Organizational journeys to CLAS, Part II: Challenges and successes for implementation

The Disparities Leadership Program: Empowering Leaders, Getting to Solutions
The Institute of Medicine Reports Crossing the Quality Chasm and Unequal Treatment highlight the critical nexus between improving quality and eliminating racial and ethnic disparities in health care. Combined, they provide a blueprint for addressing disparities that can only be achieved if a concerted, coordinated effort towards health systems change can be achieved.
The Disparities Leadership Program (DLP) is a year-long executive education program designed for leaders from hospitals, health plans and other health care organizations who want a) develop a strategic plan or b) advance a project to eliminate racial and ethnic disparities in health care, particularly through quality improvement. The DLP has two overarching goals:

1. To create a cadre of leaders in health care equipped with a) in-depth knowledge of the field of disparities, including root causes and research to date; b) cutting-edge quality improvement strategies for identifying and addressing disparities; and c) the leadership skills to implement these strategies and help transform their organizations.
   

2. To help individuals from organizations—who may be at the beginning stages or in the middle of developing or implementing a strategic plan or project to address disparities—further advance or improve their work in a customized, tailored fashion.
   

The DLP seeks to stimulate and promote the development of strategic plans or the advancement of a component of a project designed specifically to eliminate racial and ethnic disparities in health care within health care organizations. As a condition of entry, participants in the DLP must either:
A.   Develop a strategic plan to address disparities over the course of a year.
B.   Or advance a component of a project that addresses disparities. Examples of the types of projects considered include:

• Implementing a system to collect patient's race/ethnicity and language data
• Stratifying and reporting quality data by race/ethnicity
• Developing a culturally competent disease management program
• Evaluating a disparities intervention
• Expanding disparities interventions across conditions and populations

In either case, applicants must propose the ways in which they would like to advance this work over the course of the year through participation in the DLP. Again, participants can be in various stages of development in their program, ranging from developing a strategic plan to evaluating disparities interventions.
The DLP begins with
o     a two-day intensive training session focused on defining disparities and root causes
o     developing cutting-edge quality improvement strategies to identify and address disparities
o     and fostering leadership skills to implement these strategies and help transform their organizations
Some of the topics covered during the training include:

• Racial and Ethnic Disparities in Health Care: Background on the issue of racial and ethnic disparities in health care including a review of root causes and strategies to address them
• Getting Disparities on the Leadership Agenda: Building the will among leaders in the organization to become invested in identifying and addressing racial/ethnic disparities in health care, including the presentation of the business and quality case for addressing this issue
• Where to Begin: Tools and activities to help organizations get started with efforts to identify and address disparities, including the strategies, techniques and technology for collecting race and ethnicity data
• Creating Disparities Measures and Reporting Mechanisms: Guidance on how to stratify quality measures by race and ethnicity, and report them appropriately via dashboards, scorecards, or other standard or innovative mechanisms
• Adding the Community, Patient, and Staff Voice to the Disparities Agenda: Strategies for bringing in key perspectives to disparities and patient safety work, including those of the community, the patient, and the health care staff
• Developing Disparities Interventions: Developing and implementing innovative approaches to address disparities organizationally and through quality improvement
• Making Systems Responsive to the Needs of Diverse Populations: Review of tools to improve the cultural competency of the health care delivery system and capacity to address the needs of patients with limited English proficiency
• Communicating Broadly and Clearly: Developing an approach to communicating the issue of disparities both internally and externally
• Assuring Sustainability: How to assure pilot programs become standard practice within the organization and how to disseminate successes broadly

The DSC works with DLP participants to achieve their disparities project goals through various modalities of technical assistance, including three interactive conference calls for the entire group, and two interactive web seminars on additional learning topics tailored to the most pressing needs of participants. The DLP continues with a two-day closing meeting where participants will present their work and lessons learned and individual strategic plans or projects. Participants also have the opportunity to network with and learn from like-minded peers at this time and over the course of the year.

The Disparities Solutions Center at MGH
The Disparities Solutions Center at Massachusetts General Hospital is dedicated to developing and implementing strategies to eliminate racial and ethnic disparities in health care through innovative policy and practice. Created and led by Dr. Joseph Betancourt, the DSC is made up of a multidisciplinary team of health care professionals with expertise in the area of racial/ethnic data collection, performance measurement and reporting, disparities interventions, and evaluation. The DSC strives to:

• Serve as a change agent by developing new research and translating innovative research findings into policy and practice
• Develop and evaluate customized policy and practice solutions for health care providers, insurers, educators, community organizations and other stakeholders
• Provide education and leadership training to expand the community of skilled individuals dedicated to eliminating health care disparities

For our inaugural 2007-2008 DLP class, the DSC accepted 4 health plans, 5 hospitals, 3 community health centers and 1 public health department from across the nation. Our 2008-2009 class consists of 17 organizations, with 10 hospitals, 4 health plans and 3 community organizations. So far 59 participants have enrolled in the DLP and have focused their efforts on advancing a project to eliminate disparities within their organizations. Projects range from starting the collection of race and ethnicity data, using the electronic medical record to address disparities, and designing interventions based on an organizational assessment. For our inaugural 2007-2008 class, three projects were chosen to receive an award for innovation and success. These awards were based on the organizations performance over the year and their final presentation. Our three awardees were:
o        Baylor Health Care System – Design and implementation of intervention strategies with a focus on surgical infection prophylaxis
o        Harbor Health, Inc. – Implementation and analysis of race and ethnicity data collection as well as patient satisfaction surveys
o        Presbyterian Health Plan – Improving diabetes care for ethnic populations

Building on our success with our inaugural class of 2007-2008 and based on feedback received from their evaluations, we are looking into creative ways of continuing the connections made through the DLP. Some of these include posting a DLP blog, inviting DLP alumni to DLP opening meeting reception, as well identifying national meetings that might of interest to DLP participants.