5 Leading Principles for Actionable Health Equity Work

A new guidebook drafted by experts convened by the Robert Wood Johnson Foundation (RWJF) has set forward to provide actionable recommendations for how healthcare organizations can address health equity.

The guidebook, Raising the Bar, outlines a set of five foundational principles that RWJF and partner organizations said can help healthcare organizations actually deliver on the promise of health equity.

Health equity has become something of a buzzword, particularly after the COVID-19 pandemic exposed the latent health disparities that have long plagued US healthcare. Provider organizations and health systems responded to growing discussions of health disparities by making health equity pledges.

But although likely well-intentioned, committing to health equity can be an abstract goal, the report authors noted.

“Broad transformation remains too slow and often focused on narrow fixes to the most visible problems; the healthcare system, as it has evolved, is not delivering on key health goals, frustrates many of its participants, and often fails those most in need,” they wrote.

“The COVID-19 public health emergency and the national reckoning over equity and racial justice have amplified the importance and opportunity for change and shows the need for a new path for healthcare in recovering from the scope of overwhelming need.”

Raising the Bar was authored by experts convened by RWJF, including folks at the Funders Forum on Accountable Health, Health Care Transformation Task Force, National Association of Community Health Centers, the National Partnership for Women & Families, RESOLVE, Social Intervention Research & Evaluation Network, Trust for America’s Health and Well-Being and Equity (WE) in the World.

“Healthcare leaders have made a significant shift in how they view the importance of equity, but operationalizing the commitment requires a very bold and comprehensive approach. Ultimately, it requires taking actions to improve the community, patient care, workforce policy and other areas,” Donald Schwarz, MD, MPH, MBA, senior vice president at the Robert Wood Johnson Foundation, said publicly.

“Achieving equity in healthcare is multi-pronged and must ultimately be integrated throughout all operations,” Schwarz continued. “This new framework outlines how healthcare can approach its work differently to achieve much-needed change.”

Together, the organizations put forward five core principles that should guide organization health equity work, including:

• Mission: creating a mission to improve health and well-being of all patients
• Equity: pursuing health equity and racial justice, as well as eliminating discrimination
• Community: working to serve the whole community as an engaged, responsive, and informed partner
• Power: sharing and effectively using resources and influence
• Trust: building, earning, and sustaining trusting relationships with key stakeholders and populations

In addition to outlining foundational principles, Raising the Bar pointed out key roles healthcare organizations need to play in order to deliver on their promises for health equity.

Foremost is the provider role with which organizations are likely most familiar. Raising the Bar said organizations need to focus on their strategies to deliver whole-person, patient-centered care that prioritizes health equity by eliminating health disparities.

That means creating innovative strategies to facilitate patient access to care, creating and sustaining an environment that prioritizes cultural competency and personal safety, and providing holistic and high-quality care that considers the social determinants of health.

Second, organizations must understand their roles as employers. Most health systems are the biggest employers in their communities, providing jobs to clinicians, administrators, service staff, and other folks that keep hospital operations running.

Decisions about clinician workforce diversity, equal representation, healthy and safe working environments, and DEI efforts will be crucial in this area, Raising the Bar said.

Next, organizations should look at themselves as partners, something that has come to the forefront as community health partnership has shown promise for improving health outcomes. Involving community members in organization governance, building relationships with trusted leaders and community organizations, and respecting the expertise of those community partners will be key.

Finally, organizations must understand their roles as advocates with a lot of influence. Pushing for payment reforms that emphasize health equity, engaging the public in the importance of dismantling institutional racism, lobbying for health equity in public policy, and investing in the community should all be paramount for organizations pledging health equity.

Raising The Bar represents one effort at creating a playbook by which organizations can craft their health equity priorities. Health disparities existed long before COVID-19, but the pandemic served as a catalyst to push many organizations to promise action.

There hasn’t been an established roadmap for achieving health equity, most experts have acknowledged. But as more organizations begin to broach the issue, Raising the Bar has the potential to convene those experiences into a set of best practices.

“Long-standing structural and systemic challenges within healthcare are well-known, but the pandemic underscored the imperative to confront root causes of health inequities,” said Karen DeSalvo, MD, Raising the Bar Stewardship Council co-convener, co-founder NASDOH.

“Raising the Bar solicited input from all sectors and everyone who shares concerns about the current healthcare system, and they all see the need for bold action, but direction on concrete steps to take has been lacking,” DeSalvo added. “Now there is a clear framework to guide the work.”