2023 Accelerating Health Equity
Post-event Playbook

Cross-sector alignment tactics that can be leveraged to address societal factors influencing health. A shared strategic vision, coordination of data and resources, and meaningful and consistent engagement of community members at all stages when we:

• Tap into a network of partnerships by working with local municipal leaders, such as those who participate in the Cities of Opportunity initiative.
• Collaborate regionally on community health assessments, which presents opportunities to eliminate duplicate efforts and align health advancement opportunities.
• Before approaching potential philanthropic partners, understand their mission and focus areas, including topical areas, regions and specific populations served.
• Know your philanthropic partners’ limitations before beginning to work with them. For example, corporate philanthropies linked to the pharmaceutical industry are highly regulated.
• Adapt constantly and remain flexible in partnership dependent work.
• Bring services directly to community members — not all community members can easily access key resources at hospitals or community centers.
• Invest in everyone — e.g., workers, volunteers and other community members — to improve the overall health and well-being of communities.
• Focus on resilience, social support, emotional regulation, stress, belonging, and hope when partnering to develop programming for youth dealing with mental health challenges in our communities.
• Collaborate regionally on community health assessments, which presents opportunities to eliminate duplicate efforts and align health advancement opportunities.
• Take a holistic approach to address mental health in our communities to provide a foundation of resilience: Help people feel healthy, safe and supported through strong systems and relationships, while engaging them in programming that is relevant and meaningful.
• New community players can help address unique mental health challenges. Bring in new partners, such as religious, education, arts and public safety personnel to break down mental health stigmas for diverse populations.
• Hospitals and health systems do not need to — and should not — do this work alone. Partner with other organizations who have aligned interests in improving community health.
• Contribute to a capital stack and/or leverage hospital resources (financial and other) to advance this work. Hospitals and health systems do not need to be the sole financer of these investments.
• Start where you can. These investments take time, so look for the small opportunities and wins and start there.
• Tailor messaging and marketing to the communities your organization serves by being aware of population demographics. Use culturally appropriate language that is easy to understand.
• Recognize there may be deep mistrust of hospitals, health systems and researchers, and building trust will take time.
• Build in open feedback loops to keep participants informed of the outcomes and proposed solutions.
• Leave the technical jargon at the door. Convene community-led committees and focus groups to test and edit your research questions before engaging with the broader community.

The work of organizations in and with communities improves the health outcomes of their patient populations by addressing medical and social needs through the practice of cultural humility and by supporting activities that improve culturally appropriate, and person-centered care in partnership with community based organizations through:

• Front-line staff’s expertise and relationships with patients in physician office settings are critical to successfully engaging patients and communities to drive health equity.
• Before jumping into the data, make sure your health system has an agreement regarding the specific clinical or operational questions that you wish to answer, as this will help you focus on the best variables to include.
• Engage the “end user” of dashboards or other data visualizations early in the development process to ensure that the product will be most useful to front-line teams.
• Provide culturally focused navigation to patients across all sites of care, as this will improve their experience and care and also reduce provider burnout.
• To track nutrition security, collect specific data points such as the availability and accessibility of nutritious foods, utilization and stability.
• Choose language that is culturally sensitive and relevant; how you ask a question matters.
• Leverage multiple avenues to find and help patients, and go into the community to find information that is not easily available online.
• Take action to address root causes.
• Invest in training your team in collecting sexual orientation and gender identity (SOGI) demographic data and host interactive workshop sessions or create and deploy team training materials.
• Ask teams to share how they collect the data, do observations and track improvement.
• Engage patients and the community early and often using messaging that addresses “why.” Capturing REAL and SOGI data is important to build trust and transparency by integrating the voices of patients and the community, and be sure to ask patients to answer questions annually.
• Think about what a customized approach targeted to subpopulations might accomplish. Be in the neighborhood, e.g., co-sponsor events with community groups, religious organizations, local society chapters.
• Continue to examine individual and organization biases to personalize health care for every patient. Create a framework for health equity improvement and develop tactics that can be scaled to close health equity gaps. Start by providing cultural competency training.
• Work with internal teams to capture the overlap in fill-in fields on medical records to avoid having different people ask a patient the same question in multiple formats.
• Ensure that the right people are asking the right questions to ensure patients are comfortable answering questions.
• Work with your IT department to find quick fixes for updating the screening process to collect new and different data points. Collect a combination of data and input. Data alone misses neighborhood subtlety, and input alone can allow passion by itself to drive decisions.

Establish organizational infrastructure that supports shared accountability, with intentional approaches to represent the populations and communities served through diversified leadership efforts including:

• Focus on ACT — accountability, culture and transparency — to create strong cultures of equity.
• Change organizational policy and advocacy agendas by leveraging board leadership to address social drivers of health.
• Focus on workforce diversity through internal and external messaging that focuses on inclusion, diversity, equity and alignment with the communities served.
• Use data transparency, reporting and focus groups or interviews to shine an active lens on diversity, equity and inclusion measures to facilitate change and eliminate health disparities by identifying root causes of equity.
• CMS’ Health Equity Technical Assistance Program supports quality improvement partners, providers and other CMS stakeholders by offering personalized coaching and resources, guidance on data collection and analysis, assistance to develop a language access plan and resources on culturally and linguistically tailored care and communication.
• Develop Regional Health Equity Coalitions that convene grassroot stakeholders and culturally specific organizations to identify the most pressing health equity issues in specific communities.
• Create DEI learning collaboratives based on AHA’s Health Equity Roadmap, convening subject matter experts who engage with leaders and teams of rural health care systems to deepen DEI learning and foster solidarity among peers.
• Form a health equity committee at the board level and develop health equity/DEI dashboards that track progress through peer group benchmarking.
• Analyze lab data on the population-level to support community benchmarking and chronic disease surveillance.
• Build partnerships and align goals with public health organizations to review findings together and identify areas of concern.
• Continuously review and update internal policies to support historically marginalized populations in the community.

Leverage assets and work in partnership with others to improve employees’ health and well-being, diverse workforce development, and other strategies to support building diverse pipelines for the future by:

• Consider several approaches to impact workforce strategies — outside in, inside up and system change.
• Partner with schools and university to build the external pipeline. Then make sure to provide career development and growth opportunities once new employees are hired.
• Build workforce equity into organizational strategy.
• Be intentional about creating a workforce that mirrors the patient population.
• Provide job training and credentialing, and make it accessible to your community.
• Pay trainees while they are being educated and provide transportation.
• Engage potential health care workers from a young age and expose them to possible career paths in health care.
• Make small adjustments that make a big difference in reducing anxiety and burnout.
• Adopt a virtual platform to extend mental health services.
• Consider mindfulness, meditation, exercise and other self-care platforms and resources to supplement services.
• Establish and sustain a trusting environment where everyone feels they are welcomed and treated with dignity and respect.
• Leverage procurement to ensure the diversity and well-being of contract workers.
• Actively push for and adopt payment reforms, especially reforms that align investments with the mission of improving health and well-being of health care workers.

Health Equity at the Intersection of Health Care and Criminal Justice

• Develop a Reentry Opportunity Center to streamline needs identification and referrals.
• Support connecting to primary and specialty care, medication access and transitional care and bridge communication gaps between caregivers.
• Provide intake availability the same day or next day to allow patients to get the right care at the right time and in the right place.

Community Health Workers Drive Health Equity and Value

• Create standard practices and infrastructure to support community health workers.
• Hire and train CHWs from various communities to expand reach and meet the needs of those different communities. Start slowly, using resources you have first.
• Build social care modules into the EMR and allow CHWs access to the EMR.
• Standardized roles and core competencies and delineate CHW roles from other care team members to illustrate their unique purpose.
• Remember that CHWs can help build trust in communities, being the bridge between hospital and community and also between various care sites (clinic, home, etc.).
• Measure success of the program by collecting testimonies and by tracking satisfaction scores, services referrals and impact on outcomes.

Trauma Intuitive Models Advance Sustainable Health Ecosystems

• Remember that trauma-informed training does not automatically translate to practice.
• Focus on a variety of different types of trauma and on different populations that experience trauma.

Raising Awareness to Tackle Bias in Health Care

• Listen to hear patients, not to respond; learn to mirror patients’ needs in their care.
• Understand the difference between responsibility and accountability and know that each of us has a sphere of influence that impacts our actions.
• Approach implicit bias as a patient safety concern.
• Provide crucial education and resources to promote public health equity