Achieving Health Equity Hinges on Iteration, Continuous Learning

In what could feel like a culmination of decades of hard work, Hackensack Meridian University Medical Center’s recent Joint Commission certification for Health Care Equity is, in fact, another stop along its journey to health equity.

To the New Jersey-based hospital, health equity isn’t just a certificate or a sprint or even a marathon. In fact, its health equity journey doesn’t even have an endpoint.

And it shouldn’t, according to Mark Sparta, the president of Hackensack Meridian University Medical Center.

“Our health equity efforts have been a journey, and they didn't just start when health equity became one of those hot terms out in the industry,” Sparta, who’s also in charge of the northern region for Hackensack Meridian Health, said in a recent interview.

“I think back over the course of time, and it has certainly been a journey, and there's no destination. We learn new things every day that help us refine our strategies and develop new strategies towards addressing some of the health disparities and improving health equity out in the communities that we serve.”

That brick-by-brick approach has served the health system well. In August 2023, Hackensack Meridian University Medical Center was the first hospital in the nation to receive the Health Care Equity Certification from the Joint Commission.

The certification process started with data collection and analysis. The hospital had to collect information about patient care, communication, socioeconomic status, staff education, and different hospital policies like staff recruitment and retention.

From there, Hackensack Meridian University Medical Center held an on-site review during which the Joint Commission looked at 40 different standards, like quality and patient safety measures stratified by sociodemographic factors. The Joint Commission also looked at things like race, ethnicity, and languages spoken by staff and organization leadership and how that aligns with the community the hospital services.

Notably, the assessment also included a look at Hackensack Meridian University Medical Center’s Health Care Equity performance improvement plan, highlighting the never-ending nature of this work.

The process was rigorous, to be sure, but it’s one Hackensack Meridian University Medical Center was poised for after a long history of working towards health equity. Take, for example, all of that work to ensure the hospital’s staff reflected the community the hospital treats.

Cultivating workforce diversity wasn’t something Hackensack Meridian University Medical Center did to check a Joint Commission box once it decided to get Health Care Equity certified; the hospital has taken incremental steps to become that diverse because diversity aligns with its overall values for providing quality care to all.

“We have a very diverse leadership team, and that didn't happen overnight—that happened over the course of time,” Sparta explained. “That's really important because in order for us to appropriately care for a very diverse population and community, it's important that we have folks on our team who have had similar life experiences.”

In the clinical outcomes arena, too, Hackensack Meridian University Medical Center said it performs well. The hospital has good clinical quality measures, like hospital readmission rates or patient safety, and there isn’t a significant gulf in inpatient outcomes by race or other sociodemographic factors.

Still, Sparta and his team always have their eyes on where they can improve.

Separate from the Joint Commission Health Care Equity Certification, Hackensack Meridian University Medical Center has also participated in the American Hospital Association’s Health Equity Transformation Assessment (HETA) survey in its pilot phase.

It was with those results, which came in the winter of 2022, that Hackensack got insights into how it can do better with community engagement.

“Interestingly enough, when we looked at our health outcome data within the four walls of the hospital, it's been very consistent and doesn't vary a whole lot,” Sparta said. “However, when we look at our post-discharge data, whether it's discharge to home, whether it's readmission data, ED recidivism, those types of things, when we look at that data, the Health Equity Transformation Assessment survey actually highlighted some opportunities.”

Particularly, it pushed Hackensack to take a closer look at social determinants of health (SDOH) that affect its patient populations. Leaning particularly into SDOH screening, Sparta said the organization took on more responsibility for orchestrating patient access to the social services that can impact their health and outcomes outside the hospital.

“It's not about stereotyping,” he cautioned. “It's really about providing a customized level of care post-discharge, depending upon what their needs are. And really, that's what health equity is all about. It's ensuring that the folks who need specific care get it. Not simply that it's available to them, but making sure that they get it.”

Thus began another leg of Hackensack’s journey toward health equity. Working with different members of the community, the hospital created new programs that could support patients screening positive for food insecurity or poor access to pharmacy and prescriptions.

“I see us as being the orchestra conductor,” Sparta noted. “We don't necessarily have to provide housing, we don't have to provide the food bank services, but we need to be able to connect those in need with those services to ensure that they're able to maintain their health outside of an institutional setting.”

That’s a big logistical hurdle, he added. For one thing, Hackensack Meridian Health, for which the University Medical Center is the academic flagship, has 500 different sites of care across the state. That means the health system needs to serve a lot of different patients with different needs in different places. To do that, Sparta and his colleagues need to have partnerships with a lot of different community organizations, and it can be hard to coordinate all of them to meet patient needs.

What’s more, community health partners aren’t always easy to come by. Sparta said Hackensack relies heavily on boots-on-the-ground workers who can be a liaison with the health system and its hospitals, but it can be hard to keep up. Some of these social services lose their funding and shut down while others open up in their place.

It’s a constantly revolving door, and Hackensack quickly realized it needed the systems in place to keep track of it all.

“Within our population health division, we actually have a vice president of social determinants and she's done a fantastic job of really systematizing the various services that are available across the eight counties that we operate in within New Jersey, and also services that are available in other counties because clearly patients that come to us don't always just come from those eight counties,” Sparta said.

Hackensack has also leveraged its health IT providers, Epic Systems and Unite Us, to help orchestrate social services connections.

The point isn’t for Hackensack to provide every social service to every patient. Instead, it sees itself as an anchor institution that can be the epicenter of holistic patient care, Sparta said.

“Hospitals are no longer the center of care, but they are the center of many communities,” he pointed out. “They have so many far-reaching relationships within the communities that they're perfect as clearinghouses for being able to bring those community services all together in a coordinated fashion.”

It’s that work in social determinants and community health that’s led Hackensack Meridian University Medical Center to its Joint Commission recognition in health equity. But, of course, the journey is hardly over; it never will be, Sparta said.

“It's important to realize that there is no destination. It is a continuous journey, and you have to always believe that you can do something better,” he concluded. “It's impossible to boil the ocean, but it's really important to be able to understand where the opportunities are, the real opportunities in the community. Because that's when you can really begin to develop specific strategies for addressing those opportunities. One size will not fit all, for sure.”