Inequities in care happen daily and impact staff as well as patients and families

Given that disparities in health based on race, ethnicity, disability, gender, sexual orientation and more are often the result or byproduct of long-standing operations and policies, systemic changes will be required to make care equitable and safe for all. What actions do you suggest leaders and organizations take to address structural inequities in health care safety?
Sivashanker Karthik

Karthik Sivashanker, M.D., M.P.H.
Vice President of Equitable Health Systems and Innovation
American Medical Association

The first and most important thing they can do to address these structural inequities is to acknowledge that they exist. Despite decades of research pointing to preventable, widespread, and unjust differences in outcomes patterned by socially constructed factors like race or class, we still see huge gaps in awareness. We all need to understand and accept that these inequities happen daily at every institution and impact the health and well-being of our patients, staff members and communities. Committing to addressing the inequitable outcomes that our systems, structures and policies are designed to produce is, in my mind, a critical first step.

I’d also like to expand our concept of a “culture of safety” to include equity, something that is long overdue for the field of quality and safety broadly. How is it that we have standard safety event categories for wrong-site surgeries and hospital-acquired infections and yet, in 2023, still have none for harms arising from racism, classism, sexism and ableism? Those and other ‘isms contribute daily across every health care institution in this country to differential access, treatment, experience and outcomes for our patients, staff and communities. 

How can we claim to care about high-quality and safe care when those terms only apply to some of us - usually those with advantages - and not all of us, especially those that need care the most? Why aren’t we more broadly concerned and curious about identifying and addressing the inequities that erode our institutions, the well-being of our staff and patients and the quality and safety of the care we are able to deliver, like a toxic infestation making us sick from the inside out?

I should note that there is a small but growing chorus of leaders in health care, and quality and safety more specifically, who are coming together to learn, test and advocate for better and more effective strategies. For example, our AMA Advancing Equity through Quality and Safety Peer Network program is a collaboration with Brigham and Women’s Hospital and The Joint Commission. We seek to help health systems apply an equity lens to all aspects of quality and safety practices. I invite other leaders and institutions to join us in learning, testing, improving and building momentum for work like this.

Finally, I want to note the opportunity we have to reclaim the essence of why so many of us entered the field of health care, which is to act in service of healing and health. This requires a fundamental transformation of our health care system from the ground up, but change won’t come easily. There will always be resistance from those who are invested in maintaining the broken systems and structures that prioritize the profit of a few over the health of each and every one of us. That said, the power of people coming together in solidarity and common purpose to imagine, advocate and create a better and fairer system is not only possible but absolutely necessary. There is hope and energy in this work for those who are ready to commit to it.


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