Shifting power: co-developing a framework for equity in healthcare

Area of Science:

• Healthcare Improvement
• Health Equity
• Social Determinants of Health

Background:

• Growing emphasis on equity, diversity, and inclusion (EDI) in healthcare, accelerated by COVID-19.
• Concerns regarding the depth of EDI initiatives in addressing systemic roots of inequity.
• Need for structured approaches to embed EDI into healthcare practices and policies.

Purpose of the Study:

• To describe the development of a framework for advancing EDI in healthcare organizations.
• To guide healthcare organizations in disrupting systems of oppression.
• To present a framework for integrating EDI into healthcare practices, processes, and policies.

Main Methods:

• Collaborative co-development approach with a diverse advisory group.
• Rapid evidence scan to synthesize definitions and existing frameworks.
• Iterative refinement of the framework using an intersectional, anti-oppressive lens.

Main Results:

• A health equity framework emphasizing recognition and disruption of oppressive systems.
• Framework includes commitments to intersectionality, anti-oppression, relationships, trauma literacy, and learning.
• Framework designed to guide organizational and system-wide improvements for patients, caregivers, and communities.

Conclusions:

• EDI initiatives must critically understand systems of power and oppression.
• Healthcare improvement requires critical reflexivity and disruption of inequitable structures.
• The co-developed framework supports meaningful EDI advancement with ongoing evaluation and adaptation.