In a major hospital system in Atlanta, less than one-fourth of employees were able to define either equity or health equity, according to a study published in the September issue of the Journal of Healthcare Management (JHM). The official journal of the American College of Healthcare Executives, JHM is published in the Lippincott portfolio by Wolters Kluwer.
The knowledge gap was apparent even though the hospital has been engaged in projects aimed to advance health equity, report Melissa Uehling, an M.D./Ph.D. candidate in the Department of Sociology at Emory University, and colleagues led by Dr. Yolanda Wimberly, Chief Health Equity Officer at Grady Health System in Atlanta. "We anticipated that management and administration-level employees would generally have a higher level of understanding, but the results did not support this supposition."
Few employees could articulate a definition of health equity that matches research-based concepts
As part of a larger study of health equity, the Office of Health Equity conducted 28 structured focus group discussions with employees of Grady Health System. Grady is a safety net hospital, meaning a high proportion of its patients are uninsured and/or underinsured. In addition, the community it serves is primarily underrepresented racial/ethnic minorities.
Altogether, 233 employees attended a focus group. Black employees constituted 58% of participants, white employees 30%, and people of other races 12%. Over half of participants (59%) were frontline clinicians or mid-level managers/supervisors; the rest were director-level and above. Most (62%) had been employed at Grady for at least five years.
Employees were first asked to define equality, equity, and health equity. They typed their answers anonymously into their personal mobile phones, and specialized software analyzed the responses later. The researchers defined a "correct" definition of health equity as one that acknowledged the importance of determining individual needs and tailoring treatment to achieve equality.
Of the 191 participants whose answers were analyzed, only 20% correctly defined equity and only 23% correctly defined health equity. There was no correlation in how the questions were answered between job title nor length of time employed by the health system.
Even conceptual knowledge didn't indicate comprehension of how health equity can be enacted
For a qualitative analysis, the same focus group participants were asked to describe health equity successes they knew of at Grady. Major categories noted were community presence and collaboration, staff and job diversity, provision of care to all individuals in need, and specialized programs.
Interestingly, there was no association between the ability to correctly define equity or health equity and the ability to report a success at the hospital that fell into any particular category.
"Before undertaking health equity work within and for a health system, it is vital to level-set what health equity means to health system employees at all levels and roles within the organization," the authors urge. "Frontline health system staff, managers, or leaders cannot act on health equity if their notions of health equity are vague."
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About the Journal of Healthcare Management
The Journal of Healthcare Management (JHM) is an official journal of the American College of Healthcare Executives. Published bimonthly, JHM is a peer-reviewed publication dedicated to providing healthcare leaders with the information they need to manage complex healthcare issues and to make effective strategic decisions. JHM provides a forum for discussion of current trends and presentation of new research as applied to healthcare management.
About the American College of Healthcare Executives
For more than 90 years, the American College of Healthcare Executives (ACHE) has focused on one mission—advancing leaders and the field of healthcare leadership excellence. It is the professional home to more than 48,000 healthcare executives who are committed to integrity, lifelong learning, leadership, and diversity and inclusion. Through an established network of 76 chapters, members have access to networking, education, and career development at the local level. Members also can earn the prestigious, gold-standard FACHE® credential, signaling board certification in healthcare management.
About Wolters Kluwer
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Journal of Healthcare Management
Advancing Equity in U.S. Hospital Systems: Employee Understandings of Health Equity and Steps for Improvement
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