Pursuing equity: The framework of the Institute for Healthcare Improvement (IHI)

Main Line Health is committed to a pursuit of health equity in all aspects of care. Partly due to its recognition for launching the Diversity, Respect, Equity and Inclusion (DREI) Initiative, Main Line Health was selected, along with eight other health centers—diverse in size, geography and patient populations served—to participate in the inaugural Institute for Healthcare Improvement’s two-year initiative, titled “Pursuing Equity.”

The Pursuing Equity Initiative explicitly addresses institutional racism by identifying ways in which healthcare organizations can impact equity in areas such as employee wellness and social determinants of health, in addition to reducing clinical disparities at the point of care. The initiative aims to reduce inequities in health and healthcare access, treatment and outcomes by implementing comprehensive strategies to create and sustain equitable health systems.

Main Line Health adopted the Pursuing Equity Initiative’s five-pillar framework to further the work of our organization.

Pursuing Equity

Pillar 1: Make Health Equity a Strategic Priority

The Main Line Health strategic plan serves as the blueprint for achieving the goal of providing the safest and highest quality care to all who utilize our community health services. Using interprofessional collaboration with physicians, community partners and our informed and integrated staff, we're working daily to meet patient needs across the broad continuum of health concerns.

Main Line Health leadership makes the principles of Diversity, Respect, Equity and Inclusion the center of our strategic plan to better serve our diverse patient population and to fulfill our commitment to the communities and patients we serve. All our leaders, managers and supervisors have completed a two-day learning experience on Diversity, Respect, Equity and Inclusion, demonstrating our commitment to this leadership.

The open, respectful, inclusive and caring environment across our health system is what keeps our employees engaged. Our organization fosters an environment where employees, physicians and volunteers work as an integrated healthcare team across our system and within our communities to provide a superior patient experience. Our leadership system illustrates our system’s priorities and a high-level view of our operational workflow.

Pillar 2: Build Infrastructure That Supports Equity

In 2018, Main Line Health transitioned to a new electronic health record platform, Epic, and seized the opportunity to integrate social and behavioral factors into the electronic record, which now:

  • Allows for a more sophisticated stratification of data to uncover disparities in care and develop solutions to address these disparities
  • Captures sexual orientation and gender identity 
  • Acquires information on patients’ nonmedical barriers to care (such as transportation, food insecurity or income) 

The integration of social and behavioral domains allows the interprofessional team to develop comprehensive care plans that address the concerns of vulnerable and high-risk populations.

This is just one way Main Line Health is working to build infrastructure that supports equity. Other initiatives include:

  • Main Line Health has appointed a system director of “health equity”
  • Community Health Services was transformed to Community Health and Equity
  • A program administrator was appointed to Main Line Health’s medical student advocacy program
  • A role was created for a fellow in Health Care Disparities
  • A special team was formed to address the health needs of the community’s most complex and vulnerable patients

Pillar 3: Impact the Multiple Determinants of Health

The core groundwork of equity is to understand the key underlying socioeconomic determinants of health that bring about unequal outcomes.

In Main Line Health's geographic area, the Lankenau Medical Center serves one of Pennsylvania's healthiest counties—Montgomery County, ranked fourth—and also the unhealthiest county, Philadelphia County. This presents big challenges to providing high-quality, equitable care to our patients.

This fundamental understanding has led to several initiatives:

  • Creation of a Center for Population Health Research
  • Leveraging the land surrounding the Lankenau Medical Center campus to create the Delema G. Deaver Wellness Farm to promote a focus on healthy food access for our patients
  • Main Line Health appointed a system director of “health equity”
  • Community Health Services was transformed to Community Health and Equity
  • A program administrator was appointed to Main Line Health's medical student advocacy program
  • A role was created for a fellow in Health Care Disparities
  • A special team was formed to address the health needs of the community's most complex and vulnerable patients

The establishment of our Healthcare Disparities Colloquium

Creation of the Medical Student Advocate Program

Development of an Emergency Room High Utilizer Analysis

Pillar 4: Eliminate Institutional Racism and Other Forms of Oppression

Main Line Health has implemented mandatory facilitator-led DREI Learning Experiences, intended to increase employee understanding and awareness of cultural competency and the value it brings to colleagues and patients.

As part of this mandatory training, a segment on power and privilege, delivered through video and question/answer sessions, introduces the concept of institutional racism.

Institutional racism as a societal issue was also introduced to attendees at Main Line Health’s Healthcare Disparities Colloquium in 2017. The organization’s explanation was based on:

  • The unequal distribution of educational opportunities in our surrounding communities.
  • The fact that around the country in academic centers, medical clinics for the underserved based on Medicaid insurances often serve as proxies for clinics of ethnic and/or racial minorities.

Pillar 5: Partner with Community Organizations

We recognize that achieving equity cannot occur solely within the confines of our health system. As such, we have been actively employing successful strategies to partner with community organizations. 

Four key partnerships include:

Greener Partners

Together for West Philadelphia

Health Career Collaborative

Health Career Summer Academy