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Our research has demonstrated that systemic racism increases the risk of harm for minoritized patients. See what we’re doing about it.
In late 2022, research from MedStar Health and our partners at RAND Corporation examined how systemic racism contributes to differences in patient safety.
We reviewed the research and other publications that have already been conducted to learn what was known about how patient safety events and racism might be connected. We also interviewed 14 experts, all healthcare providers with experience in patient safety and health equity, to understand their perspectives. We discussed what contributes to patient safety, how formal and informal reporting of these events is handled, and racism’s impact on patient safety. This publication dug deep into how bias, reporting, and other factors place patients of color at a disadvantage.
In the study, we included concrete suggestions for how health systems can address problems that lead to patient safety events— any preventable error or injury that causes or could have caused harm during a patient’s interaction with the health system.
Several factors, including the conditions in which people live and work, can impact health inequity. According to the U.S. Centers for Disease Control and Prevention (CDC), people in minoritized groups experience higher rates of disease for several health conditions than White people. They are at higher risk for safety events like drug interactions, surgical infections, and missed diagnoses. The average life expectancy for Black or African American people in the U.S. is nearly six years lower than for White people.
Our research clarifies that racism also plays a part, but weaknesses in how health systems collect data can challenge understanding the problem’s scope. MedStar Health is committed to improving patient harm by dismantling systemic racism, and MedStar Health leadership is taking real action to work toward a solution.
Challenges to understanding the problem.
Any work to understand and change the impact of racism on patient safety is constrained by the data collection system. If the system is poorly designed or inefficient, safety events may be improperly reported—or not reported at all—and data collection can dwindle.
Uncollected data is impossible to assess. Many hospitals collect unstandardized patient safety data, particularly in recording race, ethnicity, and preferred language. Omitting these key factors makes it difficult to evaluate whether they played a role in a safety event.
A study from MedStar Health has demonstrated that safety events are recorded more often when patients are White. When minoritized patients are harmed, but the event is not noted, the data becomes skewed and conceals disparities.
Care team members must feel comfortable raising their voices to report a patient safety event. Our interviews with healthcare leaders indicate that providers from minoritized groups often fear the personal or professional consequences of speaking up.
Despite these challenges, our review of published studies and provider interviews helped us understand the relationship between racism and patient safety event reporting. Our findings suggest many factors contribute to challenges in reporting, including ongoing social inequities, historically discriminatory practices in healthcare, provider bias, and internalized race-based beliefs.
Related reading: Study Shows Effects of Racism on Patient Safety, Reporting, and Equitable Outcomes—Plus Recommendations on What Health Systems Can Do.
MedStar Health’s 3-pronged approach to equitable safety.
One way we can turn research into results is because our Healthcare Delivery Research Network teams work directly with organizational leadership. Together we develop policies informed by what we know about patient safety and quality of care. Research has demonstrated that this high-level, high-quality teamwork can make a real difference for patients.
For more than 13 years, MedStar Health has been focused on becoming a High Reliability Organization (HRO) which operates equitably in complex situations while avoiding severe failures. To accomplish this, the system’s 30,000 employees are all trained to use HRO principles to reveal and reduce errors in care.
MedStar Health has applied a health equity lens to our HRO strategy; we measure success through improvements in patient safety. Our three-pronged approach helps us address racism in patient safety, promote transparency, and limit harm.
1. Integrating race and ethnicity data in safety reporting. Working closely with the informatics and quality improvement experts, our leadership developed a system that automatically incorporates patient race and ethnicity data in voluntary safety reports.
2. Addressing implicit bias in event reviews. MedStar Health’s program, now under development, trained staff to consider the impact of implicit (unconscious) bias when reviewing patient safety events to understand what role discrimination might play.
3. Creating a culture of safety. To encourage reporting of errors and near-misses, MedStar Health removes power differentials. To promote a culture of speaking up, we defer to staff most familiar with a particular patient safety event, no matter their seniority or credentials.
These are critical first steps toward addressing the role of racism in patient safety, and we know there is more work to be done—at MedStar Health and throughout our nation’s healthcare system. Accrediting and funding organizations will likely link financial incentives to health outcomes defined by race. Health systems will face increasing pressure to meet these requirements by providing data that includes these demographics.
Acknowledgment that racism exists and impacts patient safety is a critical first step toward demonstrating leadership’s commitment to solutions.
Reporting, regulation, and funding.
Reporting systems will need to be adapted to this new focus, and leadership should continue to work toward building diversity throughout the organization. Long-term activities include automating safety reporting and empowering patients by embedding more health advocates throughout care settings.
Policymakers and regulators can play a part, too, by standing up task forces and requiring robust demographic data collection in all patient safety event reports. Existing national standards for patient complaint and grievance processes should be updated, and a national strategy to address the impacts of racism on patient safety should be developed.
Similarly, individuals and organizations distributing funding should prioritize financial support for health system efforts to combat racism, such as data collection and reporting system redesign, safety event automation, and cultural initiatives that place a premium on speaking up.
These actionable steps, many already underway at MedStar Health, can help focus reform efforts on changes that will make a difference in how patients, especially those from minoritized groups, experience interactions throughout the healthcare system.
Our commitment to dismantling racism.
MedStar Health isn’t just talking about what needs to happen—we’re taking action.
For example, the Mother’s Voice Project, in collaboration with our D.C. Safe Babies Safe Moms Program, has conducted surveys and interviews with birthing individuals who have experienced safety events before, during, and after childbirth. By placing their lived experience at the center of our understanding, we can develop standard definitions about what constitutes harm and help stop it.
By partnering with community members and organizations, and with the system-wide commitment of MedStar Health, we can begin to address the impacts of racism, improving the patient experience and investing in our community’s health.
