Children's Hospitals Today - Spring 2022 - 22

FEATURE / EQUITY
4. Choose one new adaptation
or addition.
5. Track outcomes: Is the activity
being carried out as planned? Is the
activity making a difference?
6. Move successful activities toward
sustainability.
Getting started
The initial integration activity was created
in the Clinical Safety Department,
where the HEIP team and department
staff crafted a DEI-focused question to
be included in existing scripted root
cause analysis interviews following every
serious safety event. The goal was to
prompt reflection by each interviewee
on whether characteristics of anyone
involved in the event, such as language,
culture, race or ethnicity, age, gender,
sexual orientation or religion, might
have been relevant to what happened.
The verbiage went through three
iterations with the help and feedback
of the clinical safety officers who conducted
interviews of staff involved in
an event. After six months, the activity
was considered in steady state, with
responses to the DEI question used
regularly in the analysis of each serious
safety event. The approach created by
the Clinical Safety Department is now
called the " universal question " tactic
and has become a cornerstone of integration
for many hospital groups.
The Improvement Academy (IA) at
Children's Mercy provides a series of
problem-solving courses for various
learners in the organization, including
teams from any area looking to address
a problem using quality improvement
methods. Partnering with the IA team,
a DEI checklist was created to accompany
the standard problem-solving
framework used in all problem-solving
courses. The DEI checklist provides
four steps for each team to follow, along
with detailed guidance:
Get into a DEI frame of mind. As a team,
review concepts related to DEI (10
terms and brief definitions provided
on the checklist).
Think of diversity broadly. Be aware
of the broad range of characteristics
that contribute to disparities in
opportunity, engagement and health.
Ask at every turn. Consider DEI
factors at every phase of problem
solving, including breaking down the
problem, creating interventions and
measuring outcomes.
Record your thoughts. Keep track
of how DEI efforts apply to your
project on the worksheet included
with the checklist.
In the pilot phase, teams turned in worksheets
showing how they had integrated
an equity lens into their QI projects. The
checklist achieved steady state in the
first year of use and has been modified
for internal and external use.
In the first year, four departments participated
in the HEIP, including Patient
and Family Engagement, Performance
Improvement, Evidence-Based Practice
and Education. With all departments,
the HEIP team used the mantra, " Health
equity, like safety, is everyone's work, "
to highlight that the HEIP team was
supporting departments in achieving
their goals, rather than asking them to
do something for the HEIP team. At all
times, activities were positioned as an
opportunity for teams " to make their
own work better. " Any time two or more
people work together, there is diversity
of experience, identity, outlook and need,
so no team can achieve optimal results
without understanding health equity.
Once activities, such as integrating
a universal question or DEI checklist
into a team's daily work were identified,
the HEIP team continued to follow up
regularly with departments to support
and confirm effectiveness and sustainability.
When activities were deemed to
be in steady state as standard work, they
began to move on to teams outside of the
Improvement Center.
Lessons learned
CHILDREN'S MERCY KANSAS
City created a systematic
approach to focusing on
health equity. The goal was to
make it the work of everyone
in the organization, not just
one team. The organization
adopted a quality improvement
mindset and leveraged
checklists, interviews and a
problem-solving framework.
Here are four lessons learned
while piloting this work.
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CHILDREN'S HOSPITALS TODAY Spring 2022
Teams and individuals must
own the work.
Incorporating concepts in a
team's or individual's standard
processes can make their
work better, but it must
remain their work, not that of
a consultant or expert from
outside the team. If there is a
perception that health equity
is the job of a specialized team
or department, it cannot be
broadly realized or sustained.
Children's Hospitals Today - Spring 2022

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