Equity Landscape in Healthcare Quality: A Mixed-Methods Study of Efforts within Surgical Quality Programs.

Abstract

Addressing equity in healthcare is necessary to improve population health outcomes. In doing so, a requisite level of foundational resources, organization, and processes are needed. Although increasing attention is being devoted to addressing health inequities, the current landscape supporting these efforts remains unknown. We sought to evaluate the presence of frontline resources, organization, and processes for support of health equity efforts in hospitals participating in American College of Surgeons' (ACS) quality programs. Using a mixed-methods design of online surveys and semi-structured interviews, we evaluated hospitals with ACS quality programs. Descriptive analytics were applied to survey results; interview transcripts were coded using an inductive approach. Data and methods were triangulated to report key findings. Of the 44 programs invited, 36% completed the survey. Five site program leaders were interviewed. All program leaders reported having a strategy at the institution level for supporting equity efforts and having processes in place for reporting instances of discrimination, mistreatment, or harassment. Survey results demonstrated deficient workforce capacity, lack of engagement, and insufficient organization - negatively impacting efforts. The key themes from interviews were: 1) implementation occurred primarily and superficially at the institutional level, 2) barriers to implementation included preemptive structure, lack of prioritization, and insufficient disparities data, and 3) opportunities included enhancing leadership and staff buy-in, increasing available resources, developing health equity champions, and defining clear strategies. Efforts aimed at achieving health equity exist but lack the necessary infrastructure, organization, and processes to support effective frontline practices. The findings from this study support consideration of standards development targeting problems and opportunities at both the institutional and program level for advancing equity in quality improvement efforts.