New Approaches Needed to Eliminate Racial, Ethnic Disparities in Healthcare

Racial and ethnic disparities closely linked to cost and value of care.

Results from a new survey published by Health Affairs identified 5 valuable strategies to help implement programs that address racial and ethnic disparities in healthcare.

Included in the study were participants from the Disparities Leadership Program (DLP), which was a 12-month executive education initiative aimed at addressing racial and ethnic disparities in healthcare.

"Unlike other areas of quality improvement that might be straightforward to execute, addressing disparities is a more sensitive, hot-button issue and requires greater attention to organizational change-management strategies," corresponding author Joseph Betancourt, MD, MPH, said in a press release. "Leaders need to understand that disparities are closely linked to quality, safety, cost and value and that, if they take this issue on, they can be recognized and rewarded for their work."

The DLP program includes executives from healthcare organizations, such as hospitals, health centers, medical schools, and public health departments. Participants receive a 2-day training session that is centered around defining disparities and their causes; developing strategies to identify and address the challenges; and promoting leadership and management skills to implement the initiatives, according to the study.

After the program, the teams work to craft and implement initiatives customized for each of the institutions. Through webinars, participants report their updates and gain additional information. Each participating organization also receives 2 assistance calls.

At the end of the year, the teams meet to present the results of their initiative, as well as to receive additional training.

Included in the current study were data from surveys completed by 119 teams at the end of the year meeting who participated between 2007 to 2016. The authors only included responses for hospitals, health plans, and community health centers. Other organizations were excluded due to differing structures, according to the study.

The investigators noted 5 approaches that were crucial to addressing healthcare disparities for the participating organizations.

The authors stated that knowing who to involve from the beginning was key. The participants noted that a lack of leadership figures wanting to participate was a common challenge; however, identifying executive champions, giving presentations to leadership, and involvement of midlevel and front-line staff helped overcome the barriers, according to the study.

Other barriers faced were a lack of awareness of the disparities, which was found by the participants to cause difficulties integrating the new approach into the structure. If individuals are unaware of the disparities, they may be unlikely to see the importance of new initiatives. The participants found that aligning the organizational culture with change was successful.

The authors also found that leadership must make the issue urgent among employees through communicating what other institutions have been doing, discussing patient stories, and sharing progress, according to the study.

Another important aspect of implementing plans to address racial and ethnic disparities in healthcare was to engage with both internal partners and the community to ensure that the changes are being demonstrated daily.

The authors also indicated that collaboration was found to improve the ability to anticipate changes to the environment and provide access to new findings regarding disparities. This kind of network can foster a culture of change, challenge assumptions, and encourage creative solutions, according to the study.

"There remains a strong demand among health care leaders to better understand this issue, and how to address it, given the link between disparities, quality, safety, cost and value," Dr Betancourt said. "We now have assembled a large and powerful network of DLP alumni dedicated to identifying and addressing disparities in health care. Creating a movement of this nature is unprecedented, and we plan to continue to build and expand it so we can shape health care delivery and policy as we've done over the years."