Validated Assessment Tool for Measuring Healthcare Organizations Readiness to Address Structura

Transcript

• 00:00Hi, everyone. My name is
• 00:01Hanifah Ouro-Sama, and I'm presenting
• 00:03work on behalf of the
• 00:04Global Health Leadership Initiative at
• 00:06Yale.
• 00:06This work is about a
• 00:07new tool to measure health
• 00:09system readiness to address structural
• 00:10racism in sepsis care. This
• 00:12was a team effort with
• 00:13Dr. Sinem Toraman Turk,
• 00:15Dr. Emily
• 00:16Cherlin,
• 00:17Dr. Dowin Boatright, Dr. Leslie
• 00:19Curry, and Ms. Erika Linnander.
• 00:22Sepsis impacts 1.7
• 00:24million people in the US
• 00:25each year. Racial inequities are
• 00:27clear, especially for black and
• 00:29Latinx patients who face higher
• 00:31risks, worse outcomes, and more
• 00:33readmissions.
• 00:34These inequities are are shown
• 00:36by research to be shaped
• 00:37by structural racism and not
• 00:38just individual level bias.
• 00:41This work is a part
• 00:42of a broader study, Champions
• 00:44Advancing Racial Equity in Sepsis
• 00:46Care, or rather the CARE
• 00:47Study, which is an NIH
• 00:49funded project that seeks to
• 00:50help system leaders identify and
• 00:52reduce structural racism using a
• 00:54coalition based intervention
• 00:56focused on shifting organizational culture.
• 00:59To do this work well,
• 01:01systems need to be ready
• 01:02for change. But prior to
• 01:04the study, we didn't have
• 01:05tools that readily measured,
• 01:07organizational readiness for anti racist
• 01:09work and sepsis care. Most
• 01:11surveys missed core elements like
• 01:13racial equity engagement or weren't
• 01:15tailored specifically to sepsis,
• 01:18which creates a risk of
• 01:19measuring the wrong things or
• 01:20not measuring enough.
• 01:22So in order to do
• 01:23this work, we set out
• 01:24to develop and test a
• 01:25new survey to assess readiness
• 01:27for anti racist change in
• 01:29sepsis care. The goal was
• 01:30to create a
• 01:31reliable theory based tool, which
• 01:33gives useful insights to health
• 01:35systems.
• 01:36We used a three phase
• 01:37approach: adaptation of existing scales,
• 01:40cognitive
• 01:41interviews, and psychometric testing.
• 01:44So in phase one, we
• 01:45started out by
• 01:46adapting a validated survey used
• 01:49in heart attack care,
• 01:50and that tool already measured
• 01:52four domains such as learning
• 01:54and problem solving, stress and
• 01:55pressure, psychological safety, and senior
• 01:58leadership support.
• 01:59So we reworded these items
• 02:01to focus on racial inequities
• 02:02and sepsis care and also
• 02:04added a new scale,
• 02:06structures and processes that support
• 02:08change.
• 02:09And then we interviewed nine
• 02:11experts and
• 02:12health equity experts and
• 02:14substance care experts and used
• 02:16probes in order to explore
• 02:17how they interpreted these
• 02:19items
• 02:20and how they chose responses
• 02:22and solve the tool's relevance.
• 02:24And based off of that
• 02:24feedback, we revised nineteen items
• 02:27and updated these the survey,
• 02:29developing a final survey with
• 02:31thirty items across five domains.
• 02:33We then tested the survey
• 02:34with thirty participants from three
• 02:36health care systems in the
• 02:37care study and used Cronbach's
• 02:40alpha as a measure of
• 02:41internal consistency reliability.
• 02:43So in the middle panel,
• 02:44you can see the, data
• 02:46from the study. And across
• 02:49most of the domains,
• 02:51we saw a very good,
• 02:53or acceptable
• 02:55level of alpha.
• 02:56And one important note that
• 02:58we wanted to point out
• 03:00was with the psychological
• 03:01safety
• 03:02results, which fell,
• 03:04according to research standards, as
• 03:06not acceptable.
• 03:07So
• 03:08we reasoned that one reason
• 03:10why psychological safety had such
• 03:12low internal consistency
• 03:13was because of the fact
• 03:15that a lot of these
• 03:16items measured interpersonal risk taking.
• 03:18So I put some examples
• 03:20in the middle panel on
• 03:21the bottom of some of
• 03:22the items that we looked
• 03:23at for that domain.
• 03:24These items include, we're able
• 03:26to bring up problems and
• 03:27tough issues. It is safe
• 03:29to take a risk in
• 03:30our work, and colleagues deliberately
• 03:32act in a way that
• 03:32undermines our efforts.
• 03:34And as you might notice,
• 03:35these are all talking about
• 03:37interpersonal
• 03:38aspects of risk taking, which
• 03:40is central to psychological safety.
• 03:42But we reason that anti
• 03:43racist work introduces a different
• 03:45level of risk, one that
• 03:47is more emotional, political, and
• 03:49often unsupported at the organizational
• 03:51level.
• 03:52And raising issues of racism
• 03:53can carry real consequences
• 03:55such as being labeled disruptive,
• 03:57isolated, or dismissed. So while
• 03:59people may feel safe to
• 04:00raise operational or clinical issues,
• 04:02that doesn't always translate to
• 04:03racial equity work.
• 04:05So this suggests
• 04:07what? We might need to
• 04:08reconceptualize
• 04:09psychological safety in the context
• 04:11of anti racist improvement efforts,
• 04:13and we we will be
• 04:14following up with qualitative data
• 04:16to explore this further.
• 04:18But overall, taking a step
• 04:19back, this tool offers a
• 04:21way to measure and guide
• 04:22anti racist work in sepsis
• 04:24care. It's theory driven, it's
• 04:26tested in the field, and
• 04:27it's grounded in real world
• 04:28practice.
• 04:29With more validation, it can
• 04:30accurately
• 04:31support targeted interventions
• 04:34and track progress in
• 04:35addressing inequities.
• 04:36So thank you to our
• 04:37team and funders and CARES
• 04:39partners.
• 04:40We hope this tool supports
• 04:41real change, and I'd be
• 04:42happy to answer any questions.