For health system leaders who have been thinking or talking about how to create health equity in their organizations, an AMA toolkit outlines five concrete steps to help turn words into actions.

The AMA STEPS Forward™ toolkit was developed in partnership with strategic consulting firm HealthBegins to help physicians and other health professionals in mid-sized and large health care delivery settings:

• Prepare for conversations about health equity, racial equity, racism and anti-racism.
• Engage others in the organization.
• Understand the importance of systemwide data and how to improve data quality to further racial and health equity efforts.
• Explain how to advance equity using SMART goals and quality improvement efforts.

The steps are part of a larger cycle of continuous learning, improvement and accountability envisioned in the AMA’s strategic plan to embed racial justice and advance health equity.

“The AMA is committed to embedding racial justice, advancing health equity and partnering with others to identify, prevent and eliminate racism in our health system,” said AMA President Gerald Harmon, MD. “The AMA’s newest toolkit will help guide health systems in efforts that promote positive cultural transformation and address the root cause of racial health inequities.”

Change will take courage

Improving health equity requires organizational transformation, said one of the toolkit’s authors, Rishi Manchanda, MD, MPH. He is CEO of HealthBegins, a mission-driven firm that helps physicians and other health care leaders move their organizations upstream to address the social and structural factors that drive health inequity.

“For those who don’t know how to start or are afraid the process will overwhelm them, the answer simply lies with courage and leadership,” Dr. Manchanda said. “Not just formal leadership. It is leadership that any individual—including physicians in health systems—can muster within themselves to courageously start answering a key question about how to proceed in making one’s practice, one’s own health system, an anti-racist organization.”

Here’s an overview of the five steps the toolkit outlines.

Commit as a health system to do the work. Commitment happens in two phases. Establish where you are by asking questions: Do we know whether access to care, preventive screenings, treatments, quality or outcomes measures differ by patient race, ethnicity or language? When was the last time—if ever—that we asked patients or employees how racism has affected their health and the care they’ve received? Next, identify champions to advance health equity work within the organization.

Start shifting organizational norms and practices by learning about what you don’t know. Name it, frame it, explain it. It’s important for everyone in the health system to develop a shared understanding of racism. This will involve individual and group learning, a review of insights and resources from health equity and racial justice researchers and scholars, and provide dedicated time and informal opportunities at work to talk with colleagues and patients. The AMA and Association of American Medical Colleges’ health equity guide to language, narrative and concepts should be incorporated into this step.

Get a handle on your data. Ask two basic questions within and across departments: What does our patient data tell us about racial inequities in quality, access, health outcomes and health-related social needs among our patients? And what does data from our community, including our payers and local health department, tell us about these patient and communitywide inequities?

Develop a shared, clear, compelling vision for the entire system. Engage leaders within and across departments to work in teams. Focus on a few key, actionable measures and health inequities. The toolkit explains how to define a project charter with equity-focused SMART (specific, measurable, achievable, relevant and time-bound) goals.

Launch targeted improvement efforts across the system. Focused quality improvement campaigns that explicitly and specifically aim to advance racial justice and health equity help drive positive changes. The toolkit includes examples of health-system based initiatives to embed racial justice and advance health equity.

Another AMA STEPS Forward toolkit co-written by Dr. Manchanda provides concrete steps for smaller practices to advance health equity through action.
Explore the AMA Ed Hub™ Health Equity Education Center, whose curated education from trusted sources is confronting health injustice and advancing equity.

The AMA is working to support system-level solutions that identify and address root causes of health inequities while elevating their importance to patients, communities and stakeholders. Learn more about efforts underway at the AMA Center for Health Equity.