Advancing Health Care Equity

By Stacey Barrett, MA, Research Scientist, The Joint Commission, and Beth Ann Longo, DrPH, RN, MBA, MSN, Associate Director, Department of Research, The Joint Commission

At The Joint Commission, our vision is that all people always experience the safest, highest-quality health care. To achieve this, we must reduce existing disparities and advance the equitable provision of health care.

Earlier this year, The Joint Commission’s new and revised requirements to reduce health care disparities became effective for ambulatory health care organizations, behavioral health care and human services organizations, critical access hospitals and hospitals. 

Leadership (LD) standard LD.04.03.08 requires applicable health care organizations to reduce health care disparities and to make them a quality and safety priority. The standard has six elements of performance (EPs):

1. The organization designates an individual(s) to lead activities to reduce health care disparities for the organization’s patients. 
2. The organization assesses the patient’s health-related social needs (HRSNs) and provides information about community resources and support services. 
3. The organization identifies health care disparities in its patient population by stratifying quality and safety data using the sociodemographic characteristics of the organization’s patients. 
4. The organization develops a written action plan that describes how it will address at least one of the health care disparities identified in its patient population. 
5. The organization acts when it does not achieve or sustain the goal(s) in its action plan to reduce health care disparities. 
6. At least annually, the organization informs key stakeholders, including leaders and staff, about its progress to reduce identified health care disparities. 

To further elevate the importance of health care equity, these requirements will become a National Patient Safety Goal (NPSG) on July 1, 2023. The NPSG will not include any new requirements. 

Health Care Equity Accreditation Resource Center
The Joint Commission wants health care organizations to succeed in meeting the requirements and reducing health care disparities. Six months ago, we launched our Health Care Equity Accreditation Resource Center to support organizations on their equity journeys.

The accreditation resource center includes:

• Snapshots: Brief synopses of approaches used by other organizations.
• Soundbites: Brief videos of organizations’ lessons learned.
• Strategies: Links to resources such as toolkits, templates and guides. 

The Joint Commission’s Evaluation Research Team has conducted on-site, in-depth case studies with three organizations: University Health, Boston Medical Center and most recently, Cook County Health, to explore their unique journeys to advance health care equity. Six Snapshots and six Soundbites (one for each EP) were developed for each organization to share strategies, challenges, solutions and lessons learned.

New! Resources in Partnership with Cook County Health 
“There has never been a louder call to change inequity than in this moment.” -Israel Rocha, Chief Executive Officer, Cook County Health
In a Soundbite video for EP 1, Mr. Rocha explains how Cook County Health’s vision is “to ensure that health is a human right” so that everyone can live their best life. He discusses how the health system has implemented health care equity as one of its strategic pillars, as well as established the Change Institute of Cook County Health which develops innovative, cohesive strategies to bridge gaps in treatment and prevention. 

“We are always trying to find ways that we can bring relevance to the data and to the clinicians who provide care for patients.” -William Trick, MD, Director, Health Research and Solutions, and Co-Director, Center for Health Equity and Innovation, Cook County Health
In a Soundbite video for EP 3, Dr. Trick emphasizes that while the idea of collecting social needs data is key, being able to actually identify where disparities are and take action requires complex analysis, including stratified analysis. He highlights how Cook County Health stratifies data geographically to know which neighborhoods have a high prevalence of HRSNs, as well as by conditions among those populations. 

“If we have metrics that matter, then by tracking those metrics, we can know when it’s time to pivot if we’re not hitting the mark or not making progress toward the mark.” -Lamar Hasbrouck, MD, Chief Operating Officer, Cook County Department of Public Health
In a Soundbite video for EP 5, Dr. Hasbrouck stresses the importance of monitoring progress toward achieving health care equity. He describes some of the measures that Cook County Health uses, including indicators related to life expectancy, overall health status, socioeconomic well-being, physical well-being and mental well-being. 

“We try to really listen to what we’re hearing from [community] organizations, but also from our patients and their families to make certain that we’re creating programs, initiatives and solutions to problems that are not just perceived problems, but problems we’re hearing about.” -Shannon Andrews, Chief Equity and Inclusion Officer, Cook County Health
In a Soundbite video for EP 6, Ms. Andrews explains how Cook County Health works closely with community stakeholders, including community advisory councils, to have real conversations about all types of issues that may be going on within the community. She discusses how a community survey sent to more than 20,000 individuals serves as a north star – providing a framework on how the health system approaches health care equity. 

Stay Updated with New Resources 
Additional Soundbites are available with other leaders from Cook County Health. We encourage you to visit the accreditation resource center as new resources are added frequently. You also can sign up for E-Alerts to receive notifications when resources are added. 

We also are excited to announce the launch of the Health Care Equity Certification Resource Center that provides practical strategies for organizations pursuing Health Care Equity Certification to help them meet the standards and EPs. Resources are organized by certification domains and include:

• leadership
• collaboration
• data collection
• provision of care
• performance improvement

The new certification program, available July 1, 2023, will recognize organizations working to reduce health care disparities and bridge the gap to equitable care. The certification will distinguish those organizations embedding health care equity in all aspects of care, treatment and service delivery. Stay tuned for additional blog posts on the certification resource center and its many tools, templates, guides and strategies to help organizations achieve certification. 

While systemic inequalities exist within the quality and safety of health care, there is a path forward. We look forward to working with organizations and other stakeholders to share best practices and identify innovative ways to achieve health care equity. 

Stacey Barrett, MA, is a Research Scientist in the Department of Research, Division of Healthcare Quality Evaluation and Improvement, at The Joint Commission. Ms. Barrett has over 25 years of expertise managing complex health services research studies involving a variety of topics, including infection control, health information technology, electronic clinical quality measures, vaccination practices, patient safety and quality improvement initiatives. In her current role, she oversees the development of the Health Care Equity Accreditation and Certification Resource Centers.

Beth Ann Longo, DrPH, MSN, MBA, RN, is an Associate Director in the Department of Research, Division of Healthcare Quality Evaluation and Improvement, at The Joint Commission. Dr. Longo has managed several complex federally funded projects and directed a wide range of research projects to systematically assess program effectiveness, the outcomes of a specific intervention and the impact of a product, program or service. She also is very knowledgeable on health care quality and safety measurement in nursing homes at the local, state and national level. Dr. Longo co-leads the development of the Health Care Equity Accreditation and Certification Resource Centers.