We’ve emerged from the traditional winter season of flu, strep, and stomach viruses (often on repeat for those with small children) and are well into the traditional spring season of sneezing, sniffling, and coughing. As such, it is worth considering the role healthcare plays in each of our lives. For some, we might have found ourselves at the doctor a few times over the past year—once for an annual wellness visit and once or twice for antibiotics.
Despite what we may think of as traditional encounters with the healthcare system, there is an ongoing crisis within the system that disproportionately impacts minorities. A solution requires more nuance than slapping on a Band-Aid.
The antidote, at least to a certain extent, may be surprising. Infusing diversity, equity, inclusion, and accessibility (“DEIA”) into an employer’s hiring, retention, and training practices presents opportunities to mitigate bad patient outcomes and increase the overall ability to provide high-quality patient care that is critical to a business model’s longevity.
Part One: The Floor (i.e., What must you do?)
As a healthcare employer, you may wonder, “What must we do legally to address inequities in healthcare?” Title VII and state and local anti-discrimination laws provide the bare minimum for what organizations must do regarding their employees – i.e., you cannot make employment decisions on the basis of any protected category, including race, national origin, and sex. There will inevitably be difficult situations that employers must navigate—for instance, what happens if a White patient requests not to be treated by a Black nurse? By honoring the patient’s request, the employer faces exposure to liability for employment discrimination. These situations require careful and intentional decision-making and leadership.
In addition to workplace antidiscrimination laws, we are observing a trend that indicates more regulation is coming in the healthcare industry.
A 2021 Biden executive order directed federal agencies, such as the Department of Homeland Security, the Department of Justice, and the Department of Labor, to assess and advance equity in their specific areas. As an extension of this executive order, the Centers for Medicare and Medicaid Services (CMS) recently released their Framework for Health Equity 2022-2032 and the CMS Strategic Plan, which includes equity as a key pillar.
While we can’t use our crystal ball to ascertain what this means, this data will likely be used to find gaps in healthcare coverage and implement new processes and requirements for continued funding to address systemic inequalities in obtaining healthcare. For instance, we know CMS has not hesitated to attempt to add a variety of criteria in its Conditions of Participation—so a condition directly tied to data collection on DEIA efforts is certainly possible.
Thus, while the floor hasn’t shifted for the bare minimum just yet, it may be a good idea to start considering how to increase DEIA training, resources, and awareness in your organization. One of the best ways to begin this process is by asking a different question: What should we do?
Part Two: Raising the Floor (i.e., What should you do?)
To set the stage for why employers should begin considering prioritization of DEIA, recent data provided by the Joint Commission shows the disparate outcomes that often occur in diverse populations:
- The maternal mortality rate for Black women is 4x higher than for non-Hispanic White women.
- Hispanic women are 20% more likely to die from cervical cancer than non-Hispanic White women.
- Asian Americans are 8x more likely to die from Hepatitis B than non-Hispanic White.
- Diabetes rates are more than 30% higher among Native Americans and Latinos than among Whites.
So, on January 1, 2023, in an effort to combat these statistics, the Joint Commission implemented healthcare equity standards that are integrated into various hospital, ambulatory, and behavioral healthcare accreditation programs. The Joint Commission also has plans to launch its Health Care Equity Certification on July 1, 2023. While it is a voluntary certification, the value it confers—economically and relationally—is high.
Staffing healthcare facilities with a diversity of employees—from administration to direct care providers to support staff—can positively impact diverse patients, especially those who might not seek care otherwise. Diverse team members bring diverse experiences—and these experiences will help build connections with the community that may not otherwise exist.
Similarly, employers can train current employees on cultural differences unique to their region or type of care, the value of diversity, and available resources to provide optimal care. For instance, short trainings on how to utilize online translation services with patients who struggle to communicate in English or ways to quickly assess a patient’s potential barriers to future treatment (i.e., asking if they will have a ride to their next appointment or if they have enough PTO built up to come in at a particular time for their appointment) can move the needle toward improved patient care.
For employers looking for immediate practical and proactive steps, we recommend considering the following, based on The Joint Commission’s framework.
- Make Healthcare Equity A Leader-Driven Priority
- Create a health equity roadmap, or a 30,000-foot vision, for what your organization could do to increase health equity based on its specific needs, clients, and resources. This is your proverbial treatment plan.
- Assess Health-Related Social Needs And Create A Plan To Address Them
- This component of the treatment plan will be as unique as your business model. Look at things like access to transportation for patients, difficulty paying for prescriptions or medical bills, education and literacy, languages spoken, food and housing insecurity, and even immigration status. These factors significantly contribute to an individual’s interactions (or lack thereof) with the healthcare system. This data can be gathered anonymously through a social needs screening tool. Use this information to diagnose potential problems and then create a plan to address them.
- Look for new ways to meet your community where they are. Virtual Cognitive Behavioral Therapy for Black Americans? Research says yes! Doula services within a healthy start program to reduce pregnancy disparities for women of color and poor women? Research also says yes!
- Engage With Stakeholders And Community Members About Initiatives
- Excitement fuels excitement. The more community and investor buy-in you achieve, the greater your ability to make systemic change will be.
- Consider how you communicate your DEIA goals and resources to community audiences. How will your community respond to increased diversity and inclusion in your healthcare setting? What works for a rural health care clinic may not work for an urban therapeutic setting. On top of this, some states, including Florida, Texas, and Missouri, are considering and passing laws regulating DEIA education. For insight into navigating these laws while pursuing DEIA efforts to increase quality health care for all patients, we recommend these strategies to avoid common pitfalls.
- Other big-picture ideas for disseminating DEIA achievements and continued needs include community involvement, developing community leaders who can communicate services available and help recruit diverse employees, and building a sense of permanence and investment so that you are known and trusted amongst the people you hope to serve.
These concepts are just the beginning of building a system to ensure your organization maximizes its ability to impact its community. If you feel overwhelmed, we can help! Husch Blackwell’s Workplace DEI team can draft checklists and surveys and develop toolkits and other documents based on your needs. We can also offer advice and counsel as you brainstorm a vision for your DEIA plan.
Importantly, one small step is better than no small steps. By starting to talk about these critical issues proactively—instead of reacting to changes that become mandatory—you will be better positioned to achieve your mission of quality care for all.