The world lost a true icon and a tireless advocate for community health and equity last year. As CEO of Kaiser Permanente, Bernard Tyson had a vision not just for healthier patients, but for a healthier and more just community. He recognized that hospitals and health systems can go beyond taking care of patients with serious illness and improve health outcomes by tackling such issues as violence, food insecurity, homelessness, and inequitable access to education and economic opportunity. Bernard’s mission was to think not only of the 11 million members of Kaiser’s health plans, hospitals, and health systems at that time, but rather to look at the 65 million people who live in its surrounding communities.
Indeed, in recent years, the American Hospital Association has highlighted many ways that hospitals and health systems can advance population health, reduce disparities and inequities in health and health care, and impact social factors that affect health (frequently referred to as “social determinants of health”).
So why aren’t such contributions by hospitals and health systems routinely assessed—and rewarded?
Rethinking hospital rankings
The COVID-19 pandemic and the resulting economic crisis have shed light on the enormous disparities in health and social well-being in this country, particularly those harming communities of color, rural communities, and communities affected by poverty.
Throughout the extreme pressures of the pandemic, hospitals and health systems have remained trusted and essential pillars of their communities. In many locales, these organizations are the largest employers and major contributors to community growth and development. Hospitals and health systems embracing a leadership role are offering critical preventive services on site, contributing to initiatives in their communities to protect health and save lives, and providing essential care and support for their own employees.
We can begin to incentivize a commitment to community health and equity if we embed it into our evaluations of hospital performance. Many major hospital ranking systems evaluate patient satisfaction and quality of care. Few assess preventive care. None put contributions to community health and equity on equal terms with other metrics.
It’s time for a change.
Our organizations—IBM Watson Health and the Johns Hopkins Bloomberg School of Public Health’s Bloomberg American Health Initiative and Center for Health Equity—have come together to examine how hospitals and health systems can help improve health outcomes and reduce disparities and inequities in their own communities. We believe they can accomplish this by including community health or equity measurements as part of assessing hospital and health system performance.
We believe that incentivizing hospitals and health systems to adopt best practices can help make communities everywhere healthier. That’s why our collaboration aims to identify meaningful measures of community health and equity that could be included in future rankings of hospitals and health systems, including theFortune/IBM Watson Health 100 Top Hospitals program.
Innovative hospitals lead the way
We are searching across the country to find great models of what hospitals and health systems can do for their communities.
For example, at a time when community violence is on the rise, all hospitals provide emergency care for victims of violence; however, an inspiring group of hospitals are implementing creative programs to prevent future episodes of violence. In Michigan, the Detroit Medical Center Sinai-Grace Hospital, in collaboration with the Wayne State University Department of Emergency Medicine, partners with the Detroit Life Is Valuable Everyday (DLIVE) program. DLIVE mobilizes specially trained violence intervention specialists who engage with survivors of interpersonal violence to help them avoid repeat injury by addressing traumatic stress disorder and linking people to resources in education, employment, and legal advocacy.
Other inventive hospitals and health systems support home visit programs, develop guidelines for healthy hospital food, educate new mothers on safe infant sleep practices, and partner with local schools to provide health services to students. We have an opportunity to recognize and socialize these innovative models in an effort to help bridge the gaps that exist in many communities. Our goal is to make these great efforts as commonplace as the hospital gift shop.
Struck by a terrible pandemic and recognizing the devastating legacy of racism, many U.S. communities are hurting. At this pivotal moment in time, hospitals and health systems can play a critical role not just in community recovery, but also in community renewal. Recognizing and rewarding exemplary contributions to community health and equity is one place to start.
Kyu Rhee, a primary care physician and master of public policy, is vice president and chief health officer at IBM.
Joshua Sharfstein is director of the Bloomberg American Health Initiative and professor of the practice in health policy and management at the Johns Hopkins Bloomberg School of Public Health.
Rachel Thornton is an associate professor of pediatrics at the Johns Hopkins University School of Medicine, a practicing primary care pediatrician, and associate director for policy for the JohnsHopkins Center for Health Equity.
