The Institute for Healthcare Improvement (IHI), a highly respected nonprofit dedicated to improving healthcare, recently recognized Montefiore Einstein as an example of an innovative hospital system thanks to enhancements the Montefiore Center for Performance Improvement made to the IHI’s own toolkit that now incorporates using an equity lens when working on quality improvement in healthcare.
During his keynote speech at the international organization’s annual conference in December, IHI President and CEO Kedar Mate, MD, praised the performance improvement team for its innovation, which Mate said will improve equity, safety and value in healthcare for all people.
IHI has a long-established method for developing and measuring the success of performance improvement initiatives. Montefiore Einstein’s novel approach adds a component that helps prevent the initiative from inadvertently disadvantaging certain groups. It works by screening for unintentional biases and social determinants of health (SDOH) that could cause well-intentioned initiatives to backfire.
When the IHI Board saw Montefiore Einstein’s innovative revisions, they were so impressed that they asked the performance improvement team to present at the broader conference.
“The IHI now is contemplating adopting our amended toolkit,” said Fran Ganz-Lord, MD, FACP, Senior Director, Montefiore Center for Performance Improvement. “The team’s creative ideas for revising the tool stem from the view that we need to be looking at everything through an equity lens.”
For example, if a program is designed to help people get to their doctor’s appointments on time by giving them free parking passes, anyone who uses public transportation instead of driving will be disadvantaged and an initiative intended to help everyone will fall short of its goals. Looking at unintentional bias and taking SDOH into account can help hospitals better target their programs to truly serve the needs of their communities.
Montefiore Einstein has already successfully used this new toolkit across many quality initiative projects. When White Plains Hospital was implementing a telemonitoring system aimed at decreasing the number of patients readmitted for heart failure, the novel toolkit helped the team notice a demographic disparity in who agreed to sign up. After examining SDOH, such as patients’ tech savviness and education levels, designers restructured their model to be easier to use and easier to explain, so all patients could understand what they were being asked to do. As a result, enrollment in the telemonitoring program has continued to rise, without any disparity in patient demographics.
“This tool helps accelerate equity in healthcare, even at a place like Montefiore, which is mission-driven with a commitment to serve the underserved,” Dr. Ganz-Lord said. “In systems that are not as progressive as Montefiore, it will certainly have a much bigger impact.”