To say that the COVID-19 pandemic put pressure on health care systems would be an understatement. While many industries allowed employees to work and shelter at home, health care workers showed up to care for patients daily, overhauled standard protocols and took on extra shifts to handle patient surges, even as burnout increased demand, and infections among healthcare workers themselves led to reduced staff numbers. Nevertheless, employees worked with one goal in mind – to treat patients and to save lives. While the industry most certainly rose to the occasion and endured through these challenges, it cannot be ignored that the pandemic also further exposed weaknesses and health care inequities.
The tragic deaths of George Floyd, Breonna Taylor and Ahmaud Arbery this past year ignited crucial and long-overdue conversations around racism and injustice. At the same time, we’re seeing continued increases of racism and even attacks against Asian-Americans. As many isolated at home, the world has been confronted with the reality of racism in a way that could no longer be ignored. This reality was magnified in health care as we witnessed minority populations getting infected, hospitalized and dying from COVID-19 at higher rates than white populations.
Factors that contribute to these disparities include discrimination, occupation, socioeconomic status, housing and, unfortunately, health care access and utilization. The health care industry has been necessarily focused on the demands of the pandemic, but addressing and working to combat these inequalities cannot be put on the back burner. As health care shifts to rebuild on the other side of the pandemic, one fact is clear: Racism, discrimination and exclusion will undermine healthcare organizations’ efforts to be truly safe.
The World Health Organization defines health equity as the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically. In 2003, the Institute of Medicine (IOM) published the Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care report about treatment and health outcomes of Black patients compared to white patients. The report showed that racial and ethnic minorities are more likely than white people to receive lower-quality care, even when accounting for factors that might explain the difference including income, neighborhood and health care insurance. The research prompted the IOM to add equity to a list of aims for the United States health care system. This is a goal we are still striving for today, so how can organizations work toward creating an equitable environment?
Equity in health care contributes to a culture of safety, which reinforces and supports the prevention of staff and patient harm. There are various steps that can help address this critical issue.
First and foremost, leadership must be committed to making health equity a priority. This top-down approach will help shape sentiment and show employees that equality is important to the organization.
Organizations must be willing to address disparities and biases that may exist within their culture. To drive improvement, organizations must recognize and admit the problem exists. Approaches to address disparities might include training staff on implicit biases and how to recognize and eliminate biases. It is important to seek out and champion the experience and perspectives of employees who are Black, Native American, Hispanic, Asian, Pacific Islander, immigrant, LGBTQ — groups who have been silenced and traditionally excluded from full participation in the workplace. Leaders must ask themselves and answer honestly: Are we fostering an inclusive workplace for employees and care destination for patients?
Health care organizations should work to improve their processes. Having strong processes in place can help to eliminate errors and reduce harm, but the wrong processes can hinder progress. Consider how your processes may impact individuals from different cultures or people who speak a different language. For employees, what is the process to report discrimination? Are there ways to ensure they are being heard — and to drive accountability to take and communicate action? These steps matter.
There is no question of health care’s resiliency throughout this pandemic, but even during this time of crisis, the industry must reflect on steps to improve. And if we are to become a highly reliable industry, striving toward the goal of zero harm, we must ensure that health care is safe and equitable for all.
Anne Marie Benedicto is Vice President at the Joint Commission Center for Transforming Healthcare.
High Reliability Healthcare
Data Driven Insights and Aha Moments in the Pursuit of Zero Harm and High Reliability Healthcare.