The Elephant in the Waiting Room: Survey Data Helps Address Racial and Ethnic Disparities in Healthcare

5 strategies for addressing disparities.pngAddressing disparities in healthcare remains an important but difficult issue to tackle, in part due to the uncomfortable nature of discussing racial and ethnic divides.

Research has shown that members of racial and ethnic minority groups often receive lower quality health care compared to their white counterparts. Providers may unintentionally make assumptions based on their patients’ race or ethnicity that could influence the level of care they provide.

Furthermore, patients from low income/ethnic minorities may have a language barrier which can lead to a patient feeling confused about the healthcare advice and failing to comply with medical regimens. Communication can also be hindered by cultural differences between the healthcare provider and the patient.

These factors, plus many more, contribute to poorer health outcomes and lead to higher overall healthcare costs.

A new report, published in the June issue of Health Affairs, identifies challenges to and strategies for addressing disparities in healthcare organizations. The authors also acknowledge that this is an uncomfortable subject to discuss.

“Unlike other areas of quality improvement that might be straightforward to execute, addressing disparities is a more sensitive, hot-button issue,” says Joseph Betancourt, MD, MPH, Director of the Mass General Disparities Solutions Center (DSC) and corresponding author of the report.

The report analyzed survey data compiled from participants in the Massachusetts General Hospital-based Disparities Leadership Program (DLP) – a yearlong executive-level education initiative designed to help health care leaders from around the world address racial and ethnic disparities in health care settings.

Teams at participating organizations completed surveys at the end of the program year. The Health Affairs report covers survey data responses from 97 organizations that participated from 2007 to 2016.

Participant responses demonstrated that:

  • The DLP helped engage and amplify the voices of staff from multiple levels of participating organizations as well as the broader community.
  • Getting buy-in from leadership was a struggle, though once leaders were engaged in the process, they were more likely to support and champion disparities efforts.
  • Successful projects incorporated disparities into other pre-existing initiatives and demonstrated how this work can help address other organizational priorities.

Survey feedback was compiled into five strategies that participants found effective in implementing projects at their institutions.

These strategies, and commentary from participants, are outlined in the report as follows:

1. Know who to involve. It’s important to engage leadership as well as midlevel and front-line staff. However, leadership turnover often presents a challenge to making equity a key component of the organization’s work and mission.

One participant said, “The biggest challenge we faced with buy-in amongst our executive leadership was framing health care disparities in such a way…that they placed it as a priority amongst all of the other competing priorities and allocated the proper resources to make our initiative a success.”

2. Shape organizational culture. Internal organizational cultural barriers to equity include competing priorities and lack of buy-in and awareness of disparities. Increasing awareness and integrating efforts to reduce disparities into the organization’s mission help facilitate equity.

“There continues to be competing priorities within the business and, although everyone we spoke with does believe and understand the importance of our health equity work, there are only limited funds available,” said a participant.

3. Create urgency and a vision to make a rational and emotional case. It’s important to create a sense of urgency for equity-related efforts. Grounding the work in a vision and communication strategy that integrates addressing disparities into the core work of the organization can help illustrate the pressing need to tackle this issue.

One participant reported, “Being part of the DLP gave me the opportunity to sit down with a small group of leaders including the Chief Medical Officer to explain health care disparities, and the link with data collection and quality improvement.”

4. Engage your organization and your audience. Engaging and partnering with key stakeholders is crucial. This includes internal partnerships across the organization, as well as external partnerships with stakeholders in the community.

“The work of promoting and implementing the best practices advocated by the DLP required work teams that crossed divisions/ departments and disciplines,” said a participant. “This collaborative effort helped to cement a unified actionable vision for assessment and reduction of healthcare inequities within [our] Medical Center.”

5. Harness the power of a collaborative network. Being a part of a collaborative network focused on equity promotes the development of strategic leadership skills and sharing of ideas, resources, and strategies.

One participant said, “[I received] great help from the leaders of the DLP and fellow DLP teammates by sharing ideas on coalition building, framing the message and the urgency and effective methods on educating leadership to get “buy in” on the collection of race, ethnicity and language data. The exchange of ideas and the sharing of best practices with the group proved to be invaluable.”


Moving forward, the DLP will continue its efforts to address disparities.

“We now have assembled a large and powerful network of DLP alumni dedicated to identifying and addressing disparities in health care,” says Betancourt. “Creating a movement of this nature is unprecedented, and we plan to continue to build and expand it so we can shape health care delivery and policy.”

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  1. If you don’t have money, the hospital doesn’t care. They only care about the check. So what if you don’t receive the same treatment as someone with better insurance. Who will actually make this a difference? The workers are also there for a check. You will rarely find anyone that cares enough to make a difference or that will go out there to “try”. Good luck on trying to find a lawyer if you have a case in one of these situations. If you come from nothing, you have nothing. People take what little you may or might have. If they ain’t making anything, they don’t care.

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