Opinion: Taking an integrated approach to more equitable healthcare

Inequity is undoubtedly the most persistent and pressing challenge facing the healthcare industry today. Health inequities are the result of unfair systems negatively affecting the living conditions, access to care and overall health status of individuals, usually those from disadvantaged or historically marginalized groups.

The COVID-19 pandemic has severely exacerbated long-standing disparities in healthcare and health outcomes. As a society, we must move beyond reactive narratives toward proactive intervention.

An absolute unwillingness to continue to accept these inequities drives my passion to catalyze change and informs the comprehensive approach I help lead through Sutter Health’s Institute for Advancing Health Equity. Our outlook centers on uncovering inequities in healthcare and furthering solutions within our health system, communities and the nation. Addressing bias is an integral part of this work.

Through our organization’s efforts, we’ve seen firsthand how bias can manifest in various aspects of medicine, bringing with it wide-ranging and harmful impacts on patients, their families and the communities we serve. While progress has been made, solutions are still needed—which is why we’re committed to developing a multi-dimensional strategy across our integrated network to uncover hidden bias.

Bias in healthcare—whether on the part of individuals (such as unconscious bias) or structurally built into algorithms, treatment protocols and devices—is well-documented by researchers and is known to be a key contributor to adverse health outcomes.

Our outlook centers on uncovering inequities in healthcare and furthering solutions within our health system, communities and the nation."

For years, a critical component of Sutter’s health equity work has been increasing awareness among our health system leaders, clinicians and employees of this bias and of the importance of providing care guided by the principles of cultural humility. As more health systems work to expand their unconscious bias mitigation strategies, greater clarity and guidance are needed.

To address this, the institute recently hosted the Unconscious Bias in Healthcare Symposium alongside the California Medical Association, Physicians for a Healthy California and the California Primary Care Association, bringing together health equity experts, researchers, clinicians and policymakers for a day of focused discussion and problem solving. Insights from the event will inform the development of interventions and new evidence-based recommendations to help ensure future unconscious bias mitigation strategies are measurable and effective. These tangible recommendations will be released in early 2023 to help providers nationwide move closer to achieving the intended goal: improved and equitable outcomes for patients.

Bias can also exist in the scientific tools we use for clinical decision-making, affecting how we care for different groups of patients. Pulse oximetry (used to measure blood oxygen), which was so heavily relied upon during the pandemic, is a prime example. In September, our team published research that cites bias in the device, which could have led to significant COVID-19 treatment delays for Black patients. The findings—supported by a study published in JAMA Internal Medicine—not only contributed to our understanding of COVID-19 disparities experienced by communities of color, but also increased awareness around the need for changes to devices and our standards as a society in testing and approving them. I’m pleased that the Food and Drug Administration recently recognized this, too, and that our study adds to the mounting evidence under consideration to inform FDA deliberations regarding this specific issue.

Our institute is also focused on identifying bias in the algorithms used to determine patient risk factors for things like sepsis, hospital readmission and palliative care. Unwinding systemic racism from healthcare is an ongoing and multi-layered process that requires action from every facet of the healthcare industry. As health systems and other providers look to address bias in healthcare, we have an opportunity—and a duty to our patients—to get this right.

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