(upbeat music)
-: Welcome and thank you for joining us.
I'm Stacey Barrett, a research scientist
in the Joint Commission's Division
of Healthcare Quality Evaluation and Improvement.
I'm here today with Doug Kress, Chief Community Officer
at Cambridge Health Alliance in Massachusetts.
It's a pleasure to be with you today, Doug.
-: Thank you, Stacey, it's great to be here.
-: Today we will discuss CHA's continued efforts
to foster collaborations
and develop community-based programs that increase access,
improve health outcomes,
and respond to the needs of the patient community.
Doug, we know that CHA has a deep commitment
to improving health through the lens of justice and equity.
Can you talk to me a little bit about the ways that CHA
genuinely engages with the community
to develop partnerships focused on improving patient health?
-: Yeah, great.
Thank you for asking that question.
I think that's a critical one,
especially within the healthcare systems
and how we work with our communities as well as our patients
because they're often intertwined.
I think the key thing that we always talk about
is that we are out in the community.
We are in the community, we're present in the community.
And that was not even, you know, pre-COVID,
it was during COVID and it's post-COVID
that we're out in the communities.
Part of that is listening to our communities
and understanding the health needs that they may have,
and empowering individuals to advocate
for the needs that they may have,
whether that's around healthcare
or even the social determinants of health,
there are critical ones
that we also wanna make sure are addressed,
because we realize very easily that, you know,
a person's health, about 20% of that
is what they find in the doctor's office,
whereas 80% of it is where they're living.
So we're not only thinking about their health
as a physical health, but we're also building community
through education, through training, through workshops,
and different types of development that we have
that are out in the community
in partnerships with our community.
And that community can be individuals, it can be patients,
it can be our partnerships
that we also take out into the community.
Part of what we wanna look at also in this
is that when we're taking action
we're integrating our programs based on
community identified needs and their priorities.
This isn't just something that we're coming up with,
but truly something that we wanna identify
when we do our community health needs assessments,
and then think about implementation strategies
that are really critical
for our community members themselves.
So part of that is we conduct research in partnerships
with our communities, not towards our communities.
And our stakeholders are part of the community.
And we also train our community members
on participatory interview skills
so that they can help us collect that data
and collect information about themselves,
about their neighbors and about their communities.
But finally, one of the things, I think,
that we really invest in are creating an environment
where individuals can feel supported by their community
and meeting their community needs themselves.
-: That's fantastic, Doug, thanks for sharing that.
Would you also share a bit about the infrastructure
that you've had to develop at CHA
to support these community connections
and productive partnerships that you've described?
-: Yeah, one of the great things, I think,
that we have really created here
at Cambridge Health Alliance
is that we have a community health worker program
and that is training our community, our community members.
And as we think about what a community health worker is,
is that they bring a lived experience to the program itself.
So that lived experience can be a specific topic
that they may be able to bring experience with.
It might be a language, it might be a culture,
it just may be where they have lived for multiple times
within their lives and really bringing that opportunity
and that knowledge to really actually accelerate
the chances that you have somebody who will be trusted,
a trusted individual in the community.
So I think that's a key component that we have.
The other thing that I've really built here
and that we continue to build,
and I am not laying the groundwork on this,
this had started before I even got here,
but we have our community advisory boards,
and those are critical, not only on an ongoing basis
but while we're doing the research
and while we're doing our community health needs assessment,
those community advisory boards really bring
such a rich bit of information to the process
that we have in front of us,
whether that's around the community health needs assessment,
or we think about our implementation strategies,
because it's not only for the communities,
but it's with the communities, as we move it forward.
I think some of the other things
that we really wanna make sure that we stress
is that we are an anchor institution
within our communities themselves.
So we think about our buying power.
We think about our hiring power
and really making sure that we are utilizing CHA's system
and structure to support our communities as well.
Part of that also sometimes is, when we have grants,
that we have them written into our grants
so that they can be part of that process as well.
So that's maybe sharing our funding
with the individual community-based organizations.
You know, the big thing that we always think about though
is that we show up and we're there in the communities.
So our partnerships are with community-based organizations.
It's with our municipalities in the service area
that we have our hospital system in.
It's thinking about our faith-based organizations
and how language and cultural connections
really help tie us together.
One of the nice things about CHA that we have here
in our connections and that trusted community connection
is that language capacity that we have.
We hire from the community, within the community,
who bring those language and cultural connections
that are tied both to our community,
but also tied to our healthcare system.
And we have a very robust language interpreter services
here within Cambridge Health Alliance.
Finally, one of the things
that we also use our information for
is that we collect data.
And so we share that data back to our community partners
so that they can utilize it
whenever they're writing their own grants as well.
One of the things that we have been really talking about
recently in Cambridge Health Alliance
is that how can we build backbone support
for our collaborations as well?
Because we do participate with a lot of smaller communities
and they don't necessarily have that staffing structure
to help build that backbone opportunities
that are out there.
So if we can provide some of that support for them
it actually helps build those collaborations.
It shows a partnership,
but it also shares the leadership within those partnerships.
-: Doug, would you provide some examples
of the partnerships and programs that your organization
has formed within the community?
Perhaps share some ways that you feel that these programs
have helped improve health and wellbeing
of your patient population.
-: Yeah, thank you, Stacey.
I think that's a great question.
And thinking about our partnerships are always
a great way to think about the work that we do
so that we're building those partnerships
and we think about the health and wellbeing of our patients.
So one of the areas that we really
have been able to strengthen
is our school-based health centers.
And that's really an important piece
because it's helping us improve access,
not just for our students,
but we also have to think about in our particular areas
we have a lot in the immigrant population
who are struggling with getting access into healthcare.
And in part what we're finding is that
some of our new arriving populations
are presenting themselves not necessarily in the EDs,
which is happening in a lot of places,
but they're presenting themselves
actually at the enrollment centers for school
with their school-aged group.
So we know that there's a lot of challenges
of getting into the school entry,
whether that's around vaccine compliance,
whether that is around getting a physical.
So we try to eliminate a lot of those barriers,
and it's been able to eliminate some of those barriers
within that particular area especially.
It also helps, you know, just with those kids
who are trying to get into sports,
and we can provide sports physicals and get them access
so they can actually have a full life.
And again, that is also tied
to the health and wellbeing of a young student,
whether that's around just a physical activity
or it's also a mental health support for them as well.
Some of the things that we do in there
is we also provide mental health support.
We also think about our SOGI data and our SOGI work.
So we're collecting that information
really to help us understand who our population is,
but also making sure that we are addressing the health needs
and it's an impactful health addressing that we do
for all of our populations.
Another area that we work with here
at the Community Health Improvement Group
is healthcare for the homeless.
And I think what's key
with our healthcare for the homeless program
is that we have a specific program
and it's called Street Medicine,
and we're actually out in the streets
working with our homeless population.
Really what we're doing
is we're meeting people where they are at,
and we're hoping that we're gonna be able to expand
that program if we can find additional funding
within some of that areas.
But it is an important piece,
and you have to think about Street Medicine
within that area where our docs and our nurse practitioners
and our community health workers and outreach staff
are literally putting on backpacks sometimes
and going to where there's encampments
and building those supports.
And it does take time because, again,
we have to think about those trusted relationships.
So those are the partnerships
that we always keep at our baseline.
You know, part of the way that I always talk about this
is that we can't do it alone.
We can't be everywhere and do everything.
It truly does take a village.
So we partner with early childhood programs, food pantries,
housing organizations, elder care, YMCAs,
and a variety of other agencies,
including faith-based agencies,
to really make sure that we can reach our populations
where they're at in a variety of ways,
and build those trusted relationships,
so that they know when they do come to the doctor's office
or they come into our system
that they see and they feel
like they're part of the community
and they're part of a healthcare system.
-: Thanks, Doug.
You mentioned some obstacles and barriers
kind of along the way to all of these
wonderful successes that you've been sharing.
Could you dive in a little bit deeper
into some of the challenges that CHA has faced
along the way through this healthcare equity journey?
-: Well, one of the things that we always want to think about
is we know that there's always gonna be a funding challenge.
Trying to find the right monies to do that
and balancing that out with really meeting
the deliverables that we have,
whether that's because of ACO work that we are working on
or whether those are contracts and waivers
that we always have in front of us.
So there is that challenge sometimes that appears.
And it's writing a lot of grants
and building those partnerships,
building those relationships.
And one of the things I really caution,
especially right now,
is that many communities have ARPA funding,
and we know that the public health emergencies
are ending in a lot of different places,
whether like here in Massachusetts it's ending, it will end.
We don't want to see those cliffs
where people are gonna fall off.
So we have to start preparing for some of that as well.
So it's planning.
And we're not planning for next week,
we're planning for six months to a year down the line.
So that sometimes is a challenge.
Space can be a challenge.
I mean, we are in Massachusetts in the Boston area.
Anybody who's been here knows there's no space for anything.
So finding space oftentimes can be a challenge.
But what I remind people
is that collaborations can be messy.
They take time and they can be chaotic,
but you know what, the outcomes that you get
when you're doing those collaborations are inclusive,
you have a shared vision, and it's a shared work,
which really does remind us that we put people first,
and we put patients first, and that's what's critical.
But then whenever you think about, just going back
to the first things that I was talking about,
we're a healthcare, we're a hospital,
we're a healthcare institution.
So we need to make sure that we are balancing the needs
of our inpatient, our ambulatory, and our community,
and all of those things can put a strain on a system.
But integration is critical, and we can do that and share,
but part of that is understanding where that integration
can happen and how we can do that.
And again, it's putting patients first
and our communities first.
-: So for organizations who might be at the beginning
of their journey and not as far along
as Cambridge Health Alliance,
what advice would you give to them
as they seek to develop community-based partnerships
in the way that you have?
What would you tell them?
-: So I think the first thing I'd tell them is,
remember, it's gonna take time.
So it's not gonna happen all of a sudden.
But the other thing that I always remind us
is that most of us within the healthcare
or within the health systems, we like to solve the problem.
So when we're doing that
oftentimes we're doing the fishing for people.
We need to teach people to fish,
and remember that that's gonna take time.
You gotta take time to get the pole,
get the bait, bait your hook,
and then get it in there and get it out there
and showing people how to actually do it.
And they then can not only do for themselves,
but what's really important is that they are able then
to move it forward and share what they've learned
with the next person.
So it's important to build those relationships.
And being responsive to people.
So if you're gonna say that you're gonna be someplace,
be there.
Follow up with the work that you're doing
and making sure that you're out there.
So get outta your buildings, get out of the hospitals.
Go out, meet the community.
Meet who can be a partner within your community.
And celebrate within those communities as well.
-: Thanks, Doug.
It's been a pleasure to learn about the ways
that Cambridge Health Alliance is partnering
with your community and working together
to improve the health and wellbeing of patients
and community residents.
Thank you for joining us.
-: Thank you, Stacey.
It was a joy to be here.
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