Photo by Bob Dmyt |
To improve health equity, it is critical for health care organizations to develop strong relationships with other organizations in the community. Health care organizations can avoid reinventing the wheel by leveraging community partnerships to address social determinants of health that are beyond the direct reach of health care. The following case story is adapted from IHI’s Improving Health Equity: Partner with the Community guide and describes how a multistakeholder coalition including Main Line Health is working to improve health equity in Philadelphia, Pennsylvania.
Main Line Health and Together for West Philadelphia
In October 2018, Main Line Health and 25 other health systems, academic institutions, and community organizations officially launched Together for West Philadelphia (TfWP), a collaborative nonprofit organization aiming to dissipate inequities in access to health care, education, food access, and opportunity. TfWP’s mission is to facilitate collaboration within West Philadelphia among community, public, and private sector stakeholders to foster shared projects that maximize impact in six areas: education, employment, food justice, health equity, housing, and senior wellbeing.
The power of TfWP is in the collaboration of its partner organizations. In order to break down silos and work better together, TfWP’s partners share their time, ideas, and resources as part of this cohesive organization dedicated to addressing the physical, mental, and social health needs of the residents living in the five ZIP codes of West Philadelphia. This case study is based on observations, documentation, and interviews IHI conducted with Together for West Philadelphia and Main Line Health, a participant in the two-year IHI Pursuing Equity initiative from 2017 to 2019.
Main Line Health is a not-for-profit, comprehensive health system serving portions of Philadelphia and its western suburbs. One of its hospitals, Lankenau Medical Center, is located on the border of two counties, one of the state’s wealthiest and one of the poorest. Montgomery County is consistently ranked among the top five Pennsylvania counties in the Robert Wood Johnson Foundation’s Annual County Health Rankings. Philadelphia County is consistently ranked toward the bottom and is currently ranked last at 67th.
The rankings include the following factors: access to and quality of clinical care, socioeconomic status, health behaviors, and physical environment. In Philadelphia County, many West Philadelphia residents lack access to basic resources such as food, housing, and transportation to live a healthy life. Main Line Health serves this community where a number of chronic diseases are not only more prevalent, but their presentations are notably more severe because poverty and lack of access to key social determinants of health, like healthy food, exacerbate the difficulties of achieving and maintaining positive health outcomes.
Figure 1 shows a direct connection between income and health in these areas. Main Line Health has previously described the juxtaposition as a place where “your zip code is more powerful than your genetic code.”
Figure 1. US Census Data on Geography and Income: Philadelphia and Western Suburbs
Described below are the major advances achieved in the planning and implementation process of Together for West Philadelphia.
Obtain Buy-In and Create a Common Purpose
Before establishing Together for West Philadelphia, the founding members drafted a customized plan to obtain buy-in from key stakeholders, including health system executives, academic groups, elected officials, patient care groups, community collaboratives, institutions, and schools. Tactics to garner support and foster collaboration included the following:
- Leverage existing institutional partnerships;
- Leverage the accomplishments of public education system;
- Navigate internal systems to identify governing bodies of existing collaborations and overcome competitive atmospheres;
- Identify and acknowledge community organizers already in this space to avoid reinventing the wheel; and
- Identify areas of overlapping patient care to benefit residents.
- Founding members then came together in January 2018 to develop the Together for West Philadelphia name and charter, which outlines key objectives, a common purpose, and core values.
Map Strategic Assets
In its first year, TfWP engaged Congressman Dwight Evans of Pennsylvania’s 3rd Congressional District in the US House of Representatives to create an infrastructure with a spirit of diversity and inclusion that represents the residents living in the five West Philadelphia ZIP codes that TfWP serves. TfWP leveraged existing resources from community partners (e.g., community health needs assessments, public datasets, community interviews) to construct asset maps to truly understand the needs and assets of its service area and prioritize work.
As part of this process, members of TfWP coordinated a “Zip Trip” to take a bus tour of ZIP code 19104, visiting the West Philadelphia Senior Center, Philadelphia College of Osteopathic Medicine’s Lancaster Avenue Division Health Center, Drexel’s Dornsife Center, the Clark Park Farmers’ Market, the University of the Sciences, People’s Emergency Center, and Penn Presbyterian Trauma Center. By the end of the bus tour, TfWP members could better appreciate the assets that exist in 19104, continue to refine and hone the asset map, and identify where additional collaboration might occur.
Identify Early Investments
In January 2019, TfWP was awarded five $1,000 grants from the Philadelphia Foundation’s On the Table Philly initiative to support five projects in the West Philadelphia community.
- TfWP with Penn Medicine: Develop a best practices workshop to expand the Medical Student Advocate Program (which integrates medical students to help assess patients’ social determinants of health and connect them with community resources to address their needs) and community health worker model across Philadelphia.
- TfWP with African Episcopal Church of St. Thomas: Expand Lankenau Medical Center’s existing community health education program into faith communities in West Philadelphia to increase healthy living.
- TfWP with Center City Toyota: Create a high school automotive curriculum to serve West Philadelphia students.
- TfWP with Victory Christian Center: Learn from field experts to increase the awareness of adverse childhood experiences (ACEs) and trauma affecting the community.
- TfWP with Philadelphia College of Osteopathic Medicine (PCOM) Student-Run Clinic: The student-run clinic aims to unite PCOM and Philadelphia communities by providing quality preventative and primary care to those who are underinsured.
Key Tactics and Lessons Learned
- A diverse group of community partners is imperative. Since health inequities do not have a single cause, health care organizations alone cannot remediate these inequities. It is important to engage partners from multiple fields and sectors that have substantial expertise in understanding the needs of the community experiencing health inequities. In addition to including a diverse group of community partners in the coalition, ensure that all partners have an equal opportunity to share issues, identify solutions, and make decisions.
- Ensure the community’s involvement in the partnership. A key element of an effective community partnership is the authentic engagement of community members. It is important to evaluate and assess the partnership regularly to ensure that new community members and organizations are not excluded from joining and contributing to the partnership. It may be necessary to adjust meeting times and locations to facilitate the involvement of new members.
Building a multistakeholder coalition is just one way health systems can develop partnerships with the community to improve health equity. Whether you are designing and implementing a multistakeholder coalition or exploring other ways to partner with community members and organizations, think about how to leverage the diverse resources and expertise of the community to have a comprehensive impact on improving health equity.
Editor’s note: IHI has harvested learning from the teams that participated in our Pursuing Equity initiative to develop a series of guides, teams summary reports, and an assessment tool you may also find helpful.
You may also be interested in:
IHI White Paper - Achieving Health Equity: A Guide for Health Care Organizations