THE FUTURE HOSPITALIST

Embedding diversity, equity, inclusion, and justice in hospital medicine


 

Tools for advancing comprehensive change – Repurposing PDSA cycles

Whether institutions and HMGs are at the beginning of their journey or further along in the work of reducing disparities, having a systematic approach for implementing and refining policies and procedures can cultivate more inclusive and equitable environments. Thankfully, hospitalists are already equipped with the fundamental tools needed to advance change across their institutions – QI processes in the form of Plan-Do-Study-Act (PDSA) cycles.

They allow a continuous cycle of successful incremental change based on direct evidence and experience. Any efforts to deconstruct systematic bias within our organizations must also be a continual process. Our female colleagues and colleagues of color need our institutions to engage unceasingly to bring about the equality they deserve. To that end, PDSA cycles are an apt tool to utilize in this work as they can naturally function in a never-ending process of improvement.

With PDSA as a model, we envision a cycle with steps that are intentionally purposed to fit the needs of equitable institutional change: Target-Engage-Assess-Modify. As highlighted (see graphic), these modifications ensure that stakeholders (i.e., those that unequal practices and policies affect the most) are engaged early and remain involved throughout the cycle.

Dr. Delapenha, Dr. Kisuule, Dr. Martin, and Dr. Barrett

As hospitalists, we have significant work ahead to ensure that we develop and maintain a diverse, equitable and inclusive workforce. This work to bring change will not be easy and will require a considerable investment of time and resources. However, with the strategies and tools that we have outlined, our institutions and HMGs can start the change needed in our profession for our patients and the workforce. In doing so, we can all be accomplices in the fight to achieve racial and gender equity, and social justice.

Dr. Delapenha and Dr. Kisuule are based in the department of internal medicine, division of hospital medicine, at the Johns Hopkins University, Baltimore. Dr. Martin is based in the department of medicine, section of hospital medicine at the University of Chicago. Dr. Barrett is a hospitalist in the department of internal medicine, University of New Mexico, Albuquerque.

References

1. Diversity in Medicine: Facts and Figures 2019: Figure 19. Percentage of physicians by sex, 2018. AAMC website.

2. Diversity in Medicine: Facts and Figures 2019. Figure 16. Percentage of full-time U.S. medical school faculty by sex and race/ethnicity, 2018. AAMC website.

3. Diversity in Medicine: Facts and Figures 2019. Figure 15. Percentage of full-time U.S. medical school faculty by race/ethnicity, 2018. AAMC website.

4. Diversity in Medicine: Facts and Figures 2019. Figure 6. Percentage of acceptees to U.S. medical schools by race/ethnicity (alone), academic year 2018-2019. AAMC website.

5. Diversity in Medicine: Facts and Figures 2019 Figure 18. Percentage of all active physicians by race/ethnicity, 2018. AAMC website.

6. Herzke C et al. Gender issues in academic hospital medicine: A national survey of hospitalist leaders. J Gen Intern Med. 2020;35(6):1641-6.

7. Diversity in Medicine: Facts and Figures 2019. Fostering diversity and inclusion. AAMC website.

8. Diversity in Medicine: Facts and Figures 2019. Executive summary. AAMC website.

9. Ayyala MS et al. Mentorship is not enough: Exploring sponsorship and its role in career advancement in academic medicine. Acad Med. 2019;94(1):94-100.

10. Ejike OC et al. Contribution of individual and neighborhood factors to racial disparities in respiratory outcomes. Am J Respir Crit Care Med. 2021 Apr 15;203(8):987-97.

11. Galiatsatos P et al. The effect of community socioeconomic status on sepsis-attributable mortality. J Crit Care. 2018 Aug;46:129-33.

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