By Amy Reid, Santiago Nariño, Hema Magge & Angelina Sassi, Standford Social Innovation Review, June 25, 2019.
For more than 25 years, the Institute for Healthcare Improvement (IHI) has used improvement science to advance quality and safety and to sustain better outcomes in health and health systems globally. In particular, IHI understands that quality healthcare is impossible without equity and that racism and white supremacy persist around the world. To illustrate our approach to these problems, we share lessons from IHI’s work with health systems in three settings—the United States, Brazil, and Ethiopia—to advance racial equity.
Pursuing Equity
In 2017, IHI launched Pursuing Equity with eight health system organizations in the United States to strengthen healthcare’s role in addressing equity. The initiative aimed to develop a more detailed blueprint of how healthcare can improve racial equity and to narrow clinical equity gaps. To do so, we have created, tested, and implemented a five-step framework for health systems to achieve health equity: make health equity a strategic priority; address the multiple determinants of health; build infrastructure to support health equity; partner with the community to improve health equity; and eliminate racism and other forms of oppression in healthcare.
To address racial equity with the participating teams, we began by defining racism and discussing examples and the history of racism in our health systems. Racism is how our systems, by design, perpetuate advantage and disadvantage by race, including differential access to resources, goods, and opportunities. Racism operates at multiple levels including the psychological, interpersonal, institutional, and structural, and includes discriminatory individual acts as well as policies and practices of institutions and interlocking systems. At in-person and virtual meetings throughout the two-year initiative, we discussed policies that disproportionately limit access to care and employment at the health system for communities of color, inequities that exist at the point of care for people of color resulting in inequitable outcomes, and cases of racial discrimination perpetuated by patients or employees. We also shared strategies to normalize conversations on racism, including naming it explicitly as a driver of inequities, as well as our personal challenges advancing this work in health systems.
Comments (0)