Grassroots efforts to engender the cultural change necessary for organizational cultural humility can be effective, but they do not ensure an enduring impact. System leaders must build the infrastructure and direct resources to support such a cultural shift, ensure long-term sustainability, and remove the onus from passionate but busy frontline staff. Consider the following three strategies to instill institutional accountability for culturally sensitive, equitable care:
- Assign executive-level accountability to cultural humility improvement metrics
- Assess internal and external opportunities to advance equity
- Acknowledge the health care organization’s role in contributing to structural inequities
Assign executive-level accountability to metrics for improving cultural humility
Organizations need to identify a leader responsible for engendering cultural humility at the institution level. In most cases, this will be the same leader responsible for leading the organization’s broader efforts to advance equity. Progressive organizations are establishing a dedicated Office of Health Equity or Chief Health Equity Officer role which ties funding to initiatives and ensures best practices spread across the system.
A single leader with the seniority to convene their executive counterparts can align the organization’s strategy around addressing specific metrics related to cultural humility and equity. This person can also ensure that each department’s strategic plan supports these goals. If a CXO-level position is not yet feasible, a current leader at the director level or above should be given purview over equity. That person should have sufficient time to dedicate to these responsibilities.
However, it’s important to make sure that every leader is personally accountable for advancing cultural humility at the organization. This work should not be siloed to one team, but rather should permeate every senior leader’s strategic plan and performance metrics. Executives and senior leaders must be able to articulate how their department’s priorities advance the organization’s broader efforts to engender cultural humility to advance equity. This means a close, collaborative partnership is essential between any formally designated health equity leader(s) and other leaders at an organization (e.g., CEO, CFO, clinical executives, heads of departments, directors, and managers).
Common metrics related to cultural humility include:
- Number and impact of equity initiatives implemented by shared governance councils, community board, and/or employee resource groups
- Staff engagement drivers for inclusion stratified by REGAL demographics (Race, Ethnicity, Gender identity & sexual orientation, Age, Language)
- Staff cultural humility scores
- Representation (%) and retention of diverse staff members
- Representation (%) and retention of community members on governing body and advisory committees
- Quantitative and qualitative community feedback (e.g., patient satisfaction scores, complaints, feedback from community and patient advisory councils)
- Participation in equity education sessions, patient engagement training, and cultural celebrations
Assess internal and external opportunities to advance equity
An organizational commitment to cultural humility requires a sustained assessment of how your organization is—or isn’t—actively making progress against reducing health disparities in your patient population. Organizations must understand the makeup of the communities they serve and uncover the strengths and needs of marginalized and vulnerable groups. To accomplish this, most organizations will need to strengthen their data collection and infrastructure to support a truly data-driven approach to both identification of disparities and ongoing assessment of progress made to address them.
First, focus on improving your organization’s understanding of your patients by collecting both granular demographic data and data on social determinants of health contributing to their health status. Most organizations will need to expand their demographic data collection efforts by obtaining REGAL data at minimum. All patient demographic data should be self-reported to ensure the highest possible accuracy. This demographic data serves as the basis for stratifying clinical outcomes and process-of-care metrics across key demographics to identify disparities.
Health disparity metric picklists
Advancing health equity requires a data-driven approach. Use our health disparity metric picklists to uncover focus areas for your organization.
There are two benefits to collecting data on social determinants of health. The data helps providers ensure culturally sensitive care during specific patient interactions. It also helps organizations make the case for increased investment in system-led interventions and community partnerships aimed at addressing the root causes of patients’ social needs.
Organizations must also have a solid understanding of the strengths and needs of their broader community. A community health needs assessment, done in partnership with local municipalities and other community health care providers, is a common start. Identified needs should inform strategic decisions such as prioritization, resource allocation, and community partnerships. In addition, leaders should regularly assess investments and initiatives to determine their impacts on reducing disparities within patient populations. This type of periodic needs assessment can help organizations understand both the social determinants that impact their current patients as well as the needs of people who are not currently connected to the health care system.
Refer to section 4 of this document, Elevate under-represented voices in strategic decision-making, for more guidance on how to leverage staff, community, and patient feedback to advance equity.
Acknowledge the health care organization’s role in contributing to structural inequities
Provider organizations must take responsibility for historical legacies of inequity that still impact the communities they serve. Doing so signals a readiness to collaborate with community leaders to solve the challenges they face. To start, leaders must educate themselves on the history of structural inequities—and their organization’s role in any injustices. Hospital leaders should consider and discuss openly the following questions:
- What is the history of the health care organizations that serve our community?
- How has our organization mistreated or lost the trust of specific patient groups? Have we taken steps to rectify any injustices?
- How is segregation still reflected in our health care system and the broader community, either in our leadership, staff, or the patients we serve?
- How does access to health care differ among groups in our community? How does our system design make it difficult for underserved populations to access care?