Quality and safety teams excel at clinical quality improvement, while health equity teams better understand social drivers of health (SDoH) and community needs—these complementary strengths can be leveraged to close the gap on healthcare disparities. This roundtable explores how leaders from Yale New Haven Health and Sutter Health have leveraged SDoH data and integrated governance structures to drive quality/equity integration forward.
Key Takeaways
Expert Insights: Dr. Lou Hart, MD, MBA, Attending Physician, Yale New Haven Health (Previously Medical Director, Health Equity)
Treat inequities as quality and safety failures, not separate issues. Disparities stem from system breakdowns, making equity inseparable from quality improvement rather than an optional add-on effort. YNHH consolidated governance of quality/safety, health equity, and Care Signatures (clinical pathways) work under their Chief Quality Officer, for more effective coordination.
Activate patient transparency as a powerful catalyst for organizational accountability. YNHH found that over 57 clinical decision support tools included race as an input variable (e.g., kidney function, UTI risk). They added equity mitigation comments directly into care pathways and lab results, making patients aware of when race-based indicators were being used. YNHH also convenes a volunteer-based patient and family advisory council that centers the patient voice in decision-making around quality/equity integration.
Leverage social drivers of health (SDoH) data to uncover hidden disparities and enable targeted action. While overall readmission rates seemed stable, disaggregated analysis exposed disproportionately high rates among older, Black, publicly insured males with positive SDoH screenings—driven by health literacy gaps, care navigation challenges, and unaddressed social needs rather than medical complexity. This led to embedding a CHW-led intervention directly into the quality/safety operations.
Redefine patient safety by integrating adverse events beyond technical failures into electronic incident reporting systems and root cause analyses. By asking patients and families about emotional harm and loss of trust in real-time during safety events, YNHH has integrated social and cultural dimensions into patient safety.
Expert Insights: Dr. Kristen Azar, PhD, MSN/MPH, RN, Executive Director, Institute for Advancing Health Outcomes, Sutter Health
SDoH screening programs require organizational culture changes beyond EHR implementation. Sutter Health’s “We Ask Because We Care” campaign recognizes that Epic screening fields alone aren’t sufficient. Systematic education and communication strategies are needed to create awareness among both clinicians and patients.
Equip clinicians with actionable tools to screen and respond effectively. Clinicians must be empowered to act on results in real time with accountable goals. Sutter leverages their “Social Drivers Toolkit” to provide comprehensive workflows, scripting, and training to screen and act at the point of care with intention while rigorously evaluating screening barriers.
Prioritize systematic investigation of low patient participation in SDoH screenings. Despite 75% of staff conducting screenings, only 50% of patients agreed to be screened—a significant gap that prompted Sutter to survey nurses, case managers, social workers, and patients. Their findings revealed the need for staff education, patient education, and building trust and psychologically safe spaces for screening.