Progress through Partnerships to Improve Health Outcomes in Washington, DC
Connection to Moving Health Care Upstream
Launched in 2012, the DC Health Matters Collaborative (formerly the DC Healthy Communities Collaborative) is a partnership of non-profit hospitals and community health centers that combine efforts and resources to assess and address community needs in the District of Columbia. This work is undertaken in partnership, is data-driven, and engages the community. We work together to achieve our stated vision: one healthy and thriving capital city that holds the same promise for all residents regardless of where they live.
Our first community health needs assessment (CHNA) was conducted in 2013 and identified priority health needs in DC based on quantitative and health outcome data. In 2016, we adopted a new approach to our CHNA with an expanded focus on qualitative data, community engagement, and the non-clinical determinants of health, such as food insecurity and community safety. Our 2016 community health improvement plan (CHIP) strategies were aimed upstream to make changes to policy and systems – internal system improvements, brokering relationships and dialogue, capacity building, etc. Our Collective Impact framework has therefore evolved since 2016 to move beyond the clinical interaction, aiming to modify the social conditions of the community and, ultimately, reduce disease and health disparities across the District of Columbia.
Our work revolves around six key activities: 1) a community health needs assessment (CHNA) conducted every three years, 2) a community health improvement plan (CHIP), which is a roadmap for action on a set of prioritized community needs identified in the CHNA, 3) DCHealthMatters.org – a community-driven, interactive web portal that provides actionable and timely local health information and resources, 4) DCHealthMattersConnect.org – our online resources directory to help providers and residents search and connect with an array of free and reduced cost social service programs, 5) A Policy Agenda to advocate for legislative and regulatory actions related to our CHNA findings and CHIP strategies, and 6) Community Convenings to bring together diverse stakeholders to build and execute on strategies and solutions to improve health equity.
Our Community and Our Need
The District of Columbia is a diverse urban setting that encompasses 68 square miles of land situated between the Northern Virginia counties of Arlington and Alexandria and the Maryland counties of Montgomery and Prince George’s. It is the 20th most populated city in the United States, with more than 700,000 residents.[1] Our city is racially and ethnically diverse though the proportions of racial groups are changing; Black residents comprised 45.2% of the population in 2019 compared to 50.7% in 2010 and the Latinx population grew to 11.7% compared to 9.1% in 2010. DC has a sizable community of immigrants, many of whom emigrated from El Salvador and Ethiopia. Over 14% of DC’s population was born in another country.[2] Socioeconomic characteristics of DC residents vary immensely across the city resulting in a 15+ year difference in life expectancy among different neighborhoods.[3]
In our two most recent CHNAs we made the conscious decision to shift from focusing on individual clinical conditions to larger social determinants of health that affect a wide range of health and quality-of-life outcomes as identified by our communities’ perspective. Our 2016 CHNA identified nine community-defined needs: care coordination, food insecurity, place-based care, mental health, health literacy, healthy behaviors, health data dissemination, community violence, and cultural competency. Using a modified Hanlon method,[4] we prioritized four needs based on four factors: 1) importance to the community, 2) our capacity to address the issue, 3) alignment with the mission of member organizations, and 4) strength of existing interventions and collaboration. The four final priorities were mental health, care coordination, health literacy, and place-based care. To address these larger social determinants of health, our CHIP strategies shifted from a list of individual clinical interventions to broader policy, systems, and environmental changes that begin to address the root causes of health disparities as well as effective methods of maintaining wellness in the District of Columbia.
Our Solutions and Our Community Partners
In our 2016 CHIP, our Collaborative took action in the four priority areas by developing 10 strategies. These strategies were selected based on organizational readiness, resource availability, in-house expertise, alignment with institutional priorities, and potential impact of the strategy. Collaborative organizations committed to either “lead” or “collaborate” on individual strategies. We developed three working groups – mental health, care coordination, and health literacy – that met monthly to focus on implementing the 10 CHIP strategies. Two of these working groups also addressed place-based care strategies. Workgroup leads reported outcomes through an online progress tracker on DCHealthMatters.org, gave updates at monthly Steering Committee meetings, and provided quarterly reports to our Community Advisory Board.
In 2019, we deliberated whether to replicate the 2016 process and identify new priority needs, or recommit to the four existing areas. Acknowledging that we could go even more upstream to identify more specific recommendations, we designed our new CHNA to provide a deeper systems-level analysis of the four needs identified in our 2016 assessment and issued a corresponding 2019-2022 CHIP. The 2019-2022 CHIP builds upon successes, lessons learned, and relationships built to address these four needs. For the next three years, we are focusing on nine strategic areas and a policy agenda to advocate for citywide, legislative and regulatory actions related to CHNA findings and equity goals. To accomplish this work, our Collaborative is adopting new processes that include principles from Scrum.org and the Collective Impact framework[5] to increase stakeholder engagement and allow flexibility. As such, the nine CHIP strategies will be planned and executed through system change “sprints” (short, time-limited projects with broad and inclusive participation) that are a key feature of the Scrum model.
Given that 80% of our health is driven by social factors outside of access to health care, such as housing, education and environment, our Collaborative understands the urgency and necessity for hospitals and community health centers to address these social determinants of health and other upstream factors.[6] The road to eliminating health inequities requires partners to work together. As such, our Collaborative is engaging a diverse cross-section of DC stakeholders with varied expertise in the health system and beyond in our current and future work.
Our Members
- Bread for the City
- Children’s National Hospital
- Community of Hope
- HSC Health Care System
- Howard University Hospital
- Mary’s Center
- Sibley Memorial Hospital
- Unity Health Care
- DC Behavioral Health Association
- DC Hospital Association
- DC Primary Care Association
For More Information
If you would like more information about the upstream work happening in our community, please visit our website (DCHealthMatters.org), follow us on Twitter (@DCHMcollab) or email us ([email protected]).
[1] “US City Populations 2019,” World Population Review, 2019. http://worldpopulationreview.com/us-cities/.
[2] “Fact Sheet: Immigrants in the District of Columbia,” American Immigration Council, October 16, 2017,https://www.americanimmigrationcouncil.org/research/immigrants-in-washington-dc.
[3] Community Health Needs Assessment, District of Columbia, 2019. DC
Health Matters Collaborative. June 28, 2019, www.dchealthmatters.org.
[4] Community Health Needs Assessment, District of Columbia, 2016. DC
Health Matters Collaborative. June 28, 2019, www.dchealthmatters.org.
[5] Collective Impact Principles of Practice,” Collective Impact Forum, accessed October 18, 2019, https://www.collectiveimpactforum.org/resources/collective-impact-principles-practice
[6] Carlyn Hood, Keith Gennuso, Geoffrey Swain, Bridget Catlin. “County health rankings: Relationships between determinant factors and health outcomes.” American Journal of Preventive Medicine 50(2):129-135. https://www.sciencedirect.com/science/article/pii/S0749379715005140
