Health Equity Is a Patient Safety Issue

Screen-Shot-2015-02-10-at-11.00.17-AM.png

Over 250,000 people die of medical errors each year making this the third leading cause of death in the nation.  Poor or inappropriate care is not distributed equally across all patient populations, however. One of the alarming statistics shared about health inequities is that each year over 90,000 African Americans die unnecessarily throughout the nation’s health system. A confluence of factors contribute to this number: Poor access to healthcare, limited health literacy and unconscious bias place people of color at risk—as is also true for low income patients, women or members of the LGBTQ community. US News and World Report recently featured the experience of a black physician who received less than appropriate care during a visit to the ER that serves as an essential case study of the dangers of bias in healthcare service delivery. 

How do these events happen?

Every hospital must follow an enormous array of patient safety standards with clinical and administrative protocols on everything from dispensing medications to conducting surgery. The Joint Commission’s Hospital National Patient Safety Goals provide a framework for these standards and serve as an evaluation process that is part of every hospital’s accreditation process. Most hospitals have also adopted the Institute of Medicine’s standard for quality healthcare that is safe, efficient, effective, timely, patient centered and equitable.

Unfortunately, few hospitals track health disparities as part of a hospital’s quality metrics. The American Hospital Association 2015 Equity of Care Initiative referred to as #123equitypledge was signed by 1760 organizations.  In California, just 22% of the state’s health care organizations have signed.   All this despite a growing body of research suggesting bias does shape the type of care and the quality of care delivered to diverse patients (Special coverage on this can be found in the 2017 Health Affairs Equity Series).

The Institute for Health Improvement and the National Opinion Research Center (NORC) at the University of Chicago recently published Americans’ Experiences with Medical Errors and Views on Patient Safety in which they surveyed 2,546 adults and identified 21 percent of those surveyed have personally experienced a medical error and 59% of those patients pointed to a medical problem that either was not diagnosed at all or diagnosed incorrectly. Among women, 25% reported they had personally experienced a medical error compared to 17% of men surveyed. These gaps were also seen for high versus low socioeconomic status patients, 17% versus 22% respectively. 

The study also reported that 16% of Latinos experience communication related errors versus 2% for Whites when discussing treatment goals. Latinos pointed to discussions without an interpreter or without a provider who spoke the patient’s language as contributing to the medical error. In addition, 43% of Latinos versus 28% of Whites agreed communication errors take place when discussing treatment options.

The rise in the nation’s racial anxiety and growing polarization poses heightened threats for health inequities. Almost on a weekly basis, national media outlets feature examples of people who feel enabled to outwardly act on their racial biases and verbally or physically assault people of color.  This climate has the potential to impact diverse patients’ experiences in healthcare settings because even the anticipation that bias may occur creates emotionally challenging conditions for diverse patient populations.  The US Department of Health and Human Services’ National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care should be updated to integrate into clear patient safety protocols that target the impact of unconscious bias at every stage of the healthcare delivery process. Now more than ever a deeper commitment to health equity is needed. 

It’s a matter of life or death.