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Tools and Guides for Disparities Solutions

Improving Quality and Achieving Equity:
A Guide for Hospital Leaders


The Institute of Medicine (IOM) Report Crossing the Quality Chasm, released in 2001, highlights that there is a significant gap between the quality of health care people should receive, and the quality of health care people do receive (1). Just a year later, the IOM released another influential report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, highlighting an even larger quality chasm for racial/ethnic minorities in the United States (2).

Crossing the Quality Chasm suggests that quality is a system property and that our current system of health care delivery is in need of redesign. To truly achieve quality care, health care systems must focus on six key elements—efficiency, effectiveness, safety, timeliness, patient-centeredness, and equity. Equity is achieved by providing care that does not vary in quality by personal characteristics such as ethnicity, gender, geographic location, and socioeconomic status. Over the last few years, there has been an increased focus by hospital leadership on improving quality by responding to the six key elements proposed in Crossing the Quality Chasm. In regards to equity, research has shown that racial and ethnic disparities in health care have an impact on quality, safety, cost, and risk management. Addressing disparities has now been acknowledged by the National Quality Forum and the Joint Commission as an essential component of quality. Despite this, few hospital leaders have the issue of equity, and identifying and addressing disparities, prominently on their radar screen.

The Disparities Solutions Center at Massachusetts General Hospital, with support from the Robert Wood Johnson Foundation, has created Improving Quality and Achieving Equity: A Guide for Hosptial Leaders.  The goals of this guide are to:

  1. Present the evidence for racial and ethnic disparities in health care and provide the rationale for addressing them—with a focus on quality, cost, risk management and accreditation.
  2. Highlight model practices—hospitals and leaders who are actively engaged in addressing disparities and achieving equity.
  3. Recommend a set of activities and resources that can help hospital leaders initiate an agenda for action in this area.

This guide is constructed to be clear, concise, practical, and easy to read. It is targeted to hospital leaders - including CEO’s, VP’s, and others that focus on quality, safety, finance, and risk management. The guide was also designed to be used by individuals within hospitals who either would like to help convince their leadership to take action, or who are responsible for making the case for addressing disparities to other leaders in the hospital. It is applicable to all types of hospitals - rural, urban, public, private, and veteran’s administration, among others. It was developed over the course of 2008, and includes a thorough review of the peer-reviewed literature, key informant interviews with hospital leaders, and case studies of innovative approaches that hospitals are undertaking to identify and address disparities, as well as to achieve equity. Guidance for the development of Improving Quality and Achieving Equity: A Guide for Hospital Leaders was graciously provided by our Sounding Board of health care leaders and experts (Appendix C), and the final draft was reviewed by a panel of leaders in the field of hospital quality and safety (Appendix D).

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