What can healthcare providers do to bridge healthcare inequality

Inequalities of income, wealth and power cost the UK £128.4 bn a year compared with the average high income country in the Organisation for Economic Co-operation and Development (OECD), according to the Equality Trust’s cost of inequality report.

A stark example of societal inequalities is the variation of life expectancy that can be up to 20 years between the country’s wealthiest and poorest areas. Access to services, the variation of services and quality of care are some obstacles patients face at varying levels.

Recently, sitting in a room with the board of a healthcare provider, this question popped up. Cue a debate on what we mean by inequalities. It is a convoluted one, journeying through service access, waiting list prioritisation, and how many BAME staff the organisation employs.

It was apparent that there were differing views on the definition and some ambiguity on what the organisation needed to do to resolve them. What is clear is that everyone has a point of view, and some are more passionate than others. It is a micro-reflection of opinion in society itself.

After a heated debate, the board resigns to the fact that this is bigger than the organisation, and all they can do is focus on the regulatory demand and tick the compliance box. They are developing an EDI plan and concentrating on the key metrics like WRES and WDES and how many are from the BAME community. What happens outside is out of their control and the system’s responsibility. They feel more comfortable and refocus back on waiting lists and running the services efficiently.

Looking around the room, are the individuals’ points of view reflecting those of their local population and community, or are they merely inequality statistics?

This is a typical conversation happening across boards in the country.

The issue is that inequalities, use of resources, quality of care, patient experience and how services are delivered are all interlinked. However, most current solutions are top-down, resulting in change programmes focusing on regulatory compliance. Addressing inequalities has become a numbers game. Focusing on the few and not the many.

Even organisations are turning to big data and AI to help prioritise waiting lists to improve fairness. As a medical director put it, this has the risk of reinforcing cognitive biases, a medical model. Is it the medical need or the patient’s need? Whose perspective are we looking at? Who gets what and when becomes a decision of the few.

The drivers of inequalities are complex. Since the dawn of humanity, there has always been a divide in terms of equality [ref David Graeber]. Inequalities in healthcare are like pieces of a puzzle: Some people have better health and easier access to healthcare, while others face hurdles.

But there is still a gap in understanding what we mean by inequalities and what, as health services, we can do about it. It is simply not just about race, gender, or sexuality. Humans also carry cognitive biases, prejudices and stereotypes that must be transparent to build equality in healthcare. Weapons of Math Destruction (Cathy)

Healthcare is a people-to-people ‘business’. Equality should be integral to the ‘customer’ experience. Each contact with a patient is an opportunity to address inequalities.

In this paper, we argue how healthcare providers, through common sense and systems thinking, can address inequalities by embedding this into their operating model. Doing so can also help them address the productivity challenge.

We discuss the three pieces of the jigsaw puzzle to address inequalities and the capabilities needed to execute them.

Imagine an individual walking into a hospital. How does the organisation see this interaction? From our research, they are often seen as a transaction – an elective activity, A&E, outpatient, etc. Each patient has unique needs, health disparities, and variations that must be unpacked and addressed separately.

Every patient contact is an opportunity to address health inequalities. But how much do staff know about the patient, their backstory and the real needs beyond the ‘bag’ of healthcare needs they bring into the building?

Organisations have the assets, data and the potential capability to identify these unmet needs and put a human story behind each interaction. It is possible to categorise (segment) patient needs and what matters to them, including quality of care, access to specialists, convenience, quick resolution, cleanliness or approachability.

Failure to recognise this reinforces inequalities. Organisations miss the ‘inequalities’ bag that the patients bring in. The unintended consequence is escalated needs, shifting the burden to other parts of the system, and, for healthcare providers, increased cost and pressures on capacity when, at a later date, the patient presents back into the building.

Focusing on improving the customer experience, organisations can overcome the typical barriers by rethinking their operational model to become more needs-centric and genuinely customer-centric, away from the current focus on compliance and running services. This is true innovation. The key to this will be staff and building new capabilities beyond the health intervention skills.

Healthcare staff come from all walks of life and reflect the diversity and inequity of their communities; the same health inequalities factors impact them as their patients. The majority come from the local community. These staff bring their bag of inequalities, perceptions, stereotypes, prejudices and experiences of their local communities.

Conversely, most medics and senior clinicians come from outside the local communities. Unfamiliar with the local community, they bring their perspectives and understanding to the organisation.

How they perceive inequalities and patient needs will impact every decision and interaction with the patient—an opportunity to address healthcare inequalities and drive conversations to improve care within and outside the building.

But how much do organisations spend time and effort understanding their staff beyond the professions and types? Current EDI initiatives only focus on a subset of the staff. Recognising and understanding all the staff needs is important in ensuring the skills and capacity to deliver a better staff experience and outcomes, reducing the inequalities gap.

Organisations have the resources, data, and capacity and should be able to create a thriving and fairer healthcare organisation and system by focusing on understanding the staff’s needs, behaviours, and motivations. It just needs the right focus at the board level.

Balancing the needs of both patients and staff is the key to fostering a fair and well-structured health system. But for sustainable improvements, there is a need for the third piece: communities.

What sometimes gets in the way of staff providing the care to address health inequalities is the clash with the realities of organisational structures, financial constraints, and political interventions. These introduce a cycle of short-termism, cyclical interventions, and escalating costs. Breaking this cycle is essential, but how can it be achieved?

The answer lies in reimagining the role of communities within the healthcare framework. Communities are not just groups of individuals; they are networks of support involving peers, families, and healthcare staff. When these elements connect effectively, they create an environment where individuals are understood, respected, and empowered to live their best lives. A consequence is that organisations think about what is behind their walls and take a more ecosystem approach.

Investing in developing communities is essential to address health inequalities. Communities are a reflection of the local cultures, tribes and values. Resources must also be decentralised to truly empower communities, allowing for more autonomy and tailored solutions that reflect the unique needs of each community.

But the opportunity is already here. PLACES. Organisations must accelerate and enable PLACES to be the foundation of fairer communities. This will require rethinking how resources are allocated but prioritising the needs and voices of patients and staff within their local contexts, paving the way for more sustainable, effective, and compassionate healthcare systems.

Inequalities cut across diseases, services, organisations and care settings. Organisations should plan with this in mind.

The current improvement plans and conventional thinking about addressing health inequalities must be revised to deliver high-impact actions and solutions beyond regulatory compliance and the traditional medical model of targeting health risks. Addressing inequalities should be baked into the day-to-day management of customer experience.

Additionally, the NHS WRES and WDES data, currently used to inform improvement plans and provide basic workforce metrics, must be revised to capture the full scope. Measures of success need to cover aspects such as competency, empathy, cultural awareness, relationship with local communities and customer experience. These should be integral to the models of care and the core business model.

A fair, empathetic, and learning organisation should meet the needs of all staff. Focusing on humanity in caring for patients in healthcare will foster the right behaviours, curiosity and respect in planning, allocating resources, decision-making and delivering care.

How much focus is on addressing inequalities in the organisation’s annual planning process? Most annual planning is focused on money, resources and compliance. Addressing inequalities becomes an afterthought. Consequently, there are more initiatives, more costs, and more discussions. It’s time to reprioritise.

Addressing inequalities will require healthcare providers to become learning organisations. Listening, understanding, and acting on the staff and patient needs. It’s about creating an inclusive environment where empowered staff catalyse positive change for colleagues and patients. Based on our experience and research, this needs the following:

1. Address inequalities with objectivity, decision intelligence and the human stories
Revisit current measures of inequalities to expand the limited true picture of inequalities and the inherent biases built into the organisation. This will require developing decision intelligence capability and new measures of success to address inequities across the workforce and the population they serve. Organisations do have the agency to make an impact.

2. Develop a deeper patient needs and behaviours analysis capability
Use decision intelligence tools to link consumer segments/groups to inequalities, creating a deeper understanding of wider patient needs and how they are currently served. This should be a core capability for customer-centric organisations.

3. Develop value propositions for staff based on their needs, behaviours and motivations
Organisations should make better use of their data and better understand their staff’s needs, wants and behaviours. This intelligence should then be used to create specific value propositions based on needs, not disciplines, enabling it to unpick the inequalities bag and build solutions that meet individual needs. This will allow an engaged staff member to develop the skills and capabilities to address wider patient needs.

4. Take the lead on the Place agenda and the engagement to build communities
Re-energise the strategy work and roadmap agreed with Place, using inequalities as the driver. Underpinned by data and insights, collaborating and building solutions that meet citizen needs and, through that work, meet health needs sustainably and effectively. This will enable better reallocation of resources to address inequalities more effectively.

The leadership should also prioritise exploring and making the idea of communities in the organisation, serving communities.

Get in touch if you would like to know more about how to become a learning organisation to address health inequalities or to share ideas on building a healthcare system that truly serves the needs of all, transcending barriers and fostering a fairer, more inclusive society.