Barriers & Access in Healthcare

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Blog post by Joe Babaian

A barrier. A path. Who among us doesn’t immediately recognize access denied, forbidden, or discouraged? Who doesn’t feel relief when a path forward appears or is built? This is but one metaphor for an external barrier to healthcare that many face.

Some definitions for this chat.

External barriers can be environmental like steps blocking a wheelchair or other assistance device, financial, emotional, educational, physical, digital, and more. For this discussion, I’ll consider these the external barriers to healthcare – things that keep people from engaging in the parts of healthcare they need or wish for. I could say “patients” – but “people” sounds real.

What about the internal barriers in healthcare? Those are the barriers created, faced, and perpetuated by those running, operating, hosting, administering the extended healthcare ecosystem and its attendant parts (you get it).

  • What do race, gender, and ableism have to do with your organizational decisions? How do you shed choices that create barriers?
  • You choose to run and host a conference in a time of COVID. What stops you from creating authentic pathways for patient access from design to virtual attendance?
  • You run a clinical trial. What stops you from including a diverse group of patients in the initial design, implementation, and then the study of the results after the trial is complete?
  • You run a medical center…
  • You are a PBM…
  • You run a clinic…
  • You host a blog…
  • You are a researcher, clinician, EHR developer…

All these good people are facing internal barriers in healthcare. It’s the why that is asked when people say, “Why are you doing it this way?” Few of us are comfortable facing and acknowledging the echo-chambers we live in. In fact, without some echo-chamber effect, we’d feel unmoored and alone. It’s when we become complacent and unwilling to be uncomfortable that we begin to treat these internal barriers as immovable.

  • It’s always been done this way.
  • If I rock the boat, I’ll lose face/credibility/my job.
  • All of my peers and I are happy with incremental changes. Why push harder?
  • I don’t want to be unpopular.
  • I’m a marketer, I am not paid to change things.
  • It costs too much / ROI is not there.

The internal barriers in healthcare are the other side of the coin to the external barriers that so many face, struggle against, try to change. Many have a foot in both worlds, facing the external barriers even as they work from the inside and come up against the internal walls. What cognitive dissonance they must face!

Let’s talk about this today and break down some walls.

Join us for the weekly #hcldr tweetchat on Tuesday, April 27, at 8:30pm EDT when we will discuss healthcare barriers and openings.

  • T1: Which external and internal barriers in healthcare are the most damaging that you have seen.
  • T2: How might we personally & professionally address/change the internal barriers to access/participation?
  • T3: We can each make a difference breaking down barriers. How can we put this into meaningful action?
  • T4: Who are some people or organizations that are already making a difference from the patient and/or system perspective?

Resources:

Barriers to Primary and Emergency Healthcare for Trans Adults: Culture, Health & Sexuality: Vol 20, No 2. https://www.tandfonline.com/doi/abs/10.1080/13691058.2017.1338757. Accessed 11 Aug 2020.

Gillis, Laura M., and Jeff Singer. “Breaking Through the Barriers: Healthcare for the Homeless.” JONA: The Journal of Nursing Administration, vol. 27, no. 6, June 1997, p. 30.

Huot, S et al. “Identifying barriers to healthcare delivery and access in the Circumpolar North: important insights for health professionals.” International journal of circumpolar health vol. 78,1 (): 1571385. doi:10.1080/22423982.2019.1571385

Lightfoot, Alexandra F., et al. “‘What I Wish My Doctor Knew about My Life’: Using Photovoice with Immigrant Latino Adolescents to Explore Barriers to Healthcare.” Qualitative Social Work, vol. 18, no. 1, Jan. 2019, pp. 60–80, doi:10.1177/1473325017704034.

Tackett, Sean, et al. “Barriers to Healthcare among Muslim Women: A Narrative Review of the Literature.” Women’s Studies International Forum, vol. 69, July 2018, pp. 190–94. ScienceDirect, doi:10.1016/j.wsif.2018.02.009.

Weller, Jennifer, et al. “Teams, Tribes and Patient Safety: Overcoming Barriers to Effective Teamwork in Healthcare.” Postgraduate Medical Journal, vol. 90, no. 1061, Mar. 2014, pp. 149–54. pmj.bmj.com, doi:10.1136/postgradmedj-2012-131168.

Photo by Eric Karim Cornelis on Unsplash / Unsplash grants you an irrevocable, nonexclusive, worldwide copyright license to download, copy, modify, distribute, perform, and use photos from Unsplash for free, including for commercial purposes, without permission from or attributing the photographer or Unsplash.

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