Until recently, health systems focused almost exclusively on the quality of the medical care they delivered. It involved forming the right diagnosis and delivering the right treatment for the patients who came to them for care. Some of the patients would recover well. Some would not. Those who did not would be back again, with the same problem, potentially worse.
Patients would get diagnosed and treated, again and again, as the cycle continued. Meanwhile, their health would deteriorate and the cost of treating them would escalate.
Why do some people get better after treatment and some do not? In many cases, it has nothing to do with the treatment or the person’s underlying condition; it has to do with the circumstances of their life. They might have no way to get to a doctor for follow-up care, have little access to healthy food, or feel disconnected from a health system that doesn’t reflect an understanding of their culture and background.
As health systems across the country look for ways to bring down costs and improve the overall health of the patients they serve, these inequities are getting much needed attention. Forward-looking organizations are finding ways to better understand the diverse needs of their patients, overcome barriers to care, and promote wellness through programs that reach people where they are.
Achieving health equity is one of the top priorities outlined in New Hanover Regional Medical Center’s strategic plan and one of the ten goals driving the work of the NHRMC Partnership Advisory Group as it evaluates options for the health system. It’s also one of the most complicated goals to achieve. It takes sophisticated data analytics to identify disparities, resources to launch programs with minimal, if any, short-term financial return, and the ability to attract and retain a diverse and extraordinary workforce able to bring greater understanding and sensitivity to the needs of patients.
How NHRMC is Striving for Health Equity
NHRMC’s strategic plan, introduced in 2017, brought health equity to the forefront for NHRMC employees and providers. Teams were enlisted to develop programs around the following priorities:
- Cultural competence – to build a deeper understanding of every segment of our community and how we can best care for them
- Hiring and recruitment – to support the ongoing development of diverse and inclusive workforce
- Identify disparities - to develop a systematic way of identifying which factors are most likely to impact good health and develop programs to minimize their negative effect
- Community partnerships – to collaborate with others to share resources and expertise and amplify the impact of our collective efforts
To succeed in eliminating inequities in healthcare, those who are delivering the care need to understand how different segments of the population experience the healthcare system. Biases, intended and unintended, can create barriers and erode trust, keeping people from getting the care they need.
Through the strategic plan initiatives, NHRMC has several new programs to promote better understanding. Employee Resource Groups bring together staff from across the organization to advocate for African American/black, Hispanic/Latinx, disabled and LGBTQIA populations. As a result of their efforts, NHRMC has installed universal symbols on internal wayfinding signs and promoted education programs specific to understanding LGBTQIA needs. Within three years, NHRMC expects to have every employee attend the Everyday Bias for Healthcare Professionals course.
Greater understanding also comes from having a diverse workforce, and NHRMC has been actively recruiting for every level of the organization, as well as for the medical staff. Looking to the future, NHRMC has developed a Healthcare Explorers program to inspire high school students to choose a career in healthcare.
The next step, after general understanding, is a sharper focus on the barriers most likely to keep an individual from being healthy. This takes asking many questions, documenting the answers, and then connecting to resources that can help. NHRMC does this now through NC Care 360, a statewide database of community organizations. But this effort is just beginning and will take more resources to make a large-scale impact.
Recognizing that shared resources and efforts are needed to support health equity initiatives, NHRMC is expanding its work with community partners. The hospital recently started a food pharmacy to provide healthy food to food insecure patients being discharged from the hospital. Funding for the food comes from Eastern NC Food Bank and NHRMC Foundation. NHRMC also makes food boxes provided by Nourish NC available to patients of Zimmer Cancer Center and Nunnelee Pediatric Clinics
Toxic stress is another area getting community-wide attention. NHRMC is part of the New Hanover County Resiliency Task Force to promote training and understanding of the long-term health implications that can result from toxic if not minimized.
To reach out to traditionally underserved neighborhoods in Wilmington, NHRMC is going where people are, offering health screenings in barbershops and hair salons and fun exercise/dance programs in neighborhood parks.
Accelerating Health Equity Efforts
While NHRMC has been making progress within the scope allowed by the limited resources available, truly achieving health equity will take a full-scale program backed by sophisticated data analytics. Data systems and expertise are needed to effectively identify disparities in health outcomes, build programs to address them, and measure results. NHRMC needs a way to do this on a large scale as it takes on more financial responsibility for the health of all the patients it serves.
The NHRMC Partnership Advisory Group included 13 questions in its request for proposals (RFP) that specifically address how a proposed partnership could help accelerate NHRMC’s health equity goals. The questions address the responding organizations’ charity care policy and how it would support community partnerships, wellness programs, initiatives to target health disparities, and training for staff and providers. You can see these and other questions by viewing the RFP online at www.nhrmcfuture.org. “Achieving Health Equity” is section 3 of the RFP.
The answers to the questions will be included in the proposals which will be online after March 30. The public can read the proposals and share their opinions at a public hearing on April 13 and through an email to Partnership Advisory Group members at PAGcomments@nhcgov.com.