Patient Equity

Since Leading a Culture of Safety: A Blueprint for Success was published in 2017, it has been a powerful tool for healthcare systems to improve patient safety. To reach our obligation of eliminating all patient harm, we must acknowledge that the environment in which we deliver healthcare, and our processes for maintaining patient safety, evolve over time.

The COVID-19 pandemic, and the lower-than-desirable vaccination rates among minority populations, have highlighted the extent of the justifiable lack of trust in healthcare by minority groups. Systemic and structural racism has permeated our healthcare delivery system for generations, contributing to racial inequities in health. It is this injustice that has reaffirmed our commitment to a value that we believe is critical to our goal of eliminating all patient harm, and one that should be adopted by healthcare systems nationally. That value is equity. In honor of the World Health Organization’s World Patient Safety Day, let’s examine the importance of equity to patient safety.

Leading a Culture of Safety: A Blueprint for Success says this on the subject of equity: “The reality of healthcare today is that quality and safety cannot be achieved without equity. Healthcare organizations have the power to address disparities at the point of care and to make an impact on many of the determinants that create these disparities (Institute for Healthcare Improvement 2016). Because equity in health is essential to quality and safety, mitigation of health disparities must be prioritized across the six domains for developing a culture of safety.”

Just as safety is one of Main Line Health’s non-negotiable standards, equity is also. We reaffirm and demonstrate our commitment to equity in several ways:

1. Strategic Plan:

Main Line Health’s 2022–2026 strategic plan clearly illustrates our commitment to equity. Within our strategic plan imperative to “Advance the Health and Wellbeing of the Communities We Serve,” we pledge to “build trust, identify and eliminate disparities in care with the understanding that structural racism has affected confidence in the healthcare system.”

Part of this plan is to embed equity into our clinical environment workgroups and service lines. A leading example of this is our obstetrics and gynecology CEW; to address the disproportionate rate of maternal deaths among African American mothers, leadership prioritized integrating safe and equitable treatment of minority mothers into all aspects of OB/GYN care. 

2. Mission, Vision and Values:

MLH’s mission, to meet the healthcare needs and improve the quality of life in the communities we serve, has not changed. But our vision and our values—the ways in which we commit to our mission—have been transformed in our strategic plan to encompass and prioritize equity.

Previously, MLH’s vision was to “Be the healthcare provider of choice in leading and optimizing the health of all in our communities.” Now, MLH’s vision is to, “Be the healthcare provider of choice in our communities by eliminating harm, achieving top decile performance, delivering equity for all and ensuring affordability.”

MLH also added equity to our values, as part of our Diversity, Respect, Equity and Inclusion Initiative.

3. Diversity, Respect, Equity and Inclusion Initiative:

In 2013, MLH announced the launch of our DREI initiative as integral to fostering a culture of respect and safety. Included in this initiative is a commitment to recruiting and retaining a diverse workforce by increasing diversity in management, board and professional positions; eliminating disparities in care; educating staff on cultural competencies; integrating diversity into all elements of the strategic plan; and strengthening community and vendor relations.

4. Quality, Safety and Equity Committee:

Our belief that equity is integral to promoting patient safety is further illustrated by the title of our safety committee. Established in the early 2000s, the group was originally the Quality and Patient Safety Committee. We dropped “Patient” from the committee name after the 2014–2016 Ebola outbreak, to emphasize that the safety of our employees was equally paramount to the safety of our patients—a point that has become even more evident during the COVID-19 pandemic. Most recently, we added “Equity” to the committee title to establish our commitment to equity as a vector for eliminating all harm. We are constantly learning from our lived experiences, and the evolution of Quality, Safety and Equity Committee reflects this. 

5. DREI Learning:

To enact change within our community, we needed to first establish organizational behavioral expectations around placing equity at the forefront of patient safety. A component of this campaign involved intensive DREI-focused education that empowered us to explore our role as employees in the creation and engagement of a diverse, respectful, equitable and inclusive environment. MLH leaders took classes to better understand how perception and personal bias can impact interactions with others, what behaviors help cultivate inclusion and how to foster productive communication skills.

Committing to Equity

We can incorporate key words such as equity, diversity and inclusion into our mission, vision, values and strategic plan, but it means nothing without accountability. On July 1, 2020, Main Line Health and 12 other southeastern Pennsylvania health systems announced the Anti-Racism Health Care Collaborative Commitment to combat racism, inequality and discrimination in all forms. This commitment is important in recognizing and addressing the role that systemic racism has in the healthcare industry. Together, Main Line Health and our regional colleagues have aligned to foster a diverse, equitable and accountable environment, and address healthcare disparities.

We need to commit to eliminating disparities of care the way we have committed to patient safety. This requires us to measure and assess those disparities, and commit to equity.

---

John J. Lynch III, FACHE, is the president and CEO of Main Line Health, Bryn Mawr, Penn. (lynchj@mlhs.org); Eileen Jaskuta, RN, is the MLH system vice president of quality and patient safety (jaskutae@mlhs.org); and Emma Myers, RN, is an MLH administrative fellow.

Editor’s Note: Want more on safety? Check out our continually growing collection of safety-related thought leadership, curated with you in mind. Here are the most recent pieces we’ve published from our safety repertoire. Additional resources include Leading a Culture of Safety: A Blueprint for Success and Safer Together: A National Action Plan to Advance Patient Safety.