Achieving Equity in EMS Care and Patient Outcomes Through Quality Management Systems: A Position Statement

Figures & data

Figure 1. The Institute for Healthcare Improvement Model for Improvement; reproduced with permission (4).

Figure 2. Institute for Healthcare Improvement’s quintuple aim for health care improvement (10).

Figure 3. An example of a run chart displaying a quality measure (12-lead ECG acquisition for patients with Acute Coronary Syndrome) disaggregated by sex as documented in the ePCR.

Figure 4. An example of a control chart tracking performance of a quality measure (12-lead ECG acquisition for patients with Acute Coronary Syndrome) for women, a subgroup targeted by improvement leaders striving to achieve health equity.

Table 1. Definitions of implicit bias, explicit bias and microaggressions.

Term	Definition/Description
Implicit bias	Unconscious, automatic mental association created as a product of one’s environment and exposure to sociocultural conditioning and bolstered by lived experiences. May influence affect, behavior, and cognitive processes without conscious volition, and they are difficult to consciously acknowledge and control (54).
Explicit bias	Conscious, intentional, and deliberate recognition of thoughts and feelings leading to prejudice and discrimination toward specific groups.
Microaggressions	Subtle verbal, nonverbal, and environmental slights, snubs, or insults that are directed toward historically marginalized groups, whether intentional or unintentional, and communicate hostile, derogatory, or negative messages leading to disrespect, devaluation, and exclusion (52).

Figure 5. (A–C) Example driver diagrams and associated change ideas to reduce care inequities, mapped to the Institute for Healthcare Improvement framework to achieve health care equity.

Table 2. Institute for Healthcare Improvement Framework for Achieving Health Equity (6).

Institute for Healthcare Improvement Framework for Achieving Health Equity

Make health equity a strategic priority; Develop structure and processes to support health equity work; Deploy specific strategies to address the multiple determinants of health on which health care organizations can have direct impact, such as health care services, socioeconomic status, physical environment, and healthy behaviors; Decrease institutional racism within the organization; and Develop partnerships within community organizations to improve health and equity.

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