New hospital guide pushes plan to address disparities

Eduardo A. de Oliveira | 1/21/2009, 4:53 a.m.

A new guide created by the Disparities Solutions Center at Massachusetts General Hospital (MGH) in Boston discusses the issue of health disparities head on and from the top down.

Launched on Dec. 18, 2008, at a Web seminar for 250 hospital presidents and CEOs, “Improving Quality and Achieving Equity: A Guide for Hospital Leaders” is aimed at changing habits at the top of the medical ladder.

“A lot of leaders don’t even believe that there’s [a] difference in the quality of care in their hospitals,” said Dr. Joseph Betancourt, director of the Disparities Solutions Center.

Funded by a grant from the Robert Wood Johnson Foundation, the guide already has been downloaded by more than 500 medical professionals across the U.S. and Canada.

For more than a year, a committee of six medical professionals at MGH held extensive conversations with top leaders of 10 U.S. hospitals. The committee later broadened the discussion with four case studies from the Seattle Children’s Hospital in Washington, the Duke University Hospital in North Carolina, and the Baylor Health Care System in Dallas, Texas.

The guide offers an in-depth look at the barriers faced by immigrant patients who “might not trust the hospital or its providers” or “may be afraid to seek care due to language barriers and embarrassment or cultural differences.”

For many CEOs, the guide can represent a comprehensive path to achieving cultural competency because it makes the case that detecting health disparities within their hospital ranks is also a way of “protecting the bottom line.”

In a “5 Stages of Getting Involved in Equity” PowerPoint presentation that Betancourt has used in seminars across the country, he makes it clear that confronting disparities can be a lengthy process.

Similar to the process of dealing with grief, the presentation says that addressing disparities requires experiencing denial, anger, bargaining, depression and acceptance. Hospital officials are encouraged to have a plan to get through these stages; the presentation suggests they “talk about it, think broadly, measure it (WELL), then share, do something about it [and] (repeat).”

EthnicNEWz.org caught up with Betancourt by phone while he was in San Francisco. He talked about the role of ethnic representation in hospital staff and the guide’s recommendations for hospitals about President-elect Barack Obama’s prospective policies for health care.

How can the guide address issues like racism in hospitals?

Our guide is really meant to convince people of the importance of addressing equity. A lot of leaders don’t even believe that there’s [a] difference in the quality of care in their hospitals.

The first step you take is you show the evidence that proves there is difference in quality and then, for a leader who cares about the budget, the legal environment and medical [environment], you try to make a connection between equity and all the important things that are on the leaders’ radar screen.

We don’t necessary say, “OK, here’s a training guide on how to address racism,” but we try to tell them that equality has an impact on the bottom line, on potential lawsuits, on quality care.