Health care accreditation bodies are raising the bar for health care equity again. The Joint Commission’s new Health Care Equity Certification Program, which introduces new standards for addressing health care equity and social needs for health systems, goes into effect this month. This certification program builds on a set of health care equity requirements enacted by the Joint Commission last year, which mirrors emerging standards from NCQA and CMS, as well as new requirements for Medicaid managed care plans across the country. There is no mistaking which direction the industry is going, at last.
But how are we getting there, and how fast?
We Upstreamists often think about the journey upstream as a long, sustained marathon—and in the big picture, it is. But our recent experience at HealthBegins has also shown us that if you want to move upstream, sometimes it pays to sprint.
We’ve just concluded our first REaL Data Accelerator, a 12-week program to help a cohort of primary care practices improve their REaL (race, ethnicity, and language) data collection and stratification efforts and use that data to make equity-focused improvements in care. Participating teams completed an organizational self-assessment, identified strengths and gaps in their capabilities for data collection and stratification, developed an action plan, and implemented tests of change to rapidly improve these capabilities—all within 80 days.
In this short time, we saw teams accomplish their goals and quicken the pace of system and practice transformation for equity. With online video modules, resource guides, office hours, and live learning sessions with peers and expert faculty, they quickly strengthened capabilities in their weakest areas, built on their strengths, and implemented new practices that hadn’t been in place only weeks prior. By the wrap-up session, the teams told us they had effectively prioritized their goals for continued equity-focused improvement and, in their words, “moved this work off the back burner”—all of which put them better on track to meet new requirements such as those of the Joint Commission.
And thus we saw that even amid the complexity of moving upstream for health equity, a short, goal-directed sprint can accelerate progress and serve as a catalyst for change. In fact, sometimes these shorter sprints are necessary to make long-term change effective.
The healthcare teams that participated in this accelerator program demonstrated several crucial lessons for any team using sprints to meet evolving health care equity standards.
Leadership support. The teams expressed that success depends not only on technical capabilities but on leaders who dedicate time and space for health equity work and commit to cultural shifts that prioritize racial equity. It’s essential to pair this support from leaders with support from coaches, peers, and experts who can help teams generate momentum and stay on track.
Self-assessment. Teams began with a self-assessment on their data collection and stratification capabilities, to help leverage strengths and identify gaps to accelerate improvement. The results helped them determine how to focus their improvement efforts during the program.
Specific, measurable goals. For example, one team aimed to reduce the “unreported/do not disclose” rate by 5% by the end of the program. Another set a goal to conduct outreach and validate data for 80% of patients with null values for race, ethnicity, and sexual orientation within that time.
Small, rapid tests of change. These allow Upstreamists to move into action and quickly gain insights on what works, which they can then use to improve their strategies. The teams conducted more than twenty such tests in just twelve weeks, such as validating their current data-capture methods, making patient outreach materials and satisfaction surveys available in Spanish, adapting staff trainings, and adding a flyer to patient registration materials on the importance of data collection.
A multi-level framework for learning and action. Equity work is—and must be—transformational. Beyond support to implement tests of change and drive performance improvement in a short time, participants in the program received tools and coaching to learn how to transform their institutions, relationships, and communities in the process. This multi-level framework for learning and action helps participants sustain the momentum generated during the accelerator and fuel system transformation.
These teams are still running the marathon. But with a strategic sprint, they’ve quickly propelled themselves a good ways towards their equity goals. A well-timed and well-designed accelerator program can jumpstart your efforts and help you meet new equity standards. Please feel free to contact us to learn more. We’re here to help you and your teams go far, faster, together.
Rishi Manchanda, MD, MPH.