Health System Purchasing Professionals' Approaches to Considering Equity in Procurement.

Abstract

Continuing data on racial bias in pulse oximeters and artificial intelligence have sparked calls for health systems to drive innovation against racial bias in health care device and artificial intelligence markets by incorporating equity concerns explicitly into purchasing decisions. How do health care purchasing professionals integrate equity concerns into purchasing decision-making? Between August 2023 and March 2024, we conducted semistructured interviews via videoconferencing with health care purchasing professionals about purchasing processes for pulse oximeters and other devices-and whether and where equity concerns arise in decision-making. An abductive approach was used to analyze perspectives on how equity and disparity concerns currently are integrated into health care purchasing decision-making. Health care purchasing professionals (N = 30) worked in varied supply chain roles for various health systems and supply chain support and consulting companies across the United States. Health care purchasing professionals described limited considerations of equity in current purchasing processes. They described some receptivity to diversity, equity, and inclusion initiatives, largely focused on diversifying suppliers rather than ensuring that devices and products functioned equitably. Respondents reported that they depended on clinician partners to raise and delineate requirements for equitable performance. Respondents also depicted current sources of evidence used in making purchasing decisions as providing limited information about equitable performance and that large contracts, including with group purchasing organizations, may limit purchasing options. Health system purchasing professionals suggested interest and some nascent successes in diversity, equity, and inclusion considerations in health system purchasing processes, including diverse supplier initiatives, but also expressed a need for strong clinical partnership to ensure equitable performance. Explicit approaches for incorporating equitable performance into health care purchasing likely are needed.