JULIE TROCCHIO, BSN, MS
Equity is at the forefront of today's community benefit plans and programs. Community benefit leaders use an equity lens as they work with community partners to assess needs, set priorities, develop community health improvement plans and evaluate impact.
A new resource from the Robert Wood Johnson Foundation — which is dedicated to supporting an equitable culture of health in the U.S. — can help put this work in broader perspective. The recently released "Raising the Bar: Healthcare's Transforming Role" presents a framework of five basic principles for advancing equity and excellence and describes how equity starts with the patient experience and includes workforce development, engaged partnerships and advocacy.1
The five key principles of Raising the Bar are presented in the following areas: mission, equity, community, power and trust. It describes why each is important, giving examples of "bright spots" and resources for addressing the principles.
1. Mission Principle: Commit Above All to a Mission of Improving Health and Well-Being
Committing to the mission to improve the health and well-being of individuals, families and communities, according to the report, "is at the heart of healthcare." This principle goes beyond the goal of doing no harm by providing effective, integrated care across physical wellness, mental and behavioral health and social needs. It requires working with partners, such as providers of public health and social and human services, to treat the harms that result from underlying inequities and health risks to individuals and communities.
2. Equity Principle: Systematically Pursue Health Equity, Racial Justice and the Elimination of All Forms of Discrimination
The framework calls on health care to provide everyone with the opportunity to be as healthy as possible. The equity principle takes a proactive effort to confront health equity, saying, "It is essential that healthcare acknowledge and address historic and current structural factors, systemic racism, and other forms of discrimination and inequity — in society generally, within communities locally, and also within the healthcare system itself." Achieving equity goes beyond providing access to quality care, and involves health care organization activities, including improving employment practices and fostering respectful interactions with the broader community.
3. Community Principle: Serve the Community as an Engaged, Responsive and Proactive Partner
Beyond delivering services to individuals, health care organizations and institutions are critical members of their communities. The Raising the Bar framework reflects that health care organizations treat the health consequences of deep social and economic inequities being faced in their communities. They are in a position to build on the strengths and resources of communities, interacting with a wide range of partners who bring assets, expertise and a commitment to improving their communities' health.
4. Power Principle: Share and Effectively Use Resources, Influence and Power
Health care's significant power and influence comes from its large share of the U.S. economy. Health care organizations can promote equity by driving critical changes within their own sector and exerting influence over broader social and economic policy. This principle recognizes that health care organizations, institutions and practitioners "have their greatest impact when they use their influence effectively and overcome power imbalances to co-create mutually reinforcing partnerships with individuals, families, and communities."
5. Trust Principle: Earn and Sustain Trusting Relationships
Health care organizations can raise the bar when they earn the trust of individuals, families and communities. "This starts with acknowledging persistent trust deficits, understanding the drivers of mistrust, and co-creating pathways for trust building. … Building and sustaining trust requires listening to and respecting the experience, expertise, and capabilities of the individuals, families, and communities to whom they provide care."
PUTTING 'RAISING THE BAR' INTO ACTION
To put the principles in action, Raising the Bar describes four roles for health care organizations: as providers, employers, partners and advocates. Within each role, the model offers concrete actions to advance equity and excellence. The roles begin with ensuring that all patients are treated with respect. It then looks at the employer role for creating a diverse workforce, the role of community partner for addressing inequalities and finally its role for advocating for public policies that attend to societal issues.
- Provider role: Health care organizations, as service providers, should ensure that individuals have access to receive a full range of affordable care they need and are treated with dignity and respect. This includes having a trusting environment where everyone feels welcomed.
- Employer role: This means having a workforce and leadership team that reflect the diversity of the community. It includes investing and growing leaders who advance equity and quality and ensuring that employees can be healthy and thrive.
- Partner role: Health care organizations should engage with individuals and organizations in the community, prioritizing those most affected by inequalities. They should build trust and work in partnership on activities and initiatives.
- Advocate role: Advocacy can include using the organization's economic resources and influence to impact payment reform, community well-being and resilience and equity. It also means using investment and procurement power to contribute to the health and strength of communities.
Raising the Bar presents a compelling case that equity should be in the very DNA of our organizations. When we care for patients, employ associates from diverse backgrounds, work in partnership and advocate for equity in our local and other public policies, we can advance our goal to increase equity and excellence in health care.
JULIE TROCCHIO, BSN, MS, is senior director of community benefit and continuing care for the Catholic Health Association, Washington, D.C.NOTE
- "Raising the Bar: Healthcare's Transforming Role," Raising the Bar, 2022, https://rtbhealthcare.org/wp-content/uploads/2022/07/RWJF-RTB-FULL-REPORT-060622.pdf.