clinical/community collaborativesfour things we wish we knew going in!

Jessica Saunders, MPA

Jonathan Thackeray, MD

objectives

• Describe the benefits of aligning clinical services and community engagement programs to impact the pediatric health of a community.

• Identify barriers when developing a clinical/community collaborative, with a focus on barriers identified within the clinical setting of a tertiary care children’s hospital.

• Discuss strategies to overcome identified barriers and facilitate the development of a successful clinical/community collaborative.

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setting the stage: state of children’s health in Ohio

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Ohio’s performance over time on health and healthcare spending Source: HPIO

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Bottom

QuartileThird

Quartile

Second

Quartile

Top

Quartile

Ohio’s rank in national child health and wellbeing scorecardsSource: HPIO

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Source: HPIO

Ohio’s infant mortality rate remains one of the highest in the U.S.

modifiable factors that influence health

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Source: HPIO

state of children’s health

Montgomery County is 77 out of 88Ohio counties in health outcomes.

27 percent of the county’s children

live in poverty.Ohio rate: 21 percent

50 percent of kids in our region, age

0-11 years are overweight / obese.

Montgomery County infant

mortality rate is 6.8 in every 1,000.Ohio rate: 6.0

15 percent of Ohio children

experienced 3 or more adverse

childhood experiences.National rate: 11 percent

opioid epidemic resulting in rising

rates of abuse, neglect and foster /

kinship care.

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• Primary care with

enhanced services

for:

• Foster/Kinship

• Complex Care

• Healthy

Lifestyles

• Child Advocacy

Program

• Family Resource

Connection

• Food Pharmacy

and Demo Kitchen

• Injury Prevention

Programs

• Collective Impact

Initiatives

• Neighborhood

Collaboratives

community health: the response

center for community health and advocacy

Challenge #1Picking the Correct Umbrella

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Social

Needs

Screening

Asthma

Collective

Impact

Injury

Prevention

Primary

Care

Division

Child

Abuse

Division

Existing Clinical ServicesExisting Community Programs

VP of Marketing Chief Medical Officer

Food

Pharmacy

& Demo

Kitchen

Specialty

Medical

Services

Foster/

Kinship

New Programs and Services

Complex

Care

Healthy

Life-

Styles

New VP of Community Health

Comm.

Benefit/

CHNA

lessons learned

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Be certain the work aligns with the organization’s overall mission and vision.

Leadership must have common expectations and goals for the work.

Avoid the comfort of “what’s always been” and embrace the disruption that may be necessary.

Assume everyone is acting with good intentions.

Challenge #2Knowing Who’s in the Room

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what is community health?

Community Health

Advocacy

Child Advocacy

Primary Care

Partnerships and

Outreach

Injury Prevention

Community Health Needs

Assessment

Clinical-Community Linkages

Community Benefit

master dot-connectors

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Internal Stakeholders

Pride in their employer

Advocates for “the cause”

SDOH Education

Tell the “community benefit story”

Common talking points

Legislators/Government Officials

Data & Numbers

“Their” Constituency

Personal Stories

Hot Topics

Community benefit vs. Medicaid loss

Ongoing communication for pro-

child agenda

Community Partners

Part of something worthwhile

Shared values

Education around health needs/advocacy

issues

Understand clinical-community linkages

General Public

Trust and pride in hospital brand

Beyond walls of hospital

“Feel good” stories

Community impact on issues of importance

SDOH Impact

Engagement

know thy audience

the media mix

Internal Stakeholders

Board of Trustees Retreat

GPS Sessions

Employee Intranet

Employee Newsletters

Legislators/

Government Officials

Legislative Visits

Advocacy Days

Stakeholder Publications

Community Partners

Community “Road Show”

Building Tours

Stakeholder Publications

General Public

Blog

Media Relations

Community Newsletters

lessons learned

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You can neverovercommunicate in times of tremendous transition.

Different audiences need different (yet consistent) messages.

Engage champions throughout the whole organization to help tell your story and carry the message.

As leaders it is important to always give the positive spin to keep our team energized and focused.

Challenge #3Respecting the History of Your Team Members

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three key providers of care

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• “Marla” – Director of Ambulatory Clinico Head of ambulatory clinic for over 40 years

o Strong convictions about how care should be provided and how residents should be trained

• “John” – Director of Complex Care Programo Background as Founder and CEO of FQHC

o Used to making a decision and seeing it implemented immediately

• “Lora” – Key Provider in Foster Care Programo Recent hire with background as a primary care

pediatrician in a system that lacked innovation

o Eager to change the entire system of care

1. Resistant to change1. DD

2. DD

Barriers

three key providers of care

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• “Marla” – Director of Ambulatory Clinico Head of ambulatory clinic for over 40 years

o Strong convictions about how care should be provided and how residents should be trained

• “John” – Director of Complex Care Programo Background as Founder and CEO of FQHC

o Used to making a decision and seeing it implemented immediately

• “Lora” – Key Provider in Foster Care Programo Recent hire with background as a primary care

pediatrician in a system that lacked innovation

o Eager to change the entire system of care

1. Resistant to change1. DD

2. DD

Barriers

2. Constrained by

working in context of a

larger system

three key providers of care

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• “Marla” – Director of Ambulatory Clinico Head of ambulatory clinic for over 40 years

o Strong convictions about how care should be provided and how residents should be trained

• “John” – Director of Complex Care Programo Background as Founder and CEO of FQHC

o Used to making a decision and seeing it implemented immediately

• “Lora” – Key Provider in Foster Care Programo Recent hire with background as a primary care

pediatrician in a system that lacked innovation

o Eager to change the entire system of care

1. Resistant to change1. DD

2. DD

2. Constrained by

working in context of a

larger system

Barriers

3. Eager and often

impatient for change

three key providers of care

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• “Marla” – Director of Ambulatory Clinico Head of ambulatory clinic for over 40 years

o Strong convictions about how care should be provided and how residents should be trained

• “John” – Director of Complex Care Programo Background as Founder and CEO of FQHC

o Used to making a decision and seeing it implemented immediately

• “Lora” – Key Provider in Foster Care Programo Recent hire with background as a primary care

pediatrician in a system that lacked innovation

o Eager to change the entire system of care

• Acknowledge legacy

• Seek feedback

• Update often

• Allow for venting of

frustrations

• Reinforce expectations

• Praise and encourage

• Capture ideas and

look for small “wins”

Strategies

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lessons learned

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As a leader, resist the urge to jump in and make changes immediately.

Take time to learn the history and the background of the institution and your team.

Have frank discussions about how people feel.

Eventually, you’ve got to move team members upor out.

Challenge #4Have a Plan to Measure What You Value

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investment in outcomes measurement

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$28 million budget

strategic plan objectives

year in review

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lessons learned

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Plan ahead – outcome measurement is critical!

Identify what is the return on investment you are trying to measure?

Leverage existing resources where available.

Allow time for data lag.

Celebrate simple wins.

building the plane while flying it

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summary

• This is the beginning of a journey, not the end of one.

• Create a culture where anyone who sees the opportunity to do something better for our families feels comfortable to speak up.

• Everyone has something to teach and everyone has something to learn. Recruit those who are open to both.

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questions/comments?

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