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Narayan AK, Foster N, Kadom N, Scott JA, Flores EJ, Broder JC, Yong-Hing CJ, Daye D, Kagetsu NJ, Burstin H, Atzen S. Six Steps to Improving Health Equity Using Quality Improvement and Patient Safety Tools. Radiology 2025; 314:e232750. [PMID: 39964267 PMCID: PMC11868847 DOI: 10.1148/radiol.232750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 07/03/2024] [Accepted: 07/19/2024] [Indexed: 03/03/2025]
Abstract
Health equity is a foundational principle for providing high-quality care. The COVID-19 pandemic has increased the urgency of health systems and regulatory agencies to address longstanding health disparities. Imaging disparities have been documented in the imaging literature for decades, but there is paucity of published interventions to successfully reduce disparities in imaging. Quality and safety approaches can be successfully employed to catalyze and rigorously evaluate interventions to reduce imaging disparities. Emerging from the Toyota Production System, the lean management framework focuses on continuous quality improvement to improve efficiency and reduce waste. Lean approaches have been successfully adopted by quality and safety experts in health care for problem-solving and process improvement. This article provides readers with step-by-step guidance on how to address health equity issues by adapting selected lean tools for quality improvement and patient safety. Core steps include (a) problem identification, (b) team building, (c) creation of a data infrastructure, (d) problem analysis, (e) development and testing of solutions, and (f) change management strategies to help organizations sustain successful health equity initiatives. Readers can use these six core steps to catalyze data-driven quality improvement initiatives to reduce imaging disparities within their health systems.
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Affiliation(s)
- Anand K. Narayan
- From the Department of Radiology, University of
Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave,
F6/178C, Madison, WI 53792-3252 (A.K.N., N.F.); Department of Radiology and
Imaging Sciences, Emory University, Atlanta, Ga (N.K.); New York City Health and
Hospitals Corporation, New York, NY (J.A.S.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (E.J.F., D.D.); Department of
Radiology, Lahey Hospital and Medical Center, Burlington, Mass (J.C.B.);
Department of Diagnostic Imaging, Vancouver General Hospital, Vancouver, Canada
(C.J.Y.H.); Department of Radiology, Mount Sinai Medical Center, New York, NY
(N.J.K.); and National Academy of Medicine, Washington, DC (H.B.)
| | - Nia Foster
- From the Department of Radiology, University of
Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave,
F6/178C, Madison, WI 53792-3252 (A.K.N., N.F.); Department of Radiology and
Imaging Sciences, Emory University, Atlanta, Ga (N.K.); New York City Health and
Hospitals Corporation, New York, NY (J.A.S.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (E.J.F., D.D.); Department of
Radiology, Lahey Hospital and Medical Center, Burlington, Mass (J.C.B.);
Department of Diagnostic Imaging, Vancouver General Hospital, Vancouver, Canada
(C.J.Y.H.); Department of Radiology, Mount Sinai Medical Center, New York, NY
(N.J.K.); and National Academy of Medicine, Washington, DC (H.B.)
| | - Nadja Kadom
- From the Department of Radiology, University of
Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave,
F6/178C, Madison, WI 53792-3252 (A.K.N., N.F.); Department of Radiology and
Imaging Sciences, Emory University, Atlanta, Ga (N.K.); New York City Health and
Hospitals Corporation, New York, NY (J.A.S.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (E.J.F., D.D.); Department of
Radiology, Lahey Hospital and Medical Center, Burlington, Mass (J.C.B.);
Department of Diagnostic Imaging, Vancouver General Hospital, Vancouver, Canada
(C.J.Y.H.); Department of Radiology, Mount Sinai Medical Center, New York, NY
(N.J.K.); and National Academy of Medicine, Washington, DC (H.B.)
| | - Jinel A. Scott
- From the Department of Radiology, University of
Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave,
F6/178C, Madison, WI 53792-3252 (A.K.N., N.F.); Department of Radiology and
Imaging Sciences, Emory University, Atlanta, Ga (N.K.); New York City Health and
Hospitals Corporation, New York, NY (J.A.S.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (E.J.F., D.D.); Department of
Radiology, Lahey Hospital and Medical Center, Burlington, Mass (J.C.B.);
Department of Diagnostic Imaging, Vancouver General Hospital, Vancouver, Canada
(C.J.Y.H.); Department of Radiology, Mount Sinai Medical Center, New York, NY
(N.J.K.); and National Academy of Medicine, Washington, DC (H.B.)
| | - Efren J. Flores
- From the Department of Radiology, University of
Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave,
F6/178C, Madison, WI 53792-3252 (A.K.N., N.F.); Department of Radiology and
Imaging Sciences, Emory University, Atlanta, Ga (N.K.); New York City Health and
Hospitals Corporation, New York, NY (J.A.S.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (E.J.F., D.D.); Department of
Radiology, Lahey Hospital and Medical Center, Burlington, Mass (J.C.B.);
Department of Diagnostic Imaging, Vancouver General Hospital, Vancouver, Canada
(C.J.Y.H.); Department of Radiology, Mount Sinai Medical Center, New York, NY
(N.J.K.); and National Academy of Medicine, Washington, DC (H.B.)
| | - Jennifer C. Broder
- From the Department of Radiology, University of
Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave,
F6/178C, Madison, WI 53792-3252 (A.K.N., N.F.); Department of Radiology and
Imaging Sciences, Emory University, Atlanta, Ga (N.K.); New York City Health and
Hospitals Corporation, New York, NY (J.A.S.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (E.J.F., D.D.); Department of
Radiology, Lahey Hospital and Medical Center, Burlington, Mass (J.C.B.);
Department of Diagnostic Imaging, Vancouver General Hospital, Vancouver, Canada
(C.J.Y.H.); Department of Radiology, Mount Sinai Medical Center, New York, NY
(N.J.K.); and National Academy of Medicine, Washington, DC (H.B.)
| | - Charlotte J. Yong-Hing
- From the Department of Radiology, University of
Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave,
F6/178C, Madison, WI 53792-3252 (A.K.N., N.F.); Department of Radiology and
Imaging Sciences, Emory University, Atlanta, Ga (N.K.); New York City Health and
Hospitals Corporation, New York, NY (J.A.S.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (E.J.F., D.D.); Department of
Radiology, Lahey Hospital and Medical Center, Burlington, Mass (J.C.B.);
Department of Diagnostic Imaging, Vancouver General Hospital, Vancouver, Canada
(C.J.Y.H.); Department of Radiology, Mount Sinai Medical Center, New York, NY
(N.J.K.); and National Academy of Medicine, Washington, DC (H.B.)
| | - Dania Daye
- From the Department of Radiology, University of
Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave,
F6/178C, Madison, WI 53792-3252 (A.K.N., N.F.); Department of Radiology and
Imaging Sciences, Emory University, Atlanta, Ga (N.K.); New York City Health and
Hospitals Corporation, New York, NY (J.A.S.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (E.J.F., D.D.); Department of
Radiology, Lahey Hospital and Medical Center, Burlington, Mass (J.C.B.);
Department of Diagnostic Imaging, Vancouver General Hospital, Vancouver, Canada
(C.J.Y.H.); Department of Radiology, Mount Sinai Medical Center, New York, NY
(N.J.K.); and National Academy of Medicine, Washington, DC (H.B.)
| | - Nolan J. Kagetsu
- From the Department of Radiology, University of
Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave,
F6/178C, Madison, WI 53792-3252 (A.K.N., N.F.); Department of Radiology and
Imaging Sciences, Emory University, Atlanta, Ga (N.K.); New York City Health and
Hospitals Corporation, New York, NY (J.A.S.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (E.J.F., D.D.); Department of
Radiology, Lahey Hospital and Medical Center, Burlington, Mass (J.C.B.);
Department of Diagnostic Imaging, Vancouver General Hospital, Vancouver, Canada
(C.J.Y.H.); Department of Radiology, Mount Sinai Medical Center, New York, NY
(N.J.K.); and National Academy of Medicine, Washington, DC (H.B.)
| | - Helen Burstin
- From the Department of Radiology, University of
Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave,
F6/178C, Madison, WI 53792-3252 (A.K.N., N.F.); Department of Radiology and
Imaging Sciences, Emory University, Atlanta, Ga (N.K.); New York City Health and
Hospitals Corporation, New York, NY (J.A.S.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (E.J.F., D.D.); Department of
Radiology, Lahey Hospital and Medical Center, Burlington, Mass (J.C.B.);
Department of Diagnostic Imaging, Vancouver General Hospital, Vancouver, Canada
(C.J.Y.H.); Department of Radiology, Mount Sinai Medical Center, New York, NY
(N.J.K.); and National Academy of Medicine, Washington, DC (H.B.)
| | - Sarah Atzen
- From the Department of Radiology, University of
Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave,
F6/178C, Madison, WI 53792-3252 (A.K.N., N.F.); Department of Radiology and
Imaging Sciences, Emory University, Atlanta, Ga (N.K.); New York City Health and
Hospitals Corporation, New York, NY (J.A.S.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (E.J.F., D.D.); Department of
Radiology, Lahey Hospital and Medical Center, Burlington, Mass (J.C.B.);
Department of Diagnostic Imaging, Vancouver General Hospital, Vancouver, Canada
(C.J.Y.H.); Department of Radiology, Mount Sinai Medical Center, New York, NY
(N.J.K.); and National Academy of Medicine, Washington, DC (H.B.)
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Weaver SJ, Breslau ES, Russell LE, Zhang A, Sharma R, Bass EB, Marsteller JA, Snyder C. Health-care organization characteristics in cancer care delivery: an integrated conceptual framework with content validation. J Natl Cancer Inst 2024; 116:800-811. [PMID: 38419574 PMCID: PMC12116293 DOI: 10.1093/jnci/djae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Context can influence cancer-related outcomes. For example, health-care organization characteristics, including ownership, leadership, and culture, can affect care access, communication, and patient outcomes. Health-care organization characteristics and other contextual factors can also influence whether and how clinical discoveries reduce cancer incidence, morbidity, and mortality. Importantly, policy, market, and technology changes are transforming health-care organization design, culture, and operations across the cancer continuum. Consequently, research is essential to examine when, for whom, and how organizational characteristics influence person-level, organization-level, and population-level cancer outcomes. Understanding organizational characteristics-the structures, processes, and other features of entities involved in health care delivery-and their dynamics is an important yet understudied area of care delivery research across the cancer continuum. Research incorporating organizational characteristics is critical to address health inequities, test care delivery models, adapt interventions, and strengthen implementation. The field lacks conceptual grounding, however, to help researchers identify germane organizational characteristics. We propose a framework identifying organizational characteristics relevant for cancer care delivery research based on conceptual work in health services, organizational behavior, and management science and refined using a systematic review and key informant input. The proposed framework is a tool for organizing existing research and enhancing future cancer care delivery research. Following a 2012 Journal of the National Cancer Institute monograph, this work complements National Cancer Institute efforts to stimulate research addressing the relationship between cancer outcomes and contextual factors at the patient, provider, team, delivery organization, community, and health policy levels.
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Affiliation(s)
- Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Erica S Breslau
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lauren E Russell
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allen Zhang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ritu Sharma
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Marsteller
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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