities in their institution, Dr. McAlearney says. But assessing whether disparities exist at their institution requires courage, leadership and data.

"One of the most challenging aspects of addressing disparities in care is simply beginning the conversation. In practice this requires that hospital administrators, physicians and staff communicate about a very sensitive issue that has the potential to reflect negatively on an institution," she says. "Based on the multiple interviews I conducted, hospitals can get past this, but it takes courage."

It also takes unwavering commitment from the hospital CEO and other administrators. Dr. McAlearney says hospital management should seek board buy-in, because once the conversation about disparities begins, it is an ongoing and evolving process that affects the whole institution.

Finally, it must be a data-driven process that bases discussions and possible interventions on analyses of patient care based on patients' race and ethnicity. "It's important that hospital management commit their institution to collecting and reviewing data about race and ethnicity and remain transparent about the results," says Dr. McAlearney. "Hospitals must be willing to address the findings and move forward. Ultimately, this will translate into better care for everyone."

Next Steps

Having completed the interview portion of the assessment, Dr. McAlearney's next step is to survey a broad population of organizational and clinical representatives at each of the 10 hospitals. She hopes the assessment will produce actionable information about issues related to organizational change and addressing disparities that can help hospitals move ahead with the Expecting Success program. Ultimately, her work will lead to the development of organizational assessment tools that can be used in hospitals across the country.

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Ann McAlearney, Sc.D., M.S., is an assistant professor in the Division of Health Services Management and Policy in the School of Public Health at the Ohio State University. She is responsible for the assessment of Institutional Readiness for Change within the Expecting Success National Program, and provides technical expertise in the areas of organizational assessment, leadership and organizational change management.

 

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