EquiCare Toolkit

Overview: The 2024–2025 strategic plan builds on the AMA’s ongoing commitment to advancing health equity, representing its second dedicated strategic effort in this area. It reflects a focused, coordinated, and transparent approach that acknowledges the AMA’s historical shortcomings and seeks to address systemic inequities in health care. This plan charts a path toward a more equitable and inclusive future, aiming to transform the health care ecosystem and improve outcomes for all.

American Medical Association. (2024). The AMA’s 2024-2025 strategic plan to advance health equity. https://www.ama-assn.org/system/files/ama-equity-strategic-plan-2024-2025.pdf  

Overview: The Institute for Healthcare Improvement (IHI) provides practical guides to help health care organizations advance health equity. These resources include strategies to foster commitment to equity, actionable tips, and real-world examples of applying the IHI Achieving Health Equity Framework. Each guide focuses on one of the framework’s five components, offering tested strategies, lessons learned, challenges with solutions, and practical tools. The series also features an Improving Health Equity Assessment Tool to support organizations in evaluating and enhancing their equity initiatives.

Institute for Healthcare Improvement. (n.d.). Improving health equity: Guidance for Health Care Organizations. Institute for Healthcare Improvement. https://www.ihi.org/resources/publications/improving-health-equity-guidance-health-care-organizations

Overview: Between 2020-2023, many health systems and organizations created formal positions to improve diversity, equity, and inclusion (DEI) and health equity in response to social and health injustices and public demands for diversity and equity among executive level leadership. The National Academies Roundtable on the Promotion of Health Equity hosted an October 2023 public hybrid workshop to explore the successes and challenges of DEI and health equity C-suites, dimensions of DEI and health equity commitments, strategies for achieving internal and external goals, and potential metrics for measuring success.

National Academies of Sciences, Engineering, and Medicine. (2024). Exploring diversity, equity, inclusion, and health equity commitments and approaches by health organization C-suites: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27458 or https://www.ncbi.nlm.nih.gov/books/NBK603460/

Abstract: Strengthening diversity, equity, and inclusion (DEI) is paramount to effectively meet the needs of an increasingly diverse workforce. In health care, this is compounded with the need for providers to deliver patient-centered care that respects a diversity of backgrounds, values, and beliefs. In this article, we examine the effect of leader inclusiveness on team outcomes including psychological safety (PS) and openness to diversity in health care. Furthermore, we use social identity theory to examine team engagement in DEI practices as a key mediator of the relationship between leader inclusiveness and these team outcomes. In doing so, we advance the literature in two ways. First, despite growing research that links leadership to psychological safety, we know little about the underlying mechanisms that translate leadership behaviors into a comfort speaking up. Additionally, while openness to diversity is recognized as critical in an increasingly diverse workforce, how to cultivate this openness in teams remains largely unexplored. Consistent with past research, we found that inclusive leadership was associated with greater psychological safety and openness to experience among employees. Drawing from social identity theory, we find evidence to support that one’s identification with and desire to be a part of the work group, learning about and identifying more with teammates, and the opportunity to practice behaviors associated with psychological safety and openness have the power to change attitudes and views on safety and diversity. We offer practical guidance on how to support these DEI practices from the individual, team, and organizational level.

Woods, A., Zajac, S. A., Middleton, E. D., Cavanaugh, K. J., Hayes, W. C., Johnson, S. K., & Holladay, C. L. (2024). Doing the work: The role of inclusive leadership in promoting psychological safety and openness to diversity through diversity, equity, and inclusion practices. Psychology of Leaders and Leadership, 27(1), 115 –142. https://doi.org/10.1037/mgr0000158

Abstract – Objective: To provide a research agenda and recommendations to address inequities in access to health care. Data Sources and Study Setting: The Agency for Healthcare Research and Quality (AHRQ) organized a Health Equity Summit in July 2022 to evaluate what equity in access to health care means in the context of AHRQ’s mission and health care delivery implementation portfolio. The findings are a result of this Summit, and subsequent convenings of experts on access and equity from academia, industry, and the government. Study Design: Multi‐stakeholder input from AHRQ’s Health Equity Summit, author consensus on a framework and key knowledge gaps, and summary of evidence from the supporting literature in the context of the framework ensure comprehensive recommendations. Data Collection/Extraction Methods: Through a stakeholder‐engaged process, themes were developed to conceptualize access with a lens toward health equity. A working group researched the most appropriate framework for access to care to classify limitations identified during the Summit and develop recommendations supported by research in the context of the framework. This strategy was intentional, as the literature on inequities in access to care may itself be biased. Principal Findings: The Levesque et al. framework, which incorporates multiple dimensions of access (approachability, acceptability, availability, accommodation, affordability, and appropriateness), is the backdrop for framing research priorities for AHRQ. However, addressing inequities in access cannot be done without considering the roles of racism and intersectionality. Recommendations include funding research that not only measures racism within health care but also tests burgeoning anti‐racist practices (e.g., co‐production, provider training, holistic review, discrimination reporting, etc.), acting as a convener and thought leader in synthesizing best practices to mitigate racism, and forging the path forward for research on equity and access. Conclusions: AHRQ is well‐positioned to develop an action plan, strategically fund it, and convene stakeholders across the health care spectrum to employ these recommendations.

Jindal, M., Chaiyachati, K. H., Fung, V., Manson, S. M., & Mortensen, K. (2023). Eliminating health care inequities through strengthening access to care. Health Services Research, 58(Suppl 3), 300-310. https://doi.org/10.1111/1475-6773.14202

Overview: The Health Equity Action Plan Toolkit offers a practical framework and actionable steps to create a racially and ethnically equitable health care delivery system. While designed for Massachusetts, its strategies and best practices are adaptable for other states. The toolkit features an inventory of effective interventions, policies, and programs identified through a comprehensive landscape scan and stakeholder interviews. These resources equip providers, health care leaders, and other stakeholders to advance equity and drive meaningful change.

Massachusetts Foundation & Manatt Health. (2023, December). Health equity action plan toolkit. Blue Cross Blue Shield of Massachusetts Foundation. https://www.bluecrossmafoundation.org/sites/g/files/csphws2101/files/2023-12/Health_Equity_Toolkit_Dec23_FINAL.pdf

Overview: This brief highlights the challenges of advancing health equity, particularly in the face of longstanding systemic and institutional barriers. It discusses how organizational hierarchies and power dynamics can hinder open discussions about diversity, equity, and inclusion (DEI). Additionally, it addresses the impact of recent state-level legislation that limits the ability of state-funded institutions to support DEI initiatives. Despite these obstacles, many health care leaders across state agencies, health plans, health systems, and community-based organizations remain dedicated to advancing health equity. The brief outlines five key strategies that policymakers and health equity advocates can use to maintain momentum, ensure effective planning and implementation, and prioritize personal wellness amidst these challenges.

Ohene-Ntow, A., Sterling, J., Chapman, J.,  Patel, S., & Crawford, D. E. (2023, November).  Maintaining momentum to advance health equity in adverse environments. Center for Health Care Strategies. https://www.chcs.org/resource/maintaining-momentum-to-advance-health-equity-in-adverse-environments/

Overview: The California Health Care Foundation’s Toolkit to Advance Racial Health Equity in Primary Care Improvement provides practical guidance for health care organizations aiming to integrate racial equity into primary care improvement efforts. Developed in collaboration with the California Improvement Network (CIN) and HealthBegins, this toolkit supports health care providers, payers, and organizations involved in primary care by offering actionable strategies to address the structural and social determinants of health that impact racial equity.

The toolkit outlines seven key opportunities for advancing health equity, organized into a “road map of improvement.” Each opportunity includes tactics, resources, and case studies to guide organizations in implementing change: 1. Organize teams, 2. Collect race, ethnicity, and language data, 3. Identify measures to stratify by race, ethnicity, and language, 4. Analyze and address root causes of inequities, 5. Co-design improvement efforts, 6. Use dashboards to guide and monitor progress, and 7. Support institutional transformation and community action.

This toolkit is aimed at health care administrators, clinicians, quality improvement managers, and other stakeholders who are committed to advancing racial health equity in primary care settings. It provides concrete actions and resources to turn equity goals into sustainable improvements.

California Health Care Foundation. (2022). A toolkit to advance racial health equity in primary care improvement. California Health Care Foundation. https://www.chcf.org/publication/toolkit-racial-equity-primary-care-improvement/  

Abstract – Introduction: This report examines the relationship between health equity and primary care. It identifies concrete, practice and policy-level actions that primary care stakeholders can pursue to reduce inequities and take steps toward achieving health equity. Opportunities: More can be done to leverage primary care to advance health equity. At its core, primary care is about building trust and relationships, two key ingredients to mitigating the social and structural drivers of inequities. Primary care practices can connect patients to available sources of health insurance, use telehealth and other digital health interventions to enhance access, provide culturally and linguistically appropriate care, utilize an expanded care team and community assets to address unmet social needs, and engage the community in practice- and system-level decision-making. To fully leverage this opportunity will require changing both how we pay for primary care and how much is invested in primary care. Related policy levers include maintaining and expanding the primary care safety net, incorporating equity and social needs in data collection, quality assessment and measurement, transforming primary care’s fee-for-service payment paradigm, adapting telehealth flexibilities to reduce inequities, and monitoring implementation. Conclusion: Inequities have deep roots in our broader society, and neither primary care nor the broader healthcare system can provide the only solution to overcoming barriers that prevent healthy outcomes. However, primary care does play a vital role in ensuring population health and equity by providing whole-person care, advocating for polices to accelerate practice transformation, and partnering with sectors outside of clinical medicine like social programs.

Primary Care Collaborative, Morehouse School of Medicine, & National Center for Primary Care. (2022, May). Primary care: A key lever to advance health equity. https://thepcc.org/wp-content/uploads/2022/05/PCC-NCPC-Health-Equity-Report.pdf

Overview: The American Medical Association’s (AMA) Strategic Plan to Embed Equity, led by the Center for Health Equity and informed by internal and external experts, builds on existing knowledge in equity and health equity. The 2021–2023 plan marked a significant step in aligning the AMA and the U.S. health care system with the vision of achieving optimal health for all.

American Medical Association. (2021). Organizational strategic plan to embed racial justice and advance health equity. https://www.ama-assn.org/about/leadership/ama-s-2021-2023-strategic-plan-embed-racial-justice-and-advance-health-equity 

Overview: The Institute for Healthcare Improvement (IHI) highlights the persistent inequities in health and health care, despite advancements in medical treatments and access. Recognizing the critical role health care organizations play in advancing health equity, IHI published Achieving Health Equity: A Guide for Health Care Organizations in 2016, introducing a five-component framework to guide these efforts. Building on this foundation, the 2017 Pursuing Equity initiative engaged eight U.S. health care organizations to test and refine strategies for improving equity. This guide focuses on the third framework component, addressing the multiple determinants of health. It offers three core strategies, real-world examples, and practical solutions to common challenges, providing actionable insights for health systems striving to close equity gaps.  

Institute for Healthcare Improvement. (2019). Improving health equity: Address the multiple determinants of health. Guidance for health care organizations. Institute for Healthcare Improvement. https://www.ihi.org/sites/default/files/IHI_ImprovingHealthEquity_MultipleDeterminantsofHealthGuide.pdf    

Overview: This editorial discusses the importance of diversity in healthcare and highlights the key benefits of increased representation for both providers and patients. 

University of  St. Augustine for Health Sciences. (2021, March). Diversity in healthcare and the importance of representation. USA.edu. https://www.usa.edu/blog/diversity-in-healthcare