BENTON HARBOR, Mich. – The slide on the screen in the auditorium shows a young black male. Dr. David Ansell says he is 16, lives on the West Side of Chicago and has only about a 50 percent chance of living to age 65. Why is that? Ansell asks. If you suspect gun violence, you’re wrong. But you’re not alone: Ansell has shown the slide to many audiences, “and when people see that they say gun violence, because that’s how our brains work. We see a black teenager and our brains automatically (and unconsciously) go to violence.”
In fact, in the neighborhood where the boy lives, the top two causes of premature death are cancer and heart disease, says Ansell, whom Rush University Medical Center has picked to lead its first-ever effort to bring health equity to the neighborhoods it serves. Ansell tells the anecdote to illustrate why a health system embarking on changes to improve the health of residents in its neighborhoods needs to start with solid data and also needs to actively listen to residents. In “listening tours” of the West Side, employees of Rush University Medical Center never heard residents mention violence as one of their top-priority needs.
Here are some lessons for other health systems, gleaned from what Ansell shared about Rush’s work with an audience in Benton Harbor, Mich., on Sept. 27:
- “Make the invisible visible” –The deadly effects of structural racism, so apparent to black people, need to be made apparent to white people. A health system can’t set about fixing the problem unless it can see it.
- Name structural racism as a root cause of health disparities – It’s not the only cause, but it is an important one. “What we tolerate, we promote,” Ansell says.
- See your population through an “equity lens” – “You ask the question: How is our
current world organized, and does it perpetuate historical injustices?” Your health system needs then to stop doing things that sustain uneven power dynamics, whether the imbalance is between whites and blacks, or men and women, or straight and gay people, or between any two segments of the population.
- Make equity a central, core strategy, not just a tactic along the way.
Go out into your neighborhoods and really listen –
“We decided that we were going to follow the voice of the community,” Ansell says. Rush’s team did “listening tours,” sending out white people into neighborhoods they’d never been before, “because these are vital neighborhoods, people love their neighborhoods, but they don’t like the narrative that’s been made about their neighborhoods.” They asked people: “What are your priorities?” People responded by saying things like good jobs, support of local businesses, co-location of mental health services — things that everyone everywhere wants.
“You start with your data. You start with also what’s important to the community.”
- Find lots of partners – “Our approach to this is that it has to be multi-sector and multi-partner,” Ansell says. For Rush, this means partnering with community organizations, several other hospital systems and businesses. Ansell says Berrien County, Michigan, has “a great situation with a big corporation in Whirlpool, with a great health system in Lakeland,” and a county health department “very oriented around” confronting structural racism.
- Share power around the table – Have faith: Allow community leaders to lead the effort. “This is a big deal: Do you have a community advisory committee?” Ansell asks. “Or do you have the community with an equal voice in governing … or a plus-one voice?”
- “Measure, measure, measure – “Don’t do things if they’re not working,” Ansell says. “We’ve all had programs, invested money. They don’t work. Stop doing them, right?” Most hospitals operate on low margins and are hesitant to take on social missions. But Rush is learning how to measure steps along the way to its goal of improving health of residents. For example, it has figured out intermediate measures to track progress in narrowing by half Chicago’s lifespan gap by 2030.
- Honor your “first community” – For Rush, this means its own employees. These are the people you say “Hi” to every day, the people whose personal stories you hear. Rush surveyed its employees and found that 20 percent had to take money out of their retirement funds for hardship reasons. Ansell says it has a “fantastic” tuition-reimbursement program, but the leaders recognized that many people couldn’t come up with the tuition in advance. Rush is now rethinking its base pay rate. The health system recently began a medical assistant career path in partnership with a community college. All expenses are covered for students. About 10 times as many people applied as there were openings.
- Invest in your neighborhoods – For 180 years Rush didn’t invest in its neighborhoods in an intentional way, Ansell says. Now, in partnership with two other hospitals, it is making such investments. Among the institutional “dashboard” goals are certain percentages of hires from certain neighborhoods and hiring ex-prisoners returning to society in partnership with community-based organizations. “We found that if we put a million dollars into a project, suddenly we could get the banks and others to put in a lot of money,” Ansell says. “We have a huge amount of leverage because of the regard and respect that health care has in a community.” Rush figured out how to get high school-age students trained in electronic medical records. It sent these students, “all black and brown kids,” to the headquarters in Wisconsin of Epic, the healthcare software company, and the young people got certified in the work. “We hired some of them as apprentices at Rush at $30 an hour while in junior college.” If they go to work for Epic that hourly pay rate doubles. “All we needed to do was lay down a path into the high school in the African American neighborhood and turn hopelessness into hope.”
Look to your supply chain
With support from community businesses, Rush has “gotten down and dirty” about the supply chain to figure out how to boost local businesses while meeting its own needs for such things as laundry and food services. “Hospitals don’t make a lot of money, but they use a lot of stuff,” Ansell says. “It’s just thinking differently about the economics of our health care system.”