A recent headline in the Becker Hospital Review states, “Detroit Medical Center May Outsource Housekeeping, Lay Off 565.” While many organizations are considering similar decisions, Wake Forest Baptist Medical Center (based in Winston-Salem, NC) took a different approach. Although it looked at several options during a review of housekeeping operations, the leaders did some soul-searching, went back to the Medical Center’s roots as a faith-based organization, and decided the workers had a role to play in the lives, families, and communities of Environmental Services employees. Wake Forest Baptist leaders looked at where these individuals lived and saw a significant overlap between their neighborhoods and the most socially complex patients that Wake Forest serves.
That realization turned everything around. Wake Forest Baptist converted four of their housekeeper jobs into newly created “Supporters of Health” positions. Gary Gunderson, Vice President for Faith and Health, says, “We call them the ‘Fabulous Four.’ They’ve allowed us to follow our most vulnerable patients home to their communities and neighborhoods.” Currently, about two-thirds of the cases the Supporters of Health staff manage come from contacts within the community setting and one-third from the hospital. “Every morning we check in on our most financially vulnerable patients and have the Supporters visit them,” Gunderson explains. “They’re having frank conversations with patients about their living situation and specific post-discharge and health care needs. And in many cases they are able to help them get resources and help they need.”
In addition, Wake Forest Baptist plans to offer training to all of its Environmental Services (EVS) employees in what Gunderson describes as “early inside the hospital” triage. Closely linked to the “Fabulous Four,” the EVS employees can provide a network of on-the-ground, in-the-community, trusted intelligence about the care and social needs of patients. This can change the power dynamics around the patient. For example, Annika Archie, the first Supporter of Health, heard about a woman discharged from the hospital with over $500 in prescriptions, an amount that was utterly impossible for her to pay. Annika went to the prescribing doctor at the local safety net clinic and requested that the doctor change to generics, and switch to a cheaper pharmacy. The physician was surprised, but happy to make the change, knowing the price reduction would make it easier for the patient to take her medications. The change to generics resulted in a much more manageable $14 prescription charge.
Lest this be seen as just an isolated good deed, Russell Howerton, MD, Chief Medical Officer at Wake Forest Baptist, and others work closely with a team of analysts to evaluate the success and value of this effort. The team tracks every contact with a patient and family, aggregates costs by zip code/census rather than the standard cost-per-case method, and shares the data with the Supporters of Health team in full transparency. As Howerton explains, “We as a health system are committed to delivering high-value care to these complex patients.”
Howerton and Gunderson are in this for the long term. They realize that costs may rise initially as Wake Forest Baptist cares for more vulnerable patients and families and faces having to “do more.” However, they are confident that, over the coming years, costs will drop as they all learn to “do better by delivering outcomes that matter to patients at a lower cost.” Better care, better neighborhoods, better health – all while holding onto valued employees, many of whom may be part of our most vulnerable populations.