BY , PhD, RN-BC, MBA, CCM, FACHE, FAAN
This edition of CMSA Today explores health equity and how we can use evidence-based practice to improve access and quality healthcare delivery. The Centers for Disease Control and Prevention’s Office of Minority Health and Health Equity (OMHHE) notes that “reducing and eliminating health disparities is fundamental to reaching health equity and building a healthier nation” (2021).
So what does “health equity” mean? Like many healthcare concepts, health equity has different meanings based on your values, ethical principles and perspectives. Braveman et al. (2017) of the Robert Wood Johnson Foundation notes that “While the term health equity is used widely, a common understanding of what it means is lacking.” It is important to note that health equity is not synonymous with equality. Health equity embeds fairness and just delivery of healthcare resources.
A case management example of equality would be to provide transition of care or discharge instructions to every individual leaving your healthcare organization. Each individual received the instructions equally. But was this equal distribution fair and just? What if the individual could only read in their primary language of Spanish? Would they be able to understand the instructions and use them to continue their care? The end result is that we have created a disparity or lack of similar results.
The CMSA Standards of Practice for Case Management (2016) clearly states that “the professional case manager applies these principles into practice based on the individualized needs and values of the client to assure, in collaboration with the interprofessional healthcare team, the provisions of safe, appropriate, effective, client-centered, timely, efficient, and equitable care and services” (p. 13). As professional case managers, we have a duty to implement strategies that improve equity within our practice.
There is significant research about health disparities. A simple literature search on “healthcare disparities” from 2019 to present produced 24,396 peer-reviewed journal articles. That is good news as it demonstrates that researchers are interested in how to develop interventions to address these barriers. Luciano, Aloia, & Brett (2019) note that it continues to take on average 17 years to implement evidence-based practice. How can we speed up change?
As we know, every system is perfectly designed to get the results it produces. Professional case management practice needs to carefully consider how we can change our approach to meet the needs of all the individuals we serve. Many would consider that a tall order or unsolvable imperative. As a case manager, we should consider it a vision of how we want to change our practice.
The first step is to recognize that we live within a global community that has been exposed to historical injustice. Inequity is rooted in systemic racism, prejudice and bias. Sometimes, it is hard to recognize as it has been part of our normalcy for centuries.
Second, we need to take action at all levels. Many healthcare organizations have developed strategies to improve health equity. For example, establishing a patient/consumer advisory committee that can add a community “voice” to organizational practice. Keep in mind that these are downstream interventions, and in order to create systemic health equity, we need to address challenging upstream conditions. This brings us to thinking about our present social determinants of health and how we can change them to reduce inequities for future generations.
Continue to advocate for the vulnerable individuals that you serve. Facilitate conversations that explore health equity and how case managers can make a positive impact. Get involved in community events that support and embrace equity. Truly listen to the lived experiences of others and consider their perspectives.
, PhD, RN-BC, MBA, CCM, FACHE, FAAN President, CMSA 2018-2020 is the director of Case Management at UC Irvine Health, Orange County’s only Level 1 Trauma and Burn Center.
REFERENCES
Braveman, P., Arlon, E., Orleans, T. Proctor, D., & Plough, A. (2017). What is health equity? Retrieved from: What is Health Equity? A Definition and Discussion Guide – RWJF
Case Management Society of America (CMSA). (2016). Standards of practice for case management. Little Rock, AR.
Centers for Disease Control and Prevention (CDC). (2021). Health equity. Retrieved from: Health Equity – Office of Minority Health and Health Equity – CDC
Luciano, M., Aloia, T., & Brett, J. (2019). 4 ways to make evidence-based practice the norm in health care. Harvard Business Review (online). Retrieved from: 4 Ways to Make Evidence-Based Practice the Norm in Health Care (hbr.org)
