AHA on March 29 launched the Health Equity Roadmap, an innovative framework from its Institute for Diversity and Health Equity to support hospitals and health systems in their efforts to become more equitable organizations. We spoke with Leon D. Caldwell, AHA’s senior director for health equity strategies and innovation and one of the Roadmap’s architects, about its importance to hospitals and health systems.

AHA: What was the state of play before the Health Equity Roadmap launched?

Caldwell: Previous attempts to advance health equity centered on interpersonal awareness and skills programs, case studies, workshops and webinars, conceptual maps, logic models and frameworks, each designed to highlight the necessity for health equity, to reduce health disparities, and call attention to the societal factors that impact health. All of these efforts are significant, but they would often leave hospitals and health systems and their equity advocates short on actions and resources to accomplish the aspirational goals of health equity for all.

Additionally, the primary focus of these previous equity initiatives were on addressing individual-level gaps in knowledge, skills and awareness that are usually in the form of cultural competence and humility. However, these approaches can only be impactful if they are reinforced by organizational policy and practices as a function of organizational culture.

AHA: So, it sounds like more was needed to foster systemic change?

Caldwell: Right. To sustain these efforts, now and beyond, individuals in health equity roles within organizations have to rethink, redesign, and prepare for more inclusive futures. So, the health equity landscape needs to change because the models where the primary strategy was only training or looking at training of people or individuals has limits in the ability to sustain health equity. Health equity will become sustainable when organizations or systems change the way they operate, and what they reinforce as expected or anticipated organizational behavior to promote health equity.

AHA: Makes sense. So on March 29, AHA and IFDHE flipped the switch on the Health Equity Roadmap. What changed when that switch turned on?

Caldwell: The main thing was that our members now have access to a comprehensive strategic framework to advance equity. And this comprehensive framework is a model with actionable steps. It includes an assessment, which is a tool for a hospital to locate its position on the transformation continuum. From the assessment, the hospital is given its own data in the form of a Transformation Profile that provides a visualization of the responses from each of the six Levers of Transformation. As a baseline, the hospital will gain greater insights on which levers resources can be mobilized around, while gathering internal and external stakeholders to engage with a set of Transformation Action Planners.

Hospital leaders will have clear steps to advance equity by changing policies and practices. So when the switch was flipped, hospitals now have an opportunity to learn even more information about themselves and activate tools to actually be equitable not just talk about it.

We have to be clear that the Health Equity Transformation Assessment is NOT the IFDHE Benchmark survey. This is a hospital-specific assessment whereas the benchmark survey is a snapshot of the entire field as it advances toward equity.

The benchmark survey calls attention to structural barriers, lack of equity or disparities, but does not offer a real sense of how to solve the problem. So, in some sense, flipping this switch resulted in providing more solutions to the field.

AHA: And why was it necessary?

Caldwell: Because if we don't provide solutions, in ways which are accessible to members, most systems will continue to operate in homeostasis. We offer solutions that can provide opportunities for constructive and instructive disruption in organizations.

If hospitals and health systems don't have a clear sense of direction and guidance, then they are more likely to maintain the status quo that tacitly produces disparities. Because that's the most comfortable space to operate even though it may yield inefficiencies and disparities as unintended consequences. So what we've tried to do is create a set of tools to guide hospitals in developing their own solutions to challenges in their communities. The data trend line indicating threats to patient safety, workforce shortages, supply chain limitations and community mistrust can be reversed with strategic intention and alignment of resources. Now is the time to align policy and practices to inspire system changes that themselves can eliminate decades of disparities previously revealed by ReAL and SOGI data.

AHA: So, with that in mind, what's next? Particularly for the people and the organizations that want to get on board with this effort.

Caldwell: When members begin their assessment, they will see that the process is built to meet their unique needs. As we look to implement the Roadmap we are taking an equity-within-equity approach. Meaning that we recognize that not all members are the same — thus why each hospital will receive a customized roadmap.

AHA’s membership is diverse, whether it’s geography, a community’s political leanings, resources, leadership, governance structure, all those aspects that make a hospital its own unique entity even when it’s part of a system. So a one-size-fits-all design for the Health Equity Roadmap would have undermined our intent.

What you’ll get is a set of initiatives that are strategically aligned with advancing equity in hospitals and health care, with an overarching theme of eliminating disparities as a key performance indicator for sustaining equity, past this current flashpoint in our national historic moment about equity.

AHA: Last question: What's the one thing that hospitals and health systems need to know about efforts to foster equity across the field?

Caldwell: I would say that they should understand that equity is not a standalone activity, event or concept. It flows through all aspects of our hospitals, from quality to patient safety to operations. In order for a hospital to become the most effective and efficient health delivery system, equity should be a central theme, not an adjunct to all other aspects of the hospital’s priorities.

Visit equity.aha.org to learn more about the Health Equity Roadmap.

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