Reducing health care disparities is a key component of quality. It can improve population health management, patient safety and overall performance in care delivery. For more than 10 years, Massachusetts General Hospital in Boston has implemented numerous initiatives to identify and eliminate care disparities, improve minority patient experience and access to care, and educate providers and staff about communicating and caring for diverse patient populations.
The American Hospital Association recognized Massachusetts General's efforts by presenting the hospital with the inaugural Equity of Care Award at the Health Forum–AHA Summit in July. Other hospitals and health care systems recognized for their work in reducing disparities and increasing diversity include Henry Ford Health System in Detroit; Lutheran HealthCare in New York City; and University Hospitals in Cleveland.
In a recent interview, Joseph Betancourt, M.D., director of the Disparities Solutions Center at Massachusetts General, shared advice and lessons learned in more than 12 years of work. The hospitals created the Disparities Solutions Center in 2005 to support its disparities and diversity initiatives and to provide national leadership.
Start with a Plan and Use Common Sense
Betancourt emphasized that progress in equity of care should not be determined by a hospital's size or resources. "Depth and breadth of work may depend on overall capacity. But at the end of the day, I do believe hospitals should have a strategic plan," Betancourt says. He advises: "Gather a group and chart a course that at a minimum follows recommendations from the IOM [Institute of Medicine] report "Unequal Treatment." Focus on collecting key patient demographics and measuring clinical quality performance as it relates to those demographics."
Strong support from Massachusetts General's leadership team has been crucial. Betancourt says this support "has come with some sources but not an inordinate amount of resources." Certain departments at the hospital — like quality and patient safety — were held accountable for performance. "Equity should be a key component of quality," Betancourt says. "Identify gaps [in quality] and develop interventions to meet them. Our interventions are not particularly novel, just basic common sense. We have particularly focused on health care coaches and navigators, which are not high-cost investments."
Train Staff in Cross-Cultural Care
Training staff during orientation is not enough to significantly improve performance in care delivery, Betancourt observes. He suggests that hospitals have a "learning pathway" that focuses on performance in cross-cultural care and communication. Communication is particularly essential, as it affects transitions in care and readmissions, patient access, informed consent, discharge instructions, medication reconciliation and more. All these aspects of patient care are communication-sensitive, Betancourt points out.
The Massachusetts General Physicians Organization has provided cultural competence training for physicians through its Quality Incentive Program. More than 80 percent of the hospital's eligible physicians completed this training, and most reported that afterward they had a better understanding of disparities and of the skills needed to improve patient care. The hospital's Norman Knight Nursing Center for Clinical and Professional Development offers continuing education programs for nurses on cross-cultural communication, disparities, disabilities and other diversity issues.
The Disparities Committee and the Disparities Solutions Center sponsor a variety of training opportunities for all hospital staff. Programming has included annual forums on current issues regarding disparities and health at Massachusetts General and in the community, a "keeping current" seminar series to disseminate the latest information and research findings related to racial and ethnic disparities, and seminars about key historical topics related to race and the health care system.
In addition, Betancourt, through his work with Quality Interactions, has created online modules focused on cross-cultural care and communication and has trained 125,000 health care professionals across the United States. This e-learning provides cultural competence training for physicians, nurses and front-line staff, and it awards continuing medical education credits.
Measure and Monitor Performance
Developing and using a disparities dashboard to monitor the hospital's performance and progress are important. Massachusetts General created a disparities dashboard that has evolved into its Annual Report on Equity in Healthcare Quality, a tool for measuring equity performance by stratifying quality measures according to race, ethnicity, language and education. The report identifies disparities at the hospital, then addresses them. Data from the report are released publicly on the hospital website.
Using the report, Massachusetts General has established programs to improve outcomes and eliminate racial and ethnic disparities in specialties such as diabetes management and colorectal and breast cancer screening, and in patient experience.
Small Progress Is Progress
"No organization needs to reinvent the wheel," Betancourt asserts. Plenty of resources are available in the field, and health care organizations are freely willing to share, he notes. "Small progress is progress. We did not let the perfect be the obstacle of the good," Betancourt emphasizes.
For more information about the work of Massachusetts General and the other award recipients, including the work of their diversity committees and their collaborations with community partners, visit the Equity of Care website and click on the "Award" dropdown menu under "Home."
Cynthia Hedges Greising is a communications specialist with the Health Research & Educational Trust.