D2 how can we measure progress on health equity

Co-Creating a Strategic Health Equity Framework Planning and Measurement Tool Transformation Lab Session AOHC Conference – June 14th, 2018

Heidi Schaeffer 1, Miranda Saroli 2, Axelle Janczur 2 1 Alliance

for Healthier Communities, 2Access Alliance Multicultural Health and Community Services

Disclosure of Financial Support 

This project has received financial support from the Ministry of Citizenship and Immigration in the form of a grant (Ontario Partnership Grants Program)

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No conflicts of interest to declare

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Background story – the Health Equity Project Orientation to the framework Goal for this workshop: conversion of framework into a tool Progress in Health Equity (Champions) Activity Report back Evaluation

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Building Capacity for EquityInformed Planning & Evaluation Project Lead Access Alliance

Project Capacity Building Partner Association of Ontario Health Centres

Project Champions Chigamik, Planned Parenthood; North Lambton; Rideau; Somerset West; Témiskaming; and Women’s Health in Women’s Hands CHCs

Project Cross-Sector Partners OCASI and Centre Francophone de Toronto

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Capacity Building Mechanisms

1. Benchmarking of the ‘current state’ to measure preparedness and compare the change with the ‘desired state’

2. Training Modules • Health Equity 101 (adapted for frontline staff) • Using Data to Advance Health Equity • Planning and Evaluating Health Equity Strategies

3. Toolkit including a description for intended users, and the purpose and tips for using each of the tools

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Evolution of the Health Equity Framework:

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Goal for Today: The key purpose of this session is to determine meaningful measures that can be used to assess organizational maturity with respect to each domain of the framework.

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Activity: 40 minutes 1. Divide into small groups 2. Read through the attributes, and mark them as: -High priorities (“H”) -Low priorities (“L”) -Emerging priorities (“E) 3. What did we miss? Write the ‘gaps’ on sticky notes 4. Report back

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Report Back MAKE HEALTH EQUITY A STRATEGIC PRIORITY 1. Organizational position statement on health equity, comprised of a definition as well as an expressed commitment or pledge.

2. Demonstrated leadership commitment to making health equity a strategic priority 3. Secured sustainable funding for programs and services that promote health equity

4. Continuous advocacy and community capacity building (empowerment) around health equity

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Report Back DEVELOP STRUCTURES AND PRACTICES TO SUPPORT HEALTH EQUITY WORK 1. Established a Governance Committee to oversee and manage equity work across the organization 2. Have formal and informal mechanisms to involve clients and community members in the planning, development of programs, services and community initiatives 3. Population health needs-based, evidence-informed planning and decisionmaking policies/practices 4. Equity-informed monitoring and evaluation practices/policies, and routine use of standardized tools 5. “Dedicate[d] Resources in the Budget to Support Equity Work” 

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Report Back TAKE SPECIFIC ACTIONS TO ADDRESS THE MULTIPLE DETERMINANTS OF HEALTH ON WHICH THE ORG CAN HAVE A DIRECT IMPACT 1. Routine collection and use of a disaggregated intersectional data analysis approach to identify factors that affect health equity as well as where disparities exist 2. Tailored quality improvement efforts to meet the needs of marginalized populations.

3. Provide economic and development opportunities for staff at all levels.

4. Procure supplies and services from women- and minority-owned businesses.

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Report Back DECREASE ALL FORMS OF ORGANIZATIONAL DISCRIMINATION & OPPRESSION 1. Physical accessibility: buildings and design that are welcoming to all.

2. Functional accessibility: programs and services that are welcoming to all.

3. Human Resources practices: Trainings for health service providers and all staff and boards around health equity, anti-oppression, anti-racism and cultural competency etc., those that reduce implicit bias around race, gender identity, sexual orientation, spoken language, disability status, education, employment status in service delivery, client/patient care.

4. Organizational policies/structures/norms that reduce implicit bias around race, etc.

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Report Back DEVELOP PARTNERSHIPS WITH OTHERS TO IMPROVE HEALTH AND EQUITY AT SOCIETAL/POPULATION LEVEL 1. Community partnerships, collaborations or linkages with a broad range of community services, groups or entities relevant to its objectives. Partnerships that address upstream determinants of health and health equity (sharing goals, planning and implementing projects, co-financing).

2. Involved in regional and/or cross-sectoral mechanisms /models/networks to formally support professional planning and implementation of cross-sectoral action for health equity.

3. Routine monitoring of and evaluations performed on partnership activities or programs planning, implementation, progress, outcomes, impact of joint initiatives 

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Report Back

GAPS?

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MAKE HEALTH EQUITY A STRATEGIC PRIORITY Attribute 1: Organizational position statement on health equity, comprised of a definition as well as an expressed commitment or pledge.

Sample Assessment Questions: •

Are there any clear targets or goals in place in relation to the implementation of government policies and strategies to reduce Health Equity?

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What are we doing to be publicly committed to meeting the unique and diverse needs of the communities we serve?

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To what extent do we have formal and informal mechanisms to involve clients and community members in the planning, development of programs, services and community initiatives?

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To what extent does the organization have strategic community partnerships, collaborations or linkages with a broad range of community services, groups or entities relevant to its objectives?

Source: CCA Standard - “Be publicly committed to meeting the unique and diverse needs of the communities it serves”

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MAKE HEALTH EQUITY A STRATEGIC PRIORITY Demonstrated leadership commitment to making health equity a strategic priority Sample Assessment Questions: •

To what extent is health equity a strategic priority for the organization?

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Is leadership committed to improving equity at all levels of the organization?

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To what extent is Health equity is part of strategic planning and built into operations?

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To what extent is there strong leadership (interpersonal, technical skills, personal qualities, strategic and system vision...) to support reducing HI (health inequities) in your organization?

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Does the strategic plan describe how equity issues will be addressed? -does the plan include outcome targets?

Source: IHI White Paper -“Demonstrated Leadership Commitment to Improving Health Equity at All Levels of the Organization” Health Equity 2020 Toolkit-Management support/Strong leadership to support reducing health inequities in the organization. 

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MAKE HEALTH EQUITY A STRATEGIC PRIORITY Secured sustainable funding for programs and services that promote health equity Sample Assessment Question and Measure:

• Is there a sustainable funding source for health equity work? [Scale 1-5] Where 5 = There is a sustainable funding source for health equity work.

Source: IHI White Paper- ”Secure Sustainable Funding Through New Payment Models”

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MAKE HEALTH EQUITY A STRATEGIC PRIORITY Continuous advocacy and community empowerment around health equity Sample Assessment Questions: • Is there continuous advocacy for health inequities? By whom (who are local, regional, national champions)?

• To what extent is reducing health inequities promoted by health professionals and regional health and community development organizations and in policy making?

• To what extent can the organization put the needs of the populations served / region onto the political agenda and pursue social change, community development? Can you give any examples?

Source: Health Equity 2020 Toolkit – Continuous advocacy for health inequalities

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Thank you!

REFERENCES Canadian Centre for Accreditation Leading Organizational Practice Standards for CommunityCentred Primary Health Care Organizations Neagu, O., Michelsen, K., and Ohr, M. (2015). Health equity 2020 toolkit appendix 2: Interview guide capacity assessment. Retrieved from https://survey.erasmusmc.nl/he2020/wpcontent/uploads/2015/07/Appendix-2-Interviewguide-capacity-assessment.pdf

Wyatt R, Laderman M, Botwinick L, Mate K, Whittington J. Achieving Health Equity: A Guide for Health Care Organizations. IHI White Paper.

Cambridge, Massachusetts: Institute for Healthcare Improvement; 2016. (Available at ihi.org)

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