"We must accept finite disappointment, but never lose infinite hope. - Martin Luther King, Jr.
It seems fitting given our recent observance of Martin Luther King Jr. Day that we take a moment to reflect on the responsibilities of health care organizations and their members for promoting health equity - in terms of access, quality, cost, and outcomes. Health care organizations play a pivotal role in ensuring equitable access to high-quality health care. Likewise, health care management research has contributed much to our understanding of how we can create more equitable systems of care for all people. This research, for example, has helped us recognize how organizational structures, from the Board of Directors down, can contribute to health inequities and their amelioration (Betancourt et al., 2017). Yet recent research related to COVID-19 has also brought into sharp relief that we still have far to go in ensuring equitable health outcomes and understanding more about the role of health care organizations in achieving these outcomes. For example, a recent study by Asch et al. (2021) found that "Black patients admitted with COVID-19 had a higher mortality rate than White patients and that this difference was attributable to the different hospitals to which Black and White patients were admitted" (p. 7). We can do better. We must do better.
Doing better will require us, as health care management researchers, to challenge ourselves and push beyond the familiar and even the comfortable. We need to move beyond structural factors, for example, to examine the mechanisms and conditions where these structural determinants may be most harmful or helpful. Somewhat paradoxically, it will entail moving beyond a narrow focus on health care organizations to consider how their relationships with organizations from other industry sectors and embeddedness within their local communities can be leveraged to address the myriad determinants of health inequities. Health inequities are a 'wicked problem' and enduring solutions are not likely to be found only within the health care sector. For example, a review of multi-sector coalitions found that they can be beneficial in mitigating racial/ethnic health disparities but concluded that more research is needed to understand the underlying mechanisms by which this may happen (Anderson et al., 2015). Likewise, this research needs to move beyond including affected stakeholders as study participants and include them as genuine partners. This is not easy for some of us as it likely entails new approaches to research (e.g., industry-academic partnerships, community-based participatory research). It will entail relinquishing some control over the research process and even the research questions that we ask. But as the expression goes, "if you want to go fast, go alone; if you want to go far, go together".
Eliminating health inequities will not be easy. That is why it is a wicked problem. But like Dr. King, we believe there is reason for hope. Our commitment and compassion, as a community of health care management scholars, can take us far toward finding solutions.
Larry R. Hearld, PhD
Cheryl Rathert, PhD
Co-Editors-in-Chief
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