Maureen Stapleton Kersmarki retired after 31 years with AdventHealth (formerly Adventist Health System). She most recently served as Director of Community Benefit and Director of Government and Public Policy. Maureen has an extensive background in health policy, community benefit, and healthy community work. She served as the chair of the Primary Care Access Network of Orange County (FL) for 12 years and is a leader in several grassroots healthy community efforts in the greater Orlando area. She serves on the advisory councils for the Association for Community Health Improvement (of the American Hospital Association) and Stakeholder Health, a movement of 40-plus faith-based health systems striving to change the focus of health care from the hospital to the community, with a special emphasis on the underserved. Maureen is a Class 8 graduate of the Health Forum’s Healthy Community Fellowship.
Dora Barilla: Hello, everyone, and welcome to Next Generation Community Health. I’m your host Dora Barilla with Providence St. Joseph Health and today we’re joined by Maureen Kersmarki. We’ll be talking about the importance of policy in community health and equity for women in healthcare. Let’s get started by welcoming Maureen to this show. Thank you for joining us, Maureen.
Maureen Kersmarki: Oh, it’s my pleasure to be here, Dora.
Barilla: Well, Maureen, you’ve been engaged in Stakeholder Health really from the beginning. I’m wondering if you could tell us why you became engaged and what contribution do you believe that this group can make to a national conversation on improving community health?
Kersmarki: Well, Dora, at the time that I became engaged in this, I was the director of community benefit and public policy for Adventist Health System, which is now called Advent Health. I was very intrigued by the notion of health systems partnering better with faith communities. I believe that faith communities are just the greatest assets in all of our communities and they’re really the foundation of the communities. It just seemed to me that some of these congregations would be the most likely partners for moving forward in community health improvement no matter who was leading the initiative. Now, at the same time, faith based partners, mission based hospitals, make the ideal partners to work with these congregations because they have the same mission and drive of improving our communities and the world that we live in.
The thing was Stakeholder Health too, is with its 60 members and about more than 40 of them are faith or mission-based health systems, we have a lot of assets that we can leverage locally, but we also have the opportunity to have a national voice to really change healthcare delivery, to focus on the things that make an keep people sick. We haven’t done that until now.
Barilla: What an interesting opportunity for us as a nation to really elevate this dialogue. It’s almost as if it’s been happening for really decades, if not hundreds of years, in a lot of these health systems.
Kersmarki: Yeah. I believe it has been happening. It’s happening in health systems. It’s happening in faith communities. It’s happening in our communities. It’s just that we haven’t formalized it or named it or leveraged it the way that we really could be doing.
Barilla: Yeah, exactly. I think that our conversation and coming together really gives it that language. Thank you for sharing your experience. Now, Maureen, I know that you were a part of the See2See Road Trip with Stakeholder Health. I’m wondering if you could share a few of your experiences.
Kersmarki: Well my job with the See2See Road Trip was to help set up the stops along the way. We ended up with over 25 stops over that almost 3 week period that that Winnebago was on the road. I had the opportunity to talk to people all the way across the country and find out and identify some just amazing best practices that were often very, very grassroots and that nobody had really come and talked to before. One of the examples that really stuck out to me is a group called Three Precious Miracles. This is a foster care organization in the Phoenix area. The organization works with Native American families of a certain tribe there to try to help foster families and grandparents raising children to do culturally competent foster care that really reflects the native traditions that are so important to these children and families.
Another one was a cardiac disparities project in San Diego that is having wonderful results in the mostly African American community. The results have to do with improved health and lower death rates for folks with cardiac disease in those communities. This effort was started with some folks at the University of San Diego but also really relies heavily on the pastors of a number of churches in that community. I think when you hear that message of cardiac health from the pulpit, it’s more likely that you’re going to do some of the things that you need to do to change your life and improve your health.
In Memphis the Congregational Health Network is always a blessing to hear about. There are over 600 churches doing various types of community health initiatives and working with the hospitals there to lower hospital admissions and to reduce unnecessary hospital visits and to improve health. The Highland Clinic in Winston-Salem I thought was very interesting too. It’s both primary care and mental healthcare. It’s a partnership between two hospitals, which that doesn’t always happen, but both hospitals were seeing the same folks over and over again for the same chronic diseases, and a lot of times with accompanied mental health or substance abuse issues. By teaming up and providing a very accessible, affordable place for them to come, it’s going to have wonderful results. That’s really fairly new.
There was a coffee shop in Lubbock called the Tova Coffee Shop and this was initially formed by community partners and the Church of Christs there. This coffee shop employs young people and it’s a meeting place for the whole community. It’s not in the best neighborhood, but it employs a lot of kids who are aging out of foster care and really have nowhere else to go and works to support foster kids and foster families. I could go on and on. There’s all kinds of them and those are just some of the ones that I made a list of for this conversation today.
Barilla: It certainly is refreshing to hear about the great things that we wish and dream for and imagine are already happening. To really highlight those is a paradigm shift in how we’re talking about health, so thank you for sharing, Maureen.
Kersmarki: Yes, and Dora, you’re so right. There are so many things already happening and that really was the goal of this road trip was to talk to folks who are already doing all the things that we talk about doing. Sometimes, particularly when we work in larger health systems, we think we know so much about what’s going on, but the truth is there are so many things going on all around us that are already doing the work that we want to be doing.
Barilla: Yeah, and really a great lesson for health systems that there’s so many community partners and so many great things that are already happening. How can our role be to really just help what’s already happening happen more and really be a catalyst to that rather than thinking that we’re the center of all of the solutions in community health, and really finding our way and our role in that.
Barilla: That’s exciting. Thank you, Maureen. Now, I know you alluded a little bit to your role at Adventist Health at the time—but AdventHealth now—I’m wondering if you can share why it really evolved in such a strong policy and advocacy focus.
Kersmarki: Well, when I was with a system, we had a government relations office. What happened was as we looked at the government activities locally and nationally and looked at the community health issues as well as hospital related issues, we just saw that there was just such deep complexity and that everything was really, really interwoven together. We learned pretty early on that “doing good things” for the community wasn’t always enough. We found we really needed some targeted efforts that were collaborative. Hospitals sometimes … We have unique challenges and issues, and sometimes we think we can or need to do it all, but the truth is we’re not always the best lead partners in community health improvement issues, because we don’t necessarily have the trust of folks. Nobody goes to the hospital because they want to. We go to the mall because we think it’ll be fun and we might find something fun to buy. We go to a hospital and we get a big bill and we’re sick while we’re there. It isn’t a place that people are necessarily wanting to be a part of and don’t always trust, especially because of the high costs that we have going on right now.
This kind of work and policy work needs to reflect the needs of the community and not just the hospital. That’s why I said we needed some collaborative efforts. As we started looking around at the health issues impacting people coming to the hospital when maybe they didn’t need to, we just saw that all of our healthy community work raised all sorts of policy issues. It was everything from sidewalks to safety to food security to transportation to housing, and all of these sorts of things that were really impacting people’s health. You can’t address health or improve health until you address some of these issues. Then those have policies that impact it.
For example, if you have open drainage all along the street in front of your house, you’re going to have a million mosquitoes. Mosquitoes carry disease including encephalitis. Then the parents don’t let the kids outside because they don’t want them to get sick and to get covered with mosquitoes and to play in that dirty water. In order to fix some of the health problems there, you just have to fix that drainage first. Fixing drainage and fixing things like transportation and so on require policy efforts and working with policy leaders, local and federal and state.
Barilla: That’s just really such a great example, Maureen. As we look at what really creates health, a key part of it is the clinical care, but as we know, the much larger part of contributing to health are some of the other sectors in our communities.
Kersmarki: Yeah, absolutely. Another example is families who live in substandard housing where there’s mold. Well that means that in that case it’s very likely that the children, and maybe the parents, are going to have asthma and/or other respiratory diseases. You can’t get rid of the respiratory diseases until you get rid of the mold. That takes a policy effort.
Barilla: Yeah, and so often we even silo ourselves in the policy world that healthcare policy is so fragmented from some of the other policies. Any advice to other health systems in terms of how to break down some of those policy silos? As we talk about social determinants of health, how do we partner with other sectors to co-invest in our communities?
Kersmarki: Well, in working in the policy arena in a big health system like I did, there were really a couple of tracks. One of the tracks is the obvious one and that has to do with payment, with Medicare issues, with Medicaid issues, with things like that that impacted how hospitals do business. That still has to be done, but then the other side of it is if we’re really serious about working in our communities and improving community health, then we have to look case by case at the communities that we’re working with. One of the communities that we worked with here in the greater Orlando area had the closest grocery store a mile and a half away. In order to get to the grocery store, the residents of that community had to walk along a busy five lane highway and they had to cross a bridge over a river. I think it was about 600 feet long, the bridge, and the pedestrian path along each side of the bridge honestly was about 18 inches.
Kersmarki: What would happen is people were scared to go across that bridge or they’d get hit by cars going across there. I’m telling you, if there was a semi coming along, a lot of times the kids would just jump down into the river because they were afraid they were going to get hit by the truck. In order to free up some better access to that grocery store that the folks needed to get to, that bridge had to be widened and had to have a safe walkway along the side. The leader in that community came to the hospital and we introduced him to a congressman who was a powerful member of the House transportation committee in Washington. He got the roadwork speeded up for that area and got that bridge widened within 2 years instead of the planned 18 that it was going to take. That’s policy that impacts community health and safety.
Barilla: Yeah, that really is a transformational way of looking at health policy, Maureen. Thank you for being the trailblazer in setting a lot of that, because I know that you certainly were one of the first healthcare policy leaders beginning to address this.
Kersmarki: Well you give me too much credit. There’s lots of this going on, but I just happen to have some good examples.
Barilla: No. You’ve been doing this a long time, so your wisdom is definitely welcome into our space here. Along those lines, Maureen, as we think about healthcare and community health and the diversity in our communities, how do you think diversity and inclusion is important for leadership teams in healthcare?
Kersmarki: Oh, it’s absolutely crucial. All of us have our personal histories. I mean we’re in a professional environment, certainly, working on professional issues and challenges and solutions to those challenges, but we all have a different kind of background and a different perspective to bring. If we have people who are all the same in the room trying to make a decision, we’re going to come up maybe with not as innovative solutions as if we had a more diverse group of folks that could have people of various races and ethnicities and various genders. I think you can’t have real innovation if you don’t have that. Sometimes in the past with organizations—and this isn’t just hospitals, it’s other organizations—we think we have the answers, but we’re really not talking to the people who would say, “No, that isn’t really the answer. Have you considered this?” That question of, “Have you considered this,” can only come from what we might consider to be a different point of view than we’re used to getting.
Barilla: Yeah. I mean so often, even like in our boards and in leadership, it’s just really been a certain focus. The chief executive officer comes up through finance or the traditional ways, and even our boards are mostly… You have your legal advice and your financial advice. As we think about the diversity in the boards I often say we’ve got to stop recruiting from the golf courses and we need to start recruiting from our communities.
Kersmarki: Yes. Well, even within teams … I had a fairly large team at one point. In hiring people to be on that team, I was fortunate enough to find folks of a lot of different backgrounds, but one of the things I always said was I needed to hire people who were different than me. I didn’t want to have a whole bunch of mes in the room. Really, nobody would want that. I’m pretty opinionated. Well, I’m pretty opinionated and I need to listen to folks who have different opinions and certainly different skill sets than I do. I certainly have, I think, a few talents, but a lot of the folks that worked with me, they had even better talents and a lot of them had talents that I couldn’t even begin to match. You have to have that to have a successful team and a successful leadership team.
Barilla: Absolutely. Just in terms of female leadership, any advice just being a female yourself and being an executive in a large health system, do you have any advice for women in terms of the steps that they… or to organizations on how they can really build an environment for female leaders?
That second part of that question is a little harder for me to answer. I certainly have some thoughts on, as a woman who also hired a lot of women and tried to mentor them to grow within the organization. For me, I learned early on that I really needed to understand the culture of the organization that I was working for. Some days I really didn’t understand it, but I tried very hard. I studied the culture. I would look at the people in the room who seemed to really understand what was going on and I would ask them questions, maybe not in that meeting, but afterwards, about what did I need to understand in order to participate in that meeting better?
I also think it’s important to get a strong mentor. It could be useful to have not only a female mentor for a woman, but also to have a male one so that they can tell you what you do best and what you might need to do to improve. I had a wonderful female mentor the last five years I was working at AdventHealth. She’d get me in a room after a meeting and give it to me if I needed it, to say, “You needed to do this differently and never do that that way again,” and so on and so forth. It really, really helped me. I wish I’d had her much earlier in my career.
Third thing is that within healthcare, at least in my experience these past few years, the upcoming leadership seems to be heavily dominated by finance. Given that reality, I think it really would be useful and maybe almost crucial these days to have an MBA so that you can talk the business talk with the folks that you’re talking with. I think as women we have to work three times as hard and we just do. We need to be totally professional at all times. You just have a flicker of emotion and it’s so easy to get labeled as an emotional woman. I don’t know that you see that.
I have a pretty expressive face and it’s pretty hard for me sometimes to have a deadpan face. I have ended up having a reputation as being emotional sometimes, and that wasn’t always probably the best thing for me as I was trying to provide value to the organization. The thing is that it’s easy to personalize criticism that you may get in a room or may get privately. It’s really not about personalizing. It’s really about using that input to become a better leader within the organization.
Then, one final thing that I found to be very useful, and I actually learned this by watching other people do it. If you’re going into a meeting where you’re going to be discussing the topic and the group needs to come to some sort of an agreement on the activity that needs to be done and you have a point of view that you think is pretty important to this discussion, sometimes it’s helpful to meet with some of those decision makers ahead of that meeting and say, “This is what I’m thinking. What do you think about it?” That way you vet that thought and ideas and you get some input back from folks before you go into the meeting. I think it prevents you from getting shut down or at least the possibility of getting shut down or disregarded.
Barilla: Yeah. It might make people uncomfortable, but what you state is just really so true. I think for us to just name it and have those conversations are so important as women. At Providence St. Joseph Health, we’ve had a lot of female executive leaders. We actually have a “Not Here” campaign referring to any of them, not any discrimination or really building a culture that women feel safe. It’s been really encouraging for me just to even have that conversation in the organization that I work in, but how do you think other women, just from where they are in the seat that they hold, how can they build solid platforms to ensure that other women feel safe?
Kersmarki: Well, I think it just has to do with some of the things we just talked about, about what it takes to be a successful woman yourself, and to teach those skills to the women who are working with you or who are around you. Also, I believe that folks need to have opportunities to learn new things. That can be conferences. That can be continued education. That can be just various different opportunities so that they’re continually learning and growing.
I had a boss for many years who… He was a male and he was wonderful because he basically created a learning environment for our public policy efforts. Everybody used to gather at this table in my office for lunch and we’d all sit around and we’d debate policy and talk about the policy things that we were working on. And then in would stroll the boss and he would stir things up big time to the point that we all had to be arguing with him all the time. I think everybody else on the floor was always pretty tired of us because it was pretty noisy over on our wing, but it was a total learning environment all the time. He was a wonderful teacher, and then we learned from each other. I think we had a really good team who really understood health and healthcare policy.
Barilla: Wow. What a valuable tool that doesn’t cost anything.
Kersmarki: It didn’t cost the thing. What it did was it cost me my peace and quiet at lunchtime, because if I wanted peace and quiet, I had to go out somewhere by myself because everybody was in there pretty much every day, but I wanted it that way. I encouraged that. It wasn’t just a team building thing. It was really to just keep us all learning and stimulated.
Barilla: Absolutely. I know that … I’ve always had the belief that conversations can change the world.
Barilla: That’s really just a part of, I think, a lack of civil dialogue that we’ve had in our country. What a great way to model that, even in the workplace, that we can have in our communities and in our cars, that we can have these rational debates. So important. Anything else in terms of as we want to be forward thinking in our policy around community health? Anything that you want to add in terms of creating more equity and really a more well-rounded health policy agenda?
Kersmarki: I think that there’s one thing I’d like to add, if you don’t mind. This really has to do … I guess it would apply to building policy consensus with internal and external organizations, but it also has to do with addressing the kinds of health issues that, as community benefit leaders, we address every day. Hospitals sometimes think they have the answers. Sometimes community people think we have money that’s going to solve it, but that … Certainly we have some money, but that isn’t the real reason that we’re at the table sometimes. We need to… As we meet with folks in the community, we need to listen really hard and not tell them what to do so that we can build some trust.
There’s a children’s book that I always really liked and it’s called Stone Soup. I can explain it in about three sentences so that you don’t have to hear it all, but basically, they’re these soldiers in the woods and they don’t have any food and the villagers won’t share their food with them. The soldiers heat up this big pot of water and put some stones in it. The villagers are walking along and they said, “What are you making?” They said, “Stone soup.” One villager says, “Well I have some potatoes,” another has some turnips and some carrots and so on. At the end of the day they had this giant pot of stone soup that everybody sat and shared. The moral of that story is that everybody has something to bring to the table. Let’s make sure that we take the time to hear it and to see it and to appreciate it. That’s, to me, is always step one in a collaboration is having that sort of approach.
The other thing is that we just have to create the win-wins, and not just the healthcare system win, but the win-win for every partner who’s at the table. I believe that consensus is crucial. I don’t like compromise at all because what happens is when you compromise, somebody loses. If you don’t have a total consensus in the room, then when you leave that room, the person who had to compromise might say, “Okay, I’ll do it.” Guess what? They don’t always want to do it because they don’t think it’s a good idea or maybe it doesn’t reflect the mission of their own organization. That whole idea of consensus is so important and we need to let everybody in the community, every organization or group that’s at our collaboration table, we need to let them bring their own agendas to the table so that we know where people are coming from, and we can come up with something that works for everybody so that we have the consensus and the win-win.
Barilla: Yeah, versus that win-lose, but that’s not an easy skill set, as you know.
Kersmarki: No, it is not. It’s not easy. It takes time.
Kersmarki: Sometimes you have to have some parking lot conversations to reaffirm people that, “Yes, we really do want to listen to you. I know you didn’t like what you heard today, but please come back and we’ll make sure that you’re better heard next time and we’ll try to address all your concerns.” Not everybody’s going to be happy all the time, certainly, but most of us can be pretty happy.
Barilla: Yeah. That takes patience. Really I think what I’ve seen is around the country a lot of collaborations, but how do we get collaborations with the action as well? I think we’re really needing that.
Kersmarki: Yeah. In order to get collaboration with action, you have to recognize people’s agendas and you have to have a common mission and common agenda. It’s pretty easy to get into the mission-creep business. There’s a collaboration that I chaired here in Orlando for a long time called The Primary Care Access Network and it’s all the Safety Net providers. Our mission was to provide a medical home for everyone in Orange County, Florida. By medical home, meant a permanent source of care, usually a federally qualified center or some similar kind of a clinic situation. Well, there were a lot of really cool folks at the table and so there were folks who wanted to join who said, “Well maybe I have a product or I have an idea that might really help you.” You end up off the track of providing a medical home for every person in Orange County. It’s really important to stick to your mission and that that creates action plans as well, action plans that work.
Barilla: Fabulous, such great wisdom, Maureen, that you’ve shared with our listeners today. Is there any other additional comments before we sign off?
Kersmarki: The only comment I have is a personal one and that is that I have so appreciated being a part of the Stakeholder Health movement for these past years. I’ve learned so much. I’ve seen such amazing things happen and I’ve had the opportunity to work with people who are absolutely inspiring all of the time. I look forward to your leadership, Dora, in your new role as chair of the Advisory Council. I think you’re going to bring lots of new ideas and thoughts. Gerry [Winslow] has done such a wonderful job, and I think you’ll do a wonderful job too, so I really look forward to the future of it. Even though I’m retired now, I am fully engaged in the Stakeholder Health movement.
Barilla: Well, thank you, Maureen, and you can count that we’ll be leaning into your wisdom. We definitely want to make sure that that goes into the next generation. Well we’d like to thank Maureen Kersmarki for joining us today and to everyone for listening. We look forward to our next topic where we’ll be joined by another stakeholder leaning into improving the health of our communities. Thank you so much.