Equality is important. As a publicly funded organisation, Healthcare Improvement Scotland has legal duties to take action to address the inequalities that exist in Scotland. We must also be able evidence how we have met our duties in everything that we do. So how do we make sure it underlies our work? Associate Improvement Advisor James Battye give us his thoughts.
Since joining Healthcare Improvement Scotland’s ihub, health inequalities and what to do about them has been a key theme of my work. Given what we know about health inequalities in Scotland, keeping a constant focus on this is absolutely essential.
I won’t pretend that weaving this into my own day to day role as an Associate Improvement Advisor has been easy. I’ve spent a good chunk of my time doing a bit of head scratching and wondering whether I am on the right track.
For example – did I get that Equality Impact Assessment (EQIA) right? What will I do with it now?
Sessions like the equity knowledge café session organised by our Evidence and Evaluation for Improvement (EEvIT) team have been really helpful in clarifying my thinking, and left me keen to keep exploring the question of what we can do to address health inequalities in our work.
Health inequality and quality improvement
Towards the end of 2020, with the help of Zoom/Teams I had the opportunity to attend the Institute for Healthcare Improvement (IHI) Forum.
Health inequality was a key theme of the forum. Keynote speakers included Roseanne Haggerty, CEO of Community Solutions, a charity whose mission is to end chronic homelessness in the US and Patrisse Cullors, a social activist and co-creator of Black Lives Matter. In addition, among the sixty or so breakout sessions there were a good few dedicated to improvement and inequalities.
For me, two questions stand out when I think about health inequalities and quality improvement: firstly, what can health and social care systems do to support and sustain a culture of improvement and redesign around health inequality? And secondly, how do we measure the effect improvement or redesign has had on health inequalities themselves?
Supporting a culture of improvement and redesign around health inequalities
One theme emerged early on during presentations and this was the importance of a strong values base along staff at all levels which incorporated addressing inequality.
This was particularly evident in the United States in relation to Black Lives Matter. The movement has prompted health and social care professionals to examine their practice and consider whether they were doing all they could to end the racial disparities which exist within the U.S.
In the examples shared during the forum, health and social care professionals said they felt empowered to take action as tackling inequality was part of their job. They also said they felt supported by their leadership teams to take action. On the face of it this seemed be a key factor in mobilising a health and social care system to introduce changes which aim to reduce inequalities.
Considering Scotland, I think we have some of the right building blocks in place. For example there’s our own work on Quality Management Systems in which leadership and shared values are a key part. We also have the NHS Scotland’s 2020 workforce vision which includes a focus on providing more equitable access to healthcare.
However, I’m sure we’ll all agree that there’s much more to do.
Measuring the impact of initiatives to address health inequalities
When it came to how health and social care professionals measured the impact of initiatives which sought to tackle health inequalities things were a little less clear cut. Presenters admitted that often they just didn’t have the data – e.g. on demographics, income or something else – and they needed to put their efforts into improving what data they could gather. In fact, the content of the presentations was similar to many of the conversations we had as part of EEvIT’s knowledge café on equity.
Initially I was left a little disappointed by the Forum. I didn’t get that golden nugget that I was hoping might show me the way in relation to my own day job. But on reflection I actually found this encouraging: many improvers across health and social care are at the same point as us. We want to collectively address health inequalities, but we are not always sure what we can do and we are not sure how to measure it.
What can Healthcare Improvement Scotland do to address inequalities?
For me the IHI Forum helped underline why internal initiatives like the inequalities and equity knowledge café session organised by EEvIT are so important. They provide the space for us to share what we know and what we don’t.
It has also prompted me to more actively consider inequalities throughout the entirety of an improvement programme. Not only am I going to ensure that the EQIA is as thorough as possible but I am also going to revisit it frequently – meaning that if I didn’t get it right the first time I can always change and adapt it.
James Battye is an Associate Improvement Advisor in ihub’s Maternity and Children Collaborative
Find out more about the work of our Evidence and Evaluation for Improvement Team.
Hi James, it was interesting to read your blog on health inequalities and quality improvement. I notice that you mentioned EQIA quite a few times in your discussion, however I wonder if you are aware of Health Inequalities Impact Assessment as well. These two sound synonymous but are slightly different in focus as illustrated in the picture shown in the EEvIT session. At present I am working in SHTG as a Health Economist, however before this I worked for a number of years in NHS Health Scotland (now PHS) where the conversation around equality and inequality (technically inequity) was the centerpiece. I was myself involved in a number of projects looking to undo, prevent and mitigate health inequalities while improving health outcomes. Apparently also did a masters dissertation on this as well. So happy to chat if it helps.
Thanks for sharing this, James, excellent blog!