K. Williams1, M. Byrnes1, O. Mmeje1, D. Brown1, A. Haggins1, E. Khang1, C. Wright1, S. Goold1, E. A. Newman1 1University Of Michigan, Ann Arbor, MI, USA
Introduction: Dismantling health disparities will require American hospital systems to consistently evaluate and incorporate the impact of upstream broad systemic barriers to delivering equitable care. Hospitals are often the core sites of unequal medical treatment for historically marginalized and underrepresented persons. To situate socially just care for all inpatients, this hospital developed and implemented a novel clinical Healthcare Equity Consult Service (HECS) to provide social justice expertise, consultation, and intervention with interdisciplinary medical practitioners in real-time.
Methods: We conducted an explanatory mixed methods study of a HECS in one Midwestern hospital. First, consults received by HECS between August 2022 and February 2023 were reviewed for demographic characteristics and chief complaint for equity consultation. Feedback was requested from clinical care team members, consulting clinicians, and members of the HECS Advisory Council. We then engaged patients/families who were served by HECS in qualitative interviews to expand upon clinician feedback. Transcribed interviews were analyzed inductively.
Results: Thirty-nine consults were received and completed between August 2022 and February 2023. A majority (n=27) of patients were Black/African American. The most common reason for a HECS consultation was a concern for bias due to racism. Patients and families often raised the following themes – the use of stigmatizing language (e.g., noncompliant, aggressive, questioning), inadequate pain control, request for hospital security or protective services, misgendering, and stigma related to mental illness and disability, to name a few. In most cases, the intersectionality of identities contributed to the HECS consult.
Qualitative results demonstrated that some patients, but not all, utilized HECS because of stigmatizing language that followed them in their charts and affected their care, security was weaponized during their care, communication between staff and patients were often viewed as “loaded” and where hospital policy was used inappropriately. Areas for improvement include increasing visibility, advocacy methods for patients and families, and expectations for what a consult using a health equity lens may accomplish.
Conclusion: Most HECS consults addressed patient and family experiences of bias and discrimination due to racism. The design and implementation of a coordinated and specialized healthcare equity consult team could serve as a model of clinical care for other healthcare organizations to operationalize strategies that promote equitable healthcare access and delivery.