Women of color have been underrepresented in hospital leadership positions and face challenges in advancing their careers. The benefit to hospitals providing women of color with training and support to move into leadership positions may be improved patient outcomes. Grounded in the interactional model of cultural diversity framework, the purpose of this basic qualitative study was to explore the perceptions of women of color advancing in leadership roles in hospitals and their impact on patient outcomes. The study participants included 16 women of color in leadership positions from hospitals in a western U.S. state. Data were collected through semi structured interviews. Resulting themes included (a) lack of mentorship opportunities; (b) discrimination; (c) lack psychological safety; (d) importance of representation by women of color; (e) women of color need to lead and support diversity, equity, and inclusion; (f) focus on performance and quality improvement; and (g) leading with values. Implications for positive social change include understanding the impact of racism and sexism on women of color leaders and developing programs that encourage more women of color to aspire to and work towards leadership positions. This will increase the number of women in hospital leadership roles and ultimately can help to improve health care for everyone.

Medicaid is the largest health insurance provider in the U.S. and is a major source of coverage for people with lower incomes. Furthering coverage of chronic disease prevention and management programs in Medicaid marks progress towards health equity and promotes sound fiscal policy. Health administration decisions made during the Medicaid benefit design process present opportunities for increased access to and utilization of these programs.

With support from the Centers for Disease Control and Prevention, the National Association of Chronic Disease Directors has provided technical assistance and support to 40 states since 2016 to help them 1) achieve Medicaid coverage for the National Diabetes Prevention Program (National DPP) lifestyle change program, and 2) operationalize the benefit in their states. This work has provided a unique understanding of health administration best practices. Key learnings include the importance of adapting how a program is delivered (in-person, distance learning, or virtual), determining program eligibility, defining an equitable reimbursement structure, developing pathways for inclusive program supports, and making decisions about which providers are best positioned to offer the program. These details impact health equity achievements for the eligible population.

We have gathered lessons through seven years of experience working with state health departments, Medicaid agencies, Medicaid managed care organizations, community-based organizations, and social service organizations. These include learnings through observation, evaluation, and direct feedback that can be translated for public health practitioners to consider how to realize a more equitable approach to benefit design for chronic disease prevention and management programs in Medicaid.

Background:

Disparities in marginalized communities will be upheld and exasperated if explicit considerations of equity and inclusion are excluded from our organization’s annual planning. The NYC Health Department identified a need in literature for specific guidance on how to embed equity in an organization’s goal-setting process. This presentation aims to address this gap and details practices the Department will consider when developing annual operational and programmatic goals.

Methods:

In 2020-2021 the Department conducted a literature review of forty publications and developed fifteen overarching recommendations for embedding equity in goal-setting. Department colleagues involved in equity work provided feedback on recommendations, with 267 survey responses collected. Information was gathered on how to operationalize recommendations, indicating if any are practiced, and identifying which are considered most important for goal-setting.

Results:

The survey revealed employees want to be included more in goal planning – to participate in the process of developing goals and for final goals to be shared – along with ongoing progress updates. In response, FY23 goal-setting guidance asked divisions to solicit employee feedback on division priorities (for example, by distributing an anonymous survey). Additionally, divisions were required to report final goals to employees with an explanation of how their feedback was incorporated. A more robust engagement process will be rolled out along with the remaining recommendations, and an evaluation to assess impact and adherence to new processes.

Conclusions:

Our findings provide guidance for health departments and institutions to anchor their annual goal-setting processes in tangible, actionable steps that embed health equity.

Background/Introduction

Promoting equity in the workplace is essential for creating an inclusive and supportive environment. Since participating in the 2010 Public Health Accreditation Board beta test, the Public Health Services (PHS) department, in the County of San Diego Health & Human Services Agency, has infused health equity into its infrastructure. PHS implemented an Organizational Equity Assessment Survey (OEAS) to measure results of its efforts, identify areas of opportunity, and develop a plan to achieve equity goals.

Methods

PHS utilized two nationally recognized surveys to develop the OEAS. PHS hired a consultant to facilitate discussions about the results with senior leaders and develop a final report. Results of the survey will be reflected in updates to the PHS Strategic and Health Equity Plans.

Results

PHS received responses from 359 out of 642 permanent public health staff (56%). Facilitated discussions will occur between April-June 2023, and targeted strategies will be finalized by August 2023. Strategies may involve revising policies that are found to be biased, implementing training programs to promote diversity and inclusion, or developing initiatives to support the career advancement of underrepresented groups.

Conclusion

PHS has created a more inclusive environment that values the diverse perspectives and contributions of all employees. The OEAS survey aligns with the County’s vision of a just, sustainable, and resilient future for all, and results are anticipated to lead to a range of benefits, including improved employee engagement, increased productivity and innovation, and reduced turnover.

Prior to the pandemic, culturally responsive and racially equitable evaluation (CRREE) approaches were slowly emerging as public health-community partnerships began to pursue more equitable approaches, measures, and outcomes. The pandemic exacerbated the need for community-based research that centers race and culture, provides sustainable outcomes and instills deeper elements of equity & justice in public health practice and research. From our team’s efforts, we offer examples of trainings, projects and relevant dialogue that will help community-based researchers co-create and adopt CRREE approaches. The examples shared will display lessons learned, as well as, opportunities that our team engaged in and co-created with our community partners to systematically identify and address racism, cultural stereotypes, and other forms of intolerance, injustice, and oppression primarily in Black, Indigenous, People of Color (BIPOC) communities. This roundtable will walk through multi-faceted race, culture, and community-focused strategies, while providing key project learning and evaluation examples. Through CRREE and our tenets of engagement, we co-designed and developed equitable evaluation plans and engagement strategies that helped improve project outcomes. Our examples highlight how we applied our 11 Tenets of a Culturally Responsive and Racial Equity Lens Engagement Process. These easily digestible core tenets offer guidelines for using equity-centered frameworks, such as CRREE. Further, this roundtable discussion offers opportunities to enhance, strengthen and refresh current knowledge and strategies of community-based researchers seeking to practice racially and culturally, equity-centered, evaluation and engagement practices.

Background: Although health administrators work to advance community health equity, healthcare employees are not always considered or included in these initiatives. Our project aims to build a data-driven decision-making framework around workforce HWB to identify healthcare workers’ health disparities, improve leadership around workforce HWB equity, and ultimately link workforce HWB to business performance metrics.

Methods: Qualitative interviews with 19 organizational leaders and mid-level managers at a mid-Atlantic health system were conducted to understand leadership perceptions of health equity and identify perceived gaps in existing employee HWB policies and programs. Insights from qualitative data were supplemented with quantitative data from employee medical and pharmacy claims and well-being program participation, by race, ethnicity and income levels.

Results: Participants frequently mentioned the organization’s existing programs around employee HWB and its commitment to diversity, equity, and inclusion. However, mid-level managers expressed concern that programs were not necessarily accessible to or used by all employees. For instance, preliminary data suggests lower participation in preventive care and greater emergency department use among low-wage and minority employees. Additionally, employees without regular computer access had a harder time accessing HWB programs. Healthcare leaders noted that they have historically had limited objective data to evaluate the effectiveness of HWB programs and the impact of health inequities.

Conclusion: Substantial opportunities exist to improve the value of HWB offerings to foster enhanced engagement and business outcomes among low-wage and minority employees. Despite organizational objectives, existing efforts to improve workforce HWB may be inadvertently worsening health inequities by preferentially benefiting higher-income employees.

Background: Social determinants of health such as racism, discrimination, and lack of education are key drivers of health disparities in the United States. At the healthcare delivery level, disparities exist in the experiences and outcomes of care across people groups. Insights on patient experiences of care are therefore crucial to healthcare quality improvement, and understanding the role of social determinants of health in patients’ experiences of care is critical for addressing health disparities.

Objectives: This study aims to analyze the effects of key social determinants of health (race, ethnicity, educational attainment, and gender) on patient experiences of care in hospital settings in the United States.

Methods: A sample of 65,660 U.S. adults (age ≥ 18 years) from the 2019 Adult HCAHPS Survey Database, provided upon research abstract approval by the U.S. Agency for Healthcare Research and Quality (AHRQ), is used in this study. The data obtained comprises information across the ten CAHPS standard measures for evaluating patient experiences of care in hospital settings. The main outcome variable, patients' experiences of care, is statistically derived from these standard measures, while the key predictor variables are the social determinants in focus: race, ethnicity, educational attainment, and gender.

Expected Outcomes: Through adequate data transformation and statistical analysis techniques, this study will synthesize evidence to describe and explain the influences of social determinants of health on patient experiences of care in the United States. More importantly, these results will provide valuable recommendations to support health policy development and implementation for addressing health inequities.

Issue: Health plans should play a role in reducing racism, discrimination, and bias in healthcare to impact health equity. Understanding patient experiences of discrimination/bias with providers is key to developing meaningful programs and policy that will support health equity.

Description: Blue Shield of California partnered with the California Public Employees’ Retirement System (CalPERS), the second largest public purchaser of healthcare in the U.S., to develop a health equity pilot. Through a survey (n=146) and interviews (n=9), the pilot captured the range of experiences members had with providers in accessing equitable healthcare. The survey and interview assessed three areas 1) hesitancy to self-report race/ethnicity, language, sexual orientation, gender identity, and pronouns; 2) CAHPS domains around respect and listening; and 3) experiences of discrimination captured with an adapted version of the Everyday Discrimination Index.

Lessons Learned: The pilot proved to be a successful partnership between a payor and an employer group, increasing our understanding of member experiences with discrimination/bias. Our sample revealed the need to use multiple outreach channels to increase the diversity of study participants. Interviews were critical to gain a thorough understanding of how patients process and report experiences of discrimination with providers and how they change health-seeking behaviors. Patients often minimized the reason for the negative interaction with providers.

Recommendations:

• Capture prevalent discriminatory behaviors from providers
• Increase clarity on the grievance reporting process, including implications for providers
• Create alternate, less formal channel(s) for members to report grievances
• Increase diversity among in-network providers

Background

Sweden was unique in adopting a ‘no-lockdown’ public health approach to the SARS-CoV-2 outbreak. On March 1st 2020 Stockholm healthcare (serving a population of 2.3 million) implemented its emergency management response. This study reports an evaluation of the response 2020-2023.

Methods

Rapid impact partnership implementation evaluation using mixed methods and national and local data registers with valid ultilization and epidemiological data.

Results

Sweden experienced similar mortality per million population to the UK, despite the different public health strategy used to address the COVID-19 outbreak. The regional emergency management model had never been used before and there were initial conflicts between this command and control model and the previous decentralised management in the service delivery units. After the first month of adjustment, ambulatory care service units were then able to respond quickly, appropriately and adjust to changes. One change included coordinating non-acute private health-care services, following the local government emergency directive to do so. The non-hospital services made a considerable and quantifiable contribution to reducing hospital admissions and mortality.

Conclusions

The Swedish tiered and phased strategy equitably minimised the direct and indirect harms from the virus to all age and population groups. In this context, the stockholm non-hospital healthcare services were able to make a significant contribution to public health in different ways. Two generalisable success factors are effective coordination between services allowing local response to need and optimal system functioning, and secondly methods for implementing emergency organisation and management in changing infectious disease situations.

Background

Healthcare professionals may treat blind and low vision persons (BLVP) with chronic diseases such as diabetes and cardiovascular disease in a manner that compromises trust. There is a need for a measure to assess such experiences of BLVP with chronic diseases to help us better understand the roles of these psychosocial factors in disease self-management.

Specific Aim

Validate a measure to assess psychosocial aspects of BLVP interactions with healthcare professionals.

Methods and Hypotheses

A 28-item measure based on themes of BLVP's perceptions of 1) their healthcare quality, 2) professional bias, and professionals' evaluations of BLVP's 3) competence and 4) warmth was developed and administered to 181 BLVP with diabetes and cardiovascular disease. A single-order four-factor model was predicted.

Results

To examine the factor structure beyond method effects (i.e., item valence), exploratory structural equation modeling (ESEM) was conducted. The ESEM analyses revealed best fit for a bi-factor model with two lower order factors of 1 Healthcare Quality and 2 Bias; RMSEA (CI) = 0.061 (0.051, 0.071), CFI = .942, TLI = .912, AIC = 14326.734, SRMR = .028.

Conclusions

This measure will help researchers understand the theoretical structure of BLVP perceptions of healthcare professionals’ impressions and can be used to understand the roles of these psychosocial factors in diabetes self-management and care outcomes. Future research is needed to confirm and validate the latent structure of the measure.