About Mi-CHIME
Putting the spotlight on equity in pediatric care
Michigan Community Hospitals Improving Equity for Children (Mi-CHIME) starts with a simple premise: We, as health systems, want to provide the best possible care to all the kids and families we serve. However, we do not always know where we are falling short – or what we can do better. We believe that health systems and hospitals can work together to assess areas where we may not be providing equitable care and figure out how best to improve when we find areas in which we can do better.
Mi-CHIME's leaders define equity issues as those within the control of the health systems or individual providers, either in care received by patients or in the patient/family experience. Equity issues could include differences in how patients and their families are treated relative to their gender, race and ethnicity, income, ability status, sexual orientation, weight status and more.
To ensure the care we provide is in line with our best intentions, Mi-CHIME brings together three community hospitals in Michigan to identify potential inequities in our systems, research inequities that may be common to all three health systems, address any inequities identified through quality improvement interventions, and evaluate the impact of our interventions.
What does this look like in practice? Mi-CHIME combines research and quality improvement experts to facilitate each stage of these research and improvement processes across sites.
Engaging health systems
To understand where inequities might be present, Mi-CHIME prioritizes listening to the experts: those working in our healthcare systems who have knowledge and experiences in how care is delivered. Providers in pediatric care (e.g., doctors, nurses, social workers, staff), institutional leaders and families at each hospital are given the space to voice their concerns and help identify potential inequities. Each group has a unique vantage point that can help surface key insights and identify potential areas that warrant assessment. Mi-CHIME shares information across sites so that partners at all hospitals can then work together to prioritize how to study potential inequities.
Measuring potential inequities
Mi-CHIME takes seriously the concerns, ideas and input of those working inside our hospitals when it comes to identifying inequities, but we do not stop there. We use these observations as a springboard for targeted research to examine whether inequities are systemic in nature, and if so, we measure their magnitude. The Mi-CHIME coordinating center provides the partner hospitals with expertise on the latest research and methods for assessing inequities to inform their research process. At each hospital, staff with technical expertise retrieve and analyze data. Together, hospitals learn about best practices and how to overcome any challenges they face to conduct rigorous research about inequities in their system.
Data-driven change
If inequities are confirmed through this rigorous process, Mi-CHIME is ready to act. Partners from each hospital work together and with experts in the MI-CHIME coordinating center to design quality improvement initiatives. Critical to this work, all quality improvement strategies are designed such that they can be measured and evaluated to assess impact. Each hospital implements quality improvement strategies targeted to their specific context, including collecting and evaluating data. Partners across hospitals share results to facilitate joint learning, adjust strategies and improve equity in the delivery of care across the collaborative.
Approaching equity through systems-level thinking
It is important to note that we do not believe that any inequities in care occur because of evil intent on the part of providers, staff or leadership. At Mi-CHIME, we recognize we all hold unconscious biases, and these biases are unlikely to disappear simply by taking a class, attending a town hall or reading a blog post. Our goal is to focus on systems of care rather than on individuals, and implement protocols and structural changes to achieve equitable care.
A similar approach is taken when addressing safety in clinical care. Rather than blaming individuals, healthcare systems accept that humans are fallible, so transparent measurement is encouraged, and process improvement is the norm. For example, to reduce preventable infections by improving hand hygiene, in addition to education, protocols are put in place, e.g., hand-sanitizer dispensers are placed at each patient door to make it easy to do the best thing for patient care. Drawing on the successes of this approach, we apply these same key principles to improve pediatric health equity.
Impact
Together, the Mi-CHIME quality collaborative will improve equity in the delivery of care to children. This is critical work. Variation in clinical decision making or patient/family experience has the potential to make a substantial impact on the health and wellbeing of children and their families. Mi-CHIME will help improve patient and family experiences, lead to more equitable care, foster greater patient trust in recommended therapies and the health-care system, and improve employee morale for all associated with these efforts.
Mi-CHIME starts with our health systems, but our goal is to improve equity in the delivery of care to all children. Findings from our work will be disseminated to inform local, state and national efforts to improve equity. We hope other health systems will join us in creating equitable care for our pediatric patients.