Staying the Course on Health Equity Initiatives

By fostering better communication and efficiency through health equity, diversity and inclusion (HEDI) initiatives, health systems not only enhance care delivery but also reduce costs and improve financial performance, all while growing their patient base.

That was the key message of a session titled “Staying the Course on Health Equity Amid Murky DEI Terrain,” presented during the SHSMD Connections 2024 Conference, in Denver.

Led by Desirée Duncan, Vice President of Health Equity & Inclusion, BPD Healthcare, a marketing and communications firm for healthcare's leading brands, and Elleni Almandrez, Vice President of External Affairs and Communications, Children’s Hospital Association (CHA), an organization that represents more than 200 children’s hospital nationally, the session focused on ways health organizations can continue to support HEDI initiatives amidst the growing backlash against diversity, equity and inclusion (DEI) in the United States.

From 2020 through 2022, “nationally, we saw a rise in DEI and health equity,” Duncan says. “That work had been happening for a long time, behind the scenes; it just wasn’t talked about. As soon as a name—DEI—was attached to it in the media and the world, that’s where it started to gain some conversation.”

She adds, “Now we’re seeing a backlash.”

The Backlash

Throughout 2023 and 2024, several key judicial rulings, including in the Supreme Court, saw affirmative action programs across the country “gutted,” effectively ending race-conscious admissions programs at many colleges and universities.

In September 2024, Republicans in Congress declared an “Anti-Woke” week with proposed legislation aimed at DEI initiatives in education and business, according to Almandrez, quoting an article from the New York Times.

Late last year, many businesses, across multiple industries, announced plans to end DEI programs, perhaps in response. Several health organizations also modified their DEI programming in the face of this backlash.

“The term DEI has been, in a sense, canceled; but we don’t want health equity getting caught up in the anti-DEI conversation,” Duncan cautions.

Indeed, she adds, health equity means “helping all patients achieve better health outcomes. This is about helping everyone.”

The Response

If managed and communicated effectively, HEDI initiatives can have a positive effect on health care quality while lowering costs (for both patients and health systems), improving staff morale and sense of belonging, boosting innovation, and enhancing overall patient satisfaction.

Profit margins can also be part of the “business case” for HEDI, according to Duncan and Almandrez.

In making this case, they advise HEDI advocates to remind hospital leadership that the United States is becoming a more racially diverse country, according to figures from the 2020 Census. In 2020, the national diversity index, which measures the probability that two randomly selected people are from different racial and ethnic groups, rose to 61.1% from 54.9% in 2010 and 49.6 in 2000.

“There is a perception that racial and ethnic [minorities] drive down margins, perhaps due to assumptions around whether they are publicly or privately insured,” Duncan notes. “In fact, these commercially-insured populations can help grow your margins.”

According to Duncan and Almandrez, HEDI initiatives make good business sense for health organizations because:

• implementing inclusive care practices helps hospitals connect with diverse patient populations, boosting patient satisfaction and loyalty;
• focusing on health equity can lower costs by reducing preventable diseases, while HEDI initiatives drive patient satisfaction, leading to improved financial performance, higher margins and increased reimbursements; and
• hospitals recognized for health equity efforts strengthen their reputation, attract more patients, and enhance financial outcomes.

On this latter point, Duncan cites the example of New York City’s Mount Sinai, which in 2022 received the American Hospital Association’s (AHA’s) Carolyn Boone Lewis Equity of Care Award in recognition of “a high level of success in advancing health equity, diversity and equitable health care through data, leadership, governance, cultural humility and community partnerships.”

Duncan notes, “If you’re implementing inclusive marketing practices to reach and inform folks, ‘this is a safe place; you are going to be treated like a human,’ you are going to expand market reach.”

Almandrez adds that at organizations like CHA, “we like to hear about inclusive care practices and innovations. So, if you have a story like that, share it with the AHA or CHA, if you’re a member. Good storytelling is leveraged … nationally in terms of recognitions.”

Duncan emphasizes, “Patients see that”—and they return to the health system for their care needs.

Take-Home Messages

As an example of an effective HEDI initiative that highlights efforts to understand patient needs, they cite Advocate Children’s Hospital, which connected with a hair and beauty care company to create hospital-grade hair care products for people with curly care and developed a hair care education program for staff.

Another health system, Northern Light Health in Maine, partnered with Duncan’s firm, BPD Healthcare, on the How Are You? brand campaign, which featured the tagline: “When we are connected to and understand all of you, we can better provide the care you need.”

The goal was to get patient and staff “buy-in” on asking patients about their identities and potential unique care needs, with the ultimate goal of providing true personalized care, Duncan notes.

Without these efforts, patients can feel neglected—and hospitals are the last place people want to, or should, feel neglected, Duncan adds.

For health organizations seeking to enhance their HEDI initiatives, Duncan and Almandrez advise the following action steps:

• In communication around HEDI, avoid using language that focuses on inequality with blanket terms such as “vulnerable” or “underserved,” barriers to health; instead, try language that conveys fairness and choice and person-first language such as a fair chance for good health, enabling people to choose the path best for them, and being specific and clear when possible (Figure).

• Staff and management must immerse themselves in cultural understanding by conducting in-depth research on target cultural groups, including their values, norms, and behaviors, and analyzing successful cultural marketing campaigns across industries for inspiration.
• Craft authentic, culturally resonant narratives. Develop brand stories that align with the cultural values of diverse audiences, and use culturally appropriate language, imagery and references in marketing materials.
• Implement inclusive marketing strategies. Diversify teams to include members from various cultural backgrounds. Regularly assess and adapt your marketing approach based on cultural feedback and demographic shifts in your area.

Almandrez offers one final, important message: “If you take a chance and are steadfast, you can make true change within your hospital [that] impacts your bottom line. Patients will come back and see you if they see you are making a difference in their lives. Advocate and innovate.”