The Need for an Equity-focussed Quality Improvement Strategy

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Dr Siobhán McCarthy, Programme Director for MSc Quality & Safety in Healthcare Management, Graduate School of Healthcare Management, RCSI University of Medicine & Health Sciences
Dr Siobhán McCarthy, Programme Director for MSc Quality & Safety in Healthcare Management, Graduate School of Healthcare Management, RCSI University of Medicine & Health Sciences

Those most vulnerable to patient harm in the Irish healthcare system require increased engagement, advocacy and protection, writes Dr Siobhán McCarthy.

The statistic that at least one in ten patients admitted to hospitals experience an adverse event in developed countries is well known and highlighted in the WHO Global Patient Safety Action Plan. The situation in Ireland follows the international trend. Two national patient chart reviews published in BMJ Quality and Safety identified that approximately one in eight hospital admissions are associated with an adverse event. Except for healthcare associated infections, there was minimal improvement between 2009 and 2015. The social work perspective on patient safety highlights that the groups most at risk of harm in healthcare include women, older adults, people with disabilities and mental health concerns and homeless groups.

We know that huge efforts have gone into generating a culture of quality improvement (QI) across the Irish health services, but not for which population groups.  Over the past decade, healthcare teams have been encouraged to do their job (deliver care) and improve it (enhance patient care and outcomes using QI methodologies), where possible, using principles of co-design with service users. A scoping review of QI studies conducted in Ireland between 2015 and 2020 and published in BMJ Open Quality, identified 43 largely successful improvement reports focussed on improving safety, efficiency and effectiveness in healthcare.

This offers much to celebrate. Yet, rarely do we proactively acknowledge and discuss those who are least likely to benefit from improvement efforts. None of the 43 studies aimed to improve the equity domain of healthcare quality, which represents the issue of justice and fairness in healthcare.

Since the Covid-19 pandemic and the inequities in care witnessed, equity has become a hot topic. In relation to improvement, we are now recommended to record whether the equity gap has been maintained, widened or reduced.

Ireland can learn much from other countries which prioritise equity-focussed quality improvement, and with less resources. The Ethiopian Ministry of Health for example has an equity strategic plan, and recommends the integration of the concept of equity throughout all improvement work.

Equity of improvement is essential should we endeavour to reduce the equity gap in Ireland. Precisely, this means having more improvement in disadvantaged population groups and laterally, more diversity of inclusion in co-design approaches. Such an endeavour is in no doubt possible. National level policy leadership and increased provision of training in equity-focussed quality improvement methods is required.