By Christina Cordero, PhD, MPH, Project Director, Technical
Editor’s Note: These recommendations do not represent new Joint Commission standards, but rather are aligned with or go above and beyond current requirements.
Minority and vulnerable patients have experienced poorer quality health care for decades, and the COVID-19 pandemic has highlighted not only the disparities but the role of health care organizations in addressing the needs of diverse patient populations.
There’s a serious need for organizations to reduce health care disparities with the same urgency as other health care-acquired conditions, as described in depth in Quick Safety Advisory 60: Understanding the Needs of Diverse Patients in Your Community.
Even prior to the pandemic, the groundwork for increased focus on more equitable care was laid after the Affordable Care Act established an expectation that nonprofit hospitals (nearly two-thirds of U.S. hospitals) complete Community Health Needs Assessments (CHNAs) at least every three years, in addition to consulting outside stakeholders and at least one public health agency. The objective of CHNAs is to help hospitals identify pressing community health needs. When this assessment is performed in a comprehensive manner, it can be an effective tool in developing specific interventions to improve community health.
The Centers for Medicare & Medicaid Services (CMS) Innovation Center also supports innovative care models that address the needs of local populations. Currently, CMS is in the testing stage of an ongoing initiative, its Accountable Health Communities (AHC) model. Designed to address health-related social needs of CMS beneficiaries, the model also assesses whether identifying and addressing these needs improves the quality of care and reduces costs at the individual-beneficiary level.
The AHC model acknowledges that health is not the product of a single community entity or even a single sector, and that community health improvement therefore requires a collective impact approach, aligning efforts across a variety of clinical and community-based organizations to achieve a common goal.
Role of Hospitals
Some hospitals are currently forming collaborative partnerships with government, nonprofit and other community organizations to find new ways to help address community health issues that are outside of their traditional expertise, such as social determinants of health and mental health.
By using their performance improvement infrastructure and available resources, hospitals can make significant, meaningful advances in health equity promotion. Some examples include:
- providing access to healthy food through hospital food prescription programs
- promoting housing initiatives, such as recuperative care for homeless individuals
There are four safety actions that every hospital could put into action to identify and support diverse communities.
- Make equity a strategic priority within your institution. This requires leaders to:
- leverage policies and practices that embrace anti-racism both within and beyond the hospital walls
- nurture partnerships and professional pipelines within communities
- intentionally act on addressing adverse social determinants of health
2. Use a social intervention framework, such as CMS’ AHC model (mentioned above), to help identify needs of your patient populations. The AHC model focuses on screening in 5 domains:
- housing instability
- difficulty paying utility bills
- food insecurity
- interpersonal violence
Some hospitals’ patient populations may have higher needs in some of these domains and lower or no needs in others. When needs in the community are identified, incorporate referrals to community resources and patient navigation (typically through a community health worker or patient navigator) in the social intervention framework you decide to use.
3. Create a strategic plan for community outreach. The plan should begin with an understanding of your organization’s culture, mission, vision and values, as well as an understanding of the patient populations that your organization serves. Identify opportunities to partner with the community and determine the level of involvement your organization would like to have with the community.
4. Support the local workforce. Organizations should make an effort to hire persons from their communities and provide advancement and professional development opportunities. This could potentially develop a pipeline for marginalized groups into health care professions, fostering career advancement and professional development for all employees.
Christina Cordero, PhD, MPH, is a Project Director in the Department of Standards and Survey Methods, Division of Healthcare Quality Evaluation, at The Joint Commission. She developed the patient-centered communication standards and The Joint Commission’s monograph “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals.”