Journal Article

Disruption as opportunity: Impacts of an organizational health equity intervention in primary care clinics

Jackson, Beth E., Pauly, Bernadette (Bernie), Lavoie, Josée G., Smye, Victoria, Wallace, Bruce, Blanchet Garneau, Amelie, Browne, Annette J., Wong, Sabrina T., Herbert, Carol P., Ford-Gilboe, Marilyn, Varcoe, Colleen, Nadine Wathen, C.

2018

Overview

Background The health care sector has a significant role to play in fostering equity in the context of widening global social and health inequities. The purpose of this paper is to illustrate the process and impacts of implementing an organizational-level health equity intervention aimed at enhancing capacity to provide equity-oriented health care. Methods The theoretically-informed and evidence-based intervention known as ‘EQUIP’ included educational components for staff, and the integration of three key dimensions of equity-oriented care: cultural safety, trauma- and violence-informed care, and tailoring to context. The intervention was implemented at four Canadian primary health care clinics committed to serving marginalized populations including people living in poverty, those facing homelessness, and people living with high levels of trauma, including Indigenous peoples, recent immigrants and refugees. A mixed methods design was used to examine the impacts of the intervention on the clinics’ organizational processes and priorities, and on staff. Results Engagement with the EQUIP intervention prompted increased awareness and confidence related to equity-oriented health care among staff. Importantly, the EQUIP intervention surfaced tensions that mirrored those in the wider community, including those related to racism, the impacts of violence and trauma, and substance use issues. Surfacing these tensions was disruptive but led to focused organizational strategies, for example: working to address structural and interpersonal racism; improving waiting room environments; and changing organizational policies and practices to support harm reduction. The impact of the intervention was enhanced by involving staff from all job categories, developing narratives about the socio-historical context of the communities and populations served, and feeding data back to the clinics about key health issues in the patient population (e.g., levels of depression, trauma symptoms, and chronic pain). However, in line with critiques of complex interventions, EQUIP may not have been maximally disruptive. Organizational characteristics (e.g., funding and leadership) and characteristics of intervention delivery (e.g., timeframe and who delivered the intervention components) shaped the process and impact. Conclusions This analysis suggests that organizations should anticipate and plan for various types of disruptions, while maximizing opportunities for ownership of the intervention by those within the organization. Our findings further suggest that equity-oriented interventions be paced for intense delivery over a relatively short time frame, be evaluated, particularly with data that can be made available on an ongoing basis, and explicitly include a harm reduction lens.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aggression / Analysis / Attitude of health personnel / Canada / Care and treatment / Chronic pain / Clinics / Disruption / Equality and Human Rights / Evidence-based medicine / Fairness / Female / Global health / Harm reduction / Health care / Health care disparities / Health disparities / Health equity / Health Equity - organization & administration / Health Equity - statistics & numerical data / Health Policy / Health Promotion and Disease Prevention / Health services / Health Services Research / Healthcare Disparities - organization & administration / Healthcare Disparities - statistics & numerical data / Homeless people / Homelessness / Humans / Immigrants / Impact analysis / Indigenous peoples / Inequality / Integrated care / Intensive treatment / Intervention / Leadership / Marginality / Marginalized groups / Medical care discrimination / Medical research / Medicine / Medicine & Public Health / Mental depression / Native North Americans / Ownership / Pain / Policy analysis / Populations / Poverty / Primary care / Primary health care / Primary Health Care - organization & administration / Primary Health Care - statistics & numerical data / Psychological aspects / Psychological trauma / Public Health / Racism / Racism - statistics & numerical data / Reduction / Refugees / Social aspects / Social Justice / Social Policy / Structural violence / Substance abuse / Substance use / Surfacing / Teaching methods / Trauma / Trauma (Psychology) / Trauma informed care / Trauma- and violence-informed care / Violence / Violence - statistics & numerical data / Vulnerable Populations - statistics & numerical data