Collaborating for Health Equity in Chicago: Health Care and Public Partnering with Communities
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The document discusses collaborating for health equity in Chicago through community partnerships. It describes how over 20 hospitals, 7 local health departments, and nearly 100 community partners have come together in a collaborative focused on addressing social determinants of health like food access, violence prevention, housing, and workforce development. The collaborative aims to engage communities, advance policy changes, and measure outcomes through partnership. Examples of initiatives discussed include a West Side collaborative to improve neighborhood health through cross-sector strategies and a health and housing partnership in Chicago.
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Collaborating for Health Equity in Chicago: Health Care and Public Partnering with Communities
- 1. June 1, 2017 Collaborating for Health Equity in Chicago: health care and public health partnering with communities Darlene O. Hightower, Rush University Medical Center Jameika A. Sampson, Mercy Hospital and Medical Center Jess Lynch, Illinois Public Health Institute
- 2. 2 LEARNING OBJECTIVES 1. Learn best practices to engage community residents and community based organizations in a large multi-sector, multi- partner community health initiative. 2. Review how collaboratives and community partnerships can help advance policy and system changes to address the social determinants of health, including food access, violence prevention, housing, community-based workforce development, and behavioral health. 3. Discuss lessons learned from engaging 20+ hospitals, multiple health departments, and nearly 100 community partners in building a collaborative focused on health equity.
- 3. 3 Chicago & Cook County Collaborative Values Guide Our Work
- 4. 4 Substantial Economic Inequities Data source: American Communities Survey, 2009-2013
- 5. 5 Collaborative Partners 20+ hospitals 7 local health departments over 100 community stakeholders IPHI as backbone organization Hospital and health department partners include:
- 6. 6 • Started with Three Regional CHNAs • Each assessment region (March 2015-June 2016) Regional Leadership Teams with hospital & health department representatives Stakeholder Advisory Teams • As we move into implementation, overarching structure shifting to a topical focus • Steering Committee has been crucial in designing and leading the Collaborative Collaborative Structure
- 7. 7 Together, we developed 7 values to guide our work 1. We believe the highest level of health for all people can only be achieved through the pursuit of social justice and elimination of health disparities and inequities. 2. We value having a shared vision and goals with alignment of strategies to achieve greater collective impact while addressing the unique needs of our individual communities. 3. Honoring the diversity of our communities, we value and will strive to include all voices through meaningful community engagement and participatory action. 4. We are committed to emphasizing assets and strengths and ensuring a process that identifies and builds on existing community capacity and resources. 5. We are committed to data-driven decision making through implementation of evidence-based practices, measurement and evaluation, and using findings to inform resource allocation and quality improvement. 6. We are committed to building trust and transparency through fostering an atmosphere of open dialogue, compromise, and decision making. 7. We are committed to high quality work to achieve the greatest impact possible.
- 8. 8 Our Model & Approach… evolving as we build this plane! Collaborative Infrastructure Strong Partnerships & Community Engagement Capacity Building & Shared Learning Implementation Measurement and Improvement Communications Collaborative Action Mission, Vision, Values Model as of 12/2016, adapted from the Collective Impact model
- 9. 9 Community Input is Core to the Collaborative’s Approach Community Input • 5,000+ Community Residents Surveys • 23 Focus Groups • Stakeholder Advisory Teams • Hospital’s Community Advisory Groups • Action Teams
- 10. 10 5-component framework for health equity “Triple Aim for Health Equity”, ASTHO & Minnesota Department of Public Health Social Cohesion Human Resources Investment/ Treasury Government Relations Research Health Care ServicesProcurement & Supply Community Benefit Environmental Stewardship Labor Mgmt Partnership Facilities Communications Technology Total Health Impact Health Equity as a guiding principle
- 11. 11 Focus Areas and Key Community Health Needs Improving social, economic, and structural determinants of health while reducing social and economic inequities. Economic inequities and poverty Education inequities Healthy environment Housing and transportation Safety and violence Structural racism Improving mental health & reducing substance use disorders. Preventing and reducing chronic disease. Increasing access to care & community resources. Overall access to services and funding Integrative care Mental Health First Aid and addressing stigma Violence and trauma, and ties to mental health Focus on risk factors - nutrition, physical activity, and tobacco Healthy environment Cultural & linguistic competency/ humility Health literacy Access and navigation, particularly for uninsured and underinsured Community-clinical linkages for prevention Note: Policy and data strategies are cross-cutting across all four focus areas. Focus Areas for Implementation
- 12. 12 SDOH Strategy Areas Screening/ Referrals for SDOH & Data Food Access & Security Community Safety Hospitals as Partners in Housing & Transport (via HCHC) Policy & Advocacy Capacity Building & Shared Learning Structural Discriminati on & Racism Hospitals as Partners in Workforce and Economic Dev. SDOH Strategy Areas
- 13. 13 Capacity Building for Social Determinants of Health (SDOH) Capacity Building for SDOH and Health Equity Asset- Based Approache s Partnership and Inclusive Decision- Making Culture and Attitudes Knowledg e and Skill- Building Organization al/ Institutional Capacity Measuring What Works Leadership Developmen t “Capacity Building generally refers to a process to increase the skills, infrastructure, and resources of individuals, organizations and communities.” https://www.cdc.gov/hiv/progr amresources/capacitybuilding/
- 14. 14 Capacity Building for Social Determinants of Health (SDOH) • Aspen Institute, Measuring Community Capacity Building http://www.iaced.org/wp- content/uploads/2016/05/Measuring_Community_Capactiy_Building.pdf • California Endowment “Drivers of Change” http://www.calendow.org/building-healthy- communities/ • Communities in Action: Pathways to Health Equity http://nationalacademies.org/hmd/reports/2017/communities-in-action-pathways-to- health-equity.aspx • Community Toolbox http://ctb.ku.edu/en/table-of-contents/overview/model-for- community-change-and-improvement/building-capacity/main • European Union, Building Capacity for Health Equity http://eurohealthnet.eu/sites/eurohealthnet.eu/files/publications/Working-Document-5- Capacity-Building.pdf • Stakeholder Health “Transformative Partnership” https://stakeholderhealth.org/the- movement/transformative-partnership/ • ASTHO Triple Aim for Health Equity http://www.astho.org/Health-Equity/2016- Challenge/Ehlinger-Commentary-Article/ • 100 Million Healthier Lives “Equity, the price of admission” http://www.100mlives.org/approach-priorities/#healthequityandprosperity
- 15. Coming Together to Build Health and Economic Wellness on Chicago’s West Side Darlene O. Hightower Associate Vice President, Community Engagement and Practice June 1, 2017
- 16. The West Side is Rich with Health Institutions and Clinics 16
- 17. Life Expectancy Gaps on the West Side of Chicago 17
- 18. Our West Side Community Areas Experience High Hardship 18
- 19. An Intentional, Collaborative Place-Based Approach Is Needed 19 Education Neighborhood and Physical Environment Health and Healthcare Economic Vitality Holistically address the social and structural determinants of health Have a unified “West Side Voice” to outside audiences Create opportunities to scale programs that work to the community level Identify and create new high-value connections between organizations Create common measures of success Increase the visibility of existing efforts
- 20. Proposed West Side Total Health Collaborative Approach 20 Mission To build community health and economic wellness on Chicago’s West Side and build healthy, vibrant neighborhoods Vision To improve neighborhood health by addressing inequities in healthcare, education, economic vitality and the physical environment using a cross-sector, place-based strategy. Partners will include other healthcare providers, education providers, the faith community, business, government and others that work together to coordinate investments and share outcomes.
- 21. Who Is At The Table? 21
- 22. By working together, we can magnify the impact of existing initiatives, develop new programs and provide coordinated resources to existing collaboratives Work together to hire local, buy local, invest local and engage in the community Business Units Help advocate for systems change Community Engagement Examples of Potential Collaborations on the West Side Collaborate on meeting community health needs Patient Care Support neighborhood collaboratives Lend expert advice and training to community based organizations
- 23. Example of Business Unit Activities 23 Hire locally and develop talent • Employment preference initiative • Career ladder development • Skills training • Mentoring and coaching Buy and source locally Invest locally Volunteer and support community building • Local purchasing program • Local labor for capital projects • Apprenticeship • Diversity hiring and contracts • Impact investing in local communities • Local business incubation to fulfill sourcing needs • Employee engagement in local communities • Leveraging employee expertise (e.g., teaching skills class) DRAFT
- 24. What We’ve Done To Date 24 • January 2017 Kick-off Meeting and Follow Up Survey • March 2017 Issued a “What We Heard Report” • March – April 2017 Conducted 21 Community Conversations Across the West Side • Engaged more than 300 community members and others • Developed a Planning Committee Structure • Launched internal and external Anchor Mission Strategies
- 25. What We’ve Learned 25 • Base Hits before Homeruns We need to win the crowd (institutions, collaboratives and community) We need to manage expectations around timing and funding The community doesn’t want saviors, they want authentic partners Base-hits can be as important as homeruns
- 26. What We’ve Learned – People Want 26 Employment and Support for Community Businesses Effective Youth Programs and Engaged Schools Resources for Mental Health Needs Long-term Commitments, Follow Up, Transparency, POWER
- 27. NEXT STEPS: The Planning Committee will be responsible for building the infrastructure of the Collaborative What it does How its members take responsibility How it measures impact How it operates 27 What will we do? How do we decide which initiatives to undertake? How will we be accountable to each other and to the community? How will we make key decisions? How will we fund this work? What backbone staff will be required to support this work? What data will we share? How will we store and analyze that data?
- 28. The Planning Committee will include 14 community-nominated members, representing a diverse set of communities across the West Side 28 Proposed structure Rush UIC CCHHS Presence Health sponsors Chair
- 29. Immediate Next Steps 29 • Issue Report Summarizing Community Conversations in June • Planning Committee Members announced by late June • Planning Committee will meet for 6 months – Key programmatic initiatives and metrics will be selected – More permanent Governing Committee will be defined – Decisions on operational model and funding model will be made – Communications strategy will be developed
- 30. Thank You 30 If you have any questions or comments, please contact: Darlene_Hightower@rush.edu
- 31. Partnering to Transform Communities Practical Playbook National Meeting June 1, 2017 Jameika A Sampson, MPH, MBA Director of Community Benefits Mercy Hospital and Medical Center
- 32. Our Mission Drives Our Vision and Strategy We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities. Our Core Values Reverence Commitment to those who are poor Justice Stewardship Integrity ©2015 Trinity Health - Livonia, MI 32
- 33. Building a “People-Centered Health System” Together Better Health • Better Care • Lower Costs Efficient & effective care management initiatives Efficient & effective episode delivery initiatives Serving those who are poor, other populations, and impacting the social determinants of health People-Centered Health System Community Health & Well-being Population Health Management Episodic Health Care Management for Individuals
- 34. Community Engagement: Clinical Services: Community Health & Well-being Efficient & Effective Care Delivery through Trinity’s Safety Net System Triple Aim Better health Better care Lower costs Efficient & Effective Wrap Around Services Focusing on the Vulnerable & the Poor Community Transformation: Community Building Focusing on Built-Environment Economic Revitalization, Housing, & other Social Determinants of Health Innovation in Care Delivery Innovation in Technology Innovation in Financing Transforming, Healing Presence in the Communities We Serve ©2015 Trinity Health - Livonia, MI 34
- 35. • Tobacco Policy Advocacy • Tobacco 21 • Smoke-Free Movies • Flavored Tobacco Ban • Childhood Obesity • Soccer for Success implementation with KICS United • Early Childhood Education Food & Nutrition Policy Implementation support with Centers for New Horizons • Workforce Development • Bronzeville Neighborhood Network 35©2016 Trinity Health - Livonia, Mich. Community Transformation
- 37. 37©2016 Trinity Health - Livonia, Mich.
- 38. Health and Housing • Mercy Medical Group at Oakwood Shores • Primary Care Office • 9,700 unique patients served CY16 • 24,687 patient encounters CY16 • The Community Builders @Oakwood Shores • Nonprofit real estate developer • Mixed-income community • 5,200 residents • 50% Children
- 39. Oakwood Shores • Community Life @TCB • Utilize a place-based model that uses stable housing as a platform for residents and neighborhoods to achieve success • Youth development • Education • Workforce development • Asset building • 80% of residents manage their own health with home and community-based practices
- 40. Planned Activities • Senior Health • Community –based CDC Diabetes Prevention Program • Youth Development • Violence Prevention - Mental Health First Aids - Youth Mentoring • Tobacco Prevention - Engaging youth in policy advocacy • Community Health • Supporting Smoke-Free Housing
- 41. Expected Outcomes Efforts to Outcomes Software and Community Life Questionnaire • 20% reduction in the number of youth observing or/and experiencing violence • 50% of youth are enrolled in afterschool programming • 75% of families at risk of losing housing for smoking stay housed
- 42. Jameika Sampson Jameika.Sampson@mercy-chicago.org 42©2016 Trinity Health - Livonia, Mich. Questions
- 43. Discussion Building effective partnerships for health equity Engaging community residents in multi-sector community health initiatives Building bridges between healthcare institutions for population health Building capacity together to address social determinants of health
- 44. Contacts Jess Lynch, Jessica.Lynch@iphionline.org Darlene Hightower, Darlene_Hightower@rush.edu Jameika Sampson, Jameika.Sampson@mercy-chicago.org
Notas del editor
- Population: 5.24 million residents City of Chicago: 77 community areas Cook County Suburbs: 130 municipalities 6 certified local health departments, each completing individual CHA/CHIP ~50 non-profit hospitals This work began before March 2015 with Advocate, Presence Health, CDPH, Cook County Dept of Public Health and IPHI looking for better ways to complete similar priorities. Representatives from those organizations identified hospitals and health depts. in Cook Cty and invited them to a meeting to consider a collaborative CHNA process. We identified and engaged diverse stakeholders, developed shared mission, vision and values and over the course of several months conducted the assessment. We analyzed and discussed the data identifying 4 focus areas and priority populations based on community input and other data.
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- The Health Impact Collabroative has used a number of models and frameworks to guide our work. 3 foundational frameworks are the Triple Aim for Health Equity, the IHI 5-component framework for health equity, and the Total Health model for how hospitals can engage with communities.
- The assessment phase yielded four priority areas of need that cut across all three regions: Social and Structural Determinants of Health Mental Health and Substance Use Disorders Chronic disease prevention Access to care and community resources Through a scan of collaborative initiatives already underway and an analysis of collaborative gaps, the partners determined it makes sense to focus collaborative-wide initiatives on (1) social and structural determinants and (2) mental health and substance use disorders.
- Despite investments, the sobering fact remains: people living in close proximity to one another in Rush’s service area experience differences of up to 16 years in life expectancy. In Chicago’s Loop business district, it reaches 85 years. Just five stops west on public transportation, in the blocks surrounding the Medical Center, it falls to 72; in another three stops, residents have a life expectancy of just under 69 years.
- Disparities in mortality from chronic cardiopulmonary conditions, cancer and other illnesses contribute to the life expectancy discrepancy, but Rush broadened its lens to also examine the social and structural determinants of health outcomes. The “hardship index,” which accounts for housing, income, employment and high school graduation rates, ranks each of Rush’s eight priority neighborhoods in the bottom quartile. Moreover, input from community members, as well as Rush faculty research, reveal widespread psychological trauma, which can impede day-to-day function (in school, on the job market), not to mention the ability to comply with physician recommendations for diet and exercise. Rush’s CHNA revealed the following inter-related themes that characterize the needs of Chicago’s west side communities: Improve social, economic, and structural determinants of health Improve access to care and community resources Improve mental and behavioral health Prevent and reduce chronic disease
- Projected slide
- This is how we will accomplish our vision. Payer mix has improved… Shifting from bucket on the left to the right.