Hospitals and healthcare organizations must provide race and ethnicity information about their staff and leaders if they hope to secure a new Health Care Equity Certification offered by The Joint Commission (TJC), even though there’s no evidence that doctors, nurses and other providers will treat patients differently according to these metrics.
In its explanation to healthcare providers about data collection for this new, advanced certification, TJC unbelievably acknowledges outright that racial concordance factors into it:
“It is essential for an organization to collect data and conduct analyses to understand the specific healthcare disparities that may exist at the organization and within the community it serves,” TJC states. “The organization should collect data to understand the sociodemographic characteristics and health-related social needs of the individuals in its community. In addition, data from the organization’s staff and leaders should be collected to identify opportunities to increase diversity and racial, ethnic, and language concordance.”
But do patients and their families truly care about the race or ethnicity of medical providers and staff who attend to them, or do they simply want the best clinical, ambulatory, and other types of care possible without the intrusion of political correctness and diversity, equity and inclusion (DEI) ideology? Requiring this information adds to the burden of staff members at organizations seeking certification or accreditation who spend time and resources collecting data and readying their departments to satisfy TJC’s numerous requirements — especially with its new emphasis on “healthcare equity.”
We cautioned recently that the DEI healthcare equity creep was deepening with TJC’s new National Patient Safety Goal #16, introduced in July 2023, which posits that better patient “safety” will result from identifying patients by race and ethnicity. TJC considers healthcare equity to be “a quality-of-care problem,” and asserts that NPSG 16 will help to “increase the focus on improving healthcare equity versus reducing healthcare disparities.”
Those who buy into the concept of racial concordance believe, for example, that black doctors will do a better job of taking care of black patients because white doctors supposedly hold implicit biases against them. Yet no one racial or ethnic group can claim bragging rights to biases and perceived instances of discrimination, whether on the giving or receiving end.
Moreover, healthcare organizations face the same inherent risks as other institutions if they hire to satisfy demographics and not on merit. It certainly matters to patients that their caregivers — especially doctors and nurses — are among the proverbial “best and brightest,” regardless of skin color.
On its website, TJC touts its Health Care Equity Certification as one that “guides forward movement in imbedding healthcare equity in all aspects of care, treatment, and service delivery.” As TJC explains in a webinar, the standards for compliance include asking the staff and leaders of healthcare organizations to self-report race and ethnicity, as well as languages they speak, during a TJC review for HCE certification. Organizations also must report “any incidents or perceptions of discrimination and bias that are experienced by staff or leaders,” just as TJC requires on patients.
Beyond the usual items that a TJC reviewer wants, such as organizational charts, HCE certification requires additional information that is focused on race and health equity:
- List of active patients with information about age, race, and diagnosis
- List of discharged patients with information about age, race, and diagnosis (4 months for an initial review, one year for a recertification review)
- List of self-reported race, ethnicity, and language information from staff and leaders
- Experience of patient care measures stratified by patient sociodemographic characteristics
- List of external organizations collaborating with the organization to identify community-level needs for equitable care and to address patient health-related social needs.
The review process for HCE certification begins with a 45-minute Orientation to Health Care Equity Initiatives, involving the organization’s healthcare equity leader — yes, TJC requests they assign one — as well as its certification contact and other team members. The orientation is all about goals to “improve healthcare equity,” including a strategic plan and resource allocation.
Patient population, community demographics, collaboration with stakeholders — these are all topics of discussion, along with assessing health-related social needs (HRSNs). The final part of HCE orientation examines an organization’s support for DEI among its staff and leaders — collecting their data, discussing recruitment and retention policies, and reporting any incidents or perceptions of bias/discrimination.
The Joint Commission intends to compare the data on race, ethnicity, and languages of healthcare staff to that of their local communities — but making such comparisons does not address the need for safe, effective, quality care for patients. The issue is not the skin color of the staff; it is the quality of care. There is no good evidence that the staff racial makeup has anything to do with the quality of care or patient safety. Hiring practices that focus on merit and qualifications are the only effective means of addressing patient safety goals or quality of care.
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