How healthcare organizations provide disability accommodations to promote equitable care: A qualitative study

Abstract

Background

Federal laws require healthcare organizations (HCOs) to provide patients' disability accommodations when requested. However, patients’ accommodations needs are often unmet, contributing to inequities in healthcare access and outcomes. Little is known about the systems and processes HCOs use to provide accommodations in varied settings.

Objective

To understand HCOs’ systems and processes to provide disability accommodations.

Methods

We conducted qualitative interviews with HCO representatives responsible for disability-related initiatives within their organizations. The interviews elicited participants’ current processes for providing disability-related accommodations at their HCOs. We used a team-based approach to thematic analysis, reviewing and summarizing quotations to identify themes and categorize text that exemplified themes.

Results

We interviewed 17 participants representing 15 HCOs, and identified four themes related to HCOs providing disability accommodations: 1) Providing accommodations proactively begins with identifying a need, though is often disconnected from the rest of the process; 2) Clinical areas had varied and duplicative processes; 3) Different workflows were created ad hoc for different types of accommodations; and 4) Critical need to educate staff on disability accommodations. Participants drew parallels between disability accommodations and language interpreter services, and also emphasized the importance of providing disability accommodations in a proactive rather than reactive manner.

Conclusions

Health systems struggle with a lack of standardized processes to provide disability accommodations in an efficient, systematic way. While processes should be adapted to local contexts, standardized guidelines for providing accommodations could improve consistency in their delivery, ultimately helping to mitigate health-related disparities in the healthcare setting.