In 2016, Rush University Medical Center identified that there was a 16-year gap in life expectancy between the west side of Chicago and the downtown Loop. The health system set out to use its status as an anchor health provider and employer on the west side to change the way it thought about community programs and improving health.
In a talk hosted by the Social Interventions Research and Evaluation Network (SIREN) based at the University of California San Francisco (UCSF), Darlene Hightower, J.D., vice president for community health equity at Rush, described the health system’s anchor mission journey over the past five years, as well as partnering with other health systems and community-based organizations in an effort called West Side United. (The Institute for Healthcare Improvement's CEO, Kedar Mate, M.D., highlighted the work of West Side United in a recent interview with Healthcare Innovation.)
Hightower was interviewed by Wylie Liu, M.P.H., M.P.A., the senior program manager for UCSF’s Clinical and Translational Science Institute's Community Engagement & Health Policy program as well as the director of UCSF's Center for Community Engagement. In 2019 UCSF joined the growing national movement to establish “anchor institutions” – universities and hospitals that are committing to strengthen under-resourced populations by hiring, buying and investing locally.
Hightower said the huge life expectancy gap, led by heart disease and cancer, became apparent as Rush was doing a standard community health needs assessment in 2016. “It caused us to change our mission, change the way that we implemented community programs, change the way we've thought about improving health,” she said. “We wanted to figure out — as the largest private employer on the west side of Chicago — what could we do to address that life expectancy gap. That meant looking at how our economic power could be used to positively impact communities.
Their strategy had several pillars, Hightower said. One was to hire locally and develop talent. The second was to buy locally. The third was to do social impact investing locally. The fourth was to volunteer locally. “Since 2016, we've been focused on those pillars — using our economic power to invest more intentionally in the west side.”
She said Rush saw volunteering as part of its anchor role because its power is not just in money. “We have people power,” Hightower stressed. “We have over 10,000 employees. How do you marshal the power of those amazing folks to also help improve health in communities? Volunteering locally became a pillar and a way for us to let folks know about the amazing assets and folks that are on the west side and let people in the communities know that Rush cares and that we wanted to roll up our sleeves and partner with them.”
Liu asked Hightower about any lessons learned over the last six years working on this approach.
One lesson, she said, is that you have to figure out what you're trying to do to and make sure that you have metrics in place — how are you measuring success and holding yourself accountable. “Having dedicated staff to help you roll the work out is key,” Hightower added. “Everybody within the hospital setting is super busy. We can’t just layer on something else, especially when it's something new that you're trying to lift up, so it was really important for us that a dedicated program manager and staff be in place to help us move the work forward.”
Liu also asked how the anchor mission work ties into other social determinant of health efforts.
“There's a continuum of health equity work and anchor mission is part of it,” Hightower explained. “What ties it to the social determinants of health is the economic piece, like people having high-quality jobs and support for small business. But when I think of social determinants on the health equity scale, I'm thinking more about whether we are screening folks for those things when they come into our hospital, and then what resources and referral opportunities we're providing to them for that,” she said. “If it comes up that people are food-insecure or lack quality jobs, then that's when the anchor can come in as a way to address those needs, whether it's the volunteer component and providing food sources for people or whether it's providing opportunities for people to get well-paying jobs.”
Liu asked how Rush was approaching diversity, equity and inclusion and antiracism in this work.
Part of the anchor mission is being intentional about who Rush is partnering with, Hightower explained. “We focus on partnering with small businesses and bringing businesses of color into the supply chain for Rush.” There also is a focus on our hiring initiatives and being really intentional about hiring people of color from the west side into roles within Rush. Another pillar is connecting with young people from a STEM healthcare career standpoint and “making sure that we were reaching out to kids of color in the surrounding Westside neighborhoods, to get them on a path to employment, within Rush or within healthcare.” Rush has a racial justice action committee that looks internally at the way that Rush does some of its work.
Liu asked Hightower if Rush ran into any challenges in working with community-based organizations.
“I don't know that the challenges are with the community-based organizations as much as they are with the health institutions,” she responded. “Sometimes there is a disconnect between the things that folks at health institutions want to do and the things that the community needs. The more that you can connect what the community needs with what an institution is able to do the better. Sometimes challenges arise when there's a lack of respect for the learning, understanding and needs that are coming from community-based organizations.
“As healthcare institutions, we need to work on sharing power, sharing decision-making, and putting community at the center because at the end of the day, you're trying to help people, you're trying to improve health in the in the neighborhoods, and you can't do that without the voice and leadership of community-based organizations.”
Turning to questions from the webinar audience, Liu asked Hightower to describe the West Side United effort in more detail.
“West Side United grew out of our anchor mission work,” she explained. “It grew from us working with other hospitals that want to engage in anchor mission work as well as other community-based organizations, government and residents, all working to improve the life expectancy outcomes on the west side of Chicago. We've been in that space for about three years now. We're glad this has grown to become a multisector collaborative with real initiatives and work groups around them, putting information at the core, but also being a convener.”
The organization is not just using community as a feedback loop, but asking people to be leaders in the work. “We have community representation at our executive leadership council level, so we have six health institutions and six community-based leaders and residents. We have a community advisory council and work groups for each of our initiatives, and community-based organizations and community residents are on those workgroups. It really is shared leadership and shared decision-making.”
Finally, Hightower was asked what other health system executives can do to encourage and activate their health system leaders to address equity and root causes of social determinants of health?
“I started the conversation by saying the data point opened our eyes to a 16-year life expectancy gap,” she replied. “I think you need to start with the data — like what are the differences in health outcomes that you're seeing with your patients that are coming in to your institution? What are the differences in health outcomes for the surrounding neighborhoods? Seeing differences in chronic disease rates, that data just became undeniable. We had to frame it and do storytelling around it in a way that would charge people to want to do something about it. I would say start there, and provide that information to leadership. If your institution isn't talking about this now, it's somewhat of a missed opportunity if you're really in the business of providing health and wellness to the people that you serve.”
