Last year, Advocate Health Care, based in Downers Grove, Ill., launched a new process for gathering patient data on religious preference, race, ethnicity and language through a campaign named "We Ask Because We Care.” The process began with training all Advocate scheduling and registration staff on how to ask for and collect what is called REaL data in a consistent, respectful manner using a standardized protocol. REaL data must be entered into the system’s electronic health record to advance the registration process, further reinforcing standardization. The efforts have garnered Advocate honors in the American Hospital Association's Equity of Care Award.
“Before we put this process into play, we didn’t have a consistent data collection process — we needed to ask, ‘Who are we serving?’” says Andrew Lee, Advocate’s vice president of diversity and inclusion. “Our Executive Diversity Council has made reducing health disparities an overarching strategic priority for Advocate Health Care.”
Based on the initial REaL data findings, Advocate additionally stratified its HCAHPS data by race in the survey’s pain management and discharge domains. Advocate’s Health Disparities/Health Equity Task Force identified care disparities for both conditions within different races, and six months ago, launched separate pilots to address those gaps at Advocate’s two flagship hospitals. Advocate Lutheran General Hospital in Park Ridge, Ill., is working to improve pain management among its Asian-American inpatients, while Advocate Christ Medical Center in Oak Lawn, Ill., is addressing discharge compliance among its African-American patients.
“At Lutheran General, we learned that language could be a barrier to effective pain management with our Asian-American patients,” Lee says. “They might nod their heads when asked about their pain level, but that doesn’t mean they understood the question or that their pain was under control.” The pilot aims to improve culturally appropriate communication with more specific rounding questions. At Christ Medical Center, avoidable readmission rates among African-American patients were linked to inadequate discharge instructions, so that pilot program is focused on providing more complete and culturally aware instructions on the importance of medication adherence and follow-up appointments.
A third pilot program, at Advocate Trinity Hospital in Chicago, is taking an even broader approach to reducing avoidable readmissions through a transitional care program named Project HEALTH, or Healing Effectively After Leaving the Hospital. The program utilizes community health workers, working with the patient’s hospital care team, to provide post-discharge services ranging from helping patients schedule follow-up appointments and fill prescriptions to connecting them with local social service agencies. Lee says the program, which is particularly geared toward patients with asthma, diabetes and sickle-cell disease, “has been positive in so many ways. Patients and families are grateful, and the holistic approach of connecting clinicians and community health workers under one umbrella has helped reduce readmissions.”
An internal diversity initiative showing similarly encouraging results was launched by Lee last year. “I proposed to leadership that if we needed to up the game on cultural competence, we should offer more frequent staff education in small doses,” he says. The result is “Diversity Dialogues,” led by managers in various Advocate hospital units as a part of monthly staff meetings. Managers read a 15- to 20-minute script about some aspect of patient diversity (e.g., different ethnic backgrounds, language barriers, LGBTQ patients), then lead a discussion asking associates whether they have interacted with a similar patient, what happened and what could have been done differently to improve communication and care.
“We run the gamut on all dimensions of diversity,” Lee says. “Staff now look forward to these discussions — the conversations flow organically — and it’s given us really valuable feedback.”
The American Hospital Association's Equity of Care Award is presented annually to hospitals or care systems that are noteworthy leaders and examples to the field in the area of equitable care. Honorees demonstrate a high level of success in reducing health care disparities and promote diversity in leadership and staff within their organizations.
The goals of this award are:
- Recognize outstanding efforts among hospitals and care systems to advance equity of care to all patients.
- Accelerate progress of the National Call to Action to Eliminate Health Care Disparities and its stated goals and milestones.
- Spread lessons learned and progress toward health care equity and the promotion of diversity.