Examining how hospitals can improve community health

The COVID-19 pandemic demonstrated the capabilities of hospitals in extraordinary circumstances, while also illustrating the challenges in responding to large public health threats.

Recently, the USC Schaeffer Center and the Aspen Institute formed a panel of experts to look at ways hospitals can improve community health and prepare for future health emergencies. The panel released a white paper earlier this year.

Erin Trish, co-director of the USC Schaeffer Center, recently talked with Chief Healthcare Executive® about the ways hospitals and health systems could tackle some of those problems.

“We thought it was important to pull together this panel and group of people,” Trish said. “The sort of acute need was focused on what we learned or experienced during the COVID pandemic, about the role of hospitals and health systems in providing care in that type of setting, kind of overlaid on the broader trends that are going on in the industry and have been even long before the pandemic.”

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Better monitoring

To prepare for future public health emergencies, the panel called for developing better monitoring and sharing of information at the regional and possibly national levels.

Trish said there should be more visibility in the resources and capabilities of hospitals, such as if some facilities are running low on certain supplies or seeing staffing shortages.

“There were better or worse lines of communication about what was going on at the local or regional and somewhat national levels as well,” Trish said.

With a better monitoring system, hospitals could also share with other providers that they are in position to accept more patients. Hospitals could also inform others if they have ample supplies and could be in a position to move items such as ventilators to another facility in need, she said.

She acknowledged that there could be some practical hurdles in setting up a monitoring system requiring hospitals to share more information with rivals in the marketplace. As she said, “Where do you blend the lines between this being a productive kind of infrastructure to have in place? But also, you don't want to necessarily share everything with your competitor all the time.”

Meeting social needs

To make gains in public health and prepare for future threats, hospitals and health systems need to gain more data on the unmet social needs in their communities, the panel said.

More hospitals and providers are asking patients about issues such as food or housing insecurity, but those efforts can vary. But as Trish said, “It is happening to some extent. It may not be happening kind of completely or systematically.”

Beyond collecting the data, Trish said, “What about the next step of connecting folks with social services or other kinds of resources to meet unmet needs?”

“This is not isolated to social needs,” she noted. “What's the point of screening somebody for some condition if we have no cure to offer them?”

While she said there’s value in quantifying a problem to allocate resources, she said the goal should be “to ideally move toward a direction of, when we get this information, here's something useful that we can do with it.”

While the panel generally said this is an area where hospitals are making headway, Trish said, “I would say that the takeaway was that it's not solved. There continues to be a need to improve on this.”

Hospitals and health systems should also lead a coalition of stakeholders in helping ensure there is adequate funding for unmet social needs, the panel said.

A stronger workforce

Hospitals also continue to struggle to recruit and retain staff, including nurses, technicians and other vital healthcare workers. Hospitals are still seeing high turnover, with one in five healthcare workers leaving their jobs in a 12-month span, according to a Press Ganey report.

Hospitals and health systems need to invest in career development opportunities.

“There was an overarching sentiment and understanding that major improvements to the healthcare workforce need to happen, and that that's going to need to come through multiple channels,” Trish said.

Health systems and hospitals also need to be committed to employing a diverse workforce.

“There needs to be diversity in the workforce that's serving patients in that community. And there needs to be essentially community trust with the people who are providing the care in that community,” Trish said.

Part of the answer will require longer-term solutions, including better training and educational opportunities.

Hospitals also need to offer opportunities within their system for staff to grow and advance their careers, and look at more employment opportunities for members of their own community, Trish noted.

Different payment models

The panel recommended reducing unnecessary costs by supporting payment models that promote high-value care and discourage low-value care.

In addition, the panel also called for payment models that finance services beyond acute care and would allow for greater investments in preparing for future health emergencies, addressing social needs of communities and improving health equity.

The panel called for more experiments with payment reform, across payers and at the state level, to invest in community health and improve patient care.

“I think there's a widespread recognition that the fee-for-service payment system is incompatible with a lot of the values that are expressed broadly about moving toward caring about health and health outcomes, more than just acute health care delivery, and thinking about to what extent does that incorporate things beyond just the delivery of care, but societal needs and emergency preparedness,” Trish said.

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