AHA podcast: The Intersection of Health Care and Community

00:00:00:03 - 00:00:23:18
Tom Haederle
The connection between a hospital and the community it serves is special. Working together, hospitals and communities can enhance the environment where people live, work and play. In 1986, the American Hospital Association created the Foster G. McGaw Prize to recognize hospitals and health systems that stand out through their efforts to improve the health and wellbeing of everyone in their communities.

00:00:23:21 - 00:00:45:22
Tom Haederle
The prize is generously sponsored by the Baxter International Foundation. Join us today to hear from the two prize finalists for 2024, who are notching up the bar for excellence in community support.

00:00:45:25 - 00:01:18:25
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. At the AHA Leadership Summit in July, we recognized one winner and two finalists as recipients of the Foster G. McGaw Prize. The overall winner was Boston Medical Center. In this podcast hosted by Nancy Meyers, vice president for Leadership and System Innovation with AHA’s Center for Health Innovation, we learn more about the innovative programs from the two prize finalists that have made such a positive difference in the lives of the people they serve.

00:01:18:27 - 00:01:30:25
Tom Haederle
Andy Nieto is director of community health outreach and marketing with NewYork-Presbyterian, and Jamie Ketas is vice president for population health with Englewood Health in New Jersey. And now, here's Nancy.

00:01:30:27 - 00:01:57:25
Nancy Meyers
Jamie and Andy, thanks for joining me today. Love to have this conversation from our two Foster McGaw finalists. Jamie, I'd like to start with you. Englewood Health has taken an integrated approach to your population health strategy for several years now, where you've really looked at how you're caring for patients and redesigning care, and how you're working in community to drive health outcomes in general as part of an integrated structure and strategy.

00:01:57:26 - 00:02:01:29
Nancy Meyers
Can you talk about that a little bit, and how have you gotten to this point?

00:02:02:06 - 00:02:21:02
Jamie Ketas
Sure. I think when we were forming our population health department, we sort of had to organize our own thoughts about what populations we were trying to keep healthy. And we really focus on three. One is our patients, right? Our attributed lives and all of our various value-based programs. The communities we serve is the second, and then the third is really the Englewood Health team members.

00:02:21:04 - 00:02:42:15
Jamie Ketas
And when you think about all three of those groups, they all intersect and overlap, right? We have employees who live in the area, right, who are our patients. And so the philosophy has been the same. We take the same approach as we look at what we're trying to do. And understanding, as we all do now, the impact cultural differences as well as societal drivers of health have on outcomes.

00:02:42:18 - 00:03:09:13
Jamie Ketas
We design targeted interventions. So we partner with the community organizations and social service agencies to co-develop programs that leverage the strengths of both sides. So we provide the health care expertise. We bring that to the table, and they provide access to the populations we're trying to reach, as well as the local resources, right. So we don't have our own food pharmacy, FARM at Englewood, but we certainly have great relationships with all the food pantries in the area.

00:03:09:16 - 00:03:25:18
Nancy Meyers
And how have you, as you've brought the strategy together, how are you changing the way or evolving the way that you're gaining input from your patients, from your community, from your team members to help you form that strategy?

00:03:25:19 - 00:03:42:23
Jamie Ketas
Right. So there's universal truths to everything, but at the same time you need the data. And so I think where we've struggled in the past, really the community health needs assessment, we do that every three years. And it's difficult because you don't have the same data set over time. So what we really are trying to do is be data driven in our approach using the clinical data that we have.

00:03:42:24 - 00:03:58:26
Jamie Ketas
So we've been adding additional screenings, substance use disorder screenings, SDOH screenings. So all of the information, let the patients self-report and tell us. Right. And the same thing is going to apply to the community and to our team members. No one is exempt from these issues.

00:03:58:28 - 00:04:24:17
Nancy Meyers
Great. Andy, turning to you, I'd love to hear about how NewYork-Presbyterian is thinking about really bringing in community assessment and community strategies as a foundation to the organization's overall strategic plan. How is that evolving and how are you integrating your view of community as you think about all of the work that you do to deliver care?

00:04:24:19 - 00:04:52:29
Andy Nieto
Yeah, it's interesting because the community work that NewYork-Presbyterian started over 25 years ago with a lot of work that was done in collaboration with our community partners to develop that relationship, that trust between the two of us. And over time, the hospital became much more involved in some of the work that we're doing through the community health needs assessment is done every three years, but also through a Center for Health Justice that was created about four years ago.

00:04:53:02 - 00:05:20:03
Andy Nieto
That really drives a lot of the work that's happening at NYP throughout our network. The Dalio Center for Health Justice is now a central hub where a lot of the thinking regarding what we should be doing to address health disparities is really happening. And together with the Center for Health, for Community Navigation and some of the other organizations that are part of the are the hospital network,

00:05:20:10 - 00:05:39:21
Andy Nieto
together we're thinking about how we structure some of the work and more collaboratively within the organization. And so I think we've come a long way in the last 25 years. And, you know, the creation of the Dalio Center I think was a strong message that for NYP, health justice is something that is extremely important.

00:05:39:23 - 00:05:43:09
Nancy Meyers
And what was the impetus for the creation of that center?

00:05:43:12 - 00:06:05:03
Andy Nieto
I think that we wanted to have a central organization that would kind of think through these issues, so that would bring all the different partners together. The Division of Community Population Health, which is the division that I oversee that does most of the programing out in the community, together with Department of Community and Government Affairs and the Dalio Center for Health Justice -

00:06:05:05 - 00:06:24:09
Andy Nieto
together, we are thinking about what are some of the needs in the community? What are some of the needs within the organization? I'll give you an example. Social determinants of health is something that is extremely important in addressing some of the disparities that are happening. So in the hospital now, we question all our patients for social determinants of health.

00:06:24:09 - 00:06:51:01
Andy Nieto
We screen them for social determinants of health. And that drives a lot of the work that we do as we identify some of the needs. Before the pandemic happened, we were already surveying our patients for social determinants. We identify food insecurity as a huge issue. 30% of our patients were food insecure. And so we began to create programs that address food insecurity.

00:06:51:03 - 00:07:10:21
Andy Nieto
And so by screening patients for the social determinants of health in the emergency room, in the clinics, it gives you a great idea of what's happening to your own patients together with the evaluation we do outside of the hospital. But for our patients, that's a good way to really understand what's happening with them.

00:07:10:24 - 00:07:34:09
Nancy Meyers
I'd like to ask you to reflect, as well, on how your interactions with the community organizations and the community members that you serve has evolved over the last few years, and maybe even especially over the course of the last few, with the pandemic to be more of co-design of programs and strategy. How does that happen for you that others could follow?

00:07:34:15 - 00:08:02:07
Andy Nieto
Co-design is interesting, right? Because that's our model. We do co-design with all our programs, but co-design requires that you have trust in the community. Trust is not gained in three months. Trust is gained over years of really developing programs. And really, when you say co-design, it's not coming to the organization and telling them what you think the problems are, but asking them what they think some of the issues are.

00:08:02:10 - 00:08:40:05
Andy Nieto
And I think hospitals sometimes feel like they can begin a program in the community because they've identified a certain issue and they want to go into the community, build something, and it's important for you to first go out and listen to the community and hear what they have to say. One community organizer told me once, when I introduce one of our researchers to the community organizations and he wanted to do NIH grant and the community leader told them, we don't want to be subjects, we want to be co-leaders in these grants.

00:08:40:07 - 00:08:52:09
Andy Nieto
So it's important for us to really understand that the community is not there just for us to introduce what we think is important for them, but co-design with them, whatever the issues are.

00:08:52:12 - 00:09:19:07
Nancy Meyers
And that involves the hospital or health system trusting the community, right, as well as gaining the trust of the community. So, Jamie, this is an area where Englewood has also really excelled, I think, in, in co-developing programs for some of the unique populations that you're serving people might be surprised by. You want to talk about one or two of the examples of how you, over the years, co-developed programs.

00:09:19:07 - 00:09:37:00
Jamie Ketas
Sure. I think one of the longest standing examples we have was about 30 years ago. The Jehovah's Witness population approached us at Englewood and really was in, had a huge barrier to care, and a lot of clinicians were unwilling or afraid of the liability of taking care of patients for whom blood is not an option. And this was something.

00:09:37:00 - 00:10:04:24
Jamie Ketas
It was new. And our approach has always been we don't duplicate, right. So we looked around and indeed it was an area that needed to be filled. And so we partnered with them and over the years really have built a trust that now we can use that trust to not just deliver the great, excellent care that's evolved over those 30 years where almost nobody gets transfusions in certain areas now, through the patient blood management principles that were born at Englewood, just by nature of our experience.

00:10:05:01 - 00:10:24:25
Jamie Ketas
But it's also a vehicle by which we can give information to this population, because now they trust us. And so as we all in our population health mission are trying to push to prevention and screening and prevent the need for a bloodless surgery, we can use the trust we've built with that community. Another example is the Korean Health and Wellness Center, where this was a population -

00:10:24:26 - 00:10:42:10
Jamie Ketas
Northern new Jersey has a very large and growing Korean-speaking population. And that was another barrier to care, right? They could not navigate literally, logistically, and also to get the information to them on what they should be getting and how to get it was a real barrier for these patients getting the care they needed. So we're doing the same thing.

00:10:42:10 - 00:10:52:06
Jamie Ketas
We sort of are following the example of the Jehovah's Witness population and the bloodless patients to move towards continuing to use vehicles to get not just care, but information to the populations that need it.

00:10:52:08 - 00:11:14:10
Nancy Meyers
Last question I have, I think, for both of you, is in order to do this great work that each of you are leading as a subject matter experts in your organizations, you have to have empowerment within your organization from your senior leadership, and they have to give power to you and to the community through you in order to get these programs done.

00:11:14:11 - 00:11:34:08
Nancy Meyers
I'm wondering, based on your years of experience, what do you think are one or two qualities that you've seen develop in your organization in terms of your support from senior leadership, that you would suggest that other organizations focus on or consider? How have they empowered you?

00:11:34:11 - 00:11:49:10
Jamie Ketas
So I would say at Englewood, you know, we are relatively small. We're an independent system still. And I think that there's trust, right? I think trust is really at the heart of everything. So there has to be trust at the team that the resources we put towards this are going to be used in a strategic way.

00:11:49:10 - 00:12:07:17
Jamie Ketas
Right? We're not going to go and develop a program or try to implement something that's not going to be well received by the community that we're trying to reach. We're not duplicating efforts, right. We're trying to supplement. And I think the trust that we're going to do the work in advance to make sure that whatever, wherever we put our resources right, they're not unlimited.

00:12:07:24 - 00:12:27:06
Jamie Ketas
So how do you do this in a way to drive outcomes? And our CEO is very fond of saying the good business and it's good business, right? And so for us to continue to flourish and to be a trusted health care partner for all the communities we serve, we have to be flexible, nimble, right? During the pandemic, we'd gone on weekly phone calls with all the community service agencies.

00:12:27:06 - 00:12:35:18
Jamie Ketas
What do you guys need? How can we help? Where are you guys coming from? What do you have to share? How do we do all this together and just being willing to collaborate at every level.

00:12:35:21 - 00:12:40:07
Nancy Meyers
Andy, how about at New York Presbyterian? How has the leadership been supportive of this work?

00:12:40:07 - 00:13:05:11
Andy Nieto
So obviously, we're a huge organization in New York City, but we have a CEO that is committed to this work, who knows about our work, who speaks about our work and who gives us the resources we need for us to be able to do this work. Our CEO can get up and talk about our Lang Medical Youth program, which is a program that brings sixth graders into the hospital, who spend six years with us.

00:13:05:13 - 00:13:39:01
Andy Nieto
We help them get into good high schools, good colleges, and many of them come back as employees of the hospital. Many are nurses and physicians, and these are kids from the inner cities who probably would not have had. And Dr. Corwin, who's our CEO, will speak about the program like he knows the program really well. More recently, we had an interview with two of our Lang graduates. One is an MP working in one of our pediatric floors, and the other one is a program manager who runs one of our programs.

00:13:39:03 - 00:13:50:03
Andy Nieto
And Dr. Corwin speaks to them and talks to them and can talk about these programs, you know, in a way that a CEO who's running a multibillion dollar organization is just amazing to hear.

00:13:50:05 - 00:14:11:24
Nancy Meyers
That's great. Well, on behalf of AHA, I want to thank both of you for the work that you're leading within your organizations and thank your organizations, Englewood Health and New York Presbyterian, for being leaders and being shining examples for others when it comes to investing in and developing your communities. So thank you, thank you, thank you.

00:14:11:27 - 00:14:20:07
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.