Case: Disparities in Care at Southern Regional Health system:

Theo Hank leaned back in his chair and closed his eyes. He had been afraid that the reports would contain bad news, and he now had to figure out what to do with this new information. Flipping through the first binder on his desk-reporting results of the recent Robert Wood Johnson Foundation-sponsored assessment of the cardiovascular care provided by his organization-he was increasingly concerned. Southern Regional Health System was based in Jackson, Mississippi, an area known for its diverse population and high poverty rates. Poverty and unemployment in the area affected whites and nonwhites differently: Black and Hispanic residents were about three times more likely than white residents to live in poverty, black residents were two and a half times more likely than whites to be unemployed, and Hispanic residents were more than twice as likely as whites to be unemployed. Beyond poverty and unemployment concerns, however, was the issue of disparities in healthcare-that is, different care being given to different patients. Although such disparities had received increasing attention nationwide, Hank thought that the care provided at Southern Regional was "color-blind." Under the health system's mission of providing "excellent quality of care for all," he assumed that the care was equitably delivered across patients and patient populations. Apparently, this was not the case. The first report presented heart care data that had been collected over the past year, and it showed significant disparities in the care provided by Southern Regional. For instance, using the four core measures for heart failure that the Centers for Medicare \& Medicaid Services currently collects and reports, the data indicated that only 41 percent of Southern Regional's patients were receiving all recommended heart failure care and that the number was lower for nonwhite patients than it was for whites. Whereas 68 percent of whites received all recommended care, the comparable number among nonwhites was just 27 percent. Disparities were also apparent in the percentage of heart failure patients who received discharge instructions: Only 65 percent of Hispanic patients received the information, compared to 85 percent of non-Hispanic patients. Also troubling Hank was the fact that none of the measures was close to 100 percent. The data clearly indicated that the care provided at Southern Regional was not the type of care Hank would want offered to his own family. He truly did not understand how his hospital could be providing such disparate care. The second binder on his desk offered little information to ease his concerns. This report, the "Assessment of Organizational Readiness to Change" for Southern Regional, showed that few individuals in the hospital were aware of the nationwide problem of disparities in care and that even fewer were aware that such an issue might be problematic within their own hospital. The evaluation also showed a strong tendency among hospital employees and physicians to resist proposed changes and instead "go with the flow." Hank now possessed data showing significant gaps in the care provided to African American and Hispanic patients relative to white patients, and he knew that he had to bring this issue to the forefront of hospital concerns. A meaningful reduction in these disparities would be a legacy he would love to leave. Yet he still was not sure how best to address this issue at Southern Regional.

These questions refer to the Integrative Case Studies at the back of this book. 1. Disparities in Care at Southern Regional Health System case: At the end of the case study, what change does Mr. Hank want to make? Using information in the case study, plus any inferences you want to make, conduct a force field analysis for his desired change. Explain how Mr. Hank could apply Kotter's eight-step process to achieve his change