D3/E3 Pursuing Equity: The Role of Health Care Session D: 9:30 10:45am Session E: 11:15 12:30pm Berny Gould Julie Oehlert Amy Reid Michelle Schreiber
Agenda 2 15 mins Framing & Overview 10 mins Case Study 1: Vidant Health 10 mins Case Study 2: Kaiser Permanente Hospitals and Health Plan 10 mins Case Study 3: Henry Ford Health System 15 mins Panel Conversation 15 mins Open for Questions & Discussion
Session Objectives 3 Identify opportunities and develop next steps for improvement in how your organization can impact health equity Develop strategies for engaging leadership to advance equity These presenters have nothing to disclose.
Welcome 4
What is Health Equity? When all people have the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance. CDC
What is Health Equity? A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion. Healthy People 2020
What is Health Equity? A difference or disparity in health outcomes that is systematic, avoidable, and unjust. CDC
What Is Health Equity? Institutionalized racism: differential access to goods, resources, and opportunity by race. Phyllis-Jones. Levels of Racism: a theoretical framework and a gardeners tale. AJPH
Framework for Health Care Organizations to Improve Equity Wyatt R, Laderman M, Botwinick L, Mate K, Whittington J. Achieving Health Equity: A Guide for Health Care Organizations. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2016. (Available at ihi.org)
Partners: Participating Health Care Orgs 1. HealthPartners 2. Henry Ford Health System 3. Kaiser Permanente Hospitals & Health Plan 4. Main Line Health 5. Northwest Colorado Health 6. Rush University Medical Center 7. Southern Jamaica Plain Health Center, Brigham & Women s Department of Medicine 8. Vidant Health
VIDANT HEALTH Pursuing Equity Journey Introductions Julie Kennedy Oehlert, DNP, RN Chief Experience Officer
Operational Excellence: the Value Imperatives Quality Experience Finance Patient & Team Experience Brand People Leadership Equity & Inclusion
1. Make health equity a strategic priority Demonstrate leadership commitment to improving equity at all levels Secure sustainable funding through new payment models 5. Develop partnerships with community organizations Leverage community assets to work together on community issues related to improving health and equity 2. Develop structure and processes to support health equity work Establish a governance committee with internal and external stakeholders to oversee equity work Dedicate resources in the budget to support equity work 4. Decrease racism within organization (patient and team facing) Physical space: Buildings and design Health insurance plans accepted by the organization Reduce implicit bias within organizational policies, structures, and norms, in patient care and within team members 3. Deploy strategies to address multiple determinants of health Health care services Socioeconomic status Physical environment Healthy behaviors patient and team members
Kaiser Permanente Presentation for IHI Equity Session December 2017 Berny Gould RN, MNA Sr. Director Quality and Equitable Care
KP s Journey to Eliminate Disparities Executive leadership commitment and sponsorship secured Decision to collect R/E/L member demographic data Equitable Care Health Outcomes (ECHO) group formed - infrastructure HEDIS data stratified to determine gaps Radical transparency of progress Goals set Shared learning and spread Financial incentives deployed Page 17
How many of you have data on disparities? Is it stratified by: Age Gender Race ethnicity denominators Think globally act locally Think global, act local is a common principle that is applied to organizations, business, education and governance. It asks that employees, students and citizens consider the global impact of their actions. Incentive goals/annual goals Page 18
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Use of Heat Maps 22 Page 22
Current Diabetes Project Focus on three inter-related components: Leadership Leadership interviews Manager focus group Patient focus groups Community Surveys Questionnaire data on health and well being Clinical outcomes Glycemic control in Hispanic/Latino members (HgbA1c <8.0%) Page 23
Learnings Leadership counts (at all levels) Empower with knowledge/skills and enable with technology and infrastructure in order to scale improvement Celebrate progress, but reward outcomes People tend to co-own that which they help create Transparency creates opportunity Fail fast and learn quickly All points of view matter, but some will actually make a breakthrough difference Align and embed the work into core business and operational practices Commit to excellence and strive for greatness It s a journey! Page 24
Henry Ford Health System IHI Equity Forum December 2017
Longstanding & Award-winning Commitment 2015 AHA Equity of Care winner 2017 Excellence in Supplier Diversity 2017 Top Health System in Diversity and Inclusion (DiversityInc Magazine) Diversity Inc Top 10 list of hospitals and health systems for diversity and inclusion since 2000
Equity embedded across the organization Office of System Diversity & Inclusion Multiple Employee Resource Groups (ethnic groups, LGBTQ) Annual Diversity Hero Award Systemwide Healthcare Equity campaign Supplier diversity Cultural Humility Training (LEARN) Listen to other perspectives Explain your own perspectives Ask and Acknowledge differences Recommend Negotiate plan sensitive to patient needs
Equity a key feature of all quality work Equity and Quality working together System quality dashboard includes Equity following a STEEEP format Numerous systemwide initiatives Community Health Workers to reduce diabetes disparities Readmission reduction ESRD Community partnerships such as Gleaners Food Bank Select metrics evaluated using REaL criteria (Race, Ethnicity and Language)
Healthcare Equity Scholars Program AAMC Learning Health System Award Launched in March 2014 20 employees annually chosen from multiple business units Meet half day per month for one year Equity project sponsored by senior leader
Infant Mortality Initiative Intervention for women at risk for poor pregnancy outcomes Collaboration of multiple healthcare organizations Use of Community Health Workers and group visits Support and education for women at risk Over 400 live births with zero infant mortality
Thanks for attending today s session Dr. Kimberlydawn Wisdom SVP Community Wellness and Equity HFHS Gail & Lois Warden Endowed Chair in Multicultural Health kwisdom1@hfhs.org Dr. Michelle Schreiber SVP Chief Quality Officer Breech Endowed Chair in Healthcare Quality mschrei2@hfhs.org
Panel Discussion 32
Q&A 33