Milbank Memorial Fund

Lean management is a sociotechnical approach to quality improvement that aims for consistency in work processes and outcomes. This can be leveraged to reduce inequities by ensuring delivery of high-quality care to meet the needs of patients with diverse backgrounds. Despite recent efforts in the field, there is limited study on how managers implement health equity and workforce diversity goals as strategies to improve patient care. Given the important role of leadership in fostering workplace culture, we examined leader activities and specifically their use of lean management practices to support equity initiatives in health care. More

Current primary care productivity measures do not account for investment in interprofessional primary care teams in relation to primary care goals and thus are insufficient for assessing and improving primary care efficiency and productivity. We explored alternative productivity measurement methods. More

A growing body of scholarship and practice in public health attests to the importance of addressing differences in power as a fundamental determinant of health inequities. To pursue health equity, public health practitioners must move beyond identifying differences in health outcomes among populations (disparities) to articulating why those differences are unfair or unjust (inequities) and then identifying structures, such as laws, policies, practices, and norms, that advantage some and disadvantage others. The act of doing so forces public health practitioners to consider the allocation of public resources, a process that is ultimately political. Fundamentally, going this far “upstream” to the root causes of inequity means confronting, understanding, and then addressing differences in power among and across populations. More

Individuals with behavioral health disorders are more likely to experience substantial harm from a police encounter, prompting reforms to minimize encounters between police and people experiencing a behavioral health crisis. One strategy involves expanding partnerships between certified community behavioral health clinic (CCBHC) mobile crisis teams and emergency response systems, often through two models: 911 referral, wherein a CCBHC’s behavioral health practitioner–only team responds to 911 calls, and co-response, wherein a CCBHC clinician joins a police or emergency medical services (EMS) team. We examine whether the internal capacity of the CCBHC and external police capacity influence when CCBHCs engage in these partnerships. More

Federal and state immigration policies influence access to health insurance for Latino populations. Local jurisdictions also have immigration-related policymaking power, but there has been limited study of their influence on health care access. We examined the relationship between county-level immigration policy contexts and health insurance coverage of Latino adults and youth in California using two measures that capture local-level policy decisions and immigration policy–related social inequity. More

In the United States, substance use disorder (SUD) is a significant public health and public safety challenge. Up to two-thirds of individuals who are incarcerated meet SUD criteria, compared with 16.7% of the general population. Individuals who have opioid use disorder (OUD) are also overrepresented in criminal legal settings: approximately 15.0% to 30.0% of individuals who are incarcerated have OUD, compared with 3.7% of the general population. Furthermore, individuals who are incarcerated are at high risk for fatal overdose both inside carceral facilities and upon reentry to the community. Overdose is the third leading cause of death in jails, and overdose deaths have increased more than six times over the past two decades in prisons. Among those reentering the community, fatal overdose is the leading cause of death. The risk of fatal overdose within the first two weeks following reentry is more than 100 times higher than in the general US population. More