J. Todic´ is assistant professor, Department of Social Work, The University of Texas at San Antonio College for Health, Community and Policy, faculty affiliate, Center for Community Based and Applied Health Research, The University of Texas at San Antonio, fellow, Social Work Health Futures Lab, Robert Wood Johnson Foundation, Princeton, New Jersey, and equity strategist, University of Chicago Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-6500-7567 .
S.C. Cook is quality improvement and care transformation strategist, Department of Diversity, Equity and Inclusion, Urban Health Initiative, University of Chicago Medicine, and co-director, Advancing Health Equity: Leading Care, Payment, and Systems Transformation Program, Robert Wood Johnson Foundation, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-6898-8658 .
Acad Med. 2022 Jul 1;97(7):977-988. doi: 10.1097/ACM.0000000000004680. Epub 2022 Jun 23.
Achieving optimal health for all requires confronting the complex legacies of colonialism and white supremacy embedded in all institutions, including health care institutions. As a result, health care organizations committed to health equity must build the capacity of their staff to recognize the contemporary manifestations of these legacies within the organization and to act to eliminate them. In a culture of equity, all employees-individually and collectively-identify and reflect on the organizational dynamics that reproduce health inequities and engage in activities to transform them. The authors describe 5 interconnected change strategies that their medical center uses to build a culture of equity. First, the medical center deliberately grounds diversity, equity, and inclusion efforts (DEI) in critical theory, aiming to illuminate social structures through critical analysis of power relations. Second, its training goes beyond cultural competency and humility to include critical consciousness, which includes the ability to critically analyze conditions in the organizational and broader societal contexts that produce health inequities and act to transform them. Third, it works to strengthen relationships so they can be change vehicles. Fourth, it empowers an implementation team that models a culture of equity. Finally, it aligns equity-focused culture transformation with equity-focused operations transformation to support transformative praxis. These 5 strategies are not a panacea. However, emerging processes and outcomes at the medical center indicate that they may reduce the likelihood of ahistorical and power-blind approaches to equity initiatives and provide employees with some of the critical missing knowledge and skills they need to address the root causes of health inequity.
实现所有人的最佳健康需要面对殖民主义和白人至上主义在所有机构中留下的复杂遗产，包括医疗机构。因此，致力于健康公平的医疗机构必须培养其员工的能力，使其认识到组织内这些遗产的当代表现形式，并采取行动消除这些遗产。在公平文化中，所有员工（个人和集体）都要识别和反思那些再现健康不公平的组织动态，并参与改变这些动态的活动。作者描述了他们的医疗中心使用的 5 种相互关联的变革策略，以建立公平文化。首先，医疗中心故意将多样性、公平和包容工作（DEI）建立在批判理论基础上，旨在通过对权力关系的批判性分析来阐明社会结构。其次，其培训不仅包括文化能力和谦逊，还包括批判性意识，包括批判性分析组织和更广泛的社会背景中产生健康不公平的条件，并采取行动改变这些条件的能力。第三，努力加强关系，使之成为变革的工具。第四，赋予实施团队权力，树立公平文化的榜样。最后，将以公平为重点的文化变革与以公平为重点的运营变革相协调，以支持变革性实践。这 5 种策略并不是万能的。然而，医疗中心出现的过程和结果表明，它们可能减少对公平倡议采取非历史和无视权力的方法的可能性，并为员工提供一些解决健康不公平根源所需的关键缺失知识和技能。
