A leader in the patient-safety movement recently urged hospital officials to use their organizations to take on 10 specific challenges including increasing voter registrations and addressing climate change.
Journalists may find several story ideas from a provocative keynote address at the Institute for Healthcare Improvement (IHI) forum given by a longtime leader in efforts to make people safer while getting medical care. In his Dec. 8 speech, Donald Berwick, M.D., M.P.P., president emeritus and senior fellow at IHI, sought to draw attention to the following areas:
- Health coverage
- Food security
- Housing security
- Immigrant needs
- Corrections and prison health
- Climate and decarbonization
- Voting rights
- Education supports
- Early childhood supports
- Elderly and loneliness
It seems unlikely that many if any hospital leaders will be quick to try all the challenges Berwick posed. But it could prove interesting for journalists to check with local hospitals about any work that may already be underway or planned in these areas. Another approach would be to ask people in local nonprofit organizations about how they view Berwick’s speech and what parts of it might benefit the community. (The 49-minute keynote address is available on YouTube. It’s engaging and well worth a listen.)
In his speech, Berwick also highlighted groups already making progress in each of these areas. These organizations might serve as good sources for stories looking at how hospitals can serve to trigger larger changes in their communities.
Berwick brings a rare understanding of hospitals to his advice. He served as the administrator of the Centers for Medicare and Medicaid Services (CMS) administrator from July 2010 to December 2011. In that role, he oversaw the operations of the nation’s largest insurance programs. (For more on Berwick’s experience at CMS, read AHCJ’s Parting thoughts: Berwick shares views on media coverage of health care and reform )
Berwick has also worked as a clinical professor of pediatrics and health care policy at the Harvard Medical School, professor of health policy and management at the Harvard School of Public Health, and as a member of the staff of Boston Children’s Hospital Medical Center, Massachusetts General Hospital, and the Brigham and Women’s Hospital. He has served as well on the trustee’s board of the American Hospital Association and the National Advisory Council of the Agency for Healthcare Research and Quality.
Here’s a summary of the goals as described by Berwick. This section also includes his recommended list of researchers, doctors and activists that can serve as coaches for hospital leaders. It also lists organizations Berwick described as “exemplars” in addressing each issue.
- Aim: Achieve universal health care insurance coverage for the region served by the hospital.
- Coaches: Amy Rosenthal, Health Care for All; Ron Pollack, Enroll America; Jodi Ray, Florida Covering Kids and Families
- Exemplar: Florida Covering Kids and Families, University of Southern Florida
About 30 million people in the U.S. lacked health insurance in 2020, according to a February 2021 estimate from the Department of Health and Human Services. Hospital organizations should try to persuade government officials to expand their Medicaid programs in the states that have not yet done so, he said. (Check out this map from the Kaiser Family Foundation to see which states have not yet accepted federal aid to raise the income threshold for Medicaid coverage.)
- Aim: End hunger and food insecurity in the region served by the hospital or hospital chain.
- Coach: Kate Sommerfeld, ProMedica Social Determinants of Health Institute
- Exemplar: ProMedica (Toledo, OH)
- Aim: End chronic homelessness in the region served by the hospital or hospital chain.
- Coach: Rosanne Haggerty and Community Solutions
- Exemplar: 98 Participant Communities in “Built for Zero”
- Aim: Assure excellent care and social support for all immigrants, documented or not.
- Coaches: Marsha Griffin (U Texas Rio Grande Valley), Karen Mountain (MigrantClinicians Network), Paul H. Wise (Stanford University)
- Exemplar: UT Southwestern Parkland Health & Hospital System; Migration Policy Institute
Corrections and prison health
- Aim: Create a criminal justice system focused on restoration, healing, compassion and reentry. The U.S. criminal justice system holds almost 2.3 million people in the state, federal, Indian country and military prisons, as well as juvenile correctional facilities, local jails and immigration detention facilities, according to the nonprofit Prison Policy Initiative. There is “enormous churn in and out,” with people going to jail 10.6 million times each year. Many of those jailed have mental health or substance misuse problems, Berwick said in his speech. “This is a health problem. It’s a national embarrassment in the health care system,” Berwick said. “We need a healing and restorative criminal justice system.”
- Coach: Emily Wang, The Health Justice Lab, Yale University
- Exemplar: The Johns Hopkins Hospital: Success in Hiring Ex-Offenders; Transitions Clinic Network
Climate and decarbonization
- Aim: Hospitals should aim for a 50% reduction in greenhouse gas emissions by 2030; 100% by 2050.
- Coaches: National Academy of Medicine Action Collaborative on Decarbonizing Health Care, Health Care without Harm, Jodi Sherman, M.D. of the Yale Center on Climate Change and Health, Jeff Thompson, M.D., of Gunderson Health
- Exemplars: Kaiser Permanente, Gundersen Health
- Aim: Protect voting rights for all. Assure 100% voting for staff.
- Coaches: Saranya Loehrer, M.D., M.P.H., of Civic Health Alliance), Alister Martin, M.D., M.P.P., of Vot-ER,
- Exemplar: AltaMed
- Aim: Strengthen elementary and secondary education in the region served by the hospital or the hospital chain.
- Coach: IHI’s Pathways to Population Health; Rukiya Curvey Johnson of Rush Education and Career Hub (REACH)
- Exemplar: Mariposa Unified School District and Camarena Health; Rush’s REACH; Kaiser Permanente’s Thriving Schools
Early childhood supports
- Aim: Assure safe birthing, early childhood supports and school readiness for all children under five in the region served by the hospital or the hospital chain.
- Coach: Uma Kotagal, MBBS, MSc, of Cincinnati Children’s Hospital Medical Center); Ros Gray
- Exemplar: Scotland’s Early Years Collaborative; Cincinnati Children’s Hospital Medical Center; Kaiser Permanente program working with children around Hayward, California
Elderly and loneliness
- Aim: End social isolation for elders in the region served by the hospital or the hospital chain. Berwick highlighted a decision by SCAN Health, a nonprofit group that runs Medicare Advantage plans, to create a position of a chief togetherness officer to address loneliness.
- Coach: Terry Fulmer, Ph.D., R.N., F.A.A.N, of The John A. Hartford Foundation; Sachin Jain, M.D., M.B.A, of the SCAN Health Plan; Encore
- Exemplars: CareMore and SCAN Health Plan; Papa Pals, a Miami-based company that uses apps to provide social support and everyday assistance to help with elder care, child care, and self-care (In addition to the resources highlighted by Berwick, those interested in this topic may want to read a testimony that Julianne Holt-Lunstad, Ph.D., of Brigham Young University gave to the Senate’s Special Committee on Aging in 2017. Holt-Lunstand’s work provides the basis for a common comparison made between the risk of loneliness being comparable to smoking up to 15 cigarettes per day.)
Cure for burnout?
Berwick’s speech outlined a team-based approach to tackling each of his goals. He sees this work as building on principles he previously discussed in a Viewpoint article, The Moral Determinants of Health, published in JAMA in 2020.
In his keynote, Berwick acknowledged that he is challenging hospital officials to try to take on new tasks while they cope with the persisting pandemic and the seemingly chronic issue of burnout among medical professionals.
But Berwick argues that taking on these challenges would ease some of the stress felt by overburdened hospital staff.
“Are you worried about burnout?” Berwick said. “Offering the good people who work with you and for you the chance, as part of their daily work, to become meaningfully engaged in an organizationally-supported team to improve living conditions and social justice for people in the communities you serve, and in which they live, will be oxygen.”
People will feel less overwhelmed in their work if they can participate in efforts that they see as likely to make a difference in the lives of others, Berwick said.
“Scholars who study work-life and stress time and again reach the same finding,” Berwick said. “Almost nothing contributes more to morale, resilience and joy in work than the feeling of connection to meaning, feeling that your work is a chance to improve the world or even the condition of a single person.”
Contact Joanna Clark at firstname.lastname@example.org for more information about Berwick’s address or other presentations at the IHI’s 2021 forum, which was held December, 5-8, 2021.