Addressing pervasive health inequities is an incredibly complex challenge. Valuable population health research has been done, comprehensive health equity strategies have been developed — but how to drive these strategies into action? One vital way is identifying the key levers that will most effectively support the needed policy, program, investment and service changes, and identifying the policy and resource mechanisms to shift those levers and implement and sustain the identified changes. A vital health care system priority and lever for change is performance measurement and management and evidence-driven planning. How can we drive health reform and innovation if we aren’t measuring what we are doing and managing for program impact? For equity, the challenge becomes how to embed equity within ongoing planning, delivery and performance management.
LHINs have effective mechanisms ready to hand to do just that. Toronto Central has required its hospitals to develop equity plans, first in 2009 and then refresh them in 2010. Community Health Centres have developed a common sector-wide equity plan — stay tuned for details. Central LHIN has also had its providers do equity plans.
As with the first plans, Wellesley partnered with the Evaluation Centre for Complex Health Interventions to analyze the second generation of hospital equity plans. Developing two generations of plans has accomplished several objectives:
• it further highlighted access and quality barriers and the need to explicitly address the health needs of disadvantaged populations;
• it showcased the increasing number and wide range of initiatives that hospitals have been developing to do just that, showing concretely that action is possible;
• the analyses, coordination and discussion necessary to prepare the plans mobilized more and more champions, programs and commitment within hospitals, and continued to lay a solid foundation of equity-planning mechanisms and experience;
• by building on the first plans, and planning towards the future, this process further embedded equity within hospital service delivery, performance management and working cultures; and
• it identified the challenges still to be addressed.
Our report had 13 action recommendations designed to enable and promote equity-focused planning, evaluation and innovations, and more tightly embed equity through cross-institutional equity task forces or forums, explicit performance requirements for senior management, explicit equity targets and indicators, collecting equity-relevant data, and building equity deliverables and priorities into accountability agreements.