4 questions to ask yourself to provide more inclusive health care

The Lown Institute's report is yet another effort in a series of recent attempts to quantify and rank health care organizations' progress on achieving health equity. The authors delivered a bold and necessary message: Hospitals across the U.S. are racially segregated—that is to say, their Medicare patients' racial demographics don't match the demographics in their surrounding communities. These results might come as a shock to some—especially for those working at hospitals near the bottom of the list. But this data shouldn't be surprising.

How did we get here?

Hospital-based organizations tend to thrive in diverse, urban settings, yet their patients and workforce often fail to reflect the diversity in their communities. This is not a coincidence. Rather, it is the result of centuries of racial discrimination in health care that have stark modern-day consequences. Many U.S. hospitals were once designated specifically for non-white people, and many of those institutions continue to face insufficient resourcing and staffing. As a result of this historical segregation, and due to adverse social and medical determinants of health that disproportionately affect communities of color, non-white patients not only struggle to access necessary care but are justifiably more likely to mistrust the health care system. Countless other structural features of the care delivery system—including the way hospitals get paid—also perpetuate this segregation.

So what should provider executives do about it?

Leaders today have a responsibility to actively address longstanding inequities such as racial segregation. After all, virtually every provider institution's mission statement professes a commitment to improving the lives of all people in their surrounding communities. However, if executives truly aim to become more inclusive, their solution set must go beyond addressing the segregation called out in the Lown report.

Although the metric these researchers used was informative and well-intentioned, it is misleading for them to call it a measure of "inclusivity." What the Lown Institute is really tracking here is the diversity of their patient population, relative to the surrounding community. And despite being an important baseline, this is incomplete. While diversity is about demographic representation, an inclusive culture ensures all patients feel they belong, are valued, and are treated equitably. An organization could have a very diverse patient population, but that doesn't guarantee their patients feel included, let alone receive equitable care. Leaders should ask the following questions to assess their opportunity for creating more inclusive organizations:

• Is my organization consistently providing culturally sensitive care?
• Do we have protocols for actively mitigating unconscious bias during care delivery?
• How are we building trust with historically marginalized patient communities?
• How do we incorporate community feedback into our system's strategy to reduce disparities?

Given the current absence of a perfect metric to measure consistent delivery of culturally sensitive and inclusive care, provider organizations can begin to answer these questions by stratifying:

1. their clinical quality and process of care metrics; and
2. their patient experience scores by race, ethnicity, gender identity and sexual orientation, age, and preferred language (REGAL) data.

Leaders should share the results of their analyses both internally and externally. Even if the data may not tell the story they want it to, transparency breeds accountability. Equipped with compelling evidence, executive teams can invest in reducing disparities and work to make their organizations inclusive of marginalized groups in their community.

What does this study portend for future health equity ratings and research?

Overall, research studies like this one are encouraging to see. They add nuance to how we understand health equity and apply pressure on provider organizations to make needed change. But to truly elevate our standards as an industry, we must embed equity metrics into existing rankings and industry-wide assessments, as opposed to creating new ones solely dedicated to health equity. Currently, only three hospitals from the U.S. News Honor Roll made the top 200 for "inclusivity" in the Lown report. Just as the release of the report serves as a wake-up call for many hospitals, it should also be an indicator that ranking bodies might be missing the mark by overlooking equity measures moving forward.