I was speaking to a hospital board member about the challenges of hospitals building health equity into their planning and service delivery. Some hospitals have shown significant leadership in prioritizing health equity and identifying ways their services can address health disparities and access barriers; others less so. I think there are five key arguments to hospital boards that have not sufficiently prioritized equity on why they need to act.
First of all, the recently passed Excellent Care for All act changes the context for the overall system and health care institutions significantly, and provides support for quality and consumer-driven innovation. The Act includes equity among its key principles. More generally, it is clear that the Ministry of Health and Long-Term Care will be driving its priorities through performance management means – through adjusting allocations to hospitals, tying some funding to meeting deliverables, possibly pressuring hospitals to include meeting deliverables in CEO/senior management performance management and compensation processes. Hospitals should realize that equity is part of this overall context of delivering quality and get out ahead of these coming pressures.
Secondly, several LHINs have already required their hospitals to develop equity plans. The priorities identifed within these plans will be incorporated in service accountability agreements moving forward, so the plans will have some ‘teeth’ and impact. The process of developing these plans has been beneficial to embedding equity within routine planning and delivery. Templates have been developed in two LHINs and can be easily adapted. Of course, it is hard to predict if the Ministry or other LHINs will require such plans, but it would not be surprising. Again, given their demonstrated benefits in Ontario and around the world, why not get out ahead of this as well and proactively lead?
Third, hospitals already have to deliver on key Ministry and LHIN priorities around Emergency Room and other wait times, ALCs (alternative level of care), mental health, and diabetes. The roots of these problems can only be understood within an equity lens – e.g. one factor in inappropriate ER use is inequitable and inadequate access to primary care for key disadvantaged populations, and the latter chronic conditions are especially sensitive to social conditions. Arguably, hospitals – and certainly the LHINs – will not be able to achieve their deliverables in these areas without taking equity into account in planning and programming.
Fourth, tools exist to support effective equity-focused planning: a number of LHINs have been using Health Equity Impact Assessment developed by the Ministry (view a recent presentation). It is difficult to predict if HEIA use will become mandatory, but why not proactively experiment with a proven tool?
Finally, a number of hospitals – and not just the large Toronto academic hospitals – have shown leadership in prioritizing and driving equity. Their experience can be drawn upon.