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Improving Quality and Achieving Equity:
A Guide for Hospital Leaders
Chapter 2: Why Should You Care? (pdf)
The Accreditation and Regulation Case: New Standards and Measures for Quality and Equity
“Hospitals pay very close attention to Joint Commission and their upcoming requirements, goals, etc. and they really do set the stage and foundation for what hospitals try to become.” - California Hospital Quality Leaders: Views on Culturally and Linguistically Appropriate Services (CLAS) & the Potential Role of the Joint Commission: Summary of Key Findings
The previous sections provide a solid and compelling rationale for hospitals and other health care organizations to identify and address disparities in care. Improving quality, addressing efficiency and cost, and managing risk are powerful drivers. However, one of the true signs that the issue of addressing disparities and achieving equity is becoming mainstream is the attention the issue has received from the Joint Commission. The Joint Commission has published two reports based on its project Hospitals, Language and Culture: A Snapshot of the Nation, a national, qualitative study exploring how 60 hospitals across the country provide health care to culturally and linguistically diverse patient populations (95,96). This project is the first of its kind in the nation, and the fact that it has been taken on by the Joint Commission foreshadows the development of new accreditation standards in this arena.
The most recent Joint Commission report, One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations provides a set of recommendations for hospitals on how to effectively provide culturally and linguistically appropriate services to their patients, and includes items on measuring and addressing racial and ethnic disparities in health care (96). The Joint Commission is now beginning a project to develop standards based on the findings above, which will be much more rigorous than their current standards for culturally and linguistically appropriate services. These will likely go into effect in 2010, yet hospitals will need to begin planning for these new measures well in advance.
Similarly, the National Quality Forum is working on a series of quality measures with particular attention to the provision of culturally and linguistically appropriate services (69). These measures are being developed to guide hospitals on systems development in the area of disparities and equity, and will also serve for national benchmarking purposes. The planned release date for these measures is 2009.
Finally, as the issue of community benefit and not-for-profit status takes on greater importance for hospitals across the country, addressing racial and ethnic disparities can become a valuable portfolio of work to meet these regulations (97). Based on findings from the Senate Finance Committee, hospitals with not-for-profit status are under greater scrutiny by the Internal Revenue Service, Congress and state officials, and will need to demonstrate what they do in return for their tax exemptions (98). Community based efforts to address the root causes of disparities—such as the use of community health workers, navigators, and coaches—have successfully been reported as community benefit activities (99).
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