How hospital management impacts health equity programs

Many hospitals have developed programs aimed at closing disparities in health care and outcomes, and some of those efforts have involved addressing unmet social needs that could affect their health.

Researchers examined how different hospitals were building health equity programs to address social factors that are tied to health, and they looked at how the management approaches to those programs had an impact.

In a study published in Jama Network Open in the fall, researchers found that hospitals and health systems developed more comprehensive strategies when top leadership worked with lower levels of management on social programs.

Dina Zein, a doctoral student at the NYU School of Global Public Health, collaborated with researchers from Ohio University and Florida Atlantic University on the study. The lead author of the study, Zein tells Chief Healthcare Executive® that she wanted to take a different look at health equity programs in hospitals.

“I felt like a lot of the literature had really focused more on looking at hospital board composition, or just looking at health-related social needs screenings or programs adoption, but nobody really linked it to the management side of things,” she says. “And a lot of organizational literature actually talks about how it's important to involve the right people from the beginning of the process, and that leads to more sustainable change.”

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Researchers looked at health systems’ responses to questions about social programs on a 2022 American Hospital Association Annual Survey. Hospitals were asked about nine different services aimed at different unmet needs.

Five of the nine programs were more likely to be involved if there was dual involvement between senior management and lower levels of management.

“I think it showed that having more people involved could have a more meaningful change,” Zein says.

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Hospitals have been investing more in population health and addressing community needs, but they may have better chances of success if they incorporate input from those working with patients and community members.

“I think it's one thing for executives from hospitals to say: We should be working on this, there's a need to work on this. And then another thing, when you're actually involving the people who are on the front lines that are going to be implementing it and working on it. So I think having both of them involved … my assumption would be it's actually going to lead to real change,” Zein says.

Researchers looked at more than 2,200 hospital responses. They found hospitals were more likely to offer these programs aimed at meeting community needs: Health behaviors (86.1%), transportation (83.8%), food insecurity (82.7%), and interpersonal violence (69.6%).

Hospitals were least likely to offer programs aimed at employment (52.1%).

Researchers also found hospitals in counties with higher Black and Latino populations were more likely to offer programs aimed at addressing housing and violence.

President Trump’s administration has pushed against diversity, equity and inclusion programs at the federal level, and some states have closed DEI offices and programs, including at universities. Some hospitals and health systems have said they remain committed to DEI efforts.

“I've seen some reports where hospitals have said we care about the community that we serve, and we want the people that are at this institution to reflect the community that we serve. And so that gives me some hope,” Zein says.

In an environment where diversity and equity efforts have faced more challenges, Zein says she hopes health systems maintain the commitments they espoused a few years ago.

“I think seeing what hospitals do during this time period will be kind of telling,” she says.

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