Improving racial equity in maternal health care is a long-term challenge, and with so many factors affecting outcomes it can be difficult to know where to begin to create meaningful improvements. Structural racism, implicit bias, variation in access to quality care, and underlying chronic conditions all contribute to the high rate of pregnancy-related mortalities for Black women, who are three times more likely to die in childbirth than white women, according to the CDC.
Press Ganey’s analysis of recent HCAHPS survey data further highlights a distressing care divide, with Black women reporting an almost universally less satisfactory experience during the course of their inpatient stay than non-Black women. Rectifying these disparities requires thoughtfully segmenting data and enhancing survey methodology to capture a true picture of what’s happening within patient communities.
Look beyond the high-level outcome
To effect lasting change, you must gather information on or related to race and ethnicity that is accurate and complete. While the collection of demographic and outcome-based data is frequently conducted to support equity endeavors, blind spots can lead to misrepresentation of patient characteristics that ultimately contribute to faulty improvement plans.
Take, for example, the common practice of segmenting a particular outcome—like hypertension rates—for a community. While this may help you understand which segment of the population needs dedicated attention for a particular condition, it only tells part of the story. Similarly, organizations might segment a single patient experience measure, such as likelihood to recommend, to look for global patterns. However, both approaches fail to show the complexity and nuance of experiences that a fuller set of patient experience indicators could offer. Expanding the set of measures to include allows you to see the fuller context of disparities and where needs are not being met.
HCAHPS surveys received by Press Ganey in 2019 showed that, in nearly every attribute, maternity patients who identify as Black or African American reported worse experiences than other women (Figure 1). The largest disparities were in discharge preparation, responsiveness, care transition, cleanliness, and likelihood to recommend the hospital. While this national finding could in part reflect differences in access to higher-quality hospitals, we find that many organizations see the same pattern when looking within their own organizations’ outcomes. The national pattern serves as a red flag around the need to improve processes and experience on the way to attaining positive care outcomes.
Have patients self-report, and share your data
Efforts to ensure equitable care also need to be grounded in administrative data related to race and ethnicity that’s optimized for quality and veracity. Additionally, when organizations obtain data about patient identities, the information should be shared across silos to promote segmentation and drive improvement in all spheres. This begins with patients self-reporting identity, including race/ethnicity or sexual orientation and gender identity (SOGI), which may already be in your electronic health records (EHR) or can be captured in patient surveys with the aid of CAHPS tools.
Asking patients to self-report their identity requires trust that you will not misuse the information, which may create a need for transparent discussion on the value and use of the input requested. It is nevertheless critical to ensure that segmentation is correct at the most granular level, that phrasing of survey questions reflects the way people talk about themselves, and that you have the context to better analyze comments on open-ended questions. Press Ganey’s Equity Data Diagnostic provides a comprehensive review of race/ethnicity data from your EHR.
Mount Sinai's journey to reach the pinnacle of accurate patient data
New York-based Mount Sinai Health System stands as an example of how to make equity a strategic priority, administering and executing a multiyear plan for the collection of race and ethnicity data. Started in 2015 with the formation of a task force, the Health Disparities Working Group, Mount Sinai’s journey has included: patient education on the reasons for identity collection; staff training, supplemented by FAQs from patients and staff; care provider focus groups for feedback; a race/ethnicity capture dashboard for awareness; and plans for future integration of race and ethnicity into key performance indicators. Mount Sinai aims to increase its collection rate to 90%-95% with a campaign to promote the importance of surveys to underrepresented communities, analyze data for disparities, and recommend interventions.
Watch Mount Sinai’s webinar to learn more.
Insights for improvement
Equity initiatives aren’t one and done. Hospital leaders must oversee the continued implementation of best practices, such as hourly rounding and care transition protocols, for all populations. Particularly in this era of social justice reckoning, it’s also essential to recognize that opinions and perceptions about critical services are shaped and reshaped by events and cultural shifts. Dynamic surveying—i.e., layering brief, tailored content on to surveys to capture the evolving needs of individuals—should be in every health care facility’s toolbelt. It’s used to ask timely questions that can help identify inequities and changing viewpoints among patients and subgroups, which then prompts facilities to investigate and react. These surveys also allow you to zero in on quality improvement initiatives that keep the patient voice top of mind.
The power of dynamic surveying was never more evident than in Press Ganey’s recent work on hesitancy to get the COVID-19 vaccine. Analysis of over 100,000 consumer responses to surveys received between Oct. 2, 2020, and Jan. 16, 2021, revealed that patients were slowly starting to accept a vaccine, but they were relying on guidance from individual providers and not the government. This was even more true for patients who identify as Black or African American, who reported very low levels of confidence in the safety and effectiveness of the vaccine. Those survey results made it clear that health care organizations needed to inspire vaccine uptake by integrating communication strategies into their vaccination implementation plans at the individual, community, and broader population levels.
On top of segmenting survey outcomes and employing dynamic measurement, natural language processing tools, such as NarrativeDX, are available to uncover and analyze additional nuance to patients’ verbatim descriptions of their experiences.
To lessen physical, mental, and emotional harm, hospitals and health care systems need to be willing to take a close look at their current data collection and how they use that data. Press Ganey Advisors and Strategic Consultants can support organizations in their equity work. Additional tools and resources are available for free upon joining the Press Ganey Equity Partnership, a collaborative dedicated to addressing health care disparities and the impact of racial inequities on patients and caregivers. Learn more about its mission and sign up here.