I have a greater appreciation for the ambitious and multi-faceted role the hospitals and health systems are playing in advancing health equity after attending the Association for Community Health Improvement’s (ACHI) recent conference. This conference is part of the American Hospital Association, tailored to hospital employees focused on community health improvement. Here are themes from this year’s conference that I found particularly compelling:
On social determinants of health, hospitals are moving from if to how: Over the last 4 years, the Association for Community Health Improvement conference has focused increasingly on social determinants of health. This year, addressing social determinants was not only a conference track but a component of nearly every presentation. The conversation this year was markedly more tactical—with panelists sharing exactly how they are screening patients for social and economic needs and matching them with relevant services, how partnerships are structured with nonprofits, and comparing progress on how they can integrate social determinants of health into clinical workflows and electronic health records. Some health systems are making remarkable progress on these fronts. Rachelle Yoder from Providence Health & Services shared that a clinician in their system can order social supports—like utility assistance—in a patient’s electronic medical record using exactly the same process they would use to order another service like physical therapy.
Hospitals are innovating to provide health and social services supports with “one voice.” In the most inspiring moments of the conference, I got glimpses of a future where we won’t have different buildings, funding streams, and staff attending to families’ health, dental, education, behavioral health, food, housing, and other needs. Instead, we might see hospitals collaborating with social service organizations to provide integrated supports to families with one voice, sometimes on a shared campus, with blended staff and funding structures. The most outstanding example of this was a session about 3toPhD. This unique collaboration between Kaiser Permanente, Portland Public Schools, Faubion Elementary School, Concordia University, Trillium Family Services, and Basics (formerly Pacific Foods) operates in an underserved community in Portland. 3toPhD provides early childhood care, K-12 and college education on the same campus and seamlessly integrates with health, dental, and mental care, a grocery store (where you can shop for free), a well as numerous other support services like laundry and showers for students who are homeless.
Watch their short video in which the kids who attend the school give a tour of the spectacular building. This arrangement offers staggering opportunities for alignment across organizations providing social supports. The dean of the college and K-12 principals have their offices in one suite (imagine the potential for curriculum connections); parents can give teachers permission to walk their children to the clinic when they are sick (imagine the relief for parents who would otherwise have to get off work and get an appointment at a doctor’s office); and college students studying teaching get in-classroom and internships in the very same building where they take their college courses.
Hospitals as a “hub for racial healing” and justice. Keynote speaker Dayna Bowen Matthew, and author of Just Medicine, called everyone’s attention to the role that hospitals have played and can continue play in addressing racial inequities in the U.S. She reminded participants that over 7,000 US hospitals quietly but quickly desegregated in response to the Civil Right Act and urged hospitals to remember they were part of a quiet revolution and that they can do it again. She reminded us that people of color visiting hospitals today carry in their bodies the accumulated physiologic impacts of the stress of both overt and implicit racism and discrimination they have experienced. In U.S. healthcare today, people of color receive different care due to various structural factors and implicit bias. For example, Black patients receive different treatments in part because of inaccurate perceptions that they feel less pain—a misconception promulgated during times of slavery. She urged hospitals, a major provider to the nation’s 75 million Medicaid enrollees, to consider the role they can continue to play in healing racial wounds of the past. Another keynote speaker, Mona Hanna-Attisha, author of What the Eyes Don’t See, reminded us of the role that doctors and the health care system have and continue to play in advocating for health and environmental justice. She shared her personal experience as a pediatrician in Flint, Michigan and her decision to face enormous personal and professional backlash to use her voice to call to attention to lead contamination in the city’s drinking water and its impact on children—perhaps the most glaring act of environmental and health injustice in the U.S. this century.
Hospitals and health systems are stressing commitment to a different way of engaging communities. Throughout almost all of the sessions, there was a strong emphasis on community-centered partnerships and community-determined processes. Presenters and participants raised the idea that community members are tired of being “talked at” and that real community engagement must take into account the specific history of the conditions we are seeking to change came to be. Hospital and health system representatives spoke about the need for them to be part of multisector collaboratives as equal partners, rather than needing to be seen as leading the work. Participants also stressed the importance of identifying and highlighting assets in the community, rather than focusing solely on deficits.
Some hospitals are evoking their religious roots to support renewed work on social determinants. Many of the speakers were from large health systems—like Catholic Health Association, Bon Secours Health System, and Dignity Health – founded on a religious intention to serve the poor and vulnerable. A number of speakers evoked these historical roots to justify and affirm their recent innovation to address social determinants. For instance, I spoke with David Belde, vice president of community health for Bon Secours Mercy Health, about the hundreds of affordable houses their local system in Baltimore owns, geared toward low-income individuals and families. He explained some of the complex financial structures they use to “stack” capital for housing, using system grants and investments to unlock other necessary capital to complete these capital-rich housing investments. When I asked what his colleagues in hospital administration think about their real estate developments, he shared that the health system, like their founding sisters, think holistically about improving health and recognize housing as an important determinant of health. Similarly, the Providence Health System leader who created a patient resource desk in the hospital lobby reminds her colleagues that the Sisters of Providence have been running orphanages, providing food and housing for hundreds of years, and the resource desk is just the modern manifestation of their founding sisters’ mission. While health systems’ work on social determinants is seen as cutting edge, for some, it is also a return to their roots.
Hospitals and health systems are pursuing precompetitive collaboration. Hospitals are also looking at ways to collaborate with their competitors to address social needs. For instance, 4 health systems in Sacramento, Dignity Health, UC Davis, Sutter Health and Kaiser Permanente, shared how they joined forces to perform a community health needs-assessment and then developed a shared set of priority needs and a collaborative implementation strategy that uses a collective impact approach. Although they are competitors in the health care landscape, they deemed it would be in their best interests to address issues like homelessness together.
Trauma and Adverse Childhood Experiences (ACEs) are a high-priority social determinant that hospitals aim to address. While past conversations about social determinants focus heavily on food and housing, this year I noticed more attention being paid to the role hospitals and health systems can play in preventing and mitigating the effects of adverse childhood experiences (ACEs) and other forms of childhood trauma. There seems to be an increasing appreciation of the ways that childhood trauma can impact health, education, and income and increasing desire to identify what hospitals can do. For instance, the conference hosted lively human-center design sessions where hospital leaders developed proposals for how they can advance trauma-informed care. From the various experiences people cited, it is clear that the hospitals and health systems are situating trauma as one of the high priority determinants they seek to address. (See FSG’s recent blog describing five ways that funders can address childhood trauma).
I left the conference with a huge appreciation of the enormous and multi-faced role that hospitals play in America’s social progress. Hospitals are institutions that we rely on in our times of greatest need, a major employer in our communities, a booming voice in policy discussions, and organizations with a deep history in caring for society’s most vulnerable citizens. With all of these roles, hospitals have an enormous amount of potential to provide equitable opportunities in our country.
Read Transforming Health Care Delivery, recent resources on the ways that health policy changes have helped pave the way for innovation in how safety net hospitals, health plans, and clinics address social determinants of health, what leading organizations are doing, and how funders can help address remaining gaps.