A Lifelong Vision of Total Health for the Individual and Community

On March 29, 2016, National Health Foundation (NHF), in association with the Hospital Association of Southern California (HASC), will honor Benjamin K. Chu, MD, MPH, MACP, executive vice president, Kaiser Foundation Hospitals and Health Plan, Inc., and group president of Kaiser Permanente’s Southern California and Georgia regions.
Dr. Chu has recently been named president and chief executive officer of Memorial Hermann Health System, effective June 2016. With its 13 hospitals and more than 24,000 employees and 5,500 affiliated physicians, Memorial Hermann is the largest not-for-profit health system in Southeast Texas.

During this Celebration of Leadership, Vision, and Commitment we are honoring Dr. Chu’s illustrious career. He is a leader in the development of strategic and operational innovations to foster high quality, safe and efficient health care, as well as a strong proponent for electronic health records – a powerful tool that improves quality and outcomes for patient care. In his current role at Kaiser Permanente, he directs health plan and hospital operations for 14 hospitals and 237 medical offices that serve 4.2 million Kaiser Permanente members in Southern California and Georgia. Prior to joining Kaiser Permanente, Dr. Chu served as president of the New York City Health and Hospitals Corporation, the largest public hospital system in the United States.

Dr. Chu is a past chair of the American Hospital Association Board of Trustees and is chair of the board of directors for the Commonwealth Fund in New York. Dr. Chu is also a member of the advisory committee to the director for the Centers for Disease Control and Prevention. In 2015, he was elected to the National Academy of Medicine, widely considered to be one of the highest honors in the fields of health and medicine.
Dr. Chu’s philosophy on how medical care should be delivered underscores his vision of a national-scale framework for compassionate, effective health care. “The world is really about how you build and sustain relationships.” Notes Dr. Chu. “In fact, that is what medicine should really be about, building relationships with your patients, their families and with the community.”

Early in his career as a physician, Dr. Chu began to reimagine a system where the patient could access needed care and gain the tools necessary to be an active participant in their own health journey. He also focused on how health care can become integrated into the community.

It began with a story Dr. Chu likes to tell. “Three weeks before I formally started my first leadership position at the Kings County Hospital Medical Clinic, I went in and ‘did every job’. I sat as a clerk trying to figure out how to register people – how to navigate for our patients their pathway to see the doctor and the nurse – I oversaw the residents, I saw patients, and I sat in on post-op visit conferences with the nurses.” The experience taught me a lot about both the patient experience and the work environment of the people who were charged with their care.”

Dr. Chu brought about systemic changes. By removing or modifying systems that depleted staff or created frustration for patients, the delivery of care became more effective. The very people who came to the health care field with a deep desire to serve and care were once again doing exactly that. “It is never about us as leaders. Rather, it is about creating the capability so that people who work for us can actually do the things that they do best,” shared Dr. Chu.

Realizing that the hour or so a year a health professional might spend with a patient is simply not enough to affect the health of a community, Dr. Chu has committed his career to understanding how to influence public policy and how that contributes to better community health and better health care, “I knew that I needed to understand how policy was made and how the economics work before I could become effective in changing the system.”

Over the past decade, Kaiser Permanente has had an active strategy to locate health care services much closer to where members live and work. In addition to providing the physical proximity, this presence in the community has led to health strategies rooted in the social determinants of health such as education, the availability of healthy food and access to physical activity. It has also led to fruitful conversations with banks, grocers, schools, service providers and more in an effort to have the entire community invested in this idea of health. “It takes a community-wide effort. The concepts of life integration, leveraging our investments and bringing together like-minded people intent to benefit the community is what we are all about,” said Dr. Chu.

“Delivering health care in Southern California, a ‘community’ of more than 20 million people, is poised to evolve,” notes Dr. Chu. “I look around, I see other hospital systems, and I appreciate how they are also preparing to meet this challenge. I want to learn from them, and hopefully they want to learn from us. We can make a difference in the community's life. It is a privilege and it is really a sacred mission. That is why I love what I have been doing for 35 years in the health care world and why it has been such a gift to be part of Kaiser Permanente. We have invested in Southern California and we have worked with many partners because we know we cannot do it on our own. It is a privilege. It is an absolute privilege to be here.”

For National Health Foundation, honoring Dr. Chu is also a privilege, as is echoing his vision in the work that we do. We believe in the power of the individual as well as that of the community and have seen first-hand the inspiring outcomes of programs and initiatives that were born of a community’s desire for improved health and greater equity. Dr. Chu’s boundless passion has created a new era of access. We also have a passion. Our mission to develop and support innovative programs that provide systemic solutions to gaps in health care access and delivery drives our continuous efforts to connect our neighbors to the tools they need to create healthy, vibrant communities. The Leadership, Vision, and Commitment that we are celebrating on March 29th is a shared creation with the communities we are empowering. The prospect of a healthy ‘greater California community’ is in our sights and certainly worth celebrating.

Not A Traditional Success Story

By Kelly Bruno

President and CEO, National Health Foundation

Tom lived in Los Angeles. You might have seen him; passed by him as he found shelter for himself alongside a freeway. Like nearly 45,000 others, he was homeless.

After years of living on the streets, his health deteriorated and he was diagnosed with lymphoma cancer. He was estranged from his two children and aside from one friend, was entirely alone.

What happens to homeless people who fall ill? Typically, a hospital stay is followed by a return to the streets. But can we really expect someone to heal on the streets exposed to the elements, without proper nutrition, and no follow up?

Many homeless people who have experienced a hospital stay face additional setbacks that land them back in the hospital, and this can be very expensive. Of course, if we think about the expense of repeated hospital stays, we are only looking at a part of the issue. What is the human cost of healthcare and homelessness?

After a stay at West Hills Hospital, Tom was admitted to PathwayRecuperative Care, a National Health Foundation program. This was possible only because West Hills Hospital chose to partner with Pathway Recuperative Care to ensure that Tom had a safe place to heal after he left their care.

One of our licensed nurses coordinated needed hospice services for Tom, and they were provided to him at our Pathway recuperative care facility. This was the care Tom needed as he neared the inevitable end of his life, and it was much less expensive for the hospital.

Tom had no family, and only one good friend. We made sure he could call his last remaining close friend whenever he needed to talk. NHF Social Services Coordinator Chere Daniels shared that Tom was quiet but friendly and communicative until the last few days when he started to deteriorate more rapidly and ultimately passed peacefully in his sleep.

While this may not sound like a typical success story, it is an important one to share. Because of West Hills Hospital’s partnership with our Pathway Recuperative Care program, Tom did not die alone, homeless on the streets of LA, but rather spent his last days being cared for in a compassionate and supportive environment.

Our vision is that every individual, regardless of who they are or where they live, should have access to a comprehensive and compassionate system of care. We provided that access and compassion to Tom.

Thank you West Hills Hospital for helping us make a difference.

From Homeless to Healed

Life on the street in Los Angeles means dodging one danger after another. For Heriberto, the danger became real when he was struck by a car. The accident left him with two broken legs.

Heriberto had been homeless for some time. He had lost touch with his family and drugs were very much a part of his daily life. Until his accident, any memories of living in a ‘home’ were distant and he didn’t feel compelled to reach out to get help to change his circumstances. The accident changed his perspective because he experienced care and connection.

After receiving his initial care at Ronald Reagan Hospital, he was referred to National Health Foundation’s San Gabriel Valley Recuperative Care (SGV) facility.  SGV provides 24-hour care in a safe and nurturing environment that is the most compassionate and cost-effective option for patients facing hospital release who do not have a home to return to.  

Heriberto soon asked for help to ‘get better’. Knowing that ‘housing equals health’ staff seized the opportunity to reconnect Heriberto with his family in the hopes that a permanent housing solution could be found. While he healed physically through physical therapy and doctor visits, his emotional strength began to return when he received a photo of his daughter and reconnected with his sister.

Today, Heriberto is living with his parents in Florida and has transitioned from a wheelchair to a walker. He is, in his words, getting his life together again. His gratitude for the staff of SGV could not be measured, he said. 

Since the recuperative care program’s inception in 2007, more than 1695 individuals have received post-hospital care. Of these, 525 were then placed into transitional housing, 413 into shelters, 25 into permanent supportive housing and 306 into permanent housing. The two Pathway Recuperative Care facilities, SGV and Los Angeles, offer 34 beds and 56 hospitals have partnered with the program to ensure a safe and comfortable full recovery for their patients who do not have a home.

 

BUILDing Healthy Communities, One Street at a Time

By Kelly Bruno, President and CEO, National Health Foundation

South Los Angeles is one of the most disenfranchised, underserved communities in the nation. With over 1 million people lacking convenient access to healthy food or open space for physical activity, it is not surprising that residents disproportionately suffer from high rates of overweight and obesity (over 70% of adults) and other chronic diseases. A traditional approach to the health disparities here might be to impose sweeping changes on systems already in place, but when we asked the people who make up this community what they needed in order to lead a healthy lifestyle, the answers were much closer to home.

This last summer, "The BUILD Health Challenge,"* a prestigious national program, announced the Youth-Driven Healthy South Los Angeles partnership as one of the inaugural grant awardees. The South LA partnership will work together in developing a comprehensive community-based action plan for South Central and Central Alameda neighborhoods of South Los Angeles. The goal of the plan is to identify which key community factors that promote healthy living, also referred to as “upstream solutions,” could be implemented to improve the health of these two communities. The partnership includes National Health Foundation (NHF) along with the Los Angeles County Department of Public Health, and California Hospital Medical Center.

This program incorporates lessons learned from NHF’s transformative work with Jefferson High School and the “Health Academy” where youth are engaged in participatory action research to bring about community change supporting healthier lifestyles. Essential to the project’s success, youth are engaged in understanding and tackling complex socio-health problems in the community. Similar to other NHF programs, the Youth-Driven Healthy South LA program trains youth within the community as Community Health Liaisons. These youth participate in community discussions and gather input on what changes can be made to improve social determinants of health, which often include changes in economic landscapes, regulation and public policy, the built environment, transportation and infrastructure, educational attainment, public safety and housing.

In the months since the program’s announcement, NHF staff and the community’s youth pored over available data and research to gain a comprehensive understanding of the communities’ health-related issues, current assets and opportunities ripe for adoption and expansion. In the coming months, NHF and its youth ambassadors will be soliciting input from the community on ideas for improving access to healthy food and safe, outdoor space.

Levering the ongoing work of the BUILD project, NHF obtained funding from the Los Angeles City Mayor’s office for “YES(Youth Envisioned Streets) for a Healthier South LA,” a youth-driven event on Central Avenue (in the same target neighborhood) that demonstrated how public space can be reimagined as safe, vibrant and active for all members of the community. YES is a collaboration between NHF, A Place Called Home, Coalition for Responsible Community Development, Los Angeles Walks, and Los Angeles County Bicycle Coalition.

Focusing on the area surrounding Central Avenue in South Los Angeles, the YES team, which was driven by youth and their ideas, reviewed community data and created a “reimagine the streets” survey that was administered to community members at in-person meetings and community events. The results were unveiled at the recent “GreatStreets” event on Central Avenue. For one day, Central Avenue between East 33^rd Street and East Martin Luther King Jr. Boulevard was transformed into the very space that the community envisioned. Three potential configurations were demonstrated: 1) the street with a protected bike lane, 2) the street with extended sidewalks through parklet activation, and 3) the street with an unprotected bike lane. The street was flanked with new way-finding signage indicating the distance to local points of interest and community landmarks, and there were places for families to play, learn about gardening and connect with the active health resources within their community.

The community’s response to this event was overwhelmingly positive with a chorus of “This is just what we wanted” and “We can finally have some family fun in our neighborhood” and “Central Avenue is so much safer with space for pedestrians and safe bike lanes.” During the event, 280 community surveys were collected indicating which street configuration neighbors preferred: 54% preferred protected bike lanes; 28% preferred unprotected bike lanes; and 18% preferred extended sidewalks. But not only was this event an exciting time for the community, it greatly informed the tangent work of NHF’s Youth-Driven Healthy South LA project, which continues through this summer.

By engaging youth to be a part of the decision-making in both “Youth-Driven Healthy South LA” and “YES,” they have become the agents of change and have learned how to successfully engage their parents, teachers and other community stakeholders. These projects democratize the planning process and create a participatory environment marked by innovation, creativity and cultural inclusion. By bringing together empowered youth, their communities and organizations seeking to deliver active health options, we are able to begin bridging gaps in health disparities that previously have not be crossed.

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* The BUILD Health Challenge brings together an unusual set of funding partners in The Advisory Board Company, the de Beaumont Foundation, the Colorado HealthFoundation, The Kresge Foundation, and the Robert Wood Johnson Foundation. The partnership comprises three not-for-profit foundations and a publicly traded firm, and their missions range from improving the practice of public health to expanding opportunities in America’s cities. By forging this collaboration, these partner organizations hope to inspire similar teamwork between diverse organizations at a community level, adding to the knowledge base for community health and discover new best practices for the field.

Harold’s Wish and his STARS

In high schools throughout South Los Angeles, groups of boys are learning some valuable life lessons such as building self-confidence, how to graduate from high school, interview and how to become an effective communicator. They are also learning about responsible sexual behavior to avoid the cycle of teen parenthood.

National Health Foundation’s Go Harold’s Way: Be A STAR Boys (Successful Teen Acting Responsibly) targets adolescent males at greatest risk of fathering a teen pregnancy and subsequent school dropout. The 10-week prevention curriculum promotes responsible behavior and empowers young men to make a commitment to their futures by avoiding risky behavior and focusing on values such as integrity, accountability, self-determination and goal-setting. The program provides individual services, strong linkages to community resources and peer group education sessions at partner school sites.

Kelly Bruno, President and CEO of National Health Foundation (NHF), recently explained how this program works, “ Be A Star works on scaffolding these young men in a holistic way. Yes, we offer comprehensive sexual education and offer resources for them to have access to condoms and testing for sexually transmitted diseases. But more importantly, we look at the whole individual and offer the framework for them to build their confidence, to redefine the Black and Latino male experience and to empower them to see the possibilities of education.”

The program, funded by the Harold Edelstein Foundation, is part of NHF’s larger Teen Pregnancy Prevention workshop series. The program features a robust data collection and evaluation system thanks to additional funding via an AT&T Foundation grant. Coupled with NHF’s partnership with LAUSD, the impact of the program is both far-reaching and well documented.

“It would not truly honor Harold’s legacy to simply create a program without the follow-through of statistical evidence of what works and what does not. We are able to capture quantitative data to monitor program objectives and outcomes and to provide ongoing resources, education and information to program participants. By capturing this data, NHF has the ability to evaluate the impact of the program and continues to provide resources and referrals to participants after graduation from the program,” shared Bruno. “Ultimately we are moving Harold’s and our shared concern for the health of these young men, as well as that of their partners, into measurable action that bridges the gaps in healthcare that currently exist in this community.”

Since its inception in 2011, the Be A STAR boys program has touched the lives of 71 young men. Harold would be so proud of each of his STARs.