Written by Kevin Barnett, DrPH, MCP; Senior Investigator; Public Health Institute
Disclaimer: Moving Health Care Upstream is a collaborative effort co-led by Nemours Children’s Health System (Nemours) and the Center for Healthier Children, Families & Communities at the University of California- Los Angeles (UCLA). The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of Nemours, UCLA or the Moving Health Care Upstream initiative.
In response to our recent blog regarding the key characteristics of Transformational Leaders and the effects this type of leadership has on the re-design of health care systems to achieve improved community health, please see this timely and stimulating brief. The key attributes of Transformational Leaders noted within our original white paper, Using Transformational Leadership to Move Health Care Upstream are essential, particularly now as the discourse regarding the repeal of the Affordable Care Act and how it is to be replaced, looms large within Congress. Health care leaders must utilize this important skill set as they engage colleagues within a broad spectrum of community agencies to examine what factors influence patient outcomes and implement collective approaches that improve the health and well-being of the population served within their geographic region.
The good news is that besides work of the leaders noted in our original case studies, several other hospitals and health system leaders are modeling this type of leadership and engagement. Moving Health Care Upstream invited Kevin Barnett, Dr.PH, M.C.P. (Senior Investigator , Public Health Institute) to write a guest blog highlighting his thoughts on this issue- as informed by his efforts as a whole and by his work with the “Alignment of Governance & Leadership in Healthcare: Building Momentum for Transformation” initiative. (The Public Health Institute (PHI) is the home for the initiative, and is implementing it in partnership with The Governance Institute and Stakeholder Health with support from the Robert Wood Johnson Foundation). In his blog post, Dr. Barnett briefly highlights the activities of some organizational visionaries who are at the forefront of mobilizing institutional change and strategically leveraging community level assets to improve population health. They exemplify the characteristics of transformational leadership.
Are there examples of leaders within your own organization who are also modeling these characteristics and type of influence? If so, we would very much like to hear from you about these individuals, the work in which they are engaged, and the impact it is having internal as well as external to your organization.
Denise A. Davis, DrPH, MPA, Moving Health Care Upstream Project Director
After six years of symbolic votes, the Republican-controlled Congress is now well positioned to “repeal and replace” the Affordable Care Act. As the first few weeks of the new administration have unfolded, however, it has become increasingly clear that unwinding the complex inter-workings of the ACA will be more difficult than envisioned. Legislators are also getting an earful from constituents about the potential loss of coverage among the 20 million people who enrolled in the last six years. The philosophy among those seeking to repeal the ACA is that increased market competition and cost sharing by consumers will more effectively bend the cost curve than coverage mandates that spread risk and public subsidies that ensure coverage for lower income Americans. It appears that we may have the opportunity to test that proposition.
Amid this turmoil, health care leaders and policy experts agree that the steady drive towards value-based reimbursement is essential. The incremental steps taken thus far have yielded relatively small returns, but there is no question of the need to shift financial incentives from filling beds and conducting procedures to keeping people healthy and out of inpatient settings.
One of the more profound impacts of this shift in incentives will be a transition away from the old model of hospitals as insular, acute care “body shops.” While the emphasis on high quality acute care must be retained, the imperative will grow for hospital leaders to become more informed about social and environmental factors that influence the health of patient populations, and more engaged in efforts to address them.
Engaged leaders will need colleagues across the organization with the competencies and responsibilities to collect and analyze data in areas such as income, housing, education, wages, public safety, and food access – examining their impact upon care utilization within and across providers and payer boundaries, and illuminating ways in which these factors, their interplay with health behaviors, and associated negative health outcomes are concentrated in specific geographic areas within larger service areas. There is no longer any excuse for ignoring the physical and socioeconomic context in which health or illness are manifested in our communities, and the assumption of financial risk will ensure that institutional motivation extends beyond the moral imperative.
As they illuminate the interrelationship between individual behavior and the social, physical, and economic context, engaged leaders will need to become much more active in civic affairs at the local and regional level. Engagement of agencies at the municipal level such as community/economic development and parks and recreation; county agencies such as public health and social services; school districts, which operate at different jurisdictional levels; and regional entities such as transportation planning agencies will be necessary to ensure that health and well-being considerations are brought into focus. Where appropriate, senior leaders must be sufficiently well informed to weigh in proactively when decisions are to be made that may negatively impact vulnerable populations. In short, it will no longer be sufficient to rely upon a public affairs officer to serve as the sole representative of hospitals with external stakeholders. The CEO, other senior leaders, and key staff in clinical and administrative positions across the organization will need to be prepared to inform and when necessary, use their influence in the interest of the health and well-being of people in their geographic region.
The good news is that there are a growing number of hospital and health system leaders who are modeling this form of engaged leadership. Randy Oostra, CEO of ProMedica, a regional health system in NW Ohio and SE Michigan is engaged in the implementation of a comprehensive community revitalization strategy in the inner city of Toledo, leveraging internal assets and engaging civic leaders to take actions such as building affordable housing, opening a grocery store, and stimulating small business development. At the national level, ProMedica has launched the Root Cause Coalition to serve as a convener and facilitator for action and advocacy to address the social determinants of health. Leaders of large systems such as Lloyd Dean of Dignity Health, Richard Gilfillan of Trinity Health, and Rich Statuto of Bon Secours have well-established histories of directing substantial resources from their investment portfolios to support targeted community development in low income communities, and all are exploring strategies to scale their efforts through deeper engagement with diverse stakeholders. Wright Lassiter III of Henry Ford Health System in Detroit, MI and Steve Allen, CEO of Nationwide Children’s Hospital in Columbus, OH are deeply engaged and directing investment and community benefit dollars to revitalize low income neighborhoods in their service areas.
It should be noted that much of this kind of engagement and investment by hospitals and systems such as these has been driven primarily by the visionary leadership of these individuals, and their commitment to mobilize the substantial economic and political influence of their institutions for the good of their communities. As we move forward, it will become increasingly important to connect the dots between “doing good” as an expression of moral commitment and “doing well” by building the analytic and operational capacity to demonstrate the potential to bend the cost curve. It’s time for a transformation of the acute care “body shop” into an “anchor institution,” as articulated by the Democracy Collaborative; to health systems that think and act in a holistic manner to improve health and well-being in our communities.