Systemic racism, nonstandard data collection hamper hospital equity officers' efforts, survey shows

An “early glimpse” into the work of hospital equity officers outlines a combination of internal and external roadblocks, including systemic racism, this new cadre of health system leaders face as they try to advance equity in the healthcare system.

The survey and accompanying interviews published in this month’s Health Affairs —conducted by researchers from Mass General Brigham, the American Hospital Association and other organizations—also described varying levels of buy-in across hospitals’ other leaders, limited use of sociodemographic data routinely collected by hospitals and a broad interest in tackling health equity issues that originate outside of the healthcare system.

“We found evidence of activities addressing racism but also room for improvement, given that reports of racism or the effects of racism were not uncommon and that efforts to analyze and understand data were at an early stage,” researchers wrote in the journal.

The equity officer position has been established in an increasing number of the country’s hospitals since the death of George Floyd in May 2020, researchers wrote. Of note, the equity officer role generally differs from existing diversity, equity and inclusion positions, which focus more on an organization’s internal culture.

Among a potential 1,179 eligible equity officers across the industry, the researchers’ survey received 340 responses from officers representing a total of 825 of the country’s hospitals. Two-thirds of the respondents were females, over half were white, less than 10% were of Hispanic or Latino ethnicity and 62% came from a teaching hospital. Just over a third said they had been in their equity roles for less than a year, while 16% said they had held their position for more than five years.

Most respondents reported at least moderate support for their work in advancing health equity from CEOs, executive leaders, board members and clinical and operational leaders, with 45% saying each group was “very supportive” of their mission.

The officers least often reported perceived support from clinical and operational leaders and more frequently pointed to those leaders as being “less than moderately supportive” (13.4%) than their organization’s CEO (3.6%), executives (7.3%) and board members (7%).

Among the 18 equity officers tapped by the researchers for qualitative interviews, 17 acknowledged that the buy-in from the executives and board granted them more authority and committed resources to tackle inequities.

“In contrast, some equity officers described pushback when trying to engage with clinical leaders around health equity, noting that clinicians believe that they treat everyone the same and feel that health equity efforts insinuated that they were biased in their care,” the researchers wrote. “This view, if widely held, may explain the survey finding where clinical leaders were seen as less supportive of health equity work.”

Nine in 10 of the respondents said they faced at least one obstacle in their work to improve health equity, while about half reported at least one major obstacle. Over two-thirds cited the lack of a diverse staff as a minor or major obstacle, more than half cited racist beliefs held by people in their organization as well as institutional/structural policies that perpetuate racism.

The interviewees outlined a combination of unconscious bias and incidents of overt racism as contributing obstacles, with many pointing to the behaviors of patients as a go-to example of the latter.

Eleven out of the 18 interviewees also discussed institutional/structural racism as “significant challenges” and often acknowledged that “racism, today, is a public health issue that cannot be adequately addressed in the vacuum of healthcare,” the researchers wrote.

Several interviewees went on to outline initiatives such as community organization collaborations that they hoped might help advance the anti-racism work at their hospitals.

“Although some of these systemic issues seemed beyond the control of their organizations, [hospital equity officers] still were pursuing strategies that could address these obstacles,” the researchers wrote.

One potential avenue for improvement in those efforts uncovered by the team related to the collection and use of data.

Specifically, 68% of survey respondents cited a lack of standardized social determinants of health data recording as an obstacle in their work. Even though 88% to 94% of hospitals and health systems “routinely” collect data on patients’ race, ethnicity, language or other social determinants of health, use of those data to stratify performance metrics ranged from 36% to 53%.

Interviews with the 18 officers suggested that survey respondents understand these data are important but have reservations about the validity and accuracy of collected data (nine interviewees), ensuring systemic collection (11 interviewees) and how the data can be used in an actionable way (10 interviewees).

“[Interviewed] equity officers consistently expressed a desire for standardized tools and best practices for race, ethnicity, and language and social determinants of health data collection,” the researchers wrote.”

The researchers floated their outreach, though relatively limited, as a “starting point” for equity officers and their organizations. Based on the findings, ensuring equity officers’ future success will require “hospitals to perform comprehensive and critical self-examinations of their policies and procedures, which may include empowering diverse forms of hospital leadership, assigning accountability and providing the necessary resources to accomplish objectives,” they wrote.