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A sweeping report the Department of Health and Human Services released earlier this year on the health of people in the U.S. revealed serious disparities: Black Americans are more likely than those in other racial and ethnic groups to die of heart disease. They also have higher cancer mortality and die of HIV at higher rates. Hispanic and non-Hispanic Black adults have higher unmet needs for medical care due to costs than do non-Hispanic white adults.

The American Hospital Association says there long has been widespread acknowledgment of such disparities by stakeholders across the U.S., including health care systems and facilities and government health agencies, and many of these stakeholders have been working to address the disparities. The efforts have not always been consistent and cohesive across the nation, so broadscale change has been difficult to achieve.

In response, the association has developed a Health Equity Roadmap, a comprehensive set of resources and tools for hospitals to use to assess how well they're addressing inequities and disparities, devise a plan to bolster that work and then implement the plan. AHA provides materials and support for this process.

Leon Caldwell, AHA senior director of health equity strategies and innovation, said "patients are at risk of harm" because of inequity.

"We're at an inflection point," he said.

Caldwell, who is one of eight staff members at AHA's Institute for Diversity and Health Equity, added, "There are generations of Americans who have seen the disparities, seen the inequities and sat still because they were culturally, racially and economically segregated." But now, he said, "you have generations — a newer generation — that have closer proximity to each other. That allows them to ask questions around fairness and justice and equity in ways that the previous generation did not."

This sort of introspection happening nationally, he said, has inspired the type of equity work AHA and its member hospitals are pursuing.

The roadmap initiative complements an effort CHA launched in late 2020, its Confronting Racism by Achieving Health Equity pledge and the related We Are Called initiative. Ninety percent of CHA members have committed to that pledge.

Evolving response
Joy Lewis is AHA senior vice president of health equity strategies and executive director of AHA's Institute for Diversity and Health Equity. AHA, CHA and other associations formed that institute. AHA now operates it.

During a recent CHA podcast, Lewis said the roadmap work builds upon previous AHA activity. That includes AHA designating the institute to coordinate the association's health equity work. The institute initiated in 2011 a National Call to Action to Eliminate Health Care Disparities and in 2015 issued a #123forEquity Pledge to Act that grew out of the call to action. More than 1,700 hospitals and health systems signed that pledge to take action to eliminate health care disparities.

Caldwell said that since the signatories lacked dedicated resources from AHA to move beyond the pledge, they ended up "kind of going back to homeostasis." To address the need for guidance in health equity work, AHA secured funding from the Robert Wood Johnson Foundation to build out the roadmap over the last two years. AHA bills it as a national initiative to drive improvement in health care outcomes, health equity, diversity and inclusion. AHA launched the roadmap in March 2022.

To begin the roadmap, a hospital enrolls online in the Health Equity Transformation Assessment and then completes that assessment electronically. AHA recommends that the form be completed within 45 days of signup. Information that hospitals provide to AHA through this process is kept confidential. It is only used for self-assessment, not for AHA to compare hospitals against one another.

Upon completion of the assessment, AHA provides facilities with a profile containing the results. The profile is structured around six "levers of transformation" that AHA has identified as critical to implementing change around equity. The association also provides links to "transformation action planners," which are resources to guide action and changes. Facilities completing the roadmap can join a virtual community AHA created for hospitals to support each other in the work.

Pilot, then launch
As of the middle of September, about 35% of AHA member hospitals had signed up to take part in the roadmap and had been sent the assessment to complete. More than a dozen CHA member systems representing more than 300 hospitals have signed on as intending to take part.

St. Mary's Health Care System in Athens, Georgia, which is part of Livonia, Michigan-based Trinity Health, was among AHA members that piloted the roadmap before the tool's launch.

And now, the hospitals that are part of another region, Trinity Health Mid-Atlantic, have completed the 24-page assessment that is part of the roadmap. This work involved leaders from the region's three Pennsylvania hospitals and one Delaware hospital, including presidents; chief human resources officers; and executives in quality and compliance, health informatics, community health and well-being, and diversity, equity and inclusion. As Catholic Health World went to press, the region had just received and was evaluating the assessment results.

James Woodward, president and CEO of Trinity Health Mid-Atlantic, said the roadmap has the potential to be "transformational; a catalyst for each individual (at Trinty Health facilities) to reach their full potential."

He said that while staff of Trinity Health hospitals have done laudable work furthering the system's mission to "provide the most comprehensive, compassionate and quality care possible ... it's critical that we build on that good work and make conscious efforts to deliver care that is free from bias and inequities and be respectful of cultural values and beliefs."

He said the roadmap "provides the guideposts to not only ensure we are meeting those goals, but to gain support from peers to continually evolve and do even better."

Blueprint
CommonSpirit Health has signed on to take part in the roadmap and is coordinating its facilities' participation.

Wright Lassiter III, CommonSpirit CEO, is an AHA board member and the association's immediate past chair. "CommonSpirit fully supports use of the AHA roadmap as a valuable tool to create pathways to improved health outcomes and increased community impact," Lassiter said.

Rosalyn Carpenter, CommonSpirit's senior vice president, chief diversity, equity, inclusion and community impact officer, is on the advisory council for AHA's Institute for Diversity and Health Equity.

Carpenter said in their roles with AHA, she and Lassiter have provided much support for, influence on and input into the creation of the roadmap.

Gaye Woods, system vice president of equity and inclusion, said CommonSpirit facilities long have been working to eliminate disparities and inequities, as those aims are integral to their mission. Around 2020, CommonSpirit refocused and reenvisioned that work. It created and has been pursuing a health equity blueprint that is centered on five priority areas. Woods said this preexisting effort of CommonSpirit is very much aligned with what the system now is pursuing at the same time, as a signatory to AHA's roadmap work.

"This work is very interconnected, and there is great overlap in our shared commitments," she said.

Woods added that health inequity and disparity are "an urgent issue that the pandemic amplified." She noted that with the Joint Commission and some federal agencies expected to look at health equity in new ways, and with the topic so central to the Catholic health mission, this is a perfect opportunity "to address this in a faith-based way."

She said, "This work is just an extension of what was started a long time ago, an extension of who we are. And I'm proud that CommonSpirit has taken a real stand of courage. We're advancing health equity, and that to me is powerful work that I want to be a part of."