The Role of Clinical Learning Environments In
Preparing New Clinicians to Engage in Quality Improvement Efforts to Eliminate Health Care Disparities
Engaging new clinicians is a key element of any systems-based approach, as new clinicians will shape the future of health care delivery. Clinical learning environments (CLEs), or the hospitals, medical centers, and ambulatory care clinics where new clinicians train, have an essential role in preparing new clinicians to engage in QI efforts to eliminate health care disparities.

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For health care organizations, action to eliminate health care disparities includes systems-based approaches to identify and address inherent biases, misguided processes, and missed opportunities to deliver optimal care to all patient populations. Such approaches start with data collection and analysis to inform focused, culturally appropriate quality improvement (QI) initiatives.
The NCICLE Quality Improvement: Focus on Health Care Disparities Work Group developed this document as a guide for CLEs in engaging new clinicians in QI efforts to eliminate health care disparities. In particular, this document does the following:


  • Identifies four key foundational elements CLEs need for engaging new clinicians in QI efforts to eliminate health care disparities: a culture of equity, processes to identify health care disparities, prepared clinical educators, and established QI processes.

  • Provides example leadership responsibilities to help CLE leaders establish these foundational elements.

  • Includes a set of key skills and behaviors that new clinicians need to engage in the CLE’s QI efforts to eliminate health care disparities, specifically: (1) align with the organization’s culture of equity and commitment to ongoing QI; (2) recognize health care disparities as a unique component of health disparities; (3) participate in analysis of health care disparities; and (4) translate and act to eliminate any identified health care disparities.

  • Offers a driver diagram as an example of how CLEs might organize the guidance offered in the document into an actionable set of aims, primary drivers, and secondary drivers.

Acknowledgements

Baretta Casey, MD, MPH co-chair
CLER Regional Vice President
Accreditation Council for Graduate Medical Education

Marie Chisholm-Burns, PharmD, MPH, MBA, FCCP, FASHP, FAST co-chair
Dean and Professor, College of Pharmacy
Professor of Surgery, College of Medicine
University of Tennessee Health Science Center

Phillip Alberti, PhD
Senior Director, Health Equity Research and Policy
Association of American Medical Colleges

Tracy Cardin, ACNP, SFHM
Associate Director of Clinical Integration
Adfinitas Health

Daniel J. Cobaugh, PharmD, FAACT, DABAT
Assistant Vice President and Editor in Chief, AJHP
Office of Publicans and Drug Information Systems
American Society of Health-System Pharmacists
Jason Cobb, MD
Assistant Professor of Medicine
Emory University School of Medicine

Robyn Golden, LCSW
Associate Vice President of Population Health and Aging
Rush University Medical Center

Kathleen Klink, MD
Acting Chief Officer for Academic Affiliations
Veterans Administration
Kimberly Pierce-Boggs
Executive Director
Alliance of Independent Academic Medical Centers
Maura Polansky, MS, MHPE, PA-C
Chair & Associate Professor, Dept. of Physician Assistant Studies
School of Medicine and Health Sciences
The George Washington University

Carrie Radabaugh, MPP
Director/Secretary, Council on Medical Education
American Medical Association

Ram Raju, MD
Senior Vice President
Community Health Investment Officer
Northwell Health

John Vassall, MD
Physician Executive for Quality and Safety
Qualis Health

Fran Vlasses, PhD, RN, NEA-BC, ANEF, FAAN
Co-Director, Institute for Transformative Interprofessional Education
Professor, School of Nursing, Department of  Health Systems, Leadership and Policy and Stritch School of Medicine, Department of Family Medicine
Loyola University Chicago