How Health Systems can Address Social Determinants of Health

Arena’s client, Newark Beth Israel Medical Center, has a multi-faceted approach to addressing social determinants of health. They are committed to the health of their community and described several impactful programs at a recent ACHE presentation.

The session focused on community-based hiring and the transcript of that discussion can be found here. The part of the session that described their additional programs continues below:
THE PROCESS: Involve the community in the planning

DARRELL TERRY: When you’re looking at how you can benefit a community, it’s not about what you think you should do. We should not be paternalistic in our approach. We should really work with our community. Each hospital has a Community Health Needs Assessment, that’s required by the ACA. Working with the community, with leaders in the community, we can find out what the community thinks their needs are. Then we come together to make a plan that works for both the hospital, as well as, more importantly, the community. You make mistakes when you try to build the program based on what you think the community needs. It’s a little, I’d say, arrogant. So it’s really important that we involve the community in creating the plan.

MYRA NORTON: So I’ve got a question for you, because when you talk about co-creating these initiatives, bringing together a diverse group of stakeholders to put together programs like the ones that you have at Newark Beth Israel, are there any shortcuts? Have you tried some shortcuts that didn’t work out? What happens when you don’t co-build programs together with a wide variety of stakeholders in the community?

DARRELL TERRY: I have a great example.  We have a Greenhouse — which is pretty unique in New Jersey. We have a Greenhouse on our campus at Newark Beth Israel. When we created the greenhouse we knew that there was food insecurity in our area. We knew that there was a lack of access to fresh fruits and vegetables, so we understood that we were solving the problem. We went to our neighbors and got variances because it’s literally in a community that this greenhouse sits. They were very supportive of our initiatives. However, we did not involve them in the planning aspects of it. And so there were some policy issues we found out much later.

Many people in the very community who were supportive of our efforts were not able to access our Farmers Market. They couldn’t buy our fresh fruits and vegetables because of the form of payment. They had SNAP benefits, and our set-up was not allowed to accept SNAP. And so the very community that were so supportive of our efforts are now excluded from being able to participate in a meaningful way. We went to the policy division of our system, and they actually petitioned the state and local governments to change the policies to enable us to accept SNAP benefits. Then that made a huge difference for the communities that we serve. Certainly an unintended consequence, we just didn’t think of it. That’s why it’s so important to get input —  real input — from the people that you’re trying to impact.

MYRA NORTON: That’s a great point for folks to have in mind who are trying to build these types of community programs for the first time. Talk to us about your guiding principles as you think about putting these programs in place. What do you think is important in terms of how you structure these kinds of programs?

DARRELL TERRY: We always start with the Community Health Needs Assessment and look at what the community is saying that they need. And then we look at the pathology in our community. We look at the metrics around unemployment. We look at metrics around different health outcomes. And then, together with our Patient Family Advisory Council, we come up with plans as to how we can address some of these issues and create a healthier community. It’s continuous iterations. There’s ongoing collaboration and learning, going back, doing things a little differently based on new information. It’s not something that you can just do one time and think that you have a plan, a blueprint. It’s very iterative and it takes a lot of constant feedback from the community that you serve.

MYRA NORTON: Talk to us a little bit about some of the other great programs that you and your team have instituted at Newark Beth Israel. Please take us through each of these programs a little bit, to talk about why the program exists and what the outcomes or the impact has been.

Greenhouse + Weekly Farmer’s Market in the Beth’s Lobby

DARRELL TERRY: The Greenhouse. This came up when we looked around our immediate primary service area — and even our secondary service area — and saw there was no real access to fruits and vegetables in our community.  There are a lot of bodegas and other places that don’t really focus on healthy food alternatives. I actually was born at this hospital in Newark, and I remember being a young child with my mom, who had four boys, and we would literally have to get on a bus and leave our community to go get fresh fruits or vegetables. We really wanted to make it easier for people to eat well. It was not just enough for us to say, ‘You should eat this,’ or ‘This is the right thing.’ If they did not have access to it or could not afford it, then we’d just be talking and not actually creating real opportunity for our community to have access to fresh fruits and vegetables. 

So first we created a Farmers Market, and then we actually went full tilt to create the Greenhouse. It’s a beautiful structure. We grow the fresh fruits and vegetables. It’s hydroponic. We have a weekly Farmers Market in our lobby where we’re selling this food at cost. We are not trying to make any money off of it whatsoever. We just want to create the access for our community. And it’s been very successful and a great partnership with our community. 

It’s the 10th year of our Farmers Market. We started with a small plot of land across the street from the hospital, and it has evolved into our hydroponic Greenhouse. We donate a bunch of food that we do not sell to our community food bank. 

It’s not just about the access to healthy food. It’s about learning and providing education. Our behavioral health program interacts with our Greenhouse in a significant way.  Kids come from different schools so they can learn about the whole process. You break cycles when you teach kids, and kids go back and they teach their parents. It’s just been a really good opportunity for us to interact with our community in a fun educational and meaningful way.

Career Ladders with employees

The Career Ladders program is a more recent offshoot, the next step in from our Hire Newark initiative. So it’s not enough for us to get entry level employees into our building. It’s really about creating career opportunities for them, with a livable wage. We wanted to make sure that they had pathways to the next level. We created a bunch of programs: a pharmacy tech program, nursing assistant program, a nurse internship, and others. In addition to providing tuition reimbursement, we created some of the technical positions in-house to teach them right here at our facility.  We open these pathways up to our entry level employees so that they can then take their skills to the next level.

Youth Workforce Development summer internships

When I was a kid, I didn’t know anything.  You think about doctors and nurses when you think about a hospital, but there are so many different positions that pay well, and are great careers. A radiology tech, PT, perfusionists, most people don’t know about those different specialties that really impact patient care and make a real difference in the communities that we serve. Youth Workforce Development introduces our younger kids to all the different opportunities that exist within a hospital. We expose them to different areas, we send them around. They’re very helpful to us, and at the same time we’re teaching them about different opportunities that they would not necessarily have been able to know about.

Local prioritization in hiring, purchasing, and investment practices

And this next one has been really phenomenal, our local prioritization in hiring, purchasing, and investment. We are in the midst of $150 million construction project at Newark Beth Israel. We’re looking at how we spend that money, and how our community benefits from this. Take the construction standpoint — from contractors to even people who serve food to the people who will be working on this project. We’re looking to make sure that every time we spend $1, that our community actually benefits from it. 

Every aspect of a project can also benefit our community. One of the cool things that we did here was a “wayfinding” opportunity at the Beth. We invited kids in from a local arts high school so that they can understand that signage is actually a business, a great business opportunity. People don’t know that. When I was young I never thought signage was a thing, but it is a career, a lucrative career. We brought them in and made them part of the process of the logistics of the Wayfinding program. They provided an enormous benefit to this project, and at the same time, were introduced to a whole new profession. So we’re always thinking about the kids in our community, the businesses in our community. We believe we can make the community healthier as a result of that kind of focus.

MYRA NORTON: So Wayfinding is about the signage that helps families and patients navigate the physical buildings and offices that they need to get through to access care? Young folks in that initiative — this generation has such a good sense of spatial reasoning —  they’re probably bringing creativity to that exercise that you wouldn’t have otherwise?

DARRELL TERRY: Absolutely. They have identified issues that we never knew existed. We started out by just telling them to go to a different area in the hospital, without any further instruction. Just “Find your way to the cancer center,” for example. Then they would come back and give us feedback as to how challenging that was. Our campus is over 1.2 million square feet so if people are not getting there in the most efficient way, it creates hassles, particularly for people who are elderly or infirm. So this is a very important project, and they have provided great guidance for us there. 

Women’s Wellness Pantry: Health education and healthcare access addressing maternal mortality 

DARRELL TERRY: This, to me, is an equity issue. When you look at maternal mortality, black women are dying, four times as often as their white counterparts. In New Jersey, that is actually 7 to 1. Anything that we can do to reduce that disparity and create a much better, safer delivery for our moms and our community, is an important initiative. We give fresh fruits and vegetables. We also give gift cards to local supermarkets. For our pregnant moms, they come in to get their prenatal care, and then we ask a bunch of questions and work with them to find out what their other needs are, other than clinical needs. We have the opportunity to help address some of those needs and have really great outcomes in this regard. So I’m really proud of this initiative.

MYRA NORTON: That’s wonderful. We’ve all seen the racial disparity in the wake of COVID. In the midst of all the challenges of just running a health system during a pandemic, are you still able to care for these women in the same way?

DARRELL TERRY: Yes, we are. Obviously, we are very safe in all of the interactions that we have. We follow all the CDC guidelines. But it’s really important to us that things don’t fall through the cracks and that disparities are not exacerbated as a result of this pandemic. We have an equity sheet that, when we’re thinking about new programs and new ideas, there’s a series of questions that we ask ourselves about impact in our community. There are so many times you have good intentions, but you have unintended consequences of the decisions that you make. And so thinking about them ahead of time is really important in making sure that you minimize the unintended consequences.

Rev. Dr. Ronald B. Christian Community Health & Wellness Center 

Dr. Ronald Christian was an icon in this community and had an untimely death. He was a board member here. He was a pastor at a huge church in Irvington, New Jersey, and had a real impact on this community. So we named the center after him. In the center we have wellness, cooking classes, education. That’s where the Women’s Wellness Pantry actually exists. And it is a building now that is synonymous with health and wellness in our community and so something that we’re really proud of. 

Affordable Housing Initiatives

The newest focus for us is the affordable housing initiative. We are actually purchasing housing. We don’t necessarily want to be landlords. However, we do believe that if you don’t have stable housing then it’s very difficult for you to really focus and concentrate on being as healthy as you possibly can. 

This is due to be stood up in 2022. It’s 65 to 70 apartments, it’s 2- and 3-bedroom apartments, so that we can make sure that we are addressing some larger families. The partnership is between our health system, federal government, and private developers. This is going to be a game changer. It will be located a quarter mile from Newark Beth Israel. And also, we will save apartments for some of our people who have housing challenges and have health challenges that force them to come back to our emergency department on a frequent basis. So we’re trying to address that by having wraparound services that will help them, not just to have episodic emergent care but to think about how we can treat more holistically.

And so we have entered into the affordable housing effort. This is something that we’re learning, but it is rewarding.

MYRA NORTON: You guys are really tackling literally all of the social determinants of health to, hopefully, continue to improve the health of the Newark community. You say you’re not trying to get into the business of being a landlord, but there obviously was something pretty powerful that led you to decide to tackle this. This is not a small initiative. What made you say, we need to spend time, resources, energy to do this?

DARRELL TERRY: When we did our Community Health Needs Assessment, affordable and stable housing was one of the top things that were identified by our community as being challenges to good health. And so we jumped into it. It’s something that we don’t know a lot about right now, we’re researching it, we’re just trying to do all the things that we can make sure that it’s done in a way that really benefits our team.

COMMUNITY-BASED HIRING

To learn about this comprehensive, impactful initiative continue reading here.