While preventable medical harm can touch any patient in any setting, research shows that disparities in safety outcomes based on race, ethnicity, age, disability, sex, gender and more will be found whenever they are measured.
The Roadmap to Health Care Safety for Massachusetts centers equity by making the elimination of these disparities part of its overarching definition of health care safety. The Roadmap then embeds equity in the strategies and action steps associated with goals in five areas: leadership and culture; operations and engagement; patient and family support; workforce well-being; and measurement and transparency.
For instance, patient and family support strategies include building the skills of health care professionals to communicate openly and effectively with diverse patients and families. Strategies related to measurement and transparency include improving the state’s ability to stratify safety data by race, ethnicity and other characteristics.
The Roadmap’s initial action steps also target inequities. Piloting automated electronic health record surveillance systems to detect and respond to patient harm events would enable richer data analyses, in part by overcoming lower rates of event reporting that have been shown to happen when patients of color are harmed. Another action step would bolster diverse community engagement on Patient and Family Advisory Councils.
“When crafting the Roadmap, the Consortium steered clear of making equity a siloed goal” says Barbara Fain, Executive Director the Betsy Lehman Center, which leads the Massachusetts Health Care Safety and Quality Consortium and the work on the Roadmap. “We know from experience that important initiatives tend to fail when they are layered on top of each other,” says Fain. “Continuous improvement on any organizational priority — whether it’s equity, patient experience, workforce well-being or safety — won’t happen unless the work is integrated.”
Speaking at the Massachusetts Health Policy Forum in April during the release of the Roadmap, Michael Curry, Esq., CEO of the Massachusetts League of Community Health Centers, told the audience that when he first read To Err Is Human, the seminal report on medical harm published by the Institute of Medicine in 1999, he instantly recognized that inequities in health care likely led to disparities in safety outcomes.
“And I really thought to myself, wow, I wonder how many of those errors are also race and ethnicity-based within the settings that we get our care,” he said. “And that there's a story to tell about disparate treatment and the errors that happen in our systems.”
He also advocated for better measurement, noting that community health centers have strong race and ethnicity data. “Because I think you know, ‘That which gets measured gets done,’” Curry said.
At the Forum, Deborah Washington, R.N., Ph.D., Manager of Diversity, Equity & Inclusion Community Health Partnerships at Massachusetts General Hospital, told the story of a patient of color who spoke in frustration one day, asking, “Why do I have to get angry to get what I need?”
Washington was also a member of a task force that helped to develop the Roadmap. She noted at the forum that efforts to better engage the health care workforce must also be informed by equity goals.
“We also need to be mindful that the health care workforce is also vibrantly diverse,” she noted, “and there is no one-size-fits-all approach to getting this important work done.”