“Meeting people where they are”: A conversation with America’s most socially responsible hospitals

The Lown Institute just announced their ranking of hospital social responsibility, which combines over 50 metrics across patient outcomes, health equity, and value of care. 

Performing well on all three of these categories is no easy task. Only about 5% of hospitals ranked on the Lown Index received “A” grades in outcomes, equity, and value, making it on the Lown Index “Honor Roll”. 

On the latest Lown Institute webinar launch, leaders from some of these exceptional Honor Roll hospitals joined Lown president Dr. Vikas Saini to discuss how they keep focused on their mission, even as they face unique political and financial challenges. Watch the full video and see our key takeaways below!

Guest panelists were:

• Jason Carter, Chief Operating Officer and President at Duke Health
• Christine Alexander-Rager, President and CEO of MetroHealth
• John Rich, Director of Rush BMO Institute for Health Equity

How socially responsible hospitals can “do it all”

Hospital leaders explained how their institutional culture, policies, and workforce help them deliver high-quality and high-value care while still prioritizing equity. For Duke Regional Hospital, going beyond the hospital to connect with the community is key. “We’re in the business of meeting our communities where they are,” said Jason Carter, Chief Operating Officer and President at Duke Health. “For us, access is the best indicator for downstream care.” 

History and access

History also plays a role in the culture of Duke Regional Hospital. The hospital was founded in 1976 to bring together two hospitals that were previously serving racially segregated communities, to take care of everyone. “We’re not even a generation removed from the atrocities of Jim Crow and the impact on healthcare,” said Carter. They are well aware of the obstacles when it comes to trust in the healthcare system in Black communities, which drives their commitment to local outreach and access.

Leadership and creativity

John Rich, Director of Rush BMO Institute for Health Equity, pointed to leadership buy-in as a key component of their success. “Our CEO is consistent in calling out structural racism as a public health emergency and one of the forces we have to take on,” said Rich. “That cascades throughout the organization.” 

Rush University Medical Center has also been creative in how they invest in their community. They recently helped to open a state-of-the-art hospital laundry facility in an underserved neighborhood in Chicago that has created dozens of jobs while reducing cost for hospitals that use this service. They are also opening a health center in the community-driven Sankofa Wellness Village, offering chronic disease management, mental healthcare, social services, and career opportunities. 

Workforce and value

For MetroHealth in Cleveland, OH,  their reputation as a hospital that serves everyone attracts people who are excited to work in this environment. “When people come to us in employment, whether it’s medical staff members or team members, they know they’re coming to be part of the safety net,” said Christine Alexander-Rager, President and CEO of MetroHealth. “That allows us to create [a certain] culture.”

As a family physician with decades of experience, Alexander-Rager is no stranger to working with a tight budget to get the best value. Her team identifies redundancies to remove and efficiencies to replicate to “get 13 cents out of every dime.” 

MetroHealth is also going beyond the hospital walls to address social issues in the community. Through a partnership with the city school district, they offer a program for high schoolers to study health science at the hospital, which creates a pipeline for employment.

The challenges ahead

Despite the successes of these socially responsible hospitals, there are substantial challenges ahead, including Medicaid cuts, de-valuing of equity initiatives, and loss of research funding. 

Alexander-Rager explained how the ripple effects of Medicaid cuts will make costs go up for everyone. “When we lose our [Medicaid] funding… people will just go without care and their chronic diseases will become a crisis. Then they’ll come in and receive the most expensive care possible,” she said. “As you place the safety net hospitals at risk and maybe those hospitals shut down… you have less access points but just as many people and they’re even sicker.

The costs go up for everybody because somehow the care has to get paid for.”

Rich pointed out the potential impact on mental health from impending legislation. “There is a greater need than ever before for mental health and behavioral health services delivered by community health workers,” he said. “The loss of those kinds of resources could be devastating. We have, I think, a duty to resist and stand against these kinds of cuts.”