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Tools and Guides for Disparities Solutions

Improving Quality and Achieving Equity:
A Guide for Hospital Leaders

The Disparities Solutions Center at Massachusetts General Hospital, with support from the Robert Wood Johnson Foundation, is proud to annouce the release of Improving Quality and Achieving Equity: A Guide for Hospital Leaders.

See press releases from TuBoston, Bay State Banner, Robert Wood Johnson Foundation, and the Kaiser Family Foundation

For immediate access, see the Table of Contents

The goals of this Guide
are to:

  1. Highlight 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

Who should use this Guide?

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.

Structure of the Guide

The Guide contains the following information:

  • An overview of racial/ethnic disparities in healthcare and a focus on why equity is an essential component to quality
  • Four case examples to address disparities, improve quality, and achieve equity that include:
    • The quality case: Addressing disparities, improving quality, achieving equity
    • The business case: Disparities, efficiency, financial impact
    • The risk management case: Addressing disparities and limiting risk
    • The accreditation case: New standards and measures for quality and equity
  • Root causes analysis on why disparites in care exist
  • Four case studies highlighting examples of case-based approaches to reducing disparities
  • Recommendations on how to begin the process of developing an action portfolio to improve quality, address disparities, and achieve equity
  • A resources section with links to further information issues of disparities and disparities elimination

How to Use the Guide

The complete Guide can be downloaded or you can view each chapter by clicking on the links listed below (a pdf of each chapter is also available). To access downloadable resources, please click on the "Resources" chapter below and follow the links.

An Executive Summary is available and can be either downloaded as a pdf or accessed via the link below. We also included a powerpoint presentation with speaking points for use with hospital leaders.

Please note all references are noted in the text using parentheses. For a complete list, see the references.

To request a hard copy version of this document, please contact us.

Table of Contents

Download Complete Report


Authors and Acknowledgements



Executive Summary


Chapter 1: Racial/Ethnic Disparities in Health Care Racial (pdf)

-Why Equity is an Essential Component of Care


Chapter 2: Why Should You Care? (pdf)

-The Quality Case: Addressing Disparities, Improving Quality, and Achieving Equity

-The Business Case: Disparities, Efficiency, and Financial Impact

-The Risk Management Case: Addressing Disparities and Limiting Risk

-The Accreditation Case: New Standards and Measures for Quality and Equity


Chapter 3: A Root Causes Analysis: Why Do Racial and Ethnic Disparities in Care Exist? (pdf)

-Challenges Navigating the Health Care System

-Barriers to Communication and Rapport

-Biases in Clinical Decision-Making

-Lack of Follow-Through with Providers

- A Tale of Two Patients


Chapter 4: What is Being Done Out There? (pdf)

-Baylor Health Care System Case Study

-Seattle Children's Hospital Case Study

-Duke University Hospital Case Study

-Overview: 10 Hospital Interviews


Chapter 5: What Can You Do? (pdf)


Chapter 6: Resources (pdf)




Other Materials
Powerpoint slides - Leadership Guide Exec Summary
Powerpoint slides - Disparities and Quality
Powerpoint slides - Leading Change