Health System and Hospital Peer Network Tackles Health Equity

• Atlantic Medical Group/Atlantic Health
• Children’s Hospital of Philadelphia
• Dana-Farber Cancer Institute
• University of Iowa Hospitals & Clinics
• Ochsner Medical Center
• The University of Texas MD Anderson Cancer Center
• Vanderbilt University Medical Center
• University of Wisconsin Hospitals & Clinics

The Peer Network has lofty goals, says Gerald Harmon, MD, president of the AMA. “What we are trying to do is to eliminate as many of the inequities that we can in the current healthcare delivery system. We would like to embed this focus on improving health equity and lowering health disparities in the structural DNA of hospital operations and health system delivery. We want to improve the public discourse on health equity and make it a national priority.”

The Peer Network will identify health equity interventions through a shared framework, he says. “This type of networking will generate actionable items. We are focusing on a framework of equity, quality, and safety. This framework was designed by the Institute for Healthcare Improvement and Brigham & Women’s Hospital. The framework features a couple of things: the critical role of healthcare organizations when we address inequity by incorporating equity into the DNA of the operational, day-to-day, and everything we do, as well as promoting high-quality, safe, and equitable outcomes for every patient.”

The eight early adopters of the Peer Network started their work by conducting a self-assessment, Harmon says. “The Peer Network participants provide a self-assessment outlining where they hope equity can be integrated into their current quality and safety practices. Each of the eight early adopters are going to have their own internal metrics and strategic plans. We are giving the early adopters a target outcome and letting them come up with initiatives on their own over a year.”

Peer learning is an essential part of the initiative, he says. “We are going to have monthly calls for foundational learning and to facilitate the sharing of scalable solutions and opportunities. We also will have asynchronous meetings among the early adopters with subgroups to share what is happening at the institutions and to share metrics. I’m also hoping that the participants will be able to report on wins and scale them to the larger group.”

The Peer Network will also develop health equity leaders, Harmon says. “Hopefully, what we will get is a pipeline of leaders who are capable of designing equitable healthcare systems going forward. We are going to have a learning pod of leaders who can find out what is available in their internal systems, then scale this out to other health systems and hospitals, which are desperately in need of improving equity within their own systems.”

Getting to root causes

Harmon says he has had experience with delays in diagnostic testing that have impacted marginalized communities. “For example, we would order a CT scan or an X-ray that you could not get at the point of service—you had to get follow-up on it. Then there was a delay, which could happen for several reasons such as prior authorization or other insurance concerns, and there were issues with marginalized patients such as transportation or communication. These delays seemed to happen more often with marginalized communities.”

The Peer Network is designed to get at the root causes of these kinds of health inequities, he says. “We need to find the root causes of these delays when they involve marginalized communities. Is it because of transportation? Is it because of communication? Is it because of health literacy? Whatever it is, these communities tend to have longer delays in diagnostic imaging, diagnosis, and reporting of laboratory results. When there are inherent delays, there can be inherent inequities.”

The Peer Network is going to have to craft sophisticated solutions to health equity problems, Harmon says. “If this were easy, we would not have to have things such as the Peer Network. It is an incredibly complex situation. I have been dealing with inequities for 40 years and have tried to find workarounds such as electronic medical records and other ticklers, but when you are dealing with hundreds or thousands of patients, there are several opportunities for data to slip through the cracks. You do everything you can within your skillset to improve the interaction with the patient, but if we had an easy answer for equity challenges, we would have already applied it.”