Can health care organizations move beyond lip service and take the steps needed to improve health equity?

By Wendy Gerhardt, senior manager, and Leslie Korenda, manager, Deloitte Center for Health Solutions, Deloitte Services LP

Health equity is the fair and just opportunity for every individual to achieve their full potential in all aspects of health and well-being. While all health care should be equitable, it often isn’t. Some health care organizations have been focusing on health equity for years, yet the care patients receive (and the outcomes they experience) can still vary widely by race, age, income, ethnicity, gender, and even ZIP code.

Early this year, the Deloitte Center for Health Solutions conducted nearly 30 in-depth interviews with chief equity officers, chief diversity officers (CDOs), and other executives from health systems, health plans, and biopharmaceutical companies who are in charge of their organization’s health equity efforts. We asked what they’ve done to get their leaders and board members to recognize the importance of health equity. Some interviewees seemed frustrated that health equity is often discussed as an afterthought rather than a business imperative. One of our interviewees said that a Black executive at a health system shouldn’t have to explain to white male leaders or board members that not all patients are treated the same. Another asked why anyone should have to prove that providing everyone with a high level of care is the right thing to do. Executives across industries, including the health care executives we interviewed, said that hiring a CDO—or individuals dedicated to drive diversity, equity, and inclusion efforts—is an important step, but more action is needed. CDOs across FORTUNE 500 companies often lack power or resources to effect real change, according to recent reporting from Axios.¹

In addition to our interviews, we also surveyed 20 CEOs from health systems and health plans to find out how their organizations were prioritizing and addressing health equity. Half of the respondents listed health equity as one of their top three organizational priorities for 2021, and nearly all of them said they have a dedicated team, task force, or committee (and a budget) dedicated to health equity. Ten CEOs said they have a C-suite leadership position dedicated to health equity, and nearly all of them agreed that health equity does not mean equal treatment. Instead, they said equity means that some individuals need additional or different support or interventions due to the effect of racism on institutions, the drivers of health, and the multiplier effect of those factors.

Health equity is gaining momentum, but can it be sustained?

The idea of health equity is nothing new. Many health systems and health plans already have missions to ensure the health of their communities. Some have had health equity leaders, diversity departments and/or teams in place for years. What is new is the momentum. The combination of the COVID-19 pandemic and demonstrations over social injustice have spurred many organizations to enhance their diversity, equity, and inclusion efforts. Some have created new leadership roles devoted to equity and have hired dedicated staff. However, some interviewees acknowledged that an individual or team will likely not be able to effectively and sustainably enhance equity on their own. Some interviewees voiced their concerns that the importance of health equity could wane if priorities and resources shift with new leadership or changing market dynamics.

The executives we interviewed shared the following strategies to help drive change throughout the organization to ensure that health care becomes, and remains, equitable:

• Use data to tell a story: It is difficult to dispute solid data. But rather than looking at averages and highs and lows, data should be examined to identify trends by gender, ethnicity, race, and ZIP codes. Black women, for example, have slightly lower incidence rates of breast cancer compared to white women, but Black women have a 42% higher mortality rate. Moreover, Black men are twice as likely as white men to die of prostate cancer.² Some executives said they had never examined their data through an equity lens. Looking at outcomes, quality, and satisfaction data by race and ethnicity has been eye opening for many executives. After noting disparities among Hispanic and Latino population, one organization began to work closely with social services organizations. Outcomes among this population improved as a result, according to the interviewee.
• Build health equity throughout the organization: Improving health equity should go beyond just hiring a CDO or specific individuals dedicated to drive diversity, equity and inclusion (DEI) efforts. “Heath equity cannot be an add-on initiative,” said an interviewee from a large health system.” Health equity should become engrained within the company and made a strategic priority to build sustainable and effective change. For health systems and plans, health equity is not just a moral imperative. It is necessary for supporting business goals (e.g., better clinical outcomes), strengthening consumer engagement, and improving financial performance. An interviewed health system CDO told us, “to ensure equity is not a fleeting issue, you need to embed it throughout the organization.”
• Build a stronger connection to the community: Some of the executives we interviewed are working more closely with their communities. Some of them described organization-wide townhalls and board/leadership meetings dedicated to health equity. Another way to create a stronger relationship to the community is to speak the same language. Some patients might not read or speak English fluently, which can hinder their experience and make it difficult to understand their treatment. About 40% of one East Coast health system’s patient population preferers a language other than English, one interviewee told us. The health system determined that the language a patient uses at home would be best for interpreting information, particularly if they are not proficient in English. They also discovered that staff was not accurately collecting language-preferences in patient records. The health system made a concerted effort to better collect preferred language from patients now has consent forms and vital documents available in 22 languages.
• Establish an executive governance structure: Commitment and support from the top (CEO and board)—combined with a well-organized strategy—can be essential. Many interviewees highlighted the importance of having a clear governance structure and dedicated infrastructure and leader to support health-equity initiatives. Health care CEOs should also consider a chief equity officer role to demonstrate the organization’s commitment to health equity. A chief equity officer could help ensure accountability and execution on health equity strategies for the organization. This leader should also have a seat at the executive table, a voice, and the funding and staff needed to accomplish their goals.
• Fund and support change: Some of the executives we interviewed said adding depth and action to commitments is critical. Some organizations have good intentions but only gain soft commitments, such as promises and messages without specific goals, investments, or detailed actions. Many organizations include equity in their missions and have been working to improve the health of their communities. However, some executives recalled health equity initiatives that lost funding and/or became less of a priority during difficult financial times. Firm commitments from leadership can reduce the chance of this happening. This means setting goals, having accountability, and developing measures of all the efforts behind the dollars. While health care CEOs we surveyed said they are investing the right amount of dollars and resources in health equity, many of the executives we interviewed said that their investments ranged from 1% to 5% of their budget and is a starting point toward more sustained investment.

Our research highlights a disconnect between the leaders who have designated health equity as a top priority and the executives who have seen little improvement in recent years. However, most interviewees were optimistic. Some executives told us their leaders were having real conversations, many for the first time, about systemic racism, social justice, and the implications of each on health equity. They described organization-wide townhalls and board/leadership meetings dedicated to the topic. They also said it appears that their leaders are truly listening to problems, looking at data, and designing solutions. According to the executives, this contrasts with past discussions at their organizations that were more narrowly around quality of care or hiring, and solutions rarely incorporated direct feedback from those impacted. Many organizations appear to be taking bigger steps to move beyond lip service and toward solutions.

Acknowledgement: Jessica Overman

The Deloitte Health Equity Institute

Endnotes:

^{1.        The chief diversity officer hiring frenzy, Axios, May 20, 2021}

^{2.        Caner disparities, National Cancer Institute, accessed April 28, 2021.}

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