Research finds that many health care system employees are uncertain about the meaning of 'health equity'

In a major hospital system in Atlanta, less than one-fourth of employees were able to define either equity or health equity, according to a study published in the Journal of Healthcare Management.

The knowledge gap was apparent even though the hospital has been engaged in projects aimed to advance health equity, according to the report by Melissa Uehling, an M.D./Ph.D. candidate in the Department of Sociology at Emory University, and colleagues led by Dr. Yolanda Wimberly, Chief Health Equity Officer at Grady Health System in Atlanta. "We anticipated that management and administration-level employees would generally have a higher level of understanding, but the results did not support this supposition," the researchers write.

Few employees could articulate a definition of health equity that matches research-based concepts

As part of a larger study of health equity, the Office of Health Equity conducted 28 structured focus group discussions with employees of Grady Health System. Grady is a safety net hospital, meaning a high proportion of its patients are uninsured and/or underinsured. In addition, the community it serves is primarily underrepresented racial/ethnic minorities.

Altogether, 233 employees attended a focus group. Black employees constituted 58% of participants, white employees 30%, and people of other races 12%. Over half of participants (59%) were frontline clinicians or mid-level managers/supervisors; the rest were director-level and above. Most (62%) had been employed at Grady for at least five years.

Employees were first asked to define equality, equity, and health equity. They typed their answers anonymously into their personal mobile phones, and specialized software analyzed the responses later. The researchers defined a "correct" definition of health equity as one that acknowledged the importance of determining individual needs and tailoring treatment to achieve equality.

Of the 191 participants whose answers were analyzed, only 20% correctly defined equity and only 23% correctly defined health equity. There was no correlation in how the questions were answered between job title nor length of time employed by the health system.

Even conceptual knowledge didn't indicate comprehension of how health equity can be enacted

For a qualitative analysis, the same focus group participants were asked to describe health equity successes of which they knew at Grady. Major categories noted were community presence and collaboration, staff and job diversity, provision of care to all individuals in need, and specialized programs.

Interestingly, there was no association between the ability to correctly define equity or health equity and the ability to report a success at the hospital that fell into any particular category.

"Before undertaking health equity work within and for a health system, it is vital to level-set what health equity means to health system employees at all levels and roles within the organization," the authors urge. "Frontline health system staff, managers, or leaders cannot act on health equity if their notions of health equity are vague."