June 7, 2023
These objectives also are essential elements of equitable and inclusive work environments. Having identified alignment of the widely accepted tenets of the ACS Quality Programs and those emerging from the efforts in diversity, equity, and inclusion (DEI), the College is embarking upon a comprehensive strategy to achieve surgical excellence by increasing health equity, decreasing surgical disparities, and improving quality of care by developing safe and inclusive surgical environments.
By partnering with the ACS Division of Research and Optimal Patient Care (DROPC) to create equity standards for the Quality Verification Program (QVP) and subsequently developing means for verification, review, and consultation for our stakeholders, these efforts will compose the Equity in Quality Initiative (EQI), which will replicate known and accepted processes in quality and safety.
The goal of integrating equity into quality and safety standards is not new. It was initially described by the Institute of Medicine (now known as the National Academy of Medicine) in 2001 as one of the six essential domains of quality that states care should be safe, effective, patient-centered, timely, efficient, and equitable.*
Recent external drivers for equity integration into healthcare policies and practices have been issued by The Joint Commission, and efforts to address inequities are being linked to reimbursement via the development of the Centers for Medicare & Medicaid’s health equity standards.†‡
Today, the House of Surgery has the opportunity to definitively address health equity in surgery through rigorous and definitive approaches in gathering the data necessary to develop meaningful standards, and supporting and educating our members about how to achieve these standards will benefit all surgical patients—especially those from diverse backgrounds and environments.
The initial step is to develop a system of review and accreditation of hospital and DEI programs within departments of surgery. With the input of leaders in surgery who have expertise in quality and health equity, a consensus statement will guide a formal advisory committee to develop and publish a set of equity standards that will include the implementation and accountability for institutions and their leaders to achieve these standards.
Predicated on building a body of data and evidence based on published consensus frameworks consistent with current quality verification processes, these standards will be integrated across DROPC’s programs. The ultimate goal is to create an ongoing system of review of, and accreditation of, DEI programs in hospitals and departments of surgery. Importantly, codifying goals of health equity into our standards will move the House of Surgery toward achieving health equity for our patients.
Yet, how do we get there? The more effective efforts in achieving health equity have instituted
a community approach to engage stakeholders in structured, longitudinal efforts grounded in research and education. By creating communities of excellence, the ACS Office of DEI will convene DEI leaders from academic and community surgical departments, our QVP institutions, ACS chapters, and aligned organizations.
The goal of this collaborative effort is to engage in a longitudinal, educational process of understanding the fundamentals of DEI while building and acquiring skills to implement policies and practices in a trauma-informed and trauma-responsive approach. Fundamental to this process will be a rigorous evaluative program using data to assess progress toward meeting the equity standards.
Indeed, meaningful change designed to build safe, equitable surgical environments so that our increasingly diverse workforce can perform optimally for the benefit of all patients will unfold by pursuing these strategic efforts:
If we are to fulfill the ACS mission “To Heal All with Skill and Trust” and maintain our unassailable commitment to surgical excellence, then we must help hospitals thrive in all six domains of quality and that includes delivering equitable care. Excellence and equity go hand in hand.
Dr. Bonnie Simpson Mason is the Medical Director of the ACS Office of Diversity, Equity, and Inclusion in Chicago, IL.
*Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
†The Joint Commission. R3 Report. June 20, 2022. Available at: jointcommission.org/r3_disparities_july2022-6-20-2022.pdf. Accessed May 19, 2023.
‡US Department of Health and Human Services. Centers for Medicare and Medicaid Services. CMS Framework for Health Equity. April 2022. Available at: https://www.cms.gov/files/document/cms-framework-health-equity-2022.pdf. Accessed May 19, 2023.