Designing a Statewide Hospital Equity Initiative: A Qualitative Formative Evaluation

Introduction: Implicit bias training for health professionals is widely recommended as a strategy to mitigate maternal health inequities; however, evidence to support its efficacy is limited. Furthermore, experts recommend that bias training be embedded in a program of systems-level equity interventions. Although frameworks and broad recommendations for hospitals exist, there is limited actionable guidance for operationalizing effective maternal health equity programs in hospitals. This study aimed to gather data to inform the design and implementation of a statewide offering of implicit bias training and systems-level maternal health equity-focused interventions responsive to hospital needs and preferences, and expert input. Methods: This qualitative formative evaluation consisted of in-depth interviews with maternal health leaders from Maryland birth hospitals and experts in maternal health equity to understand current maternal health equity work, recommended strategies, barriers, and facilitators of hospital-based implicit bias training and systems-level maternal health equity initiatives. Results: Seventeen interviews were conducted with birth hospital representatives and experts in maternal health equity. Hospital representatives reported limited prior work providing implicit bias training or implementing systems-level interventions. Participants recommended equity-focused interventions that align with existing health care improvement and maternal health equity recommendations. They also suggested implementation approaches aimed at leveraging facilitators and overcoming barriers of hospital-based settings. Discussion: Formative work in the design of maternal health equity initiatives can offer an expanded understanding of the actual barriers and needed support for hospitals and could improve effectiveness of these interventions.