Investing in Social Determinants of Health

For over 15 years, the St. David’s Foundation has been a critical actor in contributing to the health and wellbeing of communities across Central Texas. In early 2016, with shifting federal and state funds and persistent or worsening health outcomes for many in Central Texas, the Foundation embarked on a strategic planning process focused on identifying how they could have the most impact through a $75 million annual investment in connecting low-income populations with comprehensive health services.

The Foundation, which operates through a partnership with St. David’s Healthcare, engaged FSG to develop a strategic planning process in line with the organization’s culture and history. The Foundation’s investments previously focused on providing health care access but did not focus explicitly on how social determinants of health—factors such as housing instability, homelessness, food insecurity, neighborhood conditions, and safety—affected the health of people in Central Texas.

FSG conducted rigorous research and analysis to uncover patterns in health outcomes, develop hypotheses on contributing factors to poor health outcomes, and to identify gaps and opportunities to contribute to improved outcomes based on the external landscape and the Foundation’s unique strengths. FSG interviewed key stakeholders in the community including safety net clinics, university partners, local government officials, peer hospitals, community-based organization leaders, and other private funders to enhance the understanding of the issues at play as well as the community needs. These interviews helped unearth diverse perspectives and brought health trends and partner needs to the forefront of the strategic planning conversations.

Each individual on the FSG team was phenomenal to work with. They adapted to our culture, and they engaged our operations staff and our program staff. They were a true thought-partner.

Earl Maxwell, CEO, St. David’s foundation

FSG partnered with St. David’s Foundation Board members, program team leads, and operations staff to develop a strong understanding of stakeholders’ values, culture, and vision for the future. These conversations provided insights into high-priority health issues for the community and aspirations for the organization in the coming years and informed the design of a series of cross-departmental staff workshops aimed at collectively surfacing priorities for the new strategic plan.

During the first workshop, the Foundation’s senior leadership, community investments team, program staff, communications, human resources, evaluation, and IT teams reviewed the Foundation’s values and jointly developed a set of guiding principles that would more explicitly bring these core values into their strategic decision-making and daily work. The workshop allowed teams to discuss potential challenging implications of the new strategic directions for specific communities and organizations. In the next workshop, teams spent time reviewing the data and analyzing community health issues to identify areas where the Foundation could have the greatest impact. Engaging the full staff across programmatic and operational divisions was a critical part of the process, ensuring all stakeholders co-created and supported the Foundation’s strategic direction and priorities.

FSG connected leaders at St. David’s with leaders at several peer foundations who had adapted their organizational structures to promote deeper community engagement and stronger cross-sector partnerships, creating the space for learning across organizations. FSG conducted interviews and benchmarking research with these leaders to uncover how they explored opportunities to address social determinants of health as part of their strategic plan, how they approached community engagement, and how they fostered engagement in implementing the strategic plan across all parts of their organizations.

The St. David’s Foundation decided on 3 strategic priorities that reflected their analysis of unmet community needs, capitalized on their unique strengths and capacities, and incorporated a more explicit focus on structural determinants of health: improving access to and quality of health care, creating a healthier community environment, and supporting those with unmet health needs through programs on healthy aging, childhood resiliency, and women’s health.

St. David’s Foundation continues its commitment to building the healthiest community in the world. In 2017, the Foundation dove into its new strategic vision, awarding 10 nonprofits taking innovative approaches to improving health with $100,000 “opportunity grants,” and issuing its first-ever Request for Proposals, focused on postpartum support for Central Texas women to address the high rate of maternal deaths in Texas.

About the St. David’s Foundation
St. David’s Foundation believes good health returns great benefits to the community. Through a unique partnership, the Foundation reinvests proceeds from St. David’s HealthCare to help build the healthiest community in the world. The Foundation helps people in every corner of the community through signature programs and collaborations with more than 60 nonprofit partners.

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