By Heidi Christensen

Stakeholder Health (formerly known as Health Systems Learning Group) is a voluntary, peer-led learning collaborative that has enjoyed the participation (over the last two-and-a-half years) of some 90-plus organizations across diverse sectors (of which 52 represent hospital health systems). It developed out of a series of stakeholder convenings co-hosted by the White House Office of Faith Based and Neighborhood Partnerships, and the Partnership Center at the Department of Health and Human Services and participating health systems.

The secretariat, housed at Wake Forest School of Medicine and its health system, is overseen by Gary Gunderson and Teresa Cutts. While the Robert Wood Johnson Foundation supported the dissemination of findings, most of the on-going support comes from a core group hospital health partners that have set the table for a robust conversation and an opportunity for others to join in.

Practitioners Amidst Change

Stakeholder Health is not a membership-based or “official” organization. I think of it more as a body of practitioners working in the midst of dynamic changes in the way health care is to be provided. Given the seismic shift toward a wellness and population health orientation—not to mention compliance challenges, global budgeting strategies and the new clinical protocols necessary to improve health outcomes and reduce readmissions—it’s a more challenging day at the office than ever before.

There’s also a growing body of evidence and practice about how the social complexity of today’s health seeker is shaped by the environmental conditions in which they live, even to actual street and intersection of that address (if there is one).

How does one distill so much information into ways that can move the needle within their own organizations toward strategies that align population health efforts with institutional goals?

In many cases it’s the person at the helm of Community Health Development or Community Benefit who is translating new opportunities to folks sitting in firm institutional ways, practices and cultures—often having to sell a new reality and encourage a paradigm shift, or two. So it seems that joint-learning in a practicing community has never been more timely or necessary.

A Community of Trust and Time in the Boat

Dora Barilla, who heads Community Health Development at Loma Linda University Medical Center, recently told some of us, “These are historic times. Inside our institution there is a heightened need to accelerate progress in community health development. And I can’t do it alone.” For her it’s been enormously helpful to participate in an ongoing dialogue with “trusted peers—transparently learning—and in it for the right reasons meaning they’re not grabbing ideas for a buck but for what will move their mission.”

Dora’s comment highlights the characteristics of this particular learning collaborative:

• First, Stakeholder Health participants are committed to open source learning—to a level of transparency that is possible because of the relationships that have been built over time. The learning collaborative has evolved into a community of journeymen and women who in many ways are modeling what impactful community engagement looks like. It’s all about relationships of trust… and “time in the boat” (as we sailors like to say!).

• Second, there’s a deep sense of shared mission. Last year, participants co-wrote an 80-page monograph that was presented to their senior leadership at HHS. In it they state, “While far from perfect, the new policy direction is consistent with our mission and the fundamental belief that doing the right thing medically and socially is doing the right thing morally. Decent and efficient are the same thing. New and hopeful for us is that we now know enough to extend that mission logic to engage the social environments from which our most complex patients come.”

These folks feel deeply accountable to the most vulnerable in their communities and have been hard at work—some for decades—focusing their efforts in the places where health disparities are concentrated in order to optimality fulfill their charitable mission.

A Missional Population Health Strategy

The monograph also outlined a critical strategy for operationalizing a missional population health approach that can be captured as three critical interwoven components:

1. Seek to address the social complexity of the most challenging patients by engaging them at the neighborhood level;
2. Do so through large-scaled community partnerships;
3. These are supported, proactively, by existing resources (e.g. charity care,  relationships that exist as an anchor institution, role as advocate or the capacity to act as a backbone organization to sustain community collaboration).

• A third characteristic consistent among Stakeholder Health participants is that in most cases, those who oversee community health efforts report directly to senior leadership—often with Community Health Directors a click behind the CEO.  For example, Maureen Kersmarki, is part of the senior management at Adventist Health systems. She also knows the name of the owner of the trailer park in Bithlo, a community they are investing time and resources in to bring health and wellness to its citizens.  I believe it is this prioritization of community intelligence that sets their efforts apart and places these institutions like them at the head of the curve.

Current Focus of the Stakeholder Health

Within the context of the ensemble of practices several areas of focus are emerging which include:

• A health IT working group—with a focus on developing systems that can track the impact of community health interventions on health outcomes.
• A working group of faith-based institutions seeking to strengthen their relationships with congregations and sponsoring denominations.
• ProMedica Health is leading a coalition connecting health to hunger and other social correlates.
• Health systems exploring models for incorporating youth and seniors as volunteers navigating patient’s social circumstances impacting health.
• On-going regional meetings and site visits to learn more about what health systems are doing particularly to operationalize the ensemble of practices.

I think it’s important to emphasize that Stakeholder Health is just one particular learning group. It’s been built on relationships, like-mindedness and trust. Many other extraordinary learning opportunities and institutions are committed to spreading and scaling models and best practices. There cannot be enough learning, exploring and experiment going on.

HHS Partnership Center

A quick word about the HHS Partnership Center and why we’re in the middle of this conversation: For much of the early years of the collaborative, our office acted as the “backbone” or the coordinating hub for participants (before there was a secretariat and as people were coming to know one another).

While still active in coordination, we primarily see ourselves as part of the dissemination arm of the learning we are privy to and the extraordinary models and innovation we are witnessing around the country—along with RWJF’s New Public Health, TFAH, Prevention Institute, IOM and other disseminating platforms. We hope that our gathering activity can be a resource to other learning collaboratives and to those shaping policies, research, tools and practices that advance the quality of health delivery—especially those that engage community partners.

Stakeholder Health Forum

We also see our job as providing a resource to those who may not be working in the forward leaning institutions, but who hunger to know: “How did y’all do this? How are you operationalizing this mindset? What does authentic community engagement look like? How do I work with competing institutions in my market? How do you count that?”

The main way we do that now is through the Stakeholder Health Forum which showcases smart practice as it emerges from the field. It’s a monthly web-based presentation given by a Stakeholder Health participant as part of their core commitment to open source learning. Rather than a presentation of community health programs, presenters are addressing their peers and conveying how they are operationalizing their population health strategies. For example, one month ProMedica, a health system in the Toledo area, described how they are institutionalizing their strategy for hunger free communities and Nemours, an integrated child health system in Delaware and Florida, talked about their executive performance incentives tied to asthma outcomes.

The Forums have become quite popular—so we hope that reflects how helpful they are to practitioners in the field—with participants mostly from the health system community but also from a growing number of philanthropic foundations and public health entities. Please join us for the coming month’s presentations by visiting Stakeholder Health.org.

Many people have long hoped for the opportunity of this health reform movement and its accompanying sense of urgency. So the more learning that can be coordinated, distilled and distributed the better for those who need it most in neighborhoods across the country.

Heidi Christensen is Associate Director for Community Engagement at the Center for Faith-based and Neighborhood Partnerships, U.S. Department of Health and Human Services.

Painting: “Sailboat” by Charles Edwin Cookman, Boston Public Library, Creative Commons.