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Reducing Inequity to Increase Patient Safety

 
       

Before the pandemic, we knew Black men have shorter life expectancies than White men, and Black women are more likely to die from childbirth. However, COVID-19 uncovered new disparities in health and healthcare. In New York City—one of the most-studied areas of pandemic research—the distance of a few city blocks may have made a difference in whether someone lived or died from a COVID-19 infection.

According to the New York City’s municipal website, the overall COVID-19 death rate in Greenwich Village/SoHo (ZIP code 10012) is 64.79 per 100,000 people, while neighboring district, Chinatown/Lower East Side (ZIP code 10002) is 381.03 deaths per 100,000 people, and East Elmhurst, Queens (ZIP code 11369) reached nearly 700 deaths per 100,000 people.

Differences in the racial demographics in these districts are significant: Greenwich Village/SoHo is predominantly White (72.1%); Chinatown/Lower East Side is predominantly Asian (43.6%), followed by Hispanic (26.0%) and White (21.0%); and East Elmhurst is predominantly Hispanic (63.5%) and Black (25.4%).

And it’s not only race that places some groups at higher risk of experiencing health inequities. Patient safety liaison Catherine Reynolds shared stories in Patient Safety to bring awareness to health inequities experienced by members of the LGBTQ community. One person stated, “I went to my local ER for a chronic condition flareup, and they treated me horribly. Misgendered me every time someone spoke to me. Now I only go to the hospital further away from me and I need to be driven because it is far, but it is safe.”

Disparities and inequities in healthcare can exist anywhere. We all have an obligation to understand the causes of health inequities, including those that affect patient safety, and take robust measures to eliminate them.

Our health systems are only as safe as the care received by our most vulnerable patients.

In an NEJM Catalyst commentary, Dr. Tejal Gandhi did a brilliant job of drawing a parallel between tactics to improve patient safety while concurrently eliminating inequities in healthcare. Utilizing the National Action Plan to Advance Patient Safety as a framework, she identified steps healthcare leaders can take now to address underlying causes, like systemic racism, within their organizations. Highlights from her commentary include:

  1. Culture, Leadership, and Governance – Share inequity data at the board level, bring awareness to the issue, and institute restorative justice programs designed to bring people together to talk about the issues.

  2. Learning System – Apply a lens of equity to all quality and safety initiatives, identify root causes of inequities, focus on systemic racism and systems solutions, and measure inequity.

  3. Workforce – Understand that workforce diversity, equity, and inclusion are essential to providing patients with the highest-quality care, and ensure that training includes foundational topics to eliminate unconscious bias and bring awareness to individual behaviors and social frameworks that contribute to inequity.

  4. Patient Engagement – Codesign improvement interventions and capture data to identify bias and inequities.

The Patient Safety Authority (PSA) supports healthcare organizations on their journey to eliminate inequities in healthcare. PSA is also committed to expanding our research to better understand how inequities affect patient safety.

In January 2022, PSA will begin collecting additional demographic information through the Pennsylvania Patient Safety Reporting System (PA-PSRS). These additional data points, such as ethnicity and gender identity, will allow PSA to identify disparate safety issues and drive solutions to improve both equity and safety at the point of care.

Pennsylvania Patient Safety Officers: More information regarding these changes will be communicated in the upcoming weeks. Thank you in advance for your commitment to this important work!

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About this blog

Regina Hoffman serves as the  executive director of Pennsylvania’s Patient Safety Authority and editor-in-chief of Patient Safety, its award-winning journal.  Ms. Hoffman was recognized by Becker’s Hospital Review as one of the top 50 experts leading patient safety in both 2018 and 2020. This blog serves as a source for her to share her insights in patient safety and leadership with Pennsylvania’s healthcare leaders.

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***​ The views and opinions expressed at or through this blog are the opinions of the author alone and may not reflect the opinions or positions of the Patient Safety Authority or the Commonwealth of Pennsylvania, nor do these views represent in any way medical or legal advice. ​ 


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