Advancing Equity through Quality and Safety Peer Network

Building on aligned commitments to eliminate health inequities, the Advancing Equity Through Quality and Safety Peer Network is a year-long program offered by the Center for Health Equity at the American Medical Association (AMA) in collaboration with the Brigham & Women’s Hospital (BWH) and The Joint Commission (TJC). The program is designed to help health systems apply an equity lens to all aspects of quality and safety practices—improving health outcomes for historically marginalized populations.   

The AMA Peer Network launched in January 2022 with an all-day kick-off event. In her opening remarks at the AMA Peer Network program launch, Ana McKee, MD, from The Joint Commission, a global driver of quality improvement and patient safety in health care, set the stage by expressing the importance and necessity of embedding equity into quality and safety operations.

The AMA Peer Network will equip participating U.S. health care delivery systems with the knowledge and tools to advance racial justice and equity for their patients, staff and communities, by leveraging high-performance quality and safety (Q&S) practices and technologies to systematically make inequities visible and to address and resolve them as an integral part of health care practice.

In July 2019, Brigham and Women’s Hospital (BWH) and the Institute for Healthcare Improvement (IHI) launched a pivotal partnership to develop a new system-wide model for reducing health inequities throughout clinical operations and quality and safety infrastructure. This led to the design, testing and implementation of a new Quality, Safety and Equity framework at BWH that serves as the foundation for this AMA Peer Network.

This approach merges patient-centered approaches to quality and safety of care with robust structural analyses of racism and equity to support an overall mission of delivering equitable high-quality care to every single patient. Additionally, the AMA Peer Network brings together interdisciplinary teams including quality and safety; diversity equity; inclusion and belonging (DEI&B) and community and population health leaders, to ensure that institutionally based quality, safety and equity improvement efforts are connected to broader place-based anchor mission strategies that center community and historically marginalized voices.

The AMA Peer Network represents the first phase of amplifying this approach nationally by testing it with a cohort of early adopter health systems.

The AMA Peer Network for advancing equity through quality and safety leverages the rigor and success in quality, safety and harm reduction by:

• Systematically revealing and measuring the omnipresent and toxic effects of structural racism and other inequities on the health and well-being of patients, families, health care workers and communities.
• Highlighting the critical role of health care organizations in preventing inequities.
• Incorporating equity into the operational DNA of healthcare delivery and innovation.
• Promoting high-quality, safe and equitable outcomes for every patient, family and community served.

The AMA Peer Network is a key new program within the “push upstream” pillar of the AMA strategic plan, which seeks to effectively integrate clinical and social care as well as medicine and public health by:

• Strengthening physicians’ understanding of public health and structural/social drivers of health and inequities.
• Empowering physicians and health systems to dismantle structural racism and intersecting systems of oppression.
• Equipping physicians and health systems to improve services, technology, partnerships and payment models that advance public health and health equity.

This program seeks apply this Quality, Safety and Equity framework, tapping high-reliability tools, to reduce inequities and drive systems-level change.

The AMA Center for Health Equity seeks to accelerate this growing revolution in equitable care delivery by broadening education, spreading and scaling the implementation of this framework over time and continuing to influence and shape national policy and best practices.

The first phase of the AMA Peer Network’s approach will begin with a national group of early adopter institutions as participants, including: 

• Atlantic Medical Group/Atlantic Health (AMA Health System Program member*)
• Ochsner Health (AMA Health System Program member*)
• University of Iowa Hospitals & Clinics (AMA Health System Program member*)
• Children's Hospital of Philadelphia
• Dana-Farber Cancer Institute
• The University of Texas MD Anderson Cancer Center
• University of Wisconsin Hospitals & Clinic
• Vanderbilt University Medical Center

*The AMA’s Health System Program tailors resources for leadership to enhance support for their physicians by improving patient care, recognizing physicians and their work, and increasing professional satisfaction & well-being.

Participants from each health system include:

• Community and population health leads
• Diversity, Equity and Inclusion (DE&I) lead
• Executive leaders
• Operations lead
• Patient leads
• Quality & Safety (Q&S) leads

The AMA's goals and commitment to participating health systems are to:

• Highlight strong practices and implementation strategies for systematically identifying and addressing root causes of inequities through an integrated approach to quality, safety, equity and operations.
• Provide expert consultation on public and social health models to connect the dots between operational equity efforts and the strategy to effectively address social and structural drivers of health.
• Facilitate peer-to-peer learning where participants can bring their real-time challenges and opportunities to one another for peer support and collaborative problem-solving.
• Develop a pipeline of leaders capable of redesigning equitable health care systems, supported by learning in high reliability, anti-racist and structural justice praxis.
• Create networking opportunities and build long-term relationships for health care leaders and systems.

The AMA Peer Network activities includes:

1. Monthly all team calls for foundational learning in racial justice and equity, integrated approaches to quality, safety and equity (i.e., Quality, Safety and Equity five-driver framework) and social/structural drivers in health
2. Peer-to-peer calls to facilitate sharing of barriers, opportunities and strategies
3. Case review calls with subject matter experts to apply an equity-informed high reliability approach to analyzing individual harm events and driving systems-level change. View a brief video highlighting parts of an AMA Peer Network case review call.
4. Individual coaching calls with subject matter experts
5. Asynchronous learning
6. Action periods, where teams are actively applying the tools, strategies and best practices in their home institutions.

The expectation is that teams are committed to improving their systematic approach to quality and safety. The role of the AMA Peer Network is to bring tools, skills, structures and support to accelerate the teams on this journey.

Learn more about the subject matter experts supporting the Advancing Equity through Quality and Safety Peer Network, comprised of health care leaders and practitioners in the areas of quality and safety, population and community health, and diversity, equity and inclusion.

For questions, contact the equitable health systems team of the AMA Center for Health Equity.

• Karthik Sivashanker—Vice president, equitable health systems
• Mekdes Tsega—Senior health equity program manager
• Ryan Trevino—Project coordinator, equitable health systems
• Tam Duong—Director, quality, safety and equity

The Quality, Safety and Equity framework at the heart of this peer network was designed and tested at Brigham and Women’s Hospital in collaboration with the Institute for Healthcare Improvement. The structure and content for the peer network was co-designed with our partners at Brigham and Women’s Hospital.