From Theory To Action: Make Health Equity A Priority With A Strategic Planning Process

Health equity is a federal governmental commitment and funding opportunity through CMS. It's also a requirement for value-based care contracts and a growing aspect of quality metrics. There's a call for provider organizations to shift from hiring health equity executives and making public proclamations to taking strategic policy and operations actions.

How can provider organizations hold themselves accountable to adopt strategies that achieve health equity goals in the communities they serve? During a September 2022 webinar, Rachel A. Gonzales-Hanson, Interim President and CEO, of the National Association of Community Health Centers (NACHC) shared, 'There's no manual. We need to hold ourselves accountable."

In this article, we offer one approach to creating a strategic planning two- or three-day offsite event, combining community data and insights and facilitated sessions with actionable plans and next steps. Once completed, leadership could have a clear path to make health equity a core aspect of all services and business units, evolving beyond mission and vision statements to enabling ongoing, measurable health equity initiatives and outcomes.

Provider organizations have been slow to put health equity plans and strategies in place

As of November 2021, about one-third of US provider organizations had a documented healthy equity plan in place and one-third had committed to create one over this past year. Conducted by the BDO Center for Healthcare Excellence and Innovation and the Healthcare Information and Management Systems Society (HIMSS) Market Intelligence Unit, this research determined that measurable or identifiable outcomes from those plans were unclear. This suggests that just having a plan document doesn't go far enough to infusing health equity efforts into actionable, measurable strategies and initiatives.

Those same organizations report struggling with 5 health equity areas:

• 59% tracking economic health
• 40% receiving reimbursement
• 36% tracking provider performance
• 36% patient outcomes
• 30%+ are struggling to identify gaps in disparities

And, while more organizations are achieving health equity accreditation, the gap between the top-level and organizational view and strategy for realizing greater health equity is still low. In October this year, nine healthcare organizations attained Health Equity Accreditation (HEA) Plus. Yet, if the HIMSS research is to hold true, it would indicate that around 40% of US provider organizations haven't created a health equity vision, strategy, or plan, yet alone sought accreditation.

Healthcare organizations that carve out time and dedicate senior leadership to health equity-focused strategic planning have an opportunity to develop measurable, actionable strategies, plans, and performance targets.

Strategic planning off-site demonstrates initial or ongoing commitment to health equity

The Institute for Healthcare Improvement (IHI) published a 2019 guide on making health equity a priority. On the heels of a two-year equity initiative conducted with 8 healthcare delivery systems, they recommended that provider organizations institute 3 objectives:

• Build the will to address health equity.
• Include equity as a priority in the organization's strategic plan and department-level goals.
• Demonstrate senior leader ownership for and commitment to improving health equity.

An off-site strategic planning event, focused on health equity visioning, strategy and work plans, is an effective approach to kick-off a new commitment. It also may be used as a check-in and update to existing health equity initiatives. Putting together an efficient, stakeholder-rich off-site event requires preparation and specific aspects that are different from traditional healthcare planning efforts.

Differences between health equity strategic plans and frameworks

It's important to make a distinction between what health equity framework an organization may choose, before or during the off-site, versus the type of strategic planning approach leadership elects. We've outlined most of the available health equity frameworks and measures. However, preparation for an off-site strategic planning meeting or retreat should be informed by the framework chosen and any previous health equity work internally or with local public health and community groups.

For example, the IHI offers a framework that focuses on 5 areas, including prioritizing, creating structure and processes, deploying specific strategies, addressing institutional racism, and developing community partnerships. An effective off-site event can act as a catalyst towards achieving all of these goals, providing a new start or a refresh to the organization's commitment or during a time of leadership transitions.

Five steps to conducting an effective health equity strategic planning off-site

The following 5 areas provide a structure that can be tailored to each organization's health equity experience, resources of time and expertise, and the desired outcome. An organization's chief equity and diversity officer, chief health equity officer, or representative from center for health equity are all suited to lead preparations for the event. They may oversee any outside consultants and internal stakeholders who support the effort.

Pre-work

The pre-work includes early planning discussions and practical arrangements. However, the most important goal in this step is to:

• Establish a pre-event timeline and cadence to planning meeting and deliverables.
• Create a succinct and clear agenda.
• Establish a desired outcome.
• Determine which stakeholders should be involved in preparations and attend.
• Gather organizational, community, and health equity-related data and research.
• Create guiding principles for the event, including common language and terms, pre-reading required by participants, and rules of engagement to ensure that the dialogue is focused but allows for deeper (and sometimes uncomfortable) conversation.

Agenda and focus areas

There should be a natural progression in the agenda from opening statements that frame the event to desired outcomes coming out of the event to what aspects of (or questions around) health equity the group will discuss and decide.

Presentations around focus areas should provide a brief overview and pose issues that need action or questions that need answered. For example:

• What are the unique challenges faced across groups of people in our communities?
• How do these measurable issues align with the organizations existing strategic priorities?
• How might our priorities evolve based on what we've learned?
• Most importantly, what could equitable health and healthcare look like in our organization and the communities that we serve?

Ensure that the agenda not only builds on each topic or question; the days' plan also allows ample time for education versus conversation, as well as adequate time for decisions and actions with clear next steps.

Data needed

Data can consume all preparation time so it's important to carve out a window for prioritizing data collection. While the type of information that is available and can be curated and analyzed before the off-site will depend on your agenda, it's critical to include as much population- and geographic-related data as possible. Tap into community health assessment reports and research.

If the timeline permits it, engage patients from the community to gather information but also to let them know of your strategic planning direction. There may even be a portion of the agenda that is appropriate for inviting community organizations and advocates to share their perspectives during the event.

Best practices suggest that data analysis is presented visually in simple-to-absorb graphics, however, consider having PDF files available or printouts on hand for those who want to dig into the details between sessions and days. Some of the most useful data are those around benchmarks the organization wants to move toward, what's been done, and the current state of health equity across the organization, including workforce.

Being open to the truth within the data is key. Leaders will want to encourage transparency and honesty while honoring the planning process as a new start, but still a beginning.

Expertise needed

In the Raising the Bar webinar, Ms. Gonzales-Hanson also spoke to the diversity of expertise needed to support provider organizations in the health equity strategic planning, saying “We all need education." She sees value in tapping in-house resources and experience but using outside support as well. inviting community organizational stakeholders to present community health research and engaging healthcare consultants to facilitate health equity conversations helps groups go farther, faster.

Cross-agency partners should be tapped for appropriate involvement, either as part of the beginning presentations or as part of the closing tactical discussions. Healthcare associations also offer strategic planning guides and questions. Useful examples include the CDC's work with the Minneapolis Health Department (MHD). The National Academy of Medicine offers strategic planning model with examples of how several provider organizations used their resources.

One critical participant is the “scribe." This person takes notes, checks-in with the group, debriefs actions from sessions, and captures commitments in a format that can be easily shared.

Turning planning into action

Curating a host of learnings, insights, decisions, and next steps after a strategic planning retreat take concerted effort. It's easy for everyone to return to normal work pressures and quickly forget about commitments. Before the event closes, it's important to share a timeline and overarching plan for keeping the momentum going after the offsite.

With the follow-up plan in place, the final half-day can focus on turning insights into decisions and decisions into concrete actions. This is where the scribe shines. As the participant who is dedicated to capturing details throughout the offsite, the scribe should send out recordings, meeting notes, action steps and meeting invitations within two days of the offsite. This can ensure a seamless transition from strategic planning mode into strategic action.

What's possible when health equity strategic planning drives change?

When a provider organization takes a thoughtful and creative approach to health equity strategic planning, they build the capacity and capabilities to move from ideas and words to outcomes. For example, Robert Wood Johnson University Hospital used their strategic planning to launch a three-year program to improve equity and make their workforce more diverse. Because of their efforts, ethnic and racial minorities constitute 22% of their board of directors and 34% of executive leadership.

Another example of institutional change is the Henry Ford Health System where strategic planning gave rise to leaders establishing their Center for Healthcare Equity. One of their programs, the Women Inspired Network, uses a group prenatal care model and peer-support to reduce infant mortality in the Detroit. The program holds promise as early results indicated that, out of the first 200 births, there were no infant deaths. This is in drastic contrast to the expected infant mortality rate of 3.2 per 200 live births.

As provider organizations move from intention to action, or choose to pursue The Joint Commission's new Health Care Equity Certification, these strategic planning activities will yield many benefits and support ongoing alignment as programs and resources change.

Starting or restarting the provider organization's health equity journey

RTI Health Advance brings together experts across data science, population health, health equity, operations, and digital health to support payers and provider organizations in their pursuit for more equitable healthcare. Contact us.