“We should all have an equity lens”: Insights from hospital equity officers

Interest in diversity, equity, and inclusion (DEI) in healthcare grew substantially in 2020 as a result of Black Lives Matter and other social justice movements. Hospitals recognized the need for an institutional focus on equity and many developed DEI offices to address this need. From 2019-2022, “Chief diversity and inclusion officer” was the fastest-growing c-suite position, Becker’s Healthcare reported.

How have hospital equity officials addressed racism within their institutions and in healthcare, and what challenges have they faced? In Health Affairs, researchers from Brigham and Women’s Hospital, Harvard University, the American Hospitals Association, and the Commonwealth Fund surveyed 340 hospital equity officers from across the country. A smaller subset of 18 officers participated in longer qualitative interviews.

Advancements in equity

The survey results and interviews show where strides have already been taken towards health equity. Here are a few of the key takeaways on the positives:

• Buy-in for health equity work among hospital leadership appears to be high. Eighty-four percent of equity officers reporting that their CEO was very supportive of their efforts, and 64% said that the hospital board was very supportive.
• Data collection on demographic characteristics is widespread. A large majority (88-94%) reported routinely collecting data on patients’ race, ethnicity, language, and social determinants of health.
• Common activities to address racism include collecting information about instances of racism within the hospital (54% of officers reported doing this) and forging community partnerships to improve equity through events like listening sessions (66%).

“I think any executive needs the health equity lens. We should all have it.”

Equity officer interview participant, Health Affairs

Room for improvement

Researchers also identified obstacles to change and room for improvement:

• While support from hospital leadership for equity efforts was high, fewer respondents (52%) said they that clinical leaders were very supportive; some cited pushback from clinicians who saw health equity efforts as an accusation of bias.
• Not all institutions have committed to specific equity goals. Only 68% of survey respondents said that their hospital had specific goals or strategies to reduce inequities in the clinical care by race/ethnicity, and fewer than 50% had strategies for reducing disparities based on sex, gender identity, or sexual orientation.
• The biggest obstacles to change that officers cited were lack of diverse staff (25% reported as a “major obstacle”) and lack of a standardized way to record data on social determinants of health (26%). Some officers noted that the political climate kept them from announcing their equity initiatives publicly for fear of backlash.
• Relatively few respondents (22%) reported that their hospital was reviewing clinical algorithms for potential bias.
• Although almost all respondents said their institution collected data on race and ethnicity, only half said they used this data to stratify performance metrics (more likely in teaching and urban hospitals or systems). Why such a low rate? Officers cited doubt in the validity of this data and lack of systematic collection practices.

“Fuzzy data in, fuzzy results, right? So, we have a lot of fuzzy data.”

Equity officer interview participant, Health Affairs

Where to go next?

Equity officers identified the need for certain tools and guidelines that could help advance equity at their hospital:

• One of the largest barriers to using data has been a lack of standardized practices for collecting data, especially for social determinants of health. Issues of privacy and patient trust are important to consider when asking patients about health-related social needs.
• Equity officers noted the need for more tools and curricula for training hospital staff on DEI issues.

“What are the right clinical settings to collect [social determinants of health] data? How do we collect it in a confidential manner? When should it be collected? How often should it be collected? What do we do with the data once we have it?”

Equity officer interview participant, Health Affairs

Creating DEI positions is not a cure-all for healthcare inequities; it’s just the start. These findings provide a peek into how hospital equity leaders are making change, and how researchers and policymakers can help their work forward.