Health Equity Work in the US: What IHI’s 2021 Pulse Report Tells Us about Prioritization, Perception, and Progress

In July 2021, the Institute for Healthcare Improvement (IHI) conducted an industry poll to better understand health care leaders’ current perspectives on health equity work in the United States. Our poll found that in the short span of two years, the percentage of health care leaders who said health equity is a top priority at their organization has more than doubled — from 25 percent in 2019 to 58 percent in 2021.

While the collective will to improve health equity is increasing, myriad barriers remain for those organizations working to eliminate unjust disparities in access, treatment, and outcomes. In our poll respondents mentioned a variety of challenges, including lack of funding, lack of other resources (such as available staff), inconsistent collection of equity-related patient data, and an inability to demonstrate impact of health equity efforts. Moreover, 42 percent of respondents did not select health equity as one of their organization’s top three priorities, which might itself be a barrier.

Addressing Barriers to Health Equity

When trying to impact change in an outcome or at the system level, there are always challenges and frequently organizations cite the lack of available resources as one of those challenges. This is even more pressing in the present moment as the pandemic’s current wave crescendos. Barriers are part of the business of making change.

My message to leaders as we work to create change is that we find resources for what we value. If your mission statement, values statement, or strategic plan identifies equity as a priority, then that commitment should come with an established investment. Making an investment usually means making choices — and as we contemplate where to invest our assets and time, consider where some of the biggest gaps in outcomes exist. Inequities are often at the heart of those gaps. The return on that investment will be in lives saved, deepened relationships with your community, and, as value-based payments deepen, real economic returns as well.

With adequate resources, you can begin the hard work of improvement. Regardless of where your organization is on the journey toward health equity, my advice at every stage is to listen. ?Listen to your community. Listen to your employees. Listen actively and differently than you have listened before. This is what IHI endeavors to do: Listen, try to act on what we hear, and do so over and over again. On our own journey toward health equity, we have stumbled. You will stumble as well, and there will be misunderstandings and mistakes. That is to be expected — persist despite your stumbles. And never stop listening to hear what matters to your stakeholders — patients, families, and community partners — and act on that.

Some respondents to IHI’s poll mentioned challenges related to data. I sympathize. It’s hard to gather the appropriate data and verify that change is occurring over time. It is the gold standard to ask people for REaL (race, ethnicity, and language) and SOGI (sexual orientation and gender identity) self-identification information. Some individuals won’t want to provide that information, but the vast majority will. And it’s important to ask people repeatedly, over time, because some of these definitions change over time.

It’s also important to be open and honest about why you are collecting this information from your community and how you plan to use it. Patients will be more comfortable sharing their identification data if they know why you are collecting it and believe you intend to use it to improve health. Clearly communicate what you plan do with the data, and then, when you’re able to, show how their contributions have resulted in real changes in your system that are improving lives.

One present-day challenge is that there is plenty of guidance to go around. There are health equity training services targeted at all levels, and no shortage of advice on what to do or how to do it. We should certainly spend time understanding that advice, but we should spend even more time listening to what matters to our people. It’s wise to have a framework to organize our thoughts. But most of all, spend time in your community, hearing directly about what matters to the people that your health system serves.

Preparing for Pushback

My colleagues and I have heard from many health care professionals who want to effect change, but encounter pushback at their organizations, especially on issues of inequity. When embarking on this work, anticipate this pushback. Indeed, if you’re not getting some form of resistance, you’re probably not expressing your intent clearly enough. These issues are deep, structural, historical. They cut to our core, are deeply personal, and can be contentious.

Prepare for pushback by gathering data and stories — again, it’s important to collect data and get out into your community. If you are listening, you will hear the stories that demonstrate the need for this work. Then share the data and stories with your staff, providers, and board to help get them on board.

It’s also important to manage expectations. Do not expect immediate results. Systemic oppression and racism go back hundreds of years. To think we can change that overnight is unrealistic. We should begin with urgency, but if we’re really working to address root causes we will not see results immediately. Improving health equity is long-term work, but that shouldn’t discourage us from starting.

"Improving health equity is long-term work, but that shouldn’t discourage us from starting."

I’m encouraged to see how many more health care leaders are focused on equity today. Naming equity as a priority, however, is not enough. In the end, what really counts is the commitment to making equity a reality.

Access the IHI 2021 Pulse Report, Health Equity: Prioritization, Perception, and Progress