Designing a Road Map for Action to Address Bias and Racism Within a Large Academic Medical Center.

ABSTRACT: The convergence of the COVID-19 pandemic, the Black Lives Matter Movement, and the public anguish and outrage resulting from the murder of George Floyd in 2020 intensified the commitment of many health care institutions to pursue racial and social justice and achieve health equity. The authors describe the Road Map for Action to Address Racism, which was developed to unify and systematize antiracism efforts across the Mount Sinai Health System. A 51-member Task Force to Address Racism, comprising faculty, staff, students, alumni, health system leaders, and trustees, developed recommendations to achieve the goal of becoming an antiracist and equitable health care and learning institution by intentionally addressing all forms of racism and promoting greater diversity, inclusion, and equity for its workforce and community. Grounded in the principles of Collective Impact, the Task Force developed a set of 11 key strategies to effect systemwide change. The strategies affected all aspects of the organization: business systems and financial operations, delivery of care, workforce development and training, leadership development, medical education, and community engagement. The authors describe Road Map implementation, currently in process, including the appointment of strategy leaders, evolution of a governance structure integrating stakeholders from across the health system, development of an evaluation framework, communication and engagement efforts, and process measures and progress to date. Lessons learned include the importance of recognizing the work of dismantling racism as integral to, not apart from, the institution's day-to-day work, and the need for specialized expertise and a significant investment of time to coordinate Road Map implementation. Going forward, rigorous assessment of quantitative and qualitative outcomes and a commitment to sharing successes and challenges will be critical to eradicating systems that have perpetuated inequities in the biomedical sciences and medicine and in the delivery of health care.

Improving Patient Race and Ethnicity Data Capture to Address Health Disparities: A Case Study From a Large Urban Health System.

While research and efforts to promote health equity abound, the persistence of disparities by race and ethnicity underscores the limitations of fragmented interventions and the need for systematic, multipronged approaches to health equity. The foundational step towards reducing health disparities is the establishment of the basic information needed to identify and measure those differences, i.e., the accurate capture of race and ethnicity information of all patients. To that end, we present a case study outlining a multifaceted approach for improving the capture of race and ethnicity data in an outpatient setting culminating in a 76% improvement in the completeness of this information. The effectiveness of this plan and its scalability within a large urban health system may benefit similar institutions seeking to improve the collection of race and ethnicity information and the reliability of their data. To this aim, we present an approach relying on the assessment and evaluation of system needs, modification of data infrastructure to align with goals, training, and education of relevant stakeholders, implementation and responsive action to results, and acknowledging limitations and lessons learned. We emphasize that cross-departmental collaboration, stakeholder engagement, institutional support, and culture of anti-racism were essential to the success of this initiative.