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The “Waze” of Inequity Reduction Frameworks for Organizations: a Scoping Review

  • Sivan Spitzer-ShohatEmail author
  • Marshall H. Chin
Article

ABSTRACT

Background

Different conceptual frameworks guide how an organization can change its policies and practices to make care and outcomes more equitable for patients, and how the organization itself can become more equitable. Nonetheless, healthcare organizations often struggle with implementing these frameworks.

Objective

To assess what guidance frameworks for health equity provide for organizations implementing interventions to make care and outcomes more equitable.

Study Design

Fourteen inequity frameworks from scoping literature review 2000–2017 that provided models for improving disparities in quality of care or outcomes were assessed. We analyzed how frameworks addressed key implementation factors: (1) outer and inner organizational contexts; (2) process of translating and implementing equity interventions throughout organizations; (3) organizational and patient outcomes; and (4) sustainability of change over time.

Participants

We conducted member check interviews with framework authors to verify our assessments.

Key Results

Frameworks stressed assessing the organization’s outer context, such as population served, for tailoring change strategies. Inner context, such as existing organizational culture or readiness for change, was often not addressed. Most frameworks did not provide guidance on translation of equity across multiple organizational departments and levels. Recommended evaluation metrics focused mainly on patient outcomes, leaving organizational measures unassessed. Sustainability was not addressed by most frameworks.

Conclusions

Existing equity intervention frameworks often lack specific guidance for implementing organizational change. Future frameworks should assess inner organizational context to guide translation of programs across different organizational departments and levels and provide specific guidelines on institutionalization and sustainability of interventions.

KEY WORDS

inequities disparities organizational change frameworks implementation 

Notes

Funding Information

Dr. Spitzer-Shohat was supported by a Rivo-Essrig Fellowship from the Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University. Dr. Chin was partially supported by the Chicago Center for Diabetes Translation Research (grant number NIDDK P30 DK092949), the Robert Wood Johnson Foundation Finding Answers: Solving Disparities Through Payment and Delivery System Reform Program Office, and the Merck Foundation Bridging the Gap: Reducing Disparities in Diabetes Care National Program Office.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Department of Population Health, Azrieli Faculty of MedicineBar-Ilan UniversitySafedIsrael
  2. 2.Center for Health and the Social SciencesUniversity of ChicagoChicagoUSA
  3. 3.Section of General Internal MedicineUniversity of ChicagoChicagoUSA

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