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Systematic review
Equity in action: a scoping review and meta-framework for embedding equity in quality improvement
  1. Tara A Burra1,2,3,
  2. Bourne Auguste1,4,5,
  3. Lisha Lo1,
  4. Toluwanimi Durowaye6,
  5. Haben Dawit6,
  6. Susanna Fung7,8,
  7. Christine Shea9,
  8. Terri Rodak2,
  9. Noor Ramji8,10,
  10. Sanjeev Sockalingam2,3,
  11. Brian M Wong1,4,5
  1. 1Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
  2. 2Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  3. 3Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
  4. 4Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  5. 5Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  6. 6Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  7. 7Family and Community Medicine, Scarborough Health Network, Toronto, Ontario, Canada
  8. 8Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  9. 9Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  10. 10Family and Community Medicine, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Tara A Burra; tara.burra{at}camh.ca

Abstract

Background There are increasing efforts to include equity in all quality improvement (QI) initiatives. A comprehensive framework to embed equity in QI has been lacking, which acts as a barrier to the QI community from taking action to reduce healthcare inequities.

Objectives The objectives of this scoping review were to: (1) map and summarise available equity frameworks for QI and (2) create a ‘meta-framework’ for QI leaders and practitioners, with engagement of people with lived experience of health inequities.

Methods Articles were identified with searches of four databases (MEDLINE, Embase, PsycInfo and CINAHL) and review of reference lists from included articles. Articles that reported how equity can be meaningfully integrated into QI were included. A qualitative inductive thematic analysis and community member engagement and consultation were completed to clarify recommended strategies for embedding equity in QI.

Results The search strategy yielded 2776 unique articles, with 40 meeting the inclusion criteria. A meta-framework for embedding equity in QI was created that has two enablers: broadening theoretic underpinnings and organisational culture, structures and leadership. The meta-framework also has six domains: (1) engage with people with lived experience of health inequities; (2) define the equity problem and aim; (3) diversify and train the QI team; (4) examine broader root causes; (5) intervene to reduce inequities; and (6) measure impacts on equity. The community member consultation identified key facilitators and common pitfalls in involving community members in QI.

Conclusion This meta-framework is a comprehensive resource to integrate equity into all aspects of QI practice. Further study of its implementation is recommended. Revisions to QI guidelines and training curricula are also needed to drive and sustain the embedding of equity in QI.

  • Quality improvement
  • Healthcare quality improvement
  • Quality improvement methodologies

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/bmjqs-2024-018335

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • X @HabenDawitMDc, @SanjSockalingam, @Brian_M_Wong

    • Contributors TAB participated in the design of the data abstraction tools, contributed to screening of articles during all phases, initiated the community member engagement and consultation, analysed the data and led the drafting and revision of the paper. She is the guarantor. BA participated in the design of the data abstraction tools, contributed to screening of articles during all phases, analysed the data, drafted and revised the paper. LL participated in the design of the data abstraction tools, contributed to screening of articles during all phases, participated in the community member engagement and consultation, drafted and revised the paper. TD contributed to screening of articles during all phases and drafting and revision of the paper. HD analysed the data and contributed to the drafting and revision of the paper. SF, CS, NR and SS all contributed to screening of articles and to the drafting and revision of the paper. TR led the searches of the databases and contributed to the drafting and revision of the paper. BMW conceived of the study, participated in the design of the data abstraction tools, contributed to screening of articles during all phases, participated in the community member engagement and consultation, led the data analysis and drafted and revised the paper.

    • Funding This study was funded by Sunnybrook Education Advisory Council- Sunnybrook Hub for Applied Research in Education (Education Research and Scholarship Grant 2023).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.