Connaught project aims to develop framework to help hospitals address health-care inequities

A developing project by Myrtede Alfred aims to build a modelling approach to identify equity issues and reduce adverse outcomes for racialized patients in Canadian hospitals.  

The project will develop a modelling approach that offers hospitals a theoretical and methodological framework to examine inequities in care delivery and health outcomes at a systems level. 

“We currently don’t have strong infrastructure or a strong suite of tools to guide this work, and that’s where hospitals may struggle to support equitable care,” says Alfred, an assistant professor in the department of mechanical and industrial engineering in the Faculty of Applied Science and Engineering.  

“Ultimately, this work is about compiling evidence to understand what causes disparities and how to address them, so we can move toward robust, safe and equitable, patient-centered care and processes,” Alfred says.  

Alfred’s project is supported by the Connaught Major Research Challenge for Black Researchers. Coordinated by the Connaught Fund in partnership with the Black Research Network, the program offers up to $250,000 to support new Black-led, multidisciplinary research teams working on projects that develop solutions to address major research challenges.  

Alfred is one of three University of Toronto researchers to receive the award this year, along with Rachel Goffe, an assistant professor in the department of human geography at the University of Toronto Scarborough, and Beverley Essue, an associate professor in the Institute of Health Policy, Management and Evaluation.  

As a human-factors engineer, Alfred examines how design perspectives shape equitable care delivery to improve clinical systems. She is also advancing this work as a recently named Tier 2 in Clinical Systems Equity Canada Research Chair.  

While there are no current estimates of the cost of racial and ethnic health disparities in Canada, similar disparities in the United States have been linked to an estimated $420 billion (USD) annually in excess health-care expenditures, lost productivity, premature death and disability.  

Health equity efforts have largely focused on population-level approaches to address the social determinants of health. A 2022 NSERC Discovery Grant is supporting Alfred’s broader research, including a better understanding of how Canadian health-care systems may contribute to these disparities. 

Yet understanding how health-care systems contribute to these outcomes remains challenging. Inequities within clinical settings are often difficult to identify due to limited data, a lack of conceptual models to guide investigation, and insufficient equity-focused measures.  

“We’re going to have to adjust our approach to accommodate the lack of equity-based data within clinical settings, but we can no longer allow that gap to prevent us from doing the work we know needs to be done,” Alfred says.  

The project brings together a multidisciplinary team of engineering, public health and clinical researchers and practitioners. Team members include assistant professors Philip Asare of the Faculty of Applied Science and Engineering; Notisha Massaquoi of the department of health and society at U of T Scarborough and Onye Nnorom of the Temerty Faculty of Medicine. Essue also serves on Alfred’s research team. 

The team also includes Tamorah Lewis, division head of clinical pharmacology and toxicology at the Hospital for Sick Children, and Angela Atinga, a clinician at Sunnybrook Hospital. 

“The important part of what we do is being able to assess our current state and then see where to make improvements.” 

Alfred envisions the framework eventually being integrated into hospital patient safety infrastructure, allowing staff to assess whether equity-related factors contributed to adverse events and experiences. One example could include language barriers that affect access to appropriate care.  

The framework could also be used by hospitals to assess broader system-level factors, such as whether clinical tools and technologies have been tested for algorithmic bias, or whether recruitment and staffing practices support the delivery of culturally competent care. 

“We do want to build a specific tool, and that tool would focus on integrating equity considerations directly into existing patient safety models,” Alfred says.  

“The important part of what we do is being able to assess our current state and then see where to make improvements.”