Organizational Change Management for Health Equity: Perspectives from the Disparities Leadership Program

Introduction

This study seeks to understand the best ways to address racial and ethnic disparities within healthcare institutions, with a particular focus on organization management. The study draws upon learnings from the Disparities Solution Center at Massachusetts General Hospital and specifically references data produced from the Disparities Leadership Program (DLP) that began in 2007. The DLP helped illuminate patterns in leadership in healthcare institutions and how leaders view eliminating disparities in healthcare. Ultimately, the study identifies common barriers and potential solutions to helping healthcare institutions begin the work of achieving health equity within their respective organizations. This study is noteworthy because while there is a wealth of research on health equity, there needs to be more research on how organizational change management can spearhead or hinder the progress of addressing those inequities.

Joseph Betancourt, MD, MPH, is the Senior Vice President of Equity and Community Health at Massachusetts GeneralHospital (MGH) and the founder, senior advisor, and faculty Director of the Disparities Solutions Center (DSC) at MGH Betancourt. He also served on the leadership team of the MGHCenter for Diversity and Inclusion. Aswita Tan-McGrory, Karey S. Kenst, and Thuy Hoai Phan all serve in various roles on the Disparities Solutions Center team at Massachusetts General Hospital. Lenny Lopez is the Chief of Hospital Medicine and an Associate Professor of Medicine at the University of California, San Francisco. 

Methods and Findings

The study uses survey data from nine cohorts of participants in the DLP. Each cohort consists of multiple health organizations. Each organization sends teams of 1-9 people to participate in the program, which includes a trip to Boston, Massachusetts, Santa Monica, California, and various remote activities throughout the year. Teams can be made up of a variety of different members within an organization and are not necessarily consistent in size or makeup throughout each cohort. The unit of analysis for this study is the survey completed by each organization’s team at the end of the program. Responses from organizations that were not hospitals or health-focused centers were excluded from this study. In the end, 97 organizations, which equates to roughly 119 surveys and 269 individual participants, were used for the qualitative analysis. A sequential grounded theory approach was used to analyze the data; three authors read the survey responses separately and identified the main patterns. Then, the authors discussed the main patterns or ‘domains’ they found in the data collectively. This process was repeated on small samples of the data until all domains were identified. Using the agreed-upon domains, two authors manually coded all survey responses. After completing the analysis, five major domains were identified: 

1. Know Who to Involve. This domain focused on engaging the correct leadership members in any process involving equity or changing organizational processes. 
2. Shape Organizational Culture. How an organization decides to prioritize addressing disparities, their cultural awareness that disparities exist in their workplace, and their knowledge about how to reduce disparities were all included in this domain. 
3. Create Urgency and a Vision and Make the Rational and Emotional Case. This domain focused on communications strategies and message framing that could add urgency to the case for implementing equity-related efforts. 
4. Engage your organization and your audience. An organization’s ability to identify all relevant internal and external stakeholders was an important domain for organizations participating in the DLP. There was a particular focus on engaging with Black, Indigenous, People of Color (BIPOC) patient communities for those healthcare organizations that serve those patient populations.   
5. Harness the power of a collaborative network:  It is essential that the process by which equity-focused solutions are developed and implemented is collaborative and draws upon the collective knowledge of the entire organization. Sharing ideas, resources, and strategies was crucial for organizations participating in the DLP.

Conclusions

The authors highlight two important observations across all of their findings regarding addressing racial disparities in healthcare institutions. First, there was strong evidence to suggest that healthcare organizations already understand what racial and ethnic disparities are present in their organizations and what needs to be done to eliminate them. Second, the real barriers lie in getting leadership buy-in and organizational prioritization toward fixing these disparities. The authors offer some specific strategies and advice to best tackle these issues within the framing of the five domains listed above:

1. Many survey respondents mentioned both Executive “Champions,” who lead the effort for broader leadership buy-in, and midlevel and frontline staff members, who implement the strategy to address inequities, were critical components in creating a strategy that can help develop momentum among organizational leadership. 
2. Survey respondents proclaimed that they successfully addressed disparities once they linked disparities work with other initiatives or priorities that were already occurring. 
3. Benchmarking or numerically quantifying disparities work was crucial for creating organizational urgency and vision. It is helpful to do this in conjunction with communication strategies that are developed clearly and concisely. 
4. Engaging organizations by sharing your vision early in the strategic process was beneficial in terms of developing internal and external partnerships. Furthermore, leveraging awards or recognition achieved for disparities work helped to continue momentum. 
5. Lastly, organizations that were successful in reducing racial and ethnic disparities by the end of the program highlighted their use of diverse and collaborative coalitions that were able to anticipate changing environments, provide general networking and peer support, and encourage divergent points of view to address health disparities more effectively.

These recommendations are crucial for the future of the healthcare field, especially as the sector continues to lack clarity regarding the future of nationwide healthcare efforts like the Affordable Care Act. In the wake of governmental uncertainty, healthcare institutions themselves must work towards transforming their institutional responses to racial and ethnic disparities. Organizational change management strategies should be a core part of that discussion, and this study illustrates how effective they can be in conversations around disparities reduction specifically. The DLP and the specific recommendations in this study serve as a springboard to further the discussion around disparity reduction within healthcare institutions.