Equity in Healthcare
Release Date:
Conversations around diversity, equity, and inclusiveness have been happening in many companies in the U.S., and healthcare is no exception, especially when it comes to the care patients receive. And listening to patients’ needs and concerns is vital to providing doctors, nurses, administrative staff, and leadership with the insights required to providing equitable care for all their patients. But what does it mean to be “equitable” versus “equal” in the care providers give to their patients? Host Sara Walker welcomes Ariel Davis, head of healthcare provider solution strategy for Qualtrics, and Nicole Richendollar, vice president in our client services at Walker, for a discussion on providing equitable care to patients.
Ariel Davis
Qualtrics
Connect with Ariel
Nicole Richendollar
Walker
Connect with Nicole
Highlights
What is equity in healthcare?
Ariel: “…there’s actually a variety of understanding across organizations and teams and sometimes interchangeable terms, they don’t necessarily mean the same thing when describing health equity. But I really like to leverage the definition that Healthy People 2030 provides, and it says that it’s the attainment of the highest level of health for all people. And to achieve that, it requires valuing everyone equally, with focus in ongoing societal efforts to address avoidable inequalities, historical injustices, and elimination of health and health care disparities.”
There’s a ton of data
Nicole: “the amount of data and information that we collect from our patients and our communities, we have so much information available at our fingertips. So oftentimes it can become overwhelming. Like, what information should you be pulling? What information should you be using? And I think it really comes down to like the situation you’re in. What are you trying to achieve and what are you trying to focus on, and pulling in the specific data that will help support that? The other thing that, you know, just talking through with the different providers and how they’re going to leverage some of this information, if you don’t have it, you know, making sure that you take the time to ask people like what is needed for you, what resources do you need to have to be able to achieve success and have those health outcomes that you’re looking for, too?”
Transcript
Sara:00:00:01
When people are sick and receiving treatment at a doctor’s office or hospital, it’s important that they not only receive the best care possible, but that all patients are given the attention they need.
Ariel:00:00:10
There’s typically a somewhat blanket or equal approach and an insurance that we want to make sure that everybody gets all of these tools that we have in the same way. And the result of that is these groups of people who have additional challenges that we haven’t rightsized our health care delivery for, and that creates inequities and outcomes downstream.
Sara:00:00:33
A conversation about equity in health care and how listening to patients improves the care they receive, on this episode of The CX Leader Podcast.
Announcer:00:00:48
The CX Leader Podcast is produced by Walker, an experience management firm that helps our clients accelerate their XM success. You can find out more at walkerinfo.com.
Sara:00:01:00
Hey, everyone. I’m Sarah Walker, host of this episode of The CX Leader Podcast. And as always, thank you for listening. It’s never been a better time to be a CX leader, and we explore topics and themes to help leaders like you develop great programs and deliver amazing experiences for your customers. Conversations around diversity, equity and inclusiveness have been happening in many companies in the US, and health care is no exception, especially when it comes to the care patients receive. And listening to patients needs and concerns is vital to providing doctors, nurses, administrative staff and leadership with the insights required to providing equitable care for all their patients. But what does it mean to give equitable versus equal in the care providers give to their patients? My guest today are going to help us dig more into this topic of equity in health care. Ariel Davis is the head of health care provider solution strategy for Qualtrics, and Nicole Richendollar is a vice president in our client services here at Walker. Nicole focuses on patient experience and is no stranger to the podcast. Ariel. Nicole, thank you for being on The CX Leader Podcast.
Nicole:00:02:02
Thanks Sara. Glad to be here.
Ariel:00:02:04
Yup.
Sara:00:02:04
Yeah, we’re excited to dive into this topic a little bit more, and I think maybe to get us started in our conversation today, Ariel would be helpful if you can maybe give us an understanding or a definition of of what is health equity.
Ariel:00:02:18
Yeah. Um, actually, I love this question. Um, because it seems very simple. But the truth is, there’s actually a variety of understanding across organizations and teams, um, and sometimes interchangeable terms, they don’t necessarily mean the same thing when describing health equity, but, um, I really like to leverage, um, the definition that Healthy People 2030, uh, provides. And it says that it’s the attainment of the highest level of health for all people. Um, and to achieve that, it requires valuing everyone equally, with focus in ongoing societal efforts to address avoidable inequalities, um, historical injustices and elimination of health and health care disparities. So, uh, that is the most rounded, inclusive definition that I typically leverage.
Sara:00:03:12
Yeah that’s great. And maybe for a further clarity and clarification, just in incorrect interchangeable terms, Nicole, would you have anything to add to Ariel’s definition or maybe how health equity is different from equal health care for all, which is perhaps another term that people have heard before when discussing this topic.
Nicole:00:03:33
Yeah. So when I think about equal health care, I think about everyone getting the same exact treatment, regardless of what’s going on in your life. And it’s just very equal to every single person. But we know in the real world that that’s not always realistic. And there’s things that kind of come into play, such as social detriments of health and inclusivity and as well as, you know, access to health care, just things that are going to differ to each person who comes into contact with the health care system. So having equal access is great, but you really need to individualize that and be able to better reach the person’s needs while you’re actually caring for them.
Sara:00:04:11
Yeah. And how does equity versus equality impact people’s health? Or maybe the the system of health care and the health care providers. How does that come into play when thinking about the differences and the nuances?
Ariel:00:04:27
I think that’s a great question. And I think that’s a question that we’re all still…
Sara:00:04:30
Yep.
Ariel:00:04:30
…answering, but also have a lot of evidence as to, um, what not providing an equitable health care experience, um, has resulted in, in a, in by way of negative outcomes. Um, typically, you know, health care systems have a very high quality and safety focused approach to their health care delivery and, um, health care communication. And there’s typically a somewhat blanket or equal approach in, in insurance that we want to make sure that everybody gets all of these tools that we have in the same way, um, all the time and repeat this across all these different patient groups. Um, and the results of that, um, as Nicole kind of mentioned before, is these groups of people who have additional challenges that we haven’t rightsized our health care delivery for, um, and that creates inequities, um, and outcomes downstream. So it may seem like a small thing that, you know, like everybody needs to schedule this one way. Right?
Sara:00:05:37
Right.
Ariel:00:05:37
But if there’s a certain segment of people with a certain disability or accessibility concerns that can’t schedule in the same way everybody else does, well, then that group of people inevitably are going to end up with worse outcomes because they were never able to receive the same level of care. Um, and according to that initial definition that we shared, um, attaining this highest level outcomes for all people is what health equity is.
Sara:00:06:04
No, I think that makes a lot of sense. Um, you know, I can just reflect on my personal experience in, you know, interacting with any sort of provider. And it can be a lot for, um, various folks to be able to digest and interpret and navigate. And when we talk about this idea of, of equity, there has to be some sort of recognition that certain groups or certain classifications of patients require a little bit more support. How does that definition or how do you know when you need to be providing additional services, additional support to those patients to provide a more equitable solution? And is that data points that providers have access to in order to control for some of what we’re discussing today?
Ariel:00:06:55
Yeah. Um, Nicole, feel free to add on here. But, um, as you alluded to before, those social determinants of health have been determined as the driving factors of those inequitable outcomes across patient groups. And, you know, we often talk about some of the very obvious, um, social determinants of health, um, that come into play, things like social and community context or the neighbor, the neighborhoods that you came from. Um, things like different races or even differences in gender. Right. But also differences in, um, disability or economic status, um, or even educational level. Um, but really, even across education levels, there’s, um, a huge need to just personalize how we’re delivering information because of, um, the small amount of people, um, across the nation or, you know, really globally that are literate in health care communication…
Sara:00:07:55
Yeah.
Ariel:00:07:56
…in general. So, um, those social determinants of health, um, are pretty well known, I would say, to most health systems, but it’s not easy to leverage them in, I think, normal processes. Right. It hasn’t…
Sara:00:08:12
Right.
Ariel:00:08:12
…been um, it hasn’t been a part of the norm to include it in, in the way that care is tailored on a day to day basis because resources are limited. Right.
Sara:00:08:23
Yeah.
Ariel:00:08:24
And so I think that providers do a really great job leveraging what they have and what’s available to them. But I think that there’s still a big opportunity, um, to use those in new ways, uh, to continue to advance those outcomes.
Nicole:00:08:38
Yeah. And to add on here to, I mean, the amount of data and information that we collect from our patients and our communities, we have so much information available at our fingertips. So oftentimes it can become overwhelming. Like what information should you be pulling? What information should you be using? And I think it really comes down to like the situation you’re in. What are you trying to achieve and what are you trying to focus on, and pulling in the specific data that will help support that? The other thing that, you know, just talking through with the different providers and how they’re going to leverage some of this information, if you don’t have it, you know, making sure that you take the time to ask people like what is needed for you, what resources do you need to have to be able to achieve success and have those health outcomes that you’re looking for, too? Because I think just sometimes having those conversations can be really beneficial with the populations we’re trying to serve. And that may be sitting down one on one with a patient or having larger conversations with communities out in the public. So it doesn’t necessarily always have to be in a health care setting.
Sara:00:09:39
Hmm. Yeah, I think that’s really interesting as well, because you think of in the broader health care space, you know, while providers are attempting to provide this more equitable patient experience, there’s so many other players in the health care space because, for example, potentially your insurance is determining where you are going to seek out your, your care. Um, right? Or the communities and some of the other social determinants of health that we’ve discussed here. It’s very difficult to maybe separate the flow of the or the journey, if you will, of the patient experience. And so how do you take those factors into consideration is is got to be, you know, part of the solution that the providers are thinking about on their end.
Nicole:00:10:25
Yeah. When you’re doing process improvements to, you know, thinking about health care systems in general have been like, how does this work for us and how do we make it better from a system? But…
Sara:00:10:34
Right.
Nicole:00:10:34
…I think making sure that we’re pulling in the people who are trying to serve as the focus of how we’re going to make these process improvements better for those individuals is really important too.
Sara:00:10:44
With what you guys see in your day to day work with clients and providers and patients across the board. How does the topic of health equity get considered? Is it… Is it based on feedback that comes through, that is then, you know, um, segmented by certain groups. And we see we’ve got gaps in areas that we’d like to make up. Or is it, is it a… Is it a leading indicator of we want to do better and we know we need to make improvements, and thus we want to measure and look at our experiences that we’re providing? I think it might just be interesting for our listeners to think about the the lead versus lag in terms of health equity and how these conversations are being discussed within patient experience, kind of as an industry.
Ariel:00:11:30
Yeah, well, one, I will say right. For over 20 years it’s been established, as you know, a core requirement for…
Sara:00:11:37
Right.
Ariel:00:11:37
…quality outcomes. And so these social determinants of health are absolutely leading indicators of the potential negative outcomes that are going to be experienced if organizations aren’t flexible or leveraging that data that they do have available to them in order to tailor the care. And so we see, I see a variety of things, right. Like there are organizations that are like, hey, specifically this group of patients in our organization are struggling with this specific thing, and we need to be able to intervene in a thoughtful way here. Um, or like the work that we’re doing with Hennepin, they’ve had a system wide strategic plan around equity for the last few years, with goals implemented across several pillars, including their employees and their development, um, the future representation of care in their organization, uh, their patient representation. And so they were able to identify multiple gaps along the, um, end to end experience because equity isn’t one point in time. Right?
Sara:00:12:44
Right.
Ariel:00:12:45
Um, and so leveraging that end to end strategy, um, we’re able to come to us and say, hey, we don’t really hear enough in general from these groups of people, and we need to have a strategy around lifting their voices overall so that we can identify what they need specifically. Um, and then create interventions that are specific to the voices that they’re sharing with us and what would be required for us to improve trust, uh, which we know is directly tied to improved outcomes.
Sara:00:13:26
You mentioned a couple things there that I want to dig into a little bit more, ariel. So you said that arming employees within the provider to be able to contribute to the improvement of health equity and the individual patient experience, um, but then trust, trust and, you know, employee skills on the provider side seem like they could go hand in hand. So how does… How does trust play or factor into making inroads in providing a more equitable experience across the entire patient base? Um, is that something that you, that you measure as part of your listening program? And I would imagine that goes then into the skills training on the employee side. Can you speak to that a little bit more?
Ariel:00:14:10
Yeah. And, you know, um, I won’t pretend to be an expert in the employee side. Right. We have a team of psychologists and very brilliant people, um, that have put together our DEI framework and, um, how we support employees and their, um, improvement processes for, um, creating equity in their employment experience…
Sara:00:14:32
Right.
Ariel:00:14:32
…and their well-being, and then also them as patients themselves within the organization. But we do absolutely measure trust, um, from a patient experience perspective, um, we also measure things like well-being and belonging on an from an employee perspective.
Sara:00:14:51
Mhm.
Ariel:00:14:52
Um, and then to your point, uh, also encourage and evaluate for opportunities like unconscious bias training that will help contribute to the care, um, and the trust that is being created, um, and the experiences those employees are creating with these patients. Um, but from a patient perspective, each segment or group of patients, um, whether it’s by race or zip code or whatever other social determinant of health we’re talking about, um, has a different set of values, um, that ultimately results in the ability to trust their care provider, um, and ultimately adhere to whatever treatment recommendation and care plan that follows. And several publications, including the NIH, have been able to directly correlate trust with patient outcomes. Um, and so with Hennepin, specifically, is one organization that we’re able to measure trust. And actually trust has become a core metric on our benchmarking at…
Sara:00:15:53
Hmm.
Ariel:00:15:53
…Qualtrics as well, so that organizations can begin to evaluate and even compare, um, the trust that they’re creating within the organization, and then also be able to evaluate through, um, several other data points, what trust and values actually mean to these different groups of patients?
Sara:00:16:12
Yeah, and I think of trust too as such a, a personal data point or a personal metric. Because while I can think of do I trust an organization, do I trust that I, you know, am being treated well by this hospital system or this provider? I have to imagine that a lot of the trust element comes into the personalized care of the nurses and doctors that each of the patients is working with. Is patient experience at a level of sophistication where you can be assessing the the patient’s trust levels with the individual care providers for that shift that day, that treatment plan? And when, Nicole, you’re talking about all of the different data points that the health care system and patient experience can gather in general, I wonder if the timeliness of the listening and how that impacts some of these larger drivers of things like trust and how that factors into this broader advancement of health equity kind of comes into play. Is that… I guess, where, where is the industry with that as a whole, just factoring in some of the greater privacy concerns and all of the other intricacies that the patient experience, you know, industry as a whole, has to take into consideration?
Nicole:00:17:33
Yeah, I would say here that patient experience and healthcare in general is ready for that level of trust and to measure that and be able to collect that. I think they’re eager for this information because, you know, as healthcare providers, we want to do better. We want to treat our patients better and be able to provide that exceptional level of care that we have or can deliver. So I think we are at a level to be measuring that. I think for being able to break it down by different shifts and providers. It’s happening in today’s world. We can see that, we can pull that information and have that data. And I think there’s a lot of learnings and opportunities that we can use that for. But there’s also using it for rewards and recognition to our colleagues to call out, you know, when you’re doing really good thing. We have to look at, you know, where can we make changes, where can we make things better. But we also have to recognize that we do some stuff really, really well too. And so with trust, as it’s a leading indicator for, you know, likelihood to recommend and employees coming or patients coming back to us and having a better experience. There are some areas where we are doing really good in the trust environment to.
Ariel:00:18:43
I was just going to quickly add about your mention of timeliness. Um, it is important to evaluate the best time to ask that question, but the question is still just a metric. If you’re not doing something about actually creating trust, right. And…
Sara:00:19:00
Right.
Ariel:00:19:00
…oftentimes that isn’t directly at the hands of the care provider. And that’s why, you know, I… I’ll reiterate the importance of weaving equity throughout the experience, because trust is often broken when you know you’ve double booked my appointment. Trust is broken when I was only five minutes late and you’ve already canceled my appointment. Trust is broken when I get an incorrect bill after I left the hospital, you know? Um, and so it’s really about being able to see across these experiences and then separate them by these groups of people and say, hey, where did we break trust with this group of people most often? And what can where can we intervene to rebuild it? Um, more so than even asking and measuring the question itself.
Sara:00:19:47
Yeah, absolutely. I think that that’s a very well articulated reflection as to why actioning is so important and just what the proper mix of leading versus lagging indicators and data points and pieces of information really is. I want to talk a little bit more about understanding the data points that we have, potentially knowing where gaps occur. How do you design solutions to better serve populations that are not being treated in the most equitable manner? And what is the best way to approach something that is, you know, obviously a massive undertaking that is going to, you know, take time and resources and cooperation? Uh, where do people start? Where do organizations start when thinking about designing for some of these gaps or areas where they need to have improvements?
Ariel:00:20:42
I, you know, I would say start with the magic wand, right? Like it does take a long time for some things to happen. It is an uphill battle for some things to get accomplished. But if you start with where you could see the end being, then you can work your way back to the starting point. Because, uh, like Nicole said, there’s no health system or provider, um, or team that lacks data. Um, and so there is a way to leverage what you have today to get a better understanding, um, to start with something that may be more grassroots. You know, everyone always gets up in arms and says, we don’t have any extra people to do any extra things. Um, but technology really allows for true flexibility, right? Um, for some people that might be identifying one patient group that you need to reach out to and in completely automated way, um, just so that you can connect them from one care point to another. And for others, it’s a simple analysis of the historical data that you have to understand historically, what have these groups of patients said to us, or have we heard from them at all? And if not, how do we… how do we hear from them better moving forward? Um, so that’s what I would say. Start with what you have, because you have plenty. And it doesn’t have to be, um, something that’s huge and complex, but definitely still have the end in mind because, um, you can get there with one, one step at a time.
Nicole:00:22:22
I would add in too, it doesn’t always have to be patient experience data that you’re looking at. Like EMR, electronic medical records, how so much information about people and their journeys and exactly, you know, what they need out of their services. You can also look at other things, such as like complaints and grievances or other routes of listening or ways to gather information. It doesn’t have to be your standard cap surveys or patient experience surveys. There’s lots of other information that you can pull from to gather those information.
Sara:00:22:54
Yep. As you both have alluded to, there’s no there’s no lack of data within health care and patient experience as a whole. So getting visibility or maybe it’s like alignment and going looking for the opportunity areas, right is kind of a key first step. And then deciding what you’re going to do and being focused on progress and achieving kind of that vision over time. That makes a lot of sense. Well, I think we’re getting to the point in the podcast where we try to summarize as best we can the the discussion we’ve had today into what we call the take home value. If there was one tip or trick that you could give a PX professional listening to this podcast as far as how to make progress towards health equity, what would you recommend that they could get started with, you know, right away? Ariel will ask you first.
Ariel:00:23:46
I know that we’ve talked about it a couple of times, but I would really say, um, starting with just a current state evaluation of the information you have. Um, even down to how are our patients designating themselves in some of these, um, data points, like their race and other social determinants of health that you might want to start tracking? Because data quality is extremely important, right. As you’re trying to target specific groups and really track improved outcomes. Um, so I would say that would be one big thing. And then the second thing is just intention, um, for creating a change and taking an action. Right? It doesn’t even have to be technology as a first step. The first step could be, hey, we have this, you know, for actually for Hennepin, when they were in the beginning of their journey, they realized that their black maternal patients didn’t have black hair care products, um, and during their…
Sara:00:24:50
Hmm.
Ariel:00:24:50
…hospital stay, um, and that can make a significant difference in the quality of your experience while you’re there. And so they put together, um, specific care baskets for those patients, which was just a very caring thing to do…
Sara:00:25:03
Yeah.
Ariel:00:25:03
…right? Um, it wasn’t technology driven. It was just something that was intentional and from the heart. Um, so I think that when you have an intention to create, um, personalized experiences, the opportunity is there.
Sara:00:25:15
Yeah, that’s a great example, and definitely not one that requires ripping out old software or on-prem solutions or things that, you know, start to become super overwhelming. But an example of how the intent can make a big difference. So what a great example. Thanks for sharing that. Nicole, what would be your take home value?
Nicole:00:25:36
So I would say, you know, health equity is a global issue. It, you know, goes beyond just the United States. It can touch upon many, many people. It requires collaboration to be able to address the global and even in the United States, the health disparities and promote health equity for all. So I would say for my take home value is one, just start, start somewhere. Looking at that data, as Ariel mentioned, um, looking at the information and the resources you have at your fingertips and just start somewhere. Don’t keep pushing it up. The other thing is making sure it’s not just a check the box kind of saying, you know, oh, other health care organizations are doing this. We need a stand something up in this program. Like really do it for meaning that we need to really change the way that we are promoting health equity in our communities and for the patient population, who’s the end goal? And lastly, I would just say look internally at yourself and maybe do some, you know, unconscious bias evaluations and see if there’s anything that you know, you have going on that you can help be able to promote health equity and provide better services for the patients and the communities, too. So start somewhere.
Sara:00:26:49
Great advice. Ariel Davis is the head of healthcare provider solutions strategy for Qualtrics, and Nicole Richendollar is a vice president in our client services division here at Walker. Nicole, Ariel, thank you again for the time. If any of our listeners want to get in touch, to maybe follow up on a specific question or interest area, from what they heard today, what would be the best way to get in contact with each of you? Ariel, maybe you can share first?
Ariel:00:27:15
Yeah, by email is great. It’s arieldavis@qualtrics.com. a.r.i.e.l.d.a.v.i.s @qualtrics.com. Um or LinkedIn backslash arielldavis.
Sara:00:27:30
And Nicole?
Nicole:00:27:31
And for me, you can reach out to me at Walker, which is nrichendollar, n.r.i.c.h.e.n.d.o.l.l.a.r at walkerinfo.com. Or you can reach out to me on LinkedIn at nrichendollar.
Sara:00:27:41
Great. Thank you both. And if you want to discuss this topic with any of the other experts here at Walker, or have a great idea for a topic of a future podcast episode, you can also email us at podcast@walkerinfo.com. We’d love to hear from you! Be sure to rate The CX Leader Podcast through your podcast service and leave us a review. Your feedback will help us improve the show and deliver the best possible value to you, our listener. Check out our website cxleaderpodcast.com. From there, you can follow the show and find all our previous episodes and a link to a blog, which we update regularly. The CX Leader Podcast is a production of Walker. We’re an experience management firm that helps companies accelerate their XM success. You can read more about us at walkerinfo.com. Thank you for listening and remember, it’s a great time to be a CX leader. We’ll see you next time.
Tags: healthcare Sara Walker Nicole Richendollar equity DEI Ariel Davis