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What Does the Health Equity Officer Job Role Look Like?

A Health Affairs paper showed that health equity officers have hospital support, but there’s a long road ahead of dismantling centuries of racism.

A new paper published in the latest issue of Health Affairs takes a look at the burgeoning role of health equity officer, highlighting where hospitals are getting it right with this role and where there’s room to grow.

The report showed that health equity officers get a lot of support from their institutions’ upper echelons, but dismantling the mark that centuries of racism made on the entire field of medicine is going to be an uphill battle—one that health equity officers note usually goes beyond the scope of their hospital’s influence.

“We found evidence of activities addressing racism but also room for improvement, given that reports of racism or the effects of racism were not uncommon and that efforts to analyze and understand data were at an early stage,” the researchers wrote in the study, which PatientEngagementHIT obtained via email.

“Of note, a majority of equity officers who participated in this study recognized both systemic and institutional racism as obstacles to their work. Although some of these systemic issues seemed beyond the control of their organizations, they still were pursuing strategies that could address these obstacles.”

Health equity officer is a role that has largely stemmed from hospitals’ increasing social responsibility. Hospitals are anchor institutions for most communities, the researchers wrote, and many legislative and regulatory initiatives have outlined hospital obligations for health equity. These include but are not limited to community health needs assessments, the CMS Hospital Commitment to Health Equity measure, and Joint Commission standards for reducing health disparities.

Those obligations, plus the nation’s cultural shift toward anti-racism, propelled health equity officers to the fore, the researchers said. As opposed to diversity, equity, and inclusion (DEI) officers, health equity officers look outside the hospital to assess data, quality improvement, and community engagement.

According to the researchers, the role of health equity officer is relatively new, meaning there isn’t much information about their experiences working within hospitals and health systems. In a survey of 340 health equity officers representing 825 hospitals nationwide, the team found that this job position offers a lot of potential, but there are institutional roadblocks.

The good news is that most health equity officers feel institutional support, with 84 percent saying the hospital leadership and CEO were supportive of their roles. There was less perceived support from clinical leadership, with 52 percent of respondents saying clinical leaders were supportive of their missions.

In terms of their day-to-day, health equity officers said they mostly look for instances of racism within the organization (54 percent) through reporting portals, code systems for real-time event mitigation, and direct engagement with equity personnel.

Another 66 percent said they work on community partnerships to address inequity, with one respondent saying this strategy is important for sharing best practices.

“My hope is that…our hospital system will buy into [the community organization’s] structure, will buy into their program, and say, ‘Please help us dismantle some of the policies, procedures, and systems that we have in place that, consciously or unconsciously, have racist or White supremacists, White supremacy embedded,” the respondent said during qualitative interviews.

Finally, about a fifth of respondents said their organization was reviewing clinical algorithms for evidence of bias.

The other good news is that organizations are, indeed, collecting health equity data, with 94 percent collecting race data, 91 percent collecting ethnicity data, 89 percent collecting language data, and 88 percent collecting SDOH data.

However, hospitals aren’t yet putting this data into action. Half use race and ethnicity data to stratify performance metrics, but only 47 percent use language, and 36 percent use SDOH data to stratify performance metrics.

This may be hampering efforts to create targeted plans to address inequities, the researchers observed. Only 68 percent of health equity officers said their organization had any specific goals or strategies to reduce race/ethnicity-based inequities in the delivery of care. Meanwhile, less than 50 percent said there were efforts to reduce disparities linked to sex, gender identity, or sexual orientation.

The work of a health equity officer still appears to be an uphill battle, the researchers reported. Obstacles include limited staff diversity (25 percent), racist beliefs by individuals in the hospital or health system (13 percent), and a lack of a standardized way to record SDOH data (27 percent).

Many respondents lamented the institutional or structural policies that intentionally or unintentionally perpetuate racism (19 percent), remarking that it will be a long process to unwind the impact racism had on the medical field.

“White supremacy and the White supremacy culture is just embedded in any health care system…so trying to crawl our way out of that is going to be difficult,” one respondent noted.

Fundamentally, racism is a public health issue, respondents pointed out. Health equity officers can’t dismantle racism simply within the healthcare industry; rather, racism needs to be rooted out across cultures and industries.

That could be indicative of the nascent work of health equity officers. As noted above, the role of health equity officer is relatively new, so much of their progress is yet to be realized.

“To ensure equity officers’ success, it will be necessary for hospitals to perform comprehensive and critical self-examinations of their policies and procedures, which may include empowering diverse forms of hospital leadership, assigning accountability, and providing the necessary resources to accomplish objectives,” the researchers concluded.

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