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Putting the spotlight on pediatric health equity
The Michigan Child Health Equity Collaborative (Mi-CHEC) starts with a simple premise: We in the health-care system want to provide the best possible care to all children, and yet we know there is variation in the quality of that care. Children who differ in some characteristics may enter the hospital or doctor’s office and be responded to differently due to one or more of those characteristics. In other words, these children may experience a health inequity. Mi-CHEC's leaders define health inequites as those within the control of the health systems or individual providers, either in care received by patients or in the patient/family experience.
To ensure the care we provide is in line with our best intentions, Mi-CHEC brings together the three largest pediatric hospitals in Michigan to identify potential variation in the quality of care in our systems, research areas of concern that may be common to all three health systems, initiate quality improvement interventions to address any proven health inequity, and evaluate the impact of our interventions.
What does this look like in practice? Mi-CHEC combines research and quality improvement experts to facilitate each stage of these research and improvement processes across sites.
Engaging health systems
To understand where variation in care might be present, Mi-CHEC prioritizes listening to the experts: those working in our health-care systems who have knowledge and experiences in how care is delivered. Providers in pediatric care (e.g., doctors, nurses, social workers, staff), institutional leaders and families at each hospital are given the space to voice their concerns and help identify potential health inequities. Each group has a unique vantage point that can help surface key insights and identify potential areas that warrant assessment. Mi-CHEC shares information across sites so that partners at all hospitals can then work together to prioritize how to study potential health inequities.
Measuring potential health inequities
Mi-CHEC takes seriously the concerns, ideas and input of those working inside our hospitals when it comes to identifying any variation in care, but we do not stop there. We use these observations as a springboard for targeted research to examine whether those health inequities are pervasive, and if so, we measure their magnitude. The Mi-CHEC coordinating center provides the partner hospitals with expertise on the latest research and methods for assessing health inequities to inform their research process. At each hospital, staff with technical expertise retrieve and analyze data. Together, hospitals learn about best practices and how to overcome any challenges they face to conduct rigorous research about health inequities in their system.
Data-driven change
If health inequities are confirmed through this rigorous process, Mi-CHEC is ready to act. Partners from each hospital work together and with experts in the MI-CHEC coordinating center to design quality improvement initiatives. Critical to this work, all quality improvement strategies are designed such that they can be measured and evaluated to assess impact. Each hospital implements quality improvement strategies targeted to their specific context, including collecting and evaluating data. Partners across hospitals share results to facilitate joint learning, adjust strategies and improve quality of care across the collaborative.
Approaching health equity through systems-level thinking
It is important to note that we do not believe differences in care occur because of any evil intent on the part of providers or staff. At Mi-CHEC, our goal is to focus on systems rather than individuals and implement protocols and structural changes to achieve quality care for all children.
A similar approach is taken when addressing safety in clinical care. Rather than blaming individuals, health-care systems accept that humans are fallible, so transparent measurement is encouraged and process improvement is the norm. For example, to reduce preventable infections by improving hand hygiene, in addition to education, protocols are used (e.g., hand-sanitizer dispensers are placed at each patient door) to make it easy to do the best thing for patient care. Drawing on the successes of this approach, we apply these same key principles to improve pediatric health equity.
Impact
While Mi-CHEC starts with health systems in our collaborative, we hypothesize that variation in pediatric care is also present in other health systems across the state and the country. Thus, findings from our projects will be disseminated to inform local, state, and national decision makers to provide actionable steps to identify and address health inequities. Ultimately, our goal is quality care for all children.
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