The main traits to succeed in health equity are action-orientation and a quality improvement mindset. Equity is a combination of diversity and disparities. You have to be representative of the community. It’s to understand diversity and inclusive culture so that people of color, different genders, people of all backgrounds have access to healthcare. It’s great for organizations to have a Chief Diversity Officer or a Chief Equity Officer, but you need to work in all components.

Collecting social determinants of health is a major data collection activity. We’re systemically collecting and analyzing data; however, data collection can sometimes be an avoidance of doing hard work. We need to consider health equity as a quality improvement issue for leaders.

There’s a difference between hope and real improvement. We’re lacking quality and discipline as leaders, increasing leadership and governance. Our efforts should all have a measurable aim, a team that performs testing, makes change interventions, and tracks all the way, and we don’t.

Leaders need to further develop a quality improvement skillset; it is something we should have as a competency. First, there is still a will issue—racism as an example. If you ask most leaders, it’s about money, workforce, health equity, quality, but not with the same level of “passion” as when the George Floyd death happened. Second, there’s a lack of will building in some leaders. Third, it’s really hard. There aren’t a lot of great stories of organizations going from A to B and with a roadmap of “here’s how to do it”. We need to build that case – like we built patient safety to reduce infections. This won’t be that easy because we’re building on a long time of inequities; but it doesn’t mean we can’t have ideas, new and meaningful interventions. The last one is accountability. Are boards holding leaders accountable for quality? Leaders aren’t being held to the same level of rigor and frequency for other metrics when it comes to health equity.

I’m a firm believer in leadership diversity because it drives change. We have a leadership dashboard, to track the percentage of leaders that are nonwhite. We review it on a monthly basis. We also track that same information for our nursing leadership. We look at the percentage of open leadership positions that have diverse candidates in the final roster of candidates. We also hold unconscious bias training once a year, and we will add an inclusion question to employee pulse surveys too. We publish a health equity report on our website, looking at a dozen quality metrics that allow us to see where disparities are, and we track on a monthly basis where we measure health disparities by race and ethnicity and spoken language. These are just a few of the metrics we focus on.

Context matters. Having people who understand it is really important. So one is, are leaders from a diverse population in terms of background and lived experiences? Individuals have different backgrounds and experiences to provide them context to do this work. Are they from different educational institutions, that we don’t yet have on the team, or are they coming from historically Black colleges and universities (HBCUs)? Then it’s relationship building and your expertise.