Background Realizing an opportunity to engage in health equity more in our quality & safety projects at CHOP, we championed efforts to embed health equity into our quality improvement infrastructure. We focused on applying equity principles to our existing improvement tools to identify and address disparities in health and healthcare while training our QI workforce to ensure we examine for disparities in all projects.

Objectives

• Implement a health equity infrastructure into organizational structures

• Set ‘SMARTIE’ aims to move equity from an afterthought to the forefront of QI Projects

Methods We created a multidisciplinary committee focused on updating tools and training our workforce to drive a culture change to ensure that health equity is examined in all projects regardless of clinical/operational outcomes. This update included the following:

• Adding equity elements to the CHOP Improvement Framework

• Developing and providing health equity training

Results

• Consulted with and trained over 20 different departments and 100+ improvement education learners on tools for identifying and addressing health and healthcare disparities.

• Improvement Advisors must now have SMARTIE aims for all projects with clinical outcomes.

• In 2023, 24% of abstracts submitted for CHOP’s Quality and Safety Day conference have an equity aim or analysis, up from 7% in prior years.

Conclusions

• Cultural changes are complex – but possible.

• Lack of access to stratified data is a barrier to applying an equity lens.

• Regardless of the chosen method or framework, teams can add any health equity layer to any project.

• Before this work, ensuring equity in all clinical operations activities was an afterthought at best and we have gotten to a point where it is now becoming a default component of every project.