Table 4.

Best Practices for Implementing Interventions to Reduce Racial and Ethnic Disparities in Health Care

Practice	Rationale	Possible Strategies	Outcome
Assess organizational capacity	Interventions are more likely to succeed if the organization as a whole is ready for change.	Assess institutional resources (e.g. trained staff, materials, technology platforms) and match them with the needs of the intervention.	Organizations are equipped to implement and sustain the intervention.
		Ensure ongoing financial support.
Foster a culture of equity	Success is more likely if staff recognize that disparities exist within the organization and view inequality as an injustice that must be redressed.	Institute systems to offer feedback to providers and incentivize disparities reduction.	Staff shares a definition of equitable care and places high value on its delivery.
		Explicitly define equitable health care as a goal in mission statements.
		Build a work force that reflects the diversity of the patient population.
Appoint staff to disparities reductions initiatives	A plan to improve equity requires human resources.	Consider quality improvement specialists and on-site equity champions to fill these roles. Mainstream equity into all quality improvement efforts.	Intervention is given adequate time and effort.
		Anticipate leadership and staff turn-over: e.g. cross-train staff; incorporate intervention training into staff orientation; include program responsibilities in job descriptions.	Staff is not overtaxed.
Identify and appeal to the equity rationale that is most important to your audience	Staff members are motivated for a variety of reasons:	Leverage staff motivation to support the program:	Buy-in across the organization is secured.
	Leadership may respond well to programs that guarantee a positive return on investment and leverage existing resources.	Present data that demonstrate potential for positive financial impact.	Consistent and accurate uptake of interventions is encouraged.
	Providers are often concerned with maximizing efficiency during the office visit.	Enhance the care team and promote care management outside of the clinic.
	Front-line staff may be wary of impacting patient flow and room availability.	Minimize burden and show respect for staff time.
	Everyone cares about patient outcomes.	Inspire enthusiasm to help patients.
Incorporate disparities interventions into existing systems and anticipate ripple effects	New programs may create redundant efforts or conflicting goals with existing quality improvement initiatives.	Assess existing systems (e.g., electronic medical records) and identify opportunities for integration during the planning phase.	Workload and schedules are manageable.
			Disruptions and inconsistencies are minimized.
Involve members of the target population during program planning	Programs that are not culturally targeted risk rejection by patients.	Involve the target population in program design in a manner that is meaningful and inclusive.	Community engagement is advanced.
	Input by minority health workers is not a proxy for patient involvement.	Engage patients, not just minority health workers.	Programs are relevant and effective.
Strike a balance between adherence and adaptability	While adherence to protocol ensures consistency, flexibility is key when working with diverse patients.	Regularly collect process measures, identify opportunities for improvement, and adapt the intervention accordingly.	Programs are consistent, yet flexible.
		Use standardized checklists to monitor adherence.
Be realistic about the time necessary to move the dial on disparities	Improvements in minority health take time because of multiple challenges inside and outside the clinic.	Plan long-term follow-up to demonstrate statistically significant improvements in health outcomes.	A realistic timeline manages expectations and maintains ongoing support.