Crossing the Quality Chasm and the Ignored Pillar of Health Care Equity

Over 20 years ago, the National Academy of Medicine's reports, To Err is Human1 and Crossing the Quality Chasm2 spurred the quality improvement (QI) movement in health care. Although there has been tremendous progress toward the aspiration of delivering quality health care, among the six pillars articulated in the reports (health care should be safe, effective, timely, patient-centered, efficient, and equitable), the last pillar, equity, has been largely ignored. The coronavirus disease 2019 (COVID-19) pandemic and the murder of George Floyd have highlighted persistent and pervasive inequities across all facets of society including health and health care. Learning from the successes of the QI movement, it is past time to address the pillar of health care equity related to race/ethnicity and socioeconomic status. The Robert Wood Johnson Foundation defines health equity as a state in which ".everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay,