Fostering Equity-centred, Evidence-informed Decision-making in healthcare

Introduction
Equity-centred, evidence-informed decision-making is crucial in healthcare to ensure fair and just outcomes for all individuals. By combining the principles of equity and evidence-based practice, healthcare providers can foster a system that prioritises the needs of diverse populations and makes informed decisions based on the best available evidence. GIMBE Foundation has been fostering an evidence-based, equity-centred approach to healthcare in Italy for over two decades, and aims to foster and embed equity-centred, evidence-informed decision-making in healthcare. This article outlines the results of the considerable collective expertise gained through GIMBE Foundation’s 25 years of operation. Since its inception in 1996, GIMBE Foundation has promoted the dissemination and application of the best scientific evidence with independent research, training and scientific data in order to improve people’s health and contribute to the sustainability of the public health service.

Understanding Equity-centred, Evidence-informed Decision-making
Understanding the concept of equity-centred, evidence-informed decision-making is essential. At its core, this approach aims to integrate the principles of equity and evidence-based practice to guide healthcare decision-making. Equity ensures that all individuals receive the care they need, regardless of their socioeconomic status, racial or ethnic classification, or other qualities that contribute to disparities. Evidence-based practice integrates the best available research evidence, clinical expertise and patient preferences to inform healthcare decisions.

Recommendations for Fostering Equity-centred, Evidence-informed Decision-making

Addressing Bias and Disparities

• Promoting cultural competence: Healthcare professionals should be trained in cultural competence to understand patients' diverse needs, beliefs and values. This can help to reduce bias and disparities in healthcare delivery.
   
• Tackling implicit biases: Institutions should implement strategies to address implicit biases among healthcare providers, such as cognitive bias and anonymous decision-making processes.
   
• Collecting and analysing disaggregated data: Healthcare services should collect and analyse data based on factors such as racial or ethnic classifications, gender and socioeconomic status. Disaggregated data allow for a better understanding of disparities and facilitates targeted interventions.

Enhancing Access to Care

• Reducing financial barriers: Healthcare organisations should strive to reduce financial barriers to accessing care, especially in countries without public health services.
   
• Geographical accessibility: Ensuring that healthcare facilities are strategically located and easily accessible, particularly in under-served communities, can enhance equity and access to care.
   
• Language and communication support: Providing language translation services and culturally appropriate communication materials can improve access to care for individuals with limited language proficiency or different cultural backgrounds.

Strengthening Evidence-informed Decision-making

• Promoting research and evidence generation: Healthcare organisations should invest in research and evidence generation focused on addressing health disparities and promoting equitable healthcare outcomes.
   
• Integrating evidence into practice: Developing clinical practice guidelines based on the best available evidence can help to standardise care and reduce unwarranted variations, promoting healthcare equity.
   
• Engaging stakeholders: Involving patients, communities and diverse stakeholders in decision-making processes can ensure responsiveness of the healthcare system to their needs and preferences.

Monitoring and Evaluation

• Outcomes monitoring: Regularly monitoring and evaluating healthcare outcomes using equity indicators can help to identify disparities and inform targeted interventions.
   
• Continuous quality improvement: Implementing quality improvement programs focused on equity can foster ongoing learning and improvement in healthcare organisations.

Conclusion
Fostering and embedding equity-centred, evidence-informed decision-making in healthcare is essential for creating a more just and fair healthcare service. By addressing bias and disparities, enhancing access to care, strengthening evidence-informed decision-making, and monitoring outcomes, healthcare organisations can make significant progress towards achieving health equity for all individuals. It is an ongoing process that requires collaboration, continuous evaluation and commitment to using evidence to drive decision-making. By adopting these recommendations, healthcare providers and policymakers can contribute to a more equitable healthcare for all individuals.

Key Take-home Messages:

• Equity-centred, evidence-informed decision-making is crucial in healthcare. By integrating the principles of equity and evidence-based practice, healthcare providers can prioritise the needs of diverse populations and make informed decisions based on the best available evidence.
   
• To foster equity-centred, evidence-informed decision-making, healthcare organisations should address bias and disparities, enhance access to care, strengthen evidence-informed decision-making, and implement monitoring and evaluation strategies. This comprehensive approach involves promoting cultural competence, reducing financial barriers, integrating evidence into practice, and monitoring healthcare outcomes using equity indicators.
   
• Fostering equity-centred, evidence-informed decision-making is an ongoing process that requires collaboration, continuous evaluation and commitment to using evidence to drive decision-making. By adopting the recommended strategies, healthcare providers and policymakers can contribute to a more equitable healthcare system that strives for health equity for all individuals.

Authors
Tiziano Innocenti¹ and Nino Cartabellotta¹

1. GIMBE Foundation, Bologna, Italy.

Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.