HEALTH FACILIITIES


Healthcare as a social services agency Cultures have historically invested in social welfare in a variety of forms. In the US, these investments have significantly decreased in recent years, causing the social safety net to fray and the use of the healthcare system to increase; and because we’re spending so much on healthcare, it is using funds that could be set aside for other public needs.5


At the


same time, healthcare reform in the US has changed the reward from service based to health based, pushing institutions to focus on population health, look upstream towards preventive care and expand the continuum of care. Because healthcare systems are now


reimbursed based on outcomes, and those outcomes are largely dependent on factors outside of the system (eg social and environmental), healthcare must intervene in those areas to maximise revenue. We must realise that issues such as homelessness and behavioural health are interconnected and should be addressed as such.6


Health systems must


partner with not for profit organisations focused on poverty and addiction to invest in multifaceted solutions and realise benefits in terms of improved population health outcomes, an improved patient experience and reduced costs. It is recognised that 60 per cent of


healthcare costs are driven by social factors. It’s more cost effective to provide housing for people who are homeless than healthcare (eg frequent emergency department visits), so institutions are investing in housing programmes. Working for the public good relieves pressure on healthcare resources, preventing inefficiency and missed opportunities to provide better care.7 According to Lena Weiner: “A new emphasis on population health has helped us to realign our priorities in healthcare – the best care for every patient and not just from a quality perspective, but from an efficiency perspective too. It’s getting us back to evidence based care”.8 Beyond the business case, many organisations recognise their role in serving communities and the moral argument for population health. You often hear hospital leadership say, “We need to do this because it’s the right thing to do”. Those who haven’t historically viewed social services as core to their operations are coming around to this reality. The first step in the population health


approach is to make the case for social determinants (eg food insecurity or transportation barriers) and their connection to healthcare. Then, existing quality improvement tools are applied to these root causes of healthcare issues.7 Population health strategies include changes to internal operations and organisational structure, as well as


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partnerships with external stakeholders. Hospitals have developed population health departments and dedicated teams that often include volunteer community members. Organisations are expanding their care management responsibilities, including value based measures in physician compensation, and expanding training and certification in chronic and high utilisation diseases. They are using case management to prevent emergency department readmissions and establishing alerts when patients are admitted to nearby hospitals. There is a heightened focus on telemedicine and investment in the IT infrastructure to support the goal of providing the right care in the right place at the right time.8 Healthcare has an infinite appetite;


there Is always more we could do to become healthier and technology is continually creating new opportunities for us. By using a proactive and systems based perspective and leveraging technological advancements, key partnerships and existing quality improvement methodology, healthcare can become the social services agency that the people of the world need. Some hospitals are at the forefront of


this movement. For example, Partners in Health pioneered the idea of community health leaders. Patients often lack interaction with the healthcare system because they lack transportation.


Technology Process Home/family Respite Education


Community health leaders travel to the patient, making healthcare and education more accessible. Another example is Kaiser Permanente, which uses technology to provide a convenient way for people to interact with providers remotely, thus empowering them to become more active participants in their own healthcare. Other examples include Bronson’s Healthy Living Campus in Michigan, Carolinas HealthCare System’s Healthiest City and the Boston Health Care for the Homeless Program. We can also learn how to design


better population health solutions from healthcare systems in developing countries. For example, there is an organisation called Village Health Works in Burundi, which is one of the poorest countries in the world and where there is malnutrition, deforestation, unstable government and civil war, among other issues. The organisation’s founder has been successful in involving community members in his efforts by calling on them to take a strong role in physically creating a healthcare campus. Local farmers donated the land and residents helped carve out the roads leading to the site and build the facility itself. With such widespread buy in from the community, the organisation has been able to teach people essential skills such as how to grow healthy food. Village Health Works’ efforts illustrate the potential of healthcare


Active lifestyle


Outpatient care


Acute care


Art


Experience New drivers of function.


Nutrition


Worship New partnerships. IFHE DIGEST 2018


Work and consumption


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