Inequality in health and in the care we provide our patients is well documented, and persists in spite of a massive national effort to identify and address health inequities.

Like many professional and medical associations, the American Academy of Physician Assistants (AAPA) continues to work to find its niche in joining the effort to address health equity. It’s a tough nut to crack.

Strategically, many organizations do what the AAPA has done, which is identifying the major players in the national effort to address health disparities and building collaborative efforts. This is a reliable approach, one that avoids “reinventing the wheel,” and a strategy that builds bridges with colleagues in other professions and disciplines.

But for organizations interested in establishing leadership in this area or in other areas, we have to do more than just connecting with the work of others. As chair of the AAPA Health Disparities Work Group, I can tell you our group is striving to address these challenges.

During the past two years, we’ve developed a “four dimensional” approach to addressing health disparities. This proposes that racial health inequities occur within four realms: access to care, systems quality, provider attitudes/cultural competency, and social determinants.

In creating the 4D approach to addressing health disparities, we’ve borrowed from a lean manufacturing technique called the A3 process — a problem-solving technique pioneered by the carmaker Toyota. In the A3 process, care is given to developing a complete understanding of any process or problem before determining out how to solve it.

The Health Disparities Work Group is doing just that. We recognize that efforts to address one of the four dimensions of health disparities without addressing the other will probably not be successful. This is like making a sandwich without the bread, which we all know is really not a sandwich at all.

I plan to share more about each of the four dimensions of health disparities in my weekly blog posts. Check back often and don’t hesitate to share your thoughts with me at j.eddy.anderson@gmail.com.

Jim Anderson, MPAS, PA-C, ATC, is chair of the American Academy of Physician Assistants Health Disparities Work Group, founder of Physician Assistants for Health Equity and faculty of the Department of Anesthesia and Pain Medicine at the University of Washington School of Medicine in Seattle.