Children's Hospitals Today - Summer 2022 - 5

COMMENTARY / ROUNDS
Health equity and
harm events
To help close gaps, count events
rooted in disparities
BY SIMAN NUURALI, TAMIKA LASEGE,
GABRIELLE HESTER and EMILY CHAPMAN
I
n the United States, we are beginning to understand the devastating
disparities in health care and health outcomes in
adult and pediatric populations. Following an extensive review
of existing literature, the American Academy of Pediatrics published
a technical report in 2019 that outlined how prominent
disparities in pediatric outcomes are widespread across the
spectrum of health care. This included disparities in access to
care, prevention, health status, chronic disease, special health
care needs, quality of care and mortality.
Our journey toward understanding disparities is similar
to our safety journey. Years ago, we began to challenge how
we defined quality of care, led by seminal publications like
" To Err Is Human " and " Crossing the Quality Chasm " from the
Institute of Medicine. We began to embrace the idea that we
can unintentionally play a role in harm events.
It started with addressing medical errors and
taking accountability for harm events, such as
hospital-acquired conditions (HACs). At first,
HACs seemed unavoidable. If you needed surgery,
surgical site infection was a risk, and we
didn't know how to prevent harm.
But then we began to embrace systems
WE HAVE TAKEN AN
OATH TO " FIRST DO
thinking, best practices, measurements and
accountability. Now, our structures around
safety are robust, grounded in safety science, and they are
working slowly but surely as we drive toward zero harm.
Our response to addressing inequity in health care has been
like our initial response to the challenge of delivering safe
care. Addressing inequities is a large and complex challenge
that on the surface feels impossible. But children's hospitals
and health systems are one crucial piece to addressing the
issue. Each suboptimal outcome that results from a patient's
race, gender identity, primary language or disability is a harm
event. Why not count those events rooted in disparities and
drive them to zero as an institutional campaign just like we do
with other harm events, like falls and central line infections?
At Children's Minnesota, we are now doing that. As a
starting point, we created an equity dashboard similar to a
standard safety dashboard to measure the gaps that have the
NO HARM. " WE MUST
NOW LIVE UP TO IT.
greatest effect on our patient families. After reviewing nearly
60 potential metrics, we chose four with the most significant
gaps: delivery of childhood vaccinations (COMBO-10 vaccines);
missed or no-show appointments; measure related to
procedural pain management; and the rate of well-controlled
asthma. It's important to remember the real-life
implications of these gaps. Having experienced
measles outbreaks in Minnesota, we understand
firsthand the devastating impact of the 43%
disparity we found in up-to-date childhood
vaccinations between our white patients and
our Black patients.
Systematically tracking and sharing health
equity outcomes in these areas is a small piece
of the substantial work ahead to bridge the
alarming gaps we see. This work must begin with educating
ourselves, uncovering bias, and taking accountability for
the role we all play in upholding these systems. We must be
transparent about our shortcomings as health care institutions.
Only when we acknowledge the problem can we begin
to address it. We have each taken an oath to " first do no harm. "
We must now live up to it.
Siman Nuurali is a change management coach; Tamika
Lasege, M.D., M.H.A, is a neonatologist; Gabrielle Hester, M.D.,
M.S., is a pediatric hospitalist; and Emily Chapman, M.D., is
chief medical officer and vice president of medical affairs at
Children's Minnesota.
Tell your hospital's story. Email magazine@childrenshospitals.org.
CHILDREN'S HOSPITALS TODAY Summer 2022
5

Children's Hospitals Today - Summer 2022

Table of Contents for the Digital Edition of Children's Hospitals Today - Summer 2022

Contents
Children's Hospitals Today - Summer 2022 - Cover1
Children's Hospitals Today - Summer 2022 - Cover2
Children's Hospitals Today - Summer 2022 - Contents
Children's Hospitals Today - Summer 2022 - 2
Children's Hospitals Today - Summer 2022 - 3
Children's Hospitals Today - Summer 2022 - 4
Children's Hospitals Today - Summer 2022 - 5
Children's Hospitals Today - Summer 2022 - 6
Children's Hospitals Today - Summer 2022 - 7
Children's Hospitals Today - Summer 2022 - 8
Children's Hospitals Today - Summer 2022 - 9
Children's Hospitals Today - Summer 2022 - 10
Children's Hospitals Today - Summer 2022 - 11
Children's Hospitals Today - Summer 2022 - 12
Children's Hospitals Today - Summer 2022 - 13
Children's Hospitals Today - Summer 2022 - 14
Children's Hospitals Today - Summer 2022 - 15
Children's Hospitals Today - Summer 2022 - 16
Children's Hospitals Today - Summer 2022 - 17
Children's Hospitals Today - Summer 2022 - 18
Children's Hospitals Today - Summer 2022 - 19
Children's Hospitals Today - Summer 2022 - 20
Children's Hospitals Today - Summer 2022 - 21
Children's Hospitals Today - Summer 2022 - 22
Children's Hospitals Today - Summer 2022 - 23
Children's Hospitals Today - Summer 2022 - 24
Children's Hospitals Today - Summer 2022 - 25
Children's Hospitals Today - Summer 2022 - 26
Children's Hospitals Today - Summer 2022 - 27
Children's Hospitals Today - Summer 2022 - 28
Children's Hospitals Today - Summer 2022 - Cover3
Children's Hospitals Today - Summer 2022 - Cover4
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