Health Equity Standard Now NPSG

Why the Joint Commission elevated health equity and what it means

As of July 1, the Joint Commission has elevated its “healthcare equity standard" to a National Patient Safety Goal (NPSG) for hospitals and other healthcare organizations. Previously, the Commission had considered reducing health disparities to a quality and safety priority.

The new designation places health equity alongside other patient safety goals, such as using medicine safely and preventing mistakes in surgery. While the requirements will remain consistent, observers say the adjustment reflects a heightened awareness of the importance of health equity and the role healthcare organizations can play in improving these care and outcome gaps.

“The new National Patient Safety Goal will help increase the focus on improving healthcare equity, a global patient safety priority," said Dr. Jonathan B. Perlin, the president and chief executive officer of the Joint Commission, in a statement. 

Finding the best category for health equity

The Commission, a nonprofit that accredits hospital and other healthcare organizations, has described how healthcare disparities are also a quality-of-care problem, even though they are often viewed through the lens of social injustice.

“Like medication errors, healthcare-acquired infections, and falls, healthcare disparities must be examined, the root causes understood, and the causes addressed with targeted interventions," according to the organization's 2022 R3 Report.

Efforts should be fully integrated

Even though there are numerous examples of healthcare organizations addressing health inequities, too often these are special projects with limited funding, notes the report. As a result, they are not sustained or reproduced at a larger scale. That's why the organization is calling for a different approach that puts structures and processes in place to identify and address healthcare inequities.

“These efforts should be fully integrated with existing quality improvement activities within the organization like other priority issues such as infection prevention and control, antibiotic stewardship, and workplace violence," the Commission said.

Who is affected by this change?

The Commission's goal of improving health equity will apply to:

• Hospitals
• Critical access hospitals
• Ambulatory care organizations that provide primary care within the Medical Centers service in the ambulatory care program
• Behavioral healthcare and human services organizations that provide:
  • Addiction services
  • Eating disorder treatment
  • Intellectual disabilities/developmental delays services
  • Mental health services
  • Primary physical healthcare

What must healthcare organizations do?

Health equity responsibilities aren't changing, even though they're now stated as an NPSG. According to the Joint Commission, organizations will still be required to:

• Identify an individual to lead activities to improve healthcare equity
• Assess patients' health-related social needs
• Analyze quality and safety data to identify disparities
• Develop an action plan to improve healthcare equity
• Act when the organization does not meet the goals in its action plan
• Inform key stakeholders about progress to improve healthcare equity

Move coincides with growing national attention

The Joint Commission's increased focus on health inequities reflects the growing national attention on the country's uneven health outcomes, including the Biden-Harris Administration's emphasis on advancing health equity and improving maternal health outcomes. This year, the Centers for Medicare and Medicaid Services (CMS) also released an updated framework to advance health equity, an effort that encompasses everything from improved health data collection to advancing health literacy.

The Commission' s decision to designate health equity as an NPSG signals an increased prioritization of health equity and will likely mean the Commission will be paying more attention to organizational adherence, some observers say.

Change underscores importance of addressing social needs

The shift also underscores the importance of incorporating patients' social needs in healthcare delivery, notes a recently-published article in the American Journal of Nursing. The new standard emphasizes the need of health organizations to develop processes that optimize care for all patients, including those with social needs, rather than simply addressing their clinical needs.

For example, bedside nurses can ask about patients' health-related social needs, from transportation to access to food and housing. Addressing those social factors, though, will require community partnerships, notes Lisa Rowen, Chief Nurse Executive of the University of Maryland Medical System and Professor at the University of Maryland School of Nursing, in that journal article. That also means earlier prioritization of equity and inclusion efforts in the nursing education pipeline itself.

Be prepared for extra attention

Time will tell whether this shift will lead to quantifiable health equity impacts. At the same time, some healthcare leaders speculated that designating health equity as an NPSG is meaningful.

That's because the change may signal the Commission's prioritization of steps required to narrow these care gaps. That will likely translate into extra attention in accreditation surveys, according to an article from the Healthcare Financial Management Association,

Healthcare leaders should be prepared to describe in detail the plans they've formulated for their organizations, others noted. Surveyors will likely want detailed descriptions of the work organizations are doing in this arena—and to know that top leaders were involved in the planning.

What resources are available?

To help healthcare organizations work toward these equity goals, the Commission offers an updated resource guide with useful tools, research information, and case studies.

For example, there is information on how to screen for health-related social needs, and how to stratify measure to examine and pinpoint disparities. There are also samples of approaches other organizations have used and lessons learned, as well as published interventions to address common disparities.

Examples of evidence-based interventions

In its resource section, the Commission highlights evidence-based interventions that have addressed care gaps.

One looks at the role of a patient-navigator intervention at an academic safety-net health system that showed a reduced readmission rate for some patient populations. Another describes a dual mental health substance use intervention for Latino immigrants, which was effective in decreasing depression, PTSD, and overall mental health symptoms.

The resource guide also offers samples of quality improvement initiatives like an effort to increase the number of eligible hospitalized children who received seasonal influenza vaccines in an urban pediatric health system.

How RTI Health Advance helps

As your health organizations responds to the increasing awareness and prioritization of health equity, RTI Health Advance can help you develop tools and strategies to reduce care gaps. Our team of population health experts can help you create better systems and structures to address inequities and improve patient care. Contact us.