Building health equity is an important role for modern health systems and hospitals. It’s an essential component of healthcare excellence in the areas of safety and quality. Medicine and healthcare still have a long way to go to make truly equitable care a reality, and patients still face disparities in health and treatment outcomes across socioeconomic status, racial background, gender, region, and more. At its core, equitable treatment looks like delivering care that is tailored to the patient’s individual needs while minimizing avoidable outcome disparities. While acknowledgement of healthcare disparities is widespread, only around 23% of health care executives name health equity as a top priority. Incorporating health equity into executive strategy is vital. While there are clear ethical and compliance concerns for doing so, it also supports growth, operations, and overall business imperatives. In this article, learn more about the fundamental aspects of healthcare equity and essential strategies for developing equity in healthcare at the leadership level.
Refining Access Beyond ‘Off-the-Shelf’ Solutions
While coverage is a vital aspect of treatment access, it also necessitates culturally relevant and geographically appropriate care pathways. Technologies and devices that emphasize portability and enhance outcomes can go beyond standard offerings that under-serve certain populations, such as individuals in rural areas or with a high BMI. Healthcare executives can play a decisive role in mitigating disparities by overseeing an audit of treatment offerings to discover care gaps and nuanced barriers to treatment access. Tailored care models that mitigate potential barriers, such as linguistically adapted telehealth and community health programs, can help make an impact.
Cultural Competency as the Foundation of Equitable Care
In multicultural societies, patients can have varied linguistic, socioeconomic, and cultural needs. Adopting practices that account for these variations can potentially have a positive impact on outcomes through improved engagement with patients, better treatment adherence, better overall patient satisfaction, and improved workforce retention. Continuous education in cultural competency is vital for reducing disparities, as members of historically marginalized groups are more likely to report feelings of being ignored or outright disrespect during care encounters. A hiring and training approach that accounts for diversity can improve outcomes. From the executive suite, leadership can contribute by regularly auditing the workforce and care delivery for cultural, demographic, and linguistic diversity and representation.
Grasping the Bigger Picture: Social Determinants of Health
Social determinants of health (SDOH) encompass a broad range of factors that impact health outcomes for the individual outside of the healthcare facility itself. While healthcare leaders have limited ability to address these factors directly, understanding SDOH is critical to understanding variations in health outcomes across different population demographics.
Some of the most impactful SDOH factors include:
- Food access: Food insecurity correlates with a greater risk of chronic illness.
- Housing: Instability is shown to increase hospital readmissions.
- Transportation: Transit limitations hinder access to resources.
- Financial status: Lower-income households have significantly worse access to care compared to high-income households.
- Education level: Higher education is associated with better health behaviors, such as less smoking, better diet and exercise habits, and more use and knowledge of preventative care approaches.
While SDOH factors occur largely outside of the hospital system itself, healthcare executives can still take steps to help track impacts and minimize them. Integration of SDOH screenings as part of electronic health records (EHRs) and clinical workflows collects valuable data that can be shared with local authorities or community organizations.
Addressing Racial, Gender, and Regional Disparities: What Can Health Systems Do?
Research surveys found that “poor or fair health” status varies significantly across racial groups. This status was reported by 21.7% of Latinos, 21.6% of Black, 13.7% of White, and 9.6% of Asian adults; these differences were mostly unchanged from 2019 through 2022. Low-income Latinos have the highest reported rates of limited healthcare access.
Other key areas in which health disparities are prevalent include chronic illness, maternal health, specialty access, and cancer screenings. Drivers of these disparities are varied and systemic and include:
- Geographic resource gaps: Significant variability persists in healthcare quality and access across states and in rural versus urban areas.
- Historical bias: Marginalized populations have historically faced discrimination and exploitation in the healthcare system.
- Socioeconomic factors: Differences in income and environment can have significant impacts on health outcomes.
These disparities are projected to cost the healthcare system in the US $353 billion by mid-century without a resolution. These issues are systemic and no single health system and its leaders can solve these challenges alone. Monitoring outcomes and screening metrics by race, gender, and geography on a regular basis can give health systems the data they need to update protocols where disparities persist.
Building Trust in Marginalized Communities
Historically, not all racial groups have been treated equally in the health system, resulting in massive damage to trust of the medical field in these groups that reverberates across multiple generations. Structural racism, implicit bias, and discrimination have had lasting harmful effects in the medical field. While some improvements have occurred, people of color are more likely to report pervasive negative experiences in health system settings.
Building trust isn’t easy, but there are concrete steps that health systems can take to help:
- Visibly commit to equity in health system operations: A public commitment to equity goals with meaningful follow through can have a positive impact. Follow-through looks like prioritizing patient/community outreach and transparency in policy changes.
- Transparency in treatment decisions: A commonly cited best practice, detailed explanations of treatment plans and procedures with time for questions and patient feedback is essential to providing equitable care that improves outcomes.
- Patient engagement: patients and patient advocates should have easily accessible means to offer feedback on their treatment experience, be it through forums or patient satisfaction surveys.
Using Data to Spotlight and Close Gaps
Disaggregated data can help expose gaps and disparities that would otherwise be overlooked. Data is critical for pinpointing disparities and tracking successes. Improvement initiatives can cut screening disparities in some hospitals by as much as 13%. However, only 14-25% of health systems currently track or take action based on race, ethnicity, and language (REAL) equity data on a regular basis. Collecting, analyzing, and acting on socioeconomic, gender, and race health outcomes data is best practice. However, in doing so, stewardship of said data is of utmost importance as well; ethical handling and privacy protections are critical, and health systems should also minimize counterproductive siloing of data.
This data can then be integrated into periodic strategic reviews, such as by establishing equity-related KPIs, embedded in operational dashboards, just like readmissions or infection rates.
Data Is the Engine of Equity
Patient experience is where the impact of equity-driven data work ultimately shows up. Patients from marginalized communities consistently report poorer communication, more feelings of disrespect, and lower overall satisfaction, signals that often appear long before disparities in clinical outcomes. By examining patient experience data through an equity lens and stratifying feedback by race, ethnicity, and language, leaders can identify breakdowns in trust and communication that aggregate metrics mask. Improving culturally humble communication transforms these insights into action, strengthening trust, supporting adherence, lowering readmissions, and boosting value-based performance measures such as HCAHPS. When patient satisfaction is positioned as a strategic equity outcome, it becomes the most immediate and sensitive indicator of how well patients feel seen, respected, and understood—clear evidence of whether equity efforts are truly improving care.
Here is a national model that shows what patient-centered data infrastructure can achieve:
A powerful model for patient-centered equity work is PCORnet, the national Patient-Centered Outcomes Research Network. PCORnet links data from health systems, patient groups, and community organizations to create one of the most diverse and representative clinical datasets in the United States. Its core design is built around patient-reported outcomes, demographic stratification, and direct community input, demonstrating how equity-focused data collection can translate into better patient experience and care. By elevating patient voices and ensuring that data reflects the lived realities of different populations, PCORnet demonstrates how a health system can use structured, patient-centered information to identify gaps in communication, trust, and outcomes. This model makes clear that patient satisfaction is not separate from the data strategy; it is the clearest and most immediate outcome of an equity-driven approach.
Bias in Data and AI
One factor that can confound efforts to improve equity in healthcare is the impact of bias in clinical data and even in AI algorithms. Essential research, such as clinical trials, can still suffer from serious limitations due to underrepresentation across race and gender, leading to findings that may not represent a patient’s real-world experience with a medication or device.
Meanwhile, while AI is clearly emerging as a technology that will have transformative impacts on the healthcare sector, these systems struggle with ingrained biases, which can perpetuate current disparities and distort their recommendations. This bias is a reflection of human bias, and is the result of flawed, non-representative data being used to train AI models.
Health systems leadership can play a decisive role in countering bias through consistent, routine auditing of AI tools, which is already considered best practice for AI integration. Furthermore, staff who are working with AI systems should be properly trained and informed on the risk of bias associated with them, including countermeasures to identify and report bias.
The Leadership Role in Advancing Healthcare Equity
Commitment from healthcare executives to measurable, ongoing actions supporting equity is critical for compliance, sustainability, and improvement of outcomes for patients of all backgrounds. By establishing accountability, making investment in evidence-based programs a strategic imperative, and reporting on progress with transparency and clarity, leadership can position their hospitals and health systems as innovators committed to offering a higher, more equitable standard-of-care.
Patient satisfaction builds reputations.