Equity, Diversity & Inclusion Measures for Hospitals and Health Systems

Health Equity, Diversity & Inclusion Measures for Hospitals and Health System Dashboards

Introduction

Among the American Hospital Association’s top priorities are addressing equity, diversity and inclusion in health care. We believe that health inequities contribute to health disparities, How to Use a well-documented factor in both the cost of care and this Document: quality outcomes. We are proud to collaborate with • An interdispciplinary team our members and other stakeholders to continue to Health Equity, reporting to the C-suite executives support the shared goal of advancing the health and Diversity & Inclusion is best positioned to utilize this well-being of all individuals and communities. These Dashboard document. are necessary actions to improve health and save lives. Domains • The measures under each Health equity is core to AHA’s vision of a society of domain are intended to be healthy communities, where all individuals reach their easily integrated into existing highest potential for health. Health equity is not the dashboards. same as health equality, in which everyone receives the • The “Operationalizing this same opportunities for health. Rather, health equity requires Measure” column describes an interdisciplinary, team-based approach to ensure everyone can ways in which hospitals and achieve optimal health that is fair and just, especially for individuals who have the greatest need. health systems may engage stakeholders across the system. Hospitals and health systems are actively engaged in addressing inequities and reducing disparities in their communities through various strategies and mechanisms. A dashboard can provide health • The supporting tools and care leaders with the necessary information on their journey to advance health equity, diversity and resources feature briefs, guides inclusion. A basic level health equity, diversity and inclusion dashboard may include measures to and toolkits to help hospitals and include the following: race, ethnicity and language preference (REaL) data collection, stratification health systems make progress and use; cultural competency training; diversity and inclusion in governance and leadership; and toward achieving that measure. community partnerships. As hospitals and health systems begin to tackle these areas of opportunity, dashboards may become more advanced to include measures related to supplier diversity, employee satisfaction and other areas of organizational importance.

Desired Outcomes/ Intent of Operationalizing the Supporting Tools and Resources Measures Measures Measure

Increase the collection, Data collection, REaL data can be Addressing Health Care Disparities through Race, Ethnicity stratification and use of stratification and collected at various points and Language (REaL) Data (2020) race, ethnicity, language use are essential of care or within the This brief contains multiple resources and case studies of how (REaL) preference data. to developing community. For example, hospitals are using REaL data to better understand disparities in initiatives Henry Ford Health care. Measure(s): to eliminate System, an AHA 2020 URL: https://ifdhe.aha.org/addressing-health-care-disparities- • Percent of workforce disparities in Carolyn Boone Lewis through-race-ethnicity-and-language-real-data (staff and clinicians) health outcomes. Equity of Care Award trained regarding By collecting, Honoree, collects REaL Building an Organizational Response to Health Disparities collection of self- stratifying and data for more than 90% (2020) reported REaL data. using REaL of patients, as a result of This resource features a compilation of reports, guides, toolkits, patient data along their “We Ask Because training tools, webinars, books and articles regarding REaL data • Percent of patient with other data We Care” campaign. collection, stratification and use. records with REaL data points such as The data is stratified URL: https://www.cms.gov/About-CMS/Agency-Information/ preference complete sexual orientation, and used to implement OMH/Downloads/Data-Collection-Resources.pdf with opportunity for gender identity, programs and improve verification at multiple geographic outcomes in maternal Evaluation of the National Standards for Culturally and points of care, beyond location, veteran and infant health, Linguistically Appropriate Services in Health and Health just registration. status and diabetes management Care (National CLAS Standards) (2018) disability status, and prevention, and other This toolkit describes the National CLAS Standards and provides hospitals and areas. meaningful and practical guidance on delivering culturally and health systems linguistically appropriate services. can better identify URL: https://minorityhealth.hhs.gov/assets/PDF/ disparities Evaluation_of_the_Natn_CLAS_Standards_Toolkit_PR3599_ in patient final.508Compliant.pdf populations. Framework for Stratifying Race, Ethnicity & Language Data (2014) This guide provides a framework that allows hospitals and health systems to stratify patient data to identify health care disparities. This framework consists of five steps. URL: http://www.hpoe.org/Reports-HPOE/REAL-data- FINAL.pdf

Desired Outcomes/ Intent of Operationalizing the Supporting Tools and Resources Measures Measures Measure

Increase the collection, Atrium Health, AHA’s 2019 Do Ask, Do Tell: A Toolkit for Collecting Data on Sexual stratification and use of Carolyn Boone Lewis Orientation and Gender Identity in Clinical Settings (2020) data (sexual orientation, Equity of Care Award This toolkit provides specific sexual orientation and gender gender identity and Honoree, developed a identity (SOGI) questions recommended by national LGBTQ disability status) among “Demographic Data organizations. It also describes how to collect these data in broader culturally diverse Wall,” which is used electronic health record (EHR) systems, how to use these data populations. to identify disparities to support clinical processes, and how to train clinical staff to in population health interact with LGBTQ patients in ways that are affirming and Measure(s): measures and stratifies welcoming. • Percent of patient race, ethnicity, language, URL: https://doaskdotell.org/ehr/toolkit/ records with sexual sexual orientation and orientation, gender gender identity data Ready, Set, Go! Guidelines and Tips For Collecting Patient identity and disability allowing clinical leaders to Data on Sexual Orientation and Gender Identity (SOGI) status data complete identify gaps in outcomes (2018) with opportunity for across populations. This guide helps hospital and health systems begin to verification at multiple implement sexual orientation and gender identity (SOGI) data points of care, beyond collection. just registration. URL: https://www.lgbtqiahealtheducation.org/wp-content/ uploads/2018/03/Ready-Set-Go_2018.pdf • Percent of workforce trained regarding Washington Group Training on Disability Data Collection collection of sexual and Analysis (2015) orientation, gender This training module aims to help understand the approach identity and disability and guiding principles of the Washington Group on Disability status for patients. Statics and deepen knowledge of how to collect and analyze disability. URL: https://hilearngo.handicap-international.org/ workspaces/176/open/tool/home#/tab/-1

Desired Outcomes/ Intent of Operationalizing the Supporting Tools and Resources Measures Measures Measure

Identify and monitor Rush University Medical PRAPARE Implementation and Action Toolkit (2019) the collection and Center, an AHA 2019 Toolkit with resources, best practices and lessons learned use of patient social Carolyn Boone Lewis to guide implementation, data collection and responses to needs such as: food Equity of Care Award social determinant needs. Contains standardized patient insecurity, housing Honoree, implemented risk assessment tool as well as a process and collection of stability, transportation social needs screening resources to identify and act on the SDOH. needs, education needs, across the system and URL: http://www.nachc.org/research-and-data/prapare/ social support, financial community settings toolkit/ stability, employment, to identify risk factors physical safety and other associated with social Screening for Social Needs: Guiding Care Teams to Engage measures that are specific needs (food insecurity, Patients (2019) to your population’s housing instability and This tool helps hospitals and health systems facilitate sensitive needs. transportation). For conversations with patients about their nonmedical needs that example, Rush works may be a barrier to good health. Measure(s): to mitigate the social URL: https://www.aha.org/toolkitsmethodology/2019-06- • Percent of patient determinants of health 05-screening-social-needs-guiding-care-teams-engage- records with social (SDOH) through strategic patients needs data complete partnerships that provide with opportunity for food delivery services to ICD-10-CM Coding for Social Determinants of Health (2018) verification at multiple older adults. This brief provides an overview on ICD-10 coding for SDOH. points of care, beyond It also features a list of AHA tools and resources for hospitals, just registration. health systems and clinicians that address the social needs and the SDOH. • Percent of workforce URL: https://www.aha.org/system/files/2018-04/value- trained regarding initiative-icd-10-code-social-determinants-of-health.pdf collection of social needs areas for patients.

Desired Outcomes/ Intent of Operationalizing the Supporting Tools and Resources Measures Measures Measure

Implement and/or monitor Cultural Chatham Hospital, a Becoming a Culturally Competent Health Care cultural competency competency and member of the University Organization (2013) training amongst all unconscious/ of North Carolina Health This guide provides a high-level overview for becoming a employees and clinicians implicit bias System and an AHA 2020 culturally competent health care organization and includes two to ensure culturally trainings increase Carolyn Boone Lewis case studies. responsive care within health care Equity of Care Honoree, URL: http://www.hpoe.org/Reports-HPOE/becoming_ strategic planning professionals’ administers trainings culturally_competent_health_care_organization.PDF efforts, operations, yearly understanding in communication, employee trainings, of factors that cultural competency Building a Culturally Competent Organization: The Quest clinical care, social are important and unconscious for Equity in Health Care (2011) services and other to patients and bias to employees. This guide explores the case for cultural competency and areas specific to your play a key role in These trainings can be provides guidance for health care leaders to build a culturally organization. care decisions. implemented yearly competent organization. These trainings as part of continuing URL: https://www.aha.org/ahahret-guides/2011-05-11- Measure(s): also provide education for employees. building-culturally-competent-organization • Percent of employees an opportunity and clinicians who have for health care completed cultural professionals to competency training. be mindful of unconscious and • Percent of patient implicit biases and family complaints that may occur related to cultural when interacting competency. with patients and team members. • Rate of patient satisfaction scores (HCAHPS, CG-CAHPS) pre- and post- cultural competency training stratified by race, ethnicity and language preference.

Desired Outcomes/ Intent of Operationalizing the Supporting Tools and Resources Measures Measures Measure

Increase unconscious Health Care organizations utilizing the Implicit Association and implicit bias training Test (IAT) (2019) amongst all employees This guide outlines four ways organizations can use the Implicit and clinicians to ensure Association Test to improve health equity and quality of care. that associations or URL: https://www.aonl.org/system/files/media/file/2019/04/ attitudes that are reflexive ifd-implicit-association-0419.pdf do not alter perceptions, behaviors, interactions or decision-making.

Measure(s):

• Percent of employees and clinicians who have completed unconscious/implicit bias training.

• Rate of patient satisfaction scores (HCAHPS, CG- CAHPS) pre- and post- unconscious/implicit bias training.

Desired Outcomes/ Intent of Operationalizing the Supporting Tools and Resources Measures Measures Measure

Identify and act on Increasing Northwell Health, an AHA’s Institute for Diversity and Health Equity Summer opportunities to increase diversity, equity AHA 2019 Carolyn and Fall Enrichment Program and foster diversity, and inclusion in Boone Lewis Equity of This program provides a 10-week paid internship for equity and inclusion governance and Care Award Honoree, is graduate students from diverse backgrounds. Students in governance and leadership will committed to diversifying engage in experiential learning in hospitals and health leadership to reflect support hospitals their workforce through systems across the country. the community your and health a health care workforce URL: https://ifdhe.aha.org/summer-enrichment-program- organization serves. systems to reflect development program. overview communities Women represent 72 Measure(s): they serve and percent of Northwell Certificate in Diversity Management in Health Care • Percent of governance most importantly Health’s workforce with The CDM program is the only comprehensive diversity members who to reduce health 44 percent serving in certificate fellowship focused solely on health care and represent diverse and care disparities. executive roles. developed by diversity practitioners. inclusive backgrounds. It also aides URL: https://ifdhe.aha.org/certificate-diversity- in increasing management-health-care-cdm • Percent of leadership employee who represent engagement as Recruiting for a Diverse Health Care Board (2020) diverse and inclusive well as promoting This article features best practices, processes and a sample backgrounds. or attracting board demographic/attribute profile matrix for recruiting talent. diverse board members to better reflect community • Percent of emerging diversity. leaders who represent URL: https://trustees.aha.org/recruiting-diverse-health- diverse and inclusive care-board backgrounds.

• Percent of diverse and inclusive employees who participate in employee resource groups.

Desired Outcomes/ Intent of Operationalizing the Supporting Tools and Resources Measures Measures Measure

Local Hiring: Building the Pipeline to a Healthy Community Webinar (2018) This webinar features resources for health systems to develop an inclusive, local hiring pipeline through creating more external community connections and internal career paths. URL: https://www.healthycommunities.org/inclusive-local- hiring-building-pipeline-healthy-community

Henry Ford Health System Board Essential for Diversity (2017) This blog describes how Henry Ford Health System’s executive diversity recruitment committee helps the organization stay committed to improving its talent pipeline, talent development practices, supplier diversity and other things essential to an inclusive culture. URL: https://trustees.aha.org/articles/1300-henry-ford- health-system-board-essential-for-diversity

How and Why to Increase Board Diversity (2011) This blog provides a case and steps for increasing board diversity and guiding questions for discussion. URL: https://trustees.aha.org/articles/916-how-and-why-to- increase-board-diversity

Desired Outcomes/ Intent of Operationalizing the Supporting Tools and Resources Measures Measures Measure

Increase transparency Hospitals and health Trustee’s Guide to Population Health: Building New of data sharing with the systems can work Foundations Linking Care with Community governance body through to establish a health This video series highlights six modules for boards to ensuring health equity, equity, diversity and view along with a discussion guide designed to prompt diversity and inclusion inclusion committee at conversation and reflection. data-driven practices the governance level and URL: https://trustees.aha.org/trustees-guide-population- are embedded within this committee could health-building-new-foundations-linking-care-community governance committees. report data at a frequency deemed appropriate by Measure(s): the board. This committee Tackling Health Equity: A Two-Part Podcast for Trustees • Percent of opportunities may also operate as a This two-part podcast discusses how hospital and health in which health equity, subcommittee of the system boards across are advancing health equity in their diversity and inclusion quality and patient safety communities. data are used to drive committee of the board. URL: https://trustees.aha.org/tackling-health-equity-how- strategic decisions boards-can-do-it with governance committees.

Desired Outcomes/ Intent of Operationalizing the Supporting Tools and Resources Measures Measures Measure

Assess and disseminate Hiring health equity, Best Practices for Building Leadership Diversity Programs accountability and diversity and inclusion (2020) collaboration of executives professionals or aligning This guide highlights best practices for building leadership responsible for driving initiatives related to diversity programs and case studies demonstrating these health equity, diversity health equity, diversity elements. and inclusion initiatives and inclusion amongst URL: https://ifdhe.aha.org/system/files/media/file/2020/08/ and programs. existing executives is best-practices-for-building-leadership-diversity-programs. a widely recognized pdf Measure(s): practice for driving • Percent of executives/ initiatives within the leaders who have system, especially when explicit roles or goals outcomes are tied to related to driving health executive compensation. equity, diversity and inclusion practices in their performance expectations.

Desired Outcomes/ Intent of Operationalizing the Supporting Tools and Resources Measures Measures Measure

Increase, improve, Increasing, After analyzing data and Hospital Community Cooperative strengthen and improving and/ evaluating community This cooperative brought together 10 hospitals with evaluate partnerships or strengthening health efforts, hospitals community organizations to collectively address key SDOH in with community-based existing and health systems can their communities and promote health equity. Case studies organizations, faith- community outreach to specific cover addressing homelessness, reducing cancer disparities based organizations, partnerships can community-based and integrating social services. government agencies help hospitals and organizations to help URL: https://www.aha.org/center/population-health/hcc (including public health health systems meet their needs toward departments), businesses, better implement achieving their community Creating Cross-Sector Partnership That Succeed in Health educational institutions community health goals. Hospitals Care (2020) and other organizations health strategies and health systems can This easy-to-use guide features action steps for building trust, to meet patients’ and to improve care, also utilize community gaining alignment, establishing processes and operationalizing communities’ needs. create a network partners to serve as key a strategic plan. of sustainable stakeholders to help plan URL: https://www.aha.org/system/files/media/file/2020/06/ Measure(s): partnerships targeted interventions AHA-Crosswalk-Presentation.pdf • Percent of community to address to improve community partners that align with social needs health efforts. Evaluating Hospital-Community Partnerships to Build a Culture of strategic priorities of and optimize the effectiveness of Health: A Compendium of Case Studies (2017) the hospital or health patient navigation community partnerships This compendium features case studies of effective and system or community strategies. can be assessed through sustainable partnerships between hospitals and the health needs partner engagement, communities they serve. assessment. teamwork and community URL: https://www.aha.org/system/files/hpoe/Reports- responsiveness. For HPOE/2017/hospital-community-partnerships-case-study- example, Henry Ford compendium.pdf Allegiance Health in Michigan supports a unified community effort to identify emerging issues, take effective action and meet people’s needs during the pandemic.

Desired Outcomes/ Intent of Operationalizing the Supporting Tools and Resources Measures Measures Measure

A Playbook for Fostering Hospital-Community Partnerships to Build a Culture of Health (2017) The playbook outlines ways to advance hospital-community partnerships by using methods and strategies to develop and evaluate effective and sustainable collaborations. URL: https://www.aha.org/system/files/hpoe/Reports- HPOE/2017/A-playbook-for-fostering-hospitalcommunity- partnerships.pdf

Community Health Assessment Toolkit (2017) This toolkit offers a nine-step pathway for conducting a community health needs assessment and developing implementation strategies. URL: https://www.healthycommunities.org/resources/ community-health-assessment-toolkit

The AHA will continue to develop, curate and promote tools and resources to assist hospitals and health systems. For more information on additional resources to help you advance your health equity, diversity and inclusion organizational priorities, please refer to AHA’s Essential Health Equity, Diversity & Inclusion Resources (https://ifdhe.aha.org/essential-health-equity-diversity-inclusion-resources).

For more resources and tools to help improve health equity, diversity and inclusion, please refer to the AHA’s Institute for Diversity and Health Equity (https://ifdhe.aha.org).