Improving health system employees' engagement to address healthcare disparities: Results from a system-wide Healthcare Equity Campaign

Background: The existence of disparities in healthcare quality according to race and ethnicity is well documented. The IOM report, Unequal Treatment, and annual AHRQ reports clearly indicate that disparities in quality of healthcare are persistent and profound in the United States. Despite the wealth of evidence, awareness of this issue among healthcare professionals is lacking. In an effort to understand the level of awareness of healthcare disparities among employees and subsequently to improve it, Henry Ford Health System (HFHS) in Detroit, Michigan disseminated the AREA Survey before and after implementing activities to increase awareness. Methods: The AREA Survey was used to measure awareness of healthcare disparities and overall engagement to address them. In 2009 as the HFHS Healthcare Equity Campaign was launched, the AREA Survey was disseminated to obtain baseline measures. That year, 691 surveys were completed. Over the course of one year, the Campaign team employed multiple methods of raising employees' awareness of healthcare disparities including workshops, presentations, documentaries with discussions, articles in internal publications, and generally integrating information on disparities into existing programs. We distributed the survey again in 2010 to determine if these efforts made a difference in awareness and overall engagement; 591 surveys were completed. Results: In both years, significant differences were found between: white and non-white employees, clinicians and non-clinicians, and by work site, with non-white employees, clinicians, and employees working in Detroit having significantly higher Total scores compared to their counterparts. The baseline results showed that 61% of clinicians and 51% of non-clinicians agreed that, “Across the United States, minority patients generally receive lower quality care than white patients.” Post-intervention, these percentages were 55% and 53% respectively. Awareness scores and Total scores were compared by survey year using univariate Wilcoxon rank-sum tests. There were no significant differences between the two survey years. Conclusions: While there were no significant differences found between survey years, awareness-raising efforts will continue. The formal implementation of the 3-year Campaign has one more year ahead, and the AREA Survey will be distributed again. With over 23,000 employees, it is challenging to reach everyone; however, as more employees become aware, greater diffusion across the health system is possible. The data show us where to focus our awareness-raising efforts, as well as strengthen the argument for why this work is so critical. Employees need to be aware of the problem of disparities before they can be motivated to address them.