How Health Systems Can Recommit to Addressing Health Equity in the U.S.

Over the past several years, many health care organizations — especially in response to the Black Lives Matter movement and the murders of George Floyd, Breonna Taylor, and others — made strong public declarations of their commitment to advance equity and racial justice.

This attention was long overdue. Some have described this as the largest groundswell of energy focused on racial justice in decades.

This racial reckoning touched every industry, and health care systems were no exception. Yet, while many companies rushed to hire chief diversity officers, chief equity officers, and similar positions several years ago, the Wall Street Journal recently reported that many organizations are now shedding these positions or rolling back their initial commitments. In too many cases, positions created to advance equity were neither adequately resourced nor given clear and specific objectives. As a result, the top-tier talent who filled these roles were not set up to achieve the results that people have hoped for, leading to much frustration.

This is a troubling development and should be seen as a call to recommit ourselves to advancing equity, diversity, and inclusion. Some organizations may simply be recalibrating or rethinking how they want to do this work. But others may be abandoning these equity leadership roles and initiatives because the effort is more difficult, more complex, and takes longer than they expected. Instead of pulling back, individual organizations should consider how taking part in coordinated and collective action could strengthen their anti-racism and equity efforts.

Don’t Go It Alone

The Institute for Healthcare Improvement (IHI), the organization that I lead, has joined with the American Medical Association (AMA), in collaboration with Race Forward and a growing list of organizations, to create the Rise to Health Coalition. The Coalition brings together individuals and organizations committed to equity and justice within the health ecosystem to build, lead, and advance shared solutions and collective actions to transform and strengthen health care. We have invited a coalition of individual practitioners, health care organizations, professional societies, payers, and pharmaceutical, research, and biotechnology organizations to deliver more equitable care outcomes to patients, families, and entire communities. 

The theory behind the Rise to Health Coalition is that no individual or single organization can advance equity and justice alone, and three years into our equity commitments, many organizations are now at an inflection point. This is neither the first nor the last time we will face such a moment. But, as we have in the past, we must now commit ourselves anew to taking action with colleagues and communities to build a future where health and care are better, fairer, and more equitable. 

Advice for Leaders

Executives and boards can do the following to support equity leaders more effectively:

  • Give equity leaders what they need. Provide adequate resourcing. Work with them to create clear, specific, realistic (and yet ambitious) objectives. 
  • Act with your specific environment in mind. Diversity, equity, and inclusion may mean different things in different settings. In parts of the U.S., this may mean engaging Indigenous or immigrant populations. In some places it may mean outreach to rural populations. In many cases, it will involve addressing racial or gender bias. Using data to identify differences in outcomes and system performance will guide where to focus your efforts. 
  • Focus on culture, not just diversity. At IHI, like many organizations, our initial equity focus was on increasing staff diversity. We learned very quickly that diversity without creating a culture of equity, belonging, and inclusion often leads to considerable disillusionment and frustration. 
  • Understand that filling one position is not enough. No one leader can be expected to take on such a huge challenge. Instead, build and sustain a diverse, inclusive, and thriving health care workforce that is equipped to advance racial justice and health equity for patients, communities, and staff.
  • Stay the course. Continue to exhibit the courage necessary to support a workforce that can tackle the problems of our future. Solving those problems requires a diverse, equitable, and inclusive work environment.

Joining initiatives like the Rise to Health Coalition will support actions like those listed above. The first step is as simple as signing up, followed by other “starter” actions and activities that will help individuals and organizations progress in their journey. The Rise to Health Coalition will release additional actions and activities over time.

Now is the time to commit or recommit ourselves to improving health equity and to do so in partnership with others who share a vision of a more equitable, just, and fair health ecosystem. Together, we can create health care that cares for all of us.

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