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8 guidelines for improving rural health equity

The Hippocratic Oath guides health care providers to be active members of society with the goal of disease prevention and medical care for all. Beyond medical ethics, this concept speaks to the very heart of health equity. Every person deserves the opportunity to attain their full health potential. Unfortunately, inequities are on the rise across the country, especially in our rural communities.

Research from leading health care organizations paints a sobering picture. Recent estimates attribute only 10 to 20 percent of health outcomes to medical care. Social determinants of health (SDoH) account for 80 to 90 percent of non-medical contributors. The focus sharpens when considering that 12.3 percent of uninsured patients live in rural communities versus 10 percent in urban.

Health equity isn’t just a problem in select areas. It impacts all of us, including our neighbors. So how do we as health care leaders guide our providers and communities toward addressing health equity?

Seek out and constantly evaluate the barriers
Systemic or structural bias can be unintentional or planned, but its impact is undeniable. As one of the primary drivers of SDoH, it affects legislation, resource allocation, and patient health care access. Our goal as good community partners and health care leaders should be to constantly evaluate and own our roles in health equity.

The first step to addressing health equity barriers is to determine where the gaps or roadblocks may be in your current structure. Actively seek out feedback from your employees and patients. Routinely take a hard look at your staffing, scheduling, and policies. Ask the difficult questions and don’t shy away from tough answers. While change and mindfulness should be an organization-wide policy, it starts at the top and rests on the shoulders of those who have the power to make a difference.

Involve your neighbors
Give your community a chance to be part of the process. Those at risk of SDoH have unique insight that can streamline processes and hone large concepts into smaller, easier-to-accomplish tasks. When you share the discovery and execution stages with your neighbors, they will be more likely to seek out care, tell you when something is not working, and be advocates for themselves and others. Plus, by making them part of the change, you will build your reputation as a destination for excellent, compassionate care.

Clearly define commitments and benchmarks
Once you’ve identified any barriers, clearly define your action plans, formalize the next steps, and set realistic target completion dates. Incorporate feedback from your staff and ensure their buy-in with clearly outlined tasks. With a strong understanding of how and when to make changes, employees will feel ownership and can take pride in the steps they have taken to improve health equity for their neighbors.

Forget the elaborate fixes
It’s easy to focus on changes that have immediate, clear impacts or make for splashy news stories. Instead of constructing an all-encompassing plan, remember sometimes the greatest social and financial improvements come from helping the smaller population. It is no secret that chronic diseases often incur high costs for patients and health care organizations. By focusing on manageable actions like community screenings that increase patient access and education, we can make strides to level health disparities and increase disease prevention.

Collaboration is key
Change should be the universal language within your health system. While leadership is creating larger or new policy shifts, your staff should find ways they can make a difference in patients' lives. From HR and IT to billing and QA to housekeeping, we all have the power to improve lives and make health care work better. Empower every department head and employee to seek education, increase patient accountability, and make suggestions.

Create incentives           
In recent years and especially since the COVID-19 pandemic, patient access has influenced the Affordable Care Act, Medicaid, and value-based care. Federal and state policymakers, academic medical centers, insurance companies, and providers are acknowledging that health equity not only impacts patient quality of life but also has financial implications. Increased rates of chronic conditions and uninsured patients are straining government and corporate resources.

By reducing care barriers and improving visibility across all levels of interaction, facilities can focus on disease prevention to decrease chronic condition rates. While financial incentives for your employees will always be effective, motivating health equity adoption does not have to be expensive or complicated. Work with your teams to find meaningful ways to recognize your employees and highlight patients who have benefited. A little goes a long way, especially within a group that has dedicated their lives to helping others.

Focus on staff flexibility
Small or large changes impact health care staff. In a world where staffing shortages and burnout are a reality, it might be difficult to ask your staff for more time or energy to enact a procedure change.

This is where flexibility is key. As noted, health equity impacts your bottom line and the overall cost of doing business. Flexibility should be part of staff coverage and budget planning. Consider all the options to give your staff the freedom to focus on excellent patient care and reinforce their own work/life balance. Think about floating staff. Cover care gaps, provider leave, and even expand screening or treatment options with the help of health care staffing companies. Short, mid, and long-term staffing solutions alleviate the burden on your staff and ensure continuity of care.

Embrace the good and the bad
Creating change can be an emotional journey. Taking a hard look at your personal and professional role in health equity could inspire good and bad feelings. It’s natural to either want to ignore or run away from concerns. By acknowledging and giving space to address those feelings, staff will be better positioned to lead with confidence. Plus, normalizing the feelings that come with change helps reduce fear and improve personal ownership for future endeavors.

Continue moving forward
No matter how you choose to proceed, health equity will remain an impacting factor in medical, social, and financial sectors. As health care leaders, it is up to us to continue tackling the challenges and decreasing our community’s health care barriers. The Hippocratic Oath has guided providers for centuries to help their patients reach their full health potential, and it can continue to guide us for years to come.

NRHA adapted the above piece from Health Carousel, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.

We’ll share rural-specific strategies to target the intersection of health equity and social determinants and advance health equity within our communities at NRHA’s expanded 28th Health Equity Conference May 15-16 in San Diego.

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