Over the last 14 months, we've seen an unprecedented number of new commitments to health equity across the industry. At first, it was tempting to view this momentum as a watershed moment, where every new commitment to equity inherently benefitted the ultimate goal of advancing equity. But this line of thinking can be dangerous. Too often we've seen leaders follow statements aimed at advancing equity with efforts that are merely passion projects—relatively one-off programs or investments dedicated to pet issues based on personal interest—not true organizational transformation. They also tend to rely on a small group of motivated volunteers, rather than holding all staff accountable for their role in either advancing (or impeding) health equity. While it’s important for leaders and staff to live their organization's mission, defaulting to passion projects alone will ultimately undermine the viability of a long-term health equity strategy—and prevent organizations from meeting the very real needs of their employees, patients, and community.
Two warning signs that your organization is defaulting to passion projects
Efforts are disjointed, one off, and ultimately temporary
A hallmark of passion projects is that they're largely reliant on the efforts of a few highly self-motivated people working off the sides of their desks. This is an inherently precarious approach—what happens when these key individuals become too busy, or leave the organization? Too often, these projects lose steam or fall apart before they can make an impact.
Even when leaders can secure dedicated funding for passion projects, they're typically spun off into short-term pilots funded by temporary grants. Because these are all near-term efforts, there is rarely a plan for maintaining pilots when funding inevitably runs out.
Because of this transience, passion projects function relatively independently from one another, rather than as a coordinated part of a larger strategic push. Instead of forming something greater than the sum of its parts, these disparate initiatives can actively detract from our progress toward equity. Focusing on pet issues that don't map to the most pressing needs of target groups won't inflect our most meaningful metrics, leading to wasted resources. And if key decisionmakers lose confidence in health equity initiatives, it may ultimately stifle any future investment.
Wholly organization-centered approaches erode trust with the very groups we aim to serve
But there's another risk to these passion projects. Because they are rooted in what our own leaders see as valuable, programs aren’t necessarily mapped to what vulnerable populations want or need. And even if target populations are seeing a benefit from these pilots, these temporary solutions may ultimately alienate the very groups we want to serve. Some organizations unintentionally create a vicious cycle. If organizations center equity efforts based on their own internal agenda—launch a new pilot, scale it back when that fails or when money runs out, and then repeat—leaders risk losing what already fragile trust they had between communities and the health care enterprise.
And that will have long-term ripple effects, no matter where you sit in the industry or who you're trying to reach. When patients distrust their providers or their health plan, they may avoid necessary care and remain disengaged in care plans. When the workforce distrusts their own employer, retention and engagement suffer. And we've already seen what happens when the community distrusts life sciences companies—a rejection of certain drugs and vaccines. All of which leaves us inadvertently exacerbating the inequities we're hoping to address.
How to move forward with both passion and rigor
To be clear, neither passion nor short-term pilots are inherently bad. Widespread commitment to mission is essential, and these equity champions can use smaller projects to get their feet wet and develop new capabilities, build relationships with target groups, and prove the value of further investment. But these projects are the steppingstones along the health equity journey. They were never intended to be the end state.
Ultimately, this work will take decades, and no one has figured out the perfect solution. But we know that progress will never happen unless we can get match strategic rigor with mission and purpose. Below are four ways health leaders can shift from passion project to enterprise-wide solutions:
- Position health equity as intrinsic to business priorities, rather than efforts widely viewed as community benefit or charity
- Develop a comprehensive approach that addresses your workforce needs, patient outcomes, and community conditions
- Commit a dedicated, fully resourced team to advancing equity, but also embed equity goals in every strategy and department
- Orient all work toward a longer-term vision of addressing the root causes of disparities
To clarify your role in charting a course for lasting change, check out The CEO’s Role in Advancing Health Equity.