Utilizing Appreciative Inquiry in Health Care
By: Caroline Carter, Chief Transformation Officer, HCGC
As Chief Transformation Officer at the Healthcare Collaborative of Greater Columbus, exploring change management approaches for organizational growth and development is a crucial part of the job. One of my preferred approaches to change management at the organizational level is Appreciative Inquiry (AI). My affinity to AI is the focus on positive psychology and strengths, and the intentional engagement of diverse people/roles/stakeholders’ contributions. The AI philosophy is that in every organization something works, and change can be managed through the identification of what works, and the visioning of where the organization wants to be - its preferred state. Participants walk away from an AI experience with a sense of commitment, confidence, and affirmation that they have been successful. They know how to make more moments of success.
This past summer, I was invited to be a guest speaker for Dr. Laura Santurri’s (Ph.D., MPH, CPH) doctoral level students, in their course on Management in Healthcare at the University of Indianapolis. I was able to discuss and share my experience designing and facilitating AI Summits.
I engaged in rich dialogue with the students, discussing the benefits of using AI as a change management technique. I shared stories and examples of my experiences using AI, particularly in health care settings. The traditional approach to change looks for the problem, and then attempts to find a solution. When we look for the problem, we find it and amplify it. We have little mental energy to focus on creativity and innovation. No judgement here, we are taught this approach from a very young age. And to be honest, it is sometimes the right approach - but not always. AI differs from the traditional change model in that it is future focused, and strengths based. AI starts where you are, that is your baseline, and identifies where you want to get to, and you work towards that goal, so you end up far beyond your baseline where you started.
After receiving my Certificate in Appreciative Inquiry from Case Western Reserve University in Cleveland, Ohio, I continued facilitating AI trainings and workshops across a variety of industries, including; healthcare, education, manufacturing, and innovation and technology. In 2007 I was published in the peer-reviewed journal Quality Management in Health Care, writing ‘An Appreciative Inquiry Approach to Practice Improvement and Transformative Change in Health Care Settings. I continue to use AI because it works well for system level change for organization transformation, and engages a myriad of voices and contributions.
AI assesses the assets and strengths that have been successful so far, and focuses on how an organization can continue to utilize those strengths to maximize success. This approach helps to envision results by capturing and portraying attractive images of the ideal and preferred future, which allows the team to then identify and create actionable steps to move the practice toward that ideal image. After the action plans have been implemented, the team can share their best practices and celebrate success.
I’ve had the opportunity to perform AI with HCGC both at the board and community level. In Spring of 2019, I was honored to lead a group of about 100 participatory stakeholders in an HCGC regional learning session through the AI process. The question explored was: “What is the ideal state of health and healthcare in the Central Ohio region?” - a question of possibilities. Visualizations were created in breakout groups, and the full group came back together to share their images of the ‘preferred state’ and discuss what it would take to create real change based on their visions of the future. The most inspiring thing happened when the room full of stakeholders from different (some competing) health systems, payors, and consumer backgrounds came to a uniform realization: we must, as a region of diverse stakeholders, share our data to improve the health and healthcare experience for all people in the Columbus region. These conversations spurred new and exciting partnerships and collaborations that have, in part, contributed to the culture of data sharing, utilization, and visualization to make informed and equitable decisions to contribute to the healthcare landscape in the region. HCGC feels strongly that going on an AI journey at that place and time contributed to our ability to be impactful partners in the COVID-19 pandemic response in central Ohio, as well as other important public health initiatives. Providing a safe, neutral space for stakeholders to come together and co-create the possibilities fostered an environment of inclusivity and collaboration that is still positively impacting our work today.
We will continue to find AI opportunities as we work to strengthen our organization at the staff, board, and community level. We look forward to continuing to engage partners in the community.
HCGC Ready to Launch Second Class of Community Health Workers in Certification Program
By: McKenzie Carter, Communications Manager, HCGC
After graduating the first class of the Central Ohio Pathways HUB Community Health Worker (CHW) Certification participants in June of 2021, the Healthcare Collaborative of Greater Columbus (HCGC) will start the second session of the program starting in September.
Under the leadership of Central Ohio Pathways HUB Education Director, Dr. Tanikka Price, the HCGC CHW certification team has been working hard to grow and evolve the curriculum and design of the program based on what we learned from the first session. A major aspect to planning for this session has been collected, analyzing, and applying feedback from the 17 graduates of the inaugural class. Certification staff are excited to incorporate these recommendations as we welcome our new cohort.
With an incoming class of 21 professionals from diverse backgrounds including age ranges from 25 to 61, various genders, diverse races and ethnicities, and varied previous CHW work, we are eager to learn from this group of impressive individuals who are sure to bring unique perspectives to the program. Our certification is again being offered free of charge for participants due to generous funding of our HCGC supporters.
HCGC continues to be grateful to the Care Coordination Agencies (CCAs) participating in the Central Ohio Pathways HUB (the HUB) who have had their CHWs participate in our certification program. Our first session of the program consisted of individuals who were all working as care coordinators for our CCAs in the HUB. We are very excited that the next session of the program will welcome individuals who are both already working in the HUB, and some who are not. Our CCAs have been generous in agreeing to welcome participants to complete their required practicum hours. Such collaboration is key to allow future CHWs to have real-life experience with some of central Ohio’s most impactful health and human service agencies.
Our first unit will focus on Certified Community Health Workers Improving Lives within Larger Health and Healthcare Systems, where we will focus on understanding the role and goals of CHWs, and CHW employment models, particularly the Community Pathways HUB Model. We will also describe ways for CHWs to manage stress and anxiety, and go over best-practice client engagement strategies. This unit also covers understanding social determinants of health, and how they connect to life expectancy and outcomes. We will highlight and brainstorm strategies to keep CHWs safe in various environments. This unit is designed to empower collaborative discussions, self-esteem, establish responsibility and professionalism, as well as develop professional relationships with certified CHWs in Central Ohio. Our second unit focuses on CHWs Role in Health Education and Health Promotion. This unit will guide the cohort to demonstrate general awareness of health care needs for individuals across the life span and related health care and social services. This includes understanding pregnancy, motherhood, and the early years of life and possible barriers and concerns, and how to mitigate those risks. A focus of this section will be on identifying chronic health conditions, as well as educating clients on possible risk factors and health behaviors that decrease risks. Chronic diseases that impact African American, Latinx, and Indigenous American communities including asthma, heart disease, and diabetes will be highlighted. The unit will teach CHWs how to recognize signs indicating changes in client’s health status, and how to educate others on healthy lifestyle choices. Delving deeper into health disparities, we will work to understand the behavioral, mental, emotional, and spiritual impacts on health, and discuss substance use and effects on health. This unit concludes with a collaborative discussion on the COVID-19 pandemic, incorporating data, case investigations, testing and vaccine advocacy, and resource coordination. The goal for this unit is for participants to become an effective self/client advocate and develop and improve interpersonal communication skills and health literacy. Our third and final unit will focus on At-Risk Communities. With an emphasis on health disparities and health equity, we will consider the health disparities in Franklin County, and work to understand specific client population considerations, including African Americans, LGBTQ+, IDD, opioid/substance abuse disorder clients, New Americans, Immigrant populations, Asian Americans, and Latinx populations. We will define cultural competence, and work to understand ethical issues in research on marginalized groups. Through collaboration and advocacy-oriented discussions, we will learn how telling and listening to stories centers minority voices, and counters economic stereotypes. This cohort will be able to end this unit with conflict resolution skills, the ability to adhere to privacy and confidentiality, and understand concepts of trust amongst professional teams, CHWs, and clients.
HCGC’s Central Ohio Pathways HUB CHW Certification staff is excited to welcome and collaborate with this new cohort, and discover all of the valuable experience and insight this new groups of individuals brings to our program. If you would like to learn more about the Central Ohio Pathways HUB Certification Program, please contact HUB Education Director, Dr. Tanikka Price at Tanikka@hcgc.org.
Working with the Community to Improve Health Outcomes: Investing in Quality Improvement
By: Grant Botley, HCGC Central Ohio Pathways HUB Data Administrator
HCGC’s Care Coordination Program, the Central Ohio Pathways HUB (the HUB) has experienced exponential growth since we began managing it in March of 2019. As a result of the increase in community need indicated by the continuous increase in clients served, HCGC seized the opportunity to introduce a quality improvement process designed to better serve HUB clients and maintain the viability of the Pathways HUB Model. HCGC has historically incorporated quality improvement principles into all of our organization’s work, and is excited to continue this process with the HUB. HUB staff have selected a variety of Quality Improvement (QI) initiatives, with the goal of increasing capacity to serve more clients from referral QI processes being implemented by our Care Coordination Agency’s (CCAs) under the leadership of HUB staff at HCGC.
Implementing a QI process for the HUB is multifaceted. The primary goal for all the CCAs is to maintain an acceptable ratio of billable to unbillable services by increasing enrollment rates of clients that are being referred into the HUB. We know that the longer it takes to be contacted by a CHW, the less likely a potential client is to continue with the enrollment process. Without adequate billable services, the Pathways HUB model is not sustainable, leaving our most vulnerable populations at further risk of poor health outcomes due to lack of access. Implementing a 48-hour time frame from referral to enrollment by a CHW is vital to ensuring that at-risk clients are welcomed into the HUB and begin the process of being connected to vital care and services to set them on a course to success.
CCAs have selected agency specific approaches to impact their billable to unbillable ratios. These quality improvement initiatives should increase the likelihood that clients are receiving timely high-quality service, evidence-based care coordination, and agencies are appropriately reimbursed, thus remaining viable entities with the capacity to serve more clients.
To impact the billable to unbillable ratio, some CCAs have intentionally opted to focus on increasing enrollment rates of referred clients, reducing the time it takes to make an initial contact with a client after they are referred to the HUB.
CCAs are embracing the Model for Improvement via the Plan-Do-Study-Act (PDSA) cycle. The PDSA cycle is a system by which organizations can test for change by establishing a plan to test the change (Plan), executing the test (Do), reflecting on and learning from the outcomes of the test (Study), implementing any changes that should be made to the initial test (Act)1. The PDSA cycle is a simple and powerful tool for accelerating quality improvement. This scientific method is used for action-oriented learning.
Our hope is that through this experiential QI process, CCAs will develop a culture of continuous improvement with the ultimate goal of building QI capability rendering each CCA the efficacy to identify and achieve their unique improvement goals on an ongoing basis.
HCGC’s team is committed to supporting HUB supervisors and CHWs to the highest degree possible. One aspect of that support includes daily engagement in the HUB data management system, Care Coordination Systems (CCS), to review data from the very beginning stages of an individual client to the time of the client’s discharge from the HUB. The HUB staff takes this manual review of all client data very seriously, as it is vital in ensuring that the important work of our CCAs and CHWs out in the community is reflected in our billing and quality processes on the backend.
HCGC and the HUB staff team are very much looking forward to working through this new QI initiative with our valued CCAs. Recognizing how much growth has occurred to get us here, we also know that there is always room to grow and improve. The HUB staff is confident that this process will allow the HUB to continue to serve HUB clients with dignity and respect, while providing them a quality service that will set them on the path to success and well-being.
For more information on the Central Ohio Pathways HUB, or on this QI initiative, please contact HUB CEO, Jenelle Hoseus at email@example.com.
HCGC Celebrates Certifying First Class of Community Health Workers in New Program
By: McKenzie Carter, Program Manager, HCGC
Beginning in March of 2021, the Healthcare Collaborative of Greater Columbus convened a group of 17 professionals for our very first Community Health Worker Certification Program. This first cohort consisted of a diverse variety of genders, races, backgrounds, and experiences. With ages ranging from 23 to 64, this cohort brought more to the table than we could have hoped for. With funding from Aetna, this program was free for all of our participants. We had a wide range of agencies that had CHW’s certified through the program, including; Columbus Urban League, Ethiopian Tewahedo Social Services, Physicians CareConnection, Heart of Ohio Family Health, Primary One Health, The Breathing Association, Urban Strategies, and Wellness First.
Our first unit focused on understanding the roles and goals of Community Health Workers, and understanding CHW employment models, particularly with the Community Pathways HUB Model. Our cohort practiced Appreciative Inquiry and Motivational Interviewing, and explored Social Determinants of Health, and how they connect to life expectancy and outcomes. We discussed homelessness and housing in Central Ohio, and its relation to SDOH. Our second unit focused on CHW’s Roles in Health Education and Health Promotion. Our Cohort demonstrated general awareness of health care needs for individuals across the life span, and related health care and social services including; pregnancy and motherhood and early life barriers, and how to mitigate those risks, describing basic anatomy and physiology of major body systems and medical terminology, recognizing signs indicating a change in a client’s health status and educating on healthy lifestyle choices, understanding the behavioral, mental, emotional, and spiritual impacts on health, understanding the importance of oral care, explaining age-appropriate safety and injury prevention techniques, educating clients on becoming independent in their personal health advocacy. This unit also explored the COVID-19 pandemic in terms of data, the role of CHW’s in education, case investigation, testing, vaccinations, and resource coordination. Our third unit focused on targeting at-risk communities. Participants learned in depth about health disparities and health equity, learned about the health disparities in Franklin County, discussed how the legacy of the enslavement of Africans impacts racial disparity in America, explored ethical issues in research on marginalized groups, we defined cultural competence, and discussed the importance of telling and listening to stories that center Black voices.
More specific topics covered in this Certification were pertinent to the work that Community Health Workers do daily. This includes learning about Healthcare Models, establishing a Medical Home, client engagement, managing unconscious biases through curiosity, empathy, and compassion, discussing social determinants of health, learning about pregnancy, motherhood, and reproductive health, health literacy, behavioral health, wholistic health care, ACEs and health outcomes, and so much more.
This cohort truly brought energy, passion, and insight into this program. Our participants made this program successful in so many ways, from sharing personal narratives, exchanging stories and visions, to sharing their expertise. With that being said, at the Awards Ceremony, HCGC recognized Jabriel Harrison for his perfect attendance. His readiness to engage and participate was energizing during the past 3 months. We recognized Gabriella Craft for most improved, as watching her grow within the program was inspirational. We awarded Guy Tshimanga the Courage Award, as he shared his personal stories with the class, and even wrote a poem on Motherhood. We awarded Jabriel, Gabriella, Kate Curry-Da-Souza, and Luciana Smith the Outstanding Presentation Award for their presentations on the role of CHW’s in the medical system of care. And finally, Tifani Kendrick was awarded the First Annual Mark Redding Impact Award for exemplifying the legacy of community service, health equity, and inspiration in memory of the late Mark Redding, the co-founder of the Pathways HUB model.
If you would like to learn more about the Central Ohio Pathways HUB Certification Program, please contact HUB Education Director, Dr. Tanikka Price at Tanikka@hcgc.org.
Central Ohio Pathways HUB Joins Statewide Network of Certified Pathways HUBs
In Ohio, there are currently 10 Pathways Community HUB Institute Certified HUBs (HUBs). These HUBs have created a statewide network in order to support, grow, and sustain their model, with the goal of achieving health equity for all people in Ohio.
Managed by the Healthcare Collaborative of Greater Columbus (HCGC), the Central Ohio Pathways HUB (the HUB) acts as the Central Ohio regional HUB, training, certifying, and dispatching CHWs to use the model in order to reduce health care inequity in under-resourced communities.
The 10 Pathways Community HUB Institute Certified HUBs (HUBs) in Ohio have banded together to form a network, with the goal of supporting, growing, and sustaining the HUB model in the state.
HCGC took over management of the HUB in March of 2019, taking over the evidence-based system that guides Community Health Workers (CHWs) as they perform field work to identify and eliminate characteristic barriers to under-resourced clients’ good health outcomes. HCGC trains, certifies, and dispatches CHWs to use the HUB model in order to reduce health care inequity in vulnerable communities. Outside health care agencies, such as local health departments, federally qualified health centers, and other health and social service agencies, partner with HCGC to benefit from CHW training and certification, field support, and data.
At the core of the HUB model is the idea that social determinants affect health. When CHWs work with clients using the model, they tailor a plan to fit each individual’s specific needs across age, race, culture, geographic location, and gender. By recognizing obstacles to health—such as food insecurity or lack of reliable transportation—CHWs are able to connect clients to community-based resources that can improve health outcomes.
“The HUB has proven its effectiveness in making a substantial difference in clients’ lives,” says Jenelle Hoseus, Executive Director of the HUB. “By creating a network of Ohio HUBs, we will be able to collaborate on projects, such as providing education regarding the HUB model and Community Health Workers with government and policy leaders.”
The network will also allow the Ohio HUBs to amplify its united voice, scale innovation, and share technical assistance, support, and best practices with one another. The ultimate goal for the network is to achieve health equity for all people in Ohio.
“Rather than each of us working separately but diligently at the same goal in our own areas of the state, we can pool our knowledge and collaborate to have a greater impact on eliminating racial health inequity,” says Hoseus.
Since March of 2019, CHWs in the Central Ohio Pathways HUB have provided care coordination to 2,527 clients, completing over 12,200 connections to care and services. Overall, 192 CHWs from Ohio HUBs served 4,036 clients in those programs in 2020. HCGC and the HUB look forward to a fruitful collaboration with the other Ohio HUBS and making ever greater strides in its shared mission.
Partners In Health White Paper Highlights HCGC involved work in Ohio
"Eligibility is Not Access: Prioritizing those most at risk in the next push of vaccine rollout"
Executive Summary: "Across the United States, expanded vaccine eligibility offers hope that within months enough Americans will be immunized to allow the safe resumption of normal activity. However, relying on a national vaccination campaign to resolve the COVID-19 pandemic is not so straightforward; even with open eligibility, our health system is not designed to ensure vaccine access and uptake for all. We’ve seen time and again that simply making health care available without understanding and eliminating barriers to access perpetuates inequitable outcomes. In response, Partners In Health (PIH) is supporting and co-developing pragmatic and sustainable solutions with local communities to meet the opportunities and challenges of COVID-19 vaccination.
To get to our new normal—safely reopening our schools, our businesses and our communities —we must achieve 70-90% vaccination rates. Critically, for disease control and population immunity, we must reach these rates everywhere, at the global, national, and local levels, and we must maintain them. If not, we will continue to see hotspots of infection surface and spread, with resultant disease and mortality, potentially driving the emergence of new variants.
Standing in the way of this goal are long-standing structural inequities that have led to a disproportionate burden of COVID-19 in certain communities. We must prioritize vaccinations for those most at risk and work together to establish a more responsive and community-centered public health system in the process.
Epidemiologic and social risk factors reinforce the need to prioritize older individuals, communities of color, and essential workers. To combat the structural factors that have resulted in these groups suffering disproportionately from COVID-19 and other health inequities, PIH is supporting a 3-pronged approach to rolling out vaccination and improving health outcomes:
1) increasing vaccine demand through community engagement;
2) ensuring adequate vaccine supply through resource allocation and operations;
and 3) leveraging the vaccination opportunity to invest in long-term public health systems.
It can be done. Our work in more than 15 locations across the country demonstrates how departments of health, community-based organizations, and others—regardless of where they are in the vaccine rollout—can take action alongside community leaders to ensure older adults, communities of color, and essential workers have the resources and information they need to get vaccinated. While the focus of this memo is the U.S., our work for equitable vaccination is not, and cannot be, restricted by national borders. Globally and locally, with a strong commitment to prioritization and targeted investment in the necessary resources, we can reach population immunity and stop COVID-19.
Much of our early learnings in community engagement and operations can be adapted globally; importantly, many of these lessons build on our global experience working to implement successful, equitable vaccination campaigns."
Click to read the white paper in its entirety...
Celebrating Two Years of the Central Ohio Pathways HUB
The month of March marked the two-year anniversary of The Central Ohio Pathways HUB (the HUB), a nationally certified care coordination model for Franklin and contiguous counties that is managed by the Healthcare Collaborative of Greater Columbus (HCGC). The HUB model is utilizing 11 care coordination agencies (CCAs) that employ over 40 Community Health Workers to assess medical, behavioral, and social risks for our most vulnerable neighbors and connect them with community resources to mitigate those risks. The HUB has served more than 2,500 clients, of which 80 percent represent minority or foreign-born populations.
Addressing Disparities Among Vulnerable Populations Amplified During Pandemic
While vulnerable populations disproportionately experience disparities and inequity, the COVID-19 pandemic has amplified disparities among underserved communities in the region and in communities where the HUB is currently serving clients. HUB CHWs have provided over 900 educations related to COVID-19 to their clients since the onset of the pandemic. There has been an exponential growth in education pathways regarding COVID-19 related measures, such as understanding stay-at-home orders, mask mandates, navigating telehealth appointments, and what to do if clients or their family members become ill. Now, more than ever, CHWs are finding themselves advising and connecting clients to important information on health insurance enrollment (including Medicaid), unemployment benefits, career education, food assistance, and guidance on attending prenatal and other preventative healthcare appointments.
“We are grateful to our local and state officials who have called for a renewed focus on racial, cultural, and economic disparity in light of how COVID-19 is disproportionately affecting people,” said Carrie Baker, HCGC President and CEO. “We are committed to providing the data necessary to increase equity, while simultaneously preparing our community health workers to support and protect our growing number of clients.”
In addition to educating clients, CHWs have also been working to educate and connect Central Ohio’s most vulnerable citizens with information on receiving a COVID-19 vaccination. At each encounter, CHWs are discussing the COVID vaccine with their client, providing evidence-based education to dispel unfounded myths, and assisting clients in finding a vaccine locations, appointments and transportation when needed.
Referrals from Community Providers and Organizations Based on Trust and Success
While Medicaid Managed Care referral partnerships remain steadfast and abundant, the HUB has built trust in the community over the past two years that has inspired several other community providers and organizations to begin referring at-risk, vulnerable members of the community into the HUB. Ohio State University Wexner Medical Center, OhioHealth, The Columbus Metropolitan Housing Authority, City Attorney Zach Klein’s theft diversion program, and Franklin County Public Health’s Centers for Disease Control Opioid Data to Action initiative have all formed partnerships with the HUB to connect at-risk individuals with care coordination with a CHW.
“Our referral partners recognize the value in providing evidence-based, proactive connection to care and services that can change the course of at-risk individuals lives. By referring for coordination services with the HUB, providers and organizations know that their own systems will run more efficiently, providing an organized, successful experience for their patients and clients. CHWs are trusted, reliable caretakers in their communities, and they work for some of the most incredible agencies in central Ohio, bravely navigating both before, during and after this pandemic. CHWs can not only help find, report, and decrease the spread of COVID-19, but also support clients hardest impacted by the pandemic to recover from the health, social and economic perspectives.” said HUB Executive Director, Jenelle Hoseus.
Since HCGC began managing the HUB in March of 2019, CHWs have made several impactful connections to care and services for some of the region’s most vulnerable citizens.
Here is what we have seen:
“The HUB embodies possibility and hope. It’s infrastructure allows for intentionality and intimacy between client and CHW which is the life blood of the program. I was once in my client’s shoes – 3 ½ year ago I was a heroin addiction and living out of my car. My clients can see who and what I am today, yet know my story on where I was, and that breathes possibility and hope," said HUB CHW Matthew Demoulin who is employed by Franklin County Public Health, "The HUB Pathways allow me to live out a simple motto: To give back what was given to me. I had individuals show me a love and intentionality which allowed me to help myself out of a very dark hole. I try to do the same for my clients and the HUB Pathways gives me the platform to do so.”
HCGC is proud to celebrate Black History Month, acknowledging and appreciating the impact that Black people made in our goal to find solutions that provide the best health to all people in the Columbus region. This month we are featuring two blogs from our partners at the Columbus Medical Association on Black physicians who have made significant impact in medicine. Visit CMA's blog here: https://blog.columbusmedicalassociation.org/blog-1.
Celebrate Black History Month: Joycelyn Elders
by Annie Wilson, CMA
Joycelyn Elders is a pediatrician and outspoken public health advocate who served as the first African American Surgeon General of the United States.
Elders was born August 13, 1933, in Schaal Arkansas, to a family of sharecroppers and the first of 8 children. At 15, she entered Philander Smith College, a historically black liberal arts college in Little Rock, Arkansas, on a scholarship from the United Methodist Church. That same year she saw a doctor for the first time in her life and decided to become a physician herself.
After 3 years, she graduated and joined the Army. In 1956 she enrolled at the University of Arkansas Medical School in Little Rock on the GI Bill. At medical school, Elders was one of three black students and the only black woman student. While Elders was able to attend classes with her white classmates (the Supreme Court had declared separate but equal education unconstitutional two years earlier) she couldn’t eat with them at the white-only cafeteria.
Elders graduated with her M.D. in 1960 and went on complete her residency in Little Rock where she was appointed chief pediatric resident and specialized in pediatric endocrinology. During this time Elders became an advocate for issues regarding adolescent sexuality, particularly teen pregnancy and contraception.
By the late 1980s, 20% of children born in Arkansas were from teenage mothers, which then Governor, Bill Clinton, considered a social and fiscal crisis. So, in 1987 Clinton appointed Elders to the Office of Director of Public Health. During this time she instituted a controversial program to dispense contraceptives to public school students, promoted public awareness of AIDS and teen pregnancy, and successfully lobbied for a mandated K-12 sex education program that focused on personal responsibility, hygiene, and substance abuse prevention.
In 1993, Elders was nominated by President Bill Clinton to the post of. U.S. Surgeon General. She was only the second black person to be tapped for a cabinet-level position. Elders’ nomination was met with strong opposition from conservatives at the time because of her outspokenness on sex education, but she was eventually confirmed. As surgeon general, Elders focused on several health issues: tobacco-related disease, AIDS, and alcohol and drug abuse; she also continued her advocacy for sex education. She played an important role in Clinton’s early efforts to reorganize the health care system, and she regularly urged the public to consider unorthodox solutions to public health problems. Some of her suggestions concerning sex education in public schools, however, caused great controversy, and in December 1994 Clinton asked her to resign.
Elders returned to the University of Arkansas as a faculty researcher and professor of pediatric endocrinology at the Arkansas Children's Hospital. As of 2021 and now retired from practice, Elders serves as professor emerita at the University of Arkansas School of Medicine and remains active in public health education often advocating for comprehensive sexual health education and speaking out against teen pregnancy.
Celebrate Black History Month: Patricia Bath
by Annie Wilson, CMA
Patricia Bath, MD, was an ophthalmologist and inventor of the Laserphaco Probe used in cataract surgery which resulted in her becoming the first black woman physician to receive a medical patent.
Bath was born 1942, in the Harlem neighborhood of New York City. When she was still a teenager, she received a scholarship from the US National Science Foundation, which led to an opportunity to join a research project at Yeshiva University and the then Harlem Hospital Center in New York. She stayed in New York for her undergraduate degree, studying chemistry at Hunter College, and then moved to Washington, DC, for her medical degree at Howard University College of Medicine. Bath interned at Harlem Hospital from 1968 to 1969 and completed a fellowship in ophthalmology at Columbia University from 1969 to 1970.
While at Harlem Hospital and Columbia University, Bath quickly noticed the eye clinic in Harlem had an extraordinary amount of blind or visually impaired patients compared to the few at Columbia. This observation led her to conduct a retrospective epidemiological study, which documented that blindness among black patients was double that among white patients. Bath concluded that the high prevalence of blindness among the black population was due to lack of access to ophthalmic care. As a result, she proposed a new discipline, known as community ophthalmology, which was grounded in her belief that “eyesight is a basic human right”.
Bath went on to join the faculty of UCLA Charles R Drew University of Medicine and Science. During this time, she began to think that emerging laser technology might provide a more precise and less painful way to remove cataracts and restore eyesight. Bath took a sabbatical from her positions in Los Angeles to pursue her research in Europe after experiencing numerous instances of racism and sexism. In 1988, after five years of research while in Paris, Bath invented the Laserphaco Probe. With this device, Bath was able to restore the vision of patients who had been blind for decades and it’s still used today.
Bath died on May 30, 2019.
Supporting CHWs as they Support the Community
By Tanikka Price, Director of Education, Central Ohio Pathways HUB
Technical Assistance support may conjure images of someone walking through how to use a computer program, or how to input data entry. Technical Assistance (TA) with Community Health Workers (CHWs) and their Supervisors in the Central Ohio Pathways HUB is so much more than that. HUB Director of Education, I approach every TA session armed with the knowledge that CHWs have a huge turnover rate, and that the assistance I provide may make the difference between this CHW remaining employed or not. General issues that CHWs face include burnout, time management challenges, unclear expectations and overwhelming personal issues.
For most CHWs the opportunity to serve clients in their community is exciting. During Onboarding with the HUB, CHWs are warned of burnout in a session called “Self-care.” Meditation, exercise, a balanced diet, and boundaries with clients are explored as ways to manage the challenging work that is ahead of them as CHWs. They are trained to model and coach clients to a point of self-sufficiency, enabling the clients to advocate and do for themselves eventually as the relationship progresses. However, for some CHWs, they begin making appointments for clients, getting food for clients at the local food bank, picking up diapers and wipes from local agencies, and that gets taxing over time. So these CHWs are more likely to experience burnout. In our TA session, we work with setting boundaries and working smarter, not harder. We roll play talking directly to clients, not in a way that hurts their feelings, but in a way that garners respect and understanding.
Time Management Challenges
A calendar is a must for CHWs. Time must be managed. It is so easy to get derailed by an emergency call from a frantic client which takes up the entire day. In our TA session we discuss keeping a calendar which includes having time for breakfast, lunch and dinner (you’d be surprised how many CHWs don’t make time to eat during the workday). We also discuss building in time for time in Care Coordination Systems (CCS) our data system and time to reflect. For CHWs with a history of trauma or adverse childhood experiences, it is important to build in time to journal or, when necessary, therapy. Working with clients from similar backgrounds may be triggering, and it may be even more challenging to establish boundaries with a client who is struggling through something you can remember struggling through.
Sometimes there is nothing more than a caseload and a data system and CHWs have to figure out on their own how to prioritize the work. In this case, our TA session may incorporate finding out what the CHW is unclear on and then meeting with the Supervisor to make sure we are all on the same page. A good example of this is- a CHW may think that being efficient at work is checking all the emails in a day, while the Supervisor may have an expectation that she contacts clients every day. Communication and clear expectations are the key to making sure that the CHWs work is aligned with the expectations of the agency.
Overwhelming personal issues
Sometimes life situations come up that feels unmanageable. It happens to us all. In our TA sessions, sometimes the CHW just needs a trusting ear with which to vent. There is no therapy that happens during TA sessions, but there are suggestions made regarding time management, self-care, and communication with administration that are helpful to CHWs during a time when personal issues threaten their employment. CHWs are strong and resilient and that is what makes them so effective. Sometimes they just need to hear that everything is going to be okay, and to be reminded that they have made it through before and they will again. In those situations where personal issues are so overwhelming that they are not able to fulfill their responsibilities as a CHW, they are coached in a way that they can always come back to gainful employment when the time arises. When appropriate, they are referred to mental health agencies, or other social service agencies. During one TA session, I noticed the CHW squinting to read the notes on the computer and immediately referred him to Divine Family Eyecare where he was able to get an appointment and get new glasses to perform his job more effectively! In other words, sometimes we have to be a CHW to the CHW.
Reducing turnover with CHWs begins the day they decide to do the work of a CHW. At the Central Ohio Pathways HUB, we take our mission seriously: we cannot serve the community without ensuring that the needs of our CHWs are fulfilled. We do that by providing TA sessions that can empower and encourage CHWs to continue on their path.
HCGC Releases Latest Regional Quality Transparency Report
Innovations and Lessons Learned Amidst Pandemic
by Carrie Baker, President & CEO
Central Ohio providers continue to be open and transparent with one another about how they perform on specific quality measures with an eye on improving health and healthcare delivery across the region. HCGC is pleased to release our second Quality Transparency report of 2020 with data on nine clinical quality measures from 13 healthcare organizations representing over 223 primary care practice sites that are caring for more than 881,234 patients across Central Ohio. Our Quality Improvement Learning Group (QILG) has hosts quarterly work sessions for practices and quality improvement system leaders to evaluate regional performance, set goals, and align improvement activities at a system and practice level.
Since 2014, the report has been released twice a year, providing benchmarking, trends and important insights to help as practices strive for continuous improvement. Over the years, HCGC has increased the number of practices from just over 80 reporting in 2014, to 223 in the most current iteration of the report. The number of quality measures has also increased as a result of the collaborative work of the QILG.
For the first time, and amidst a global pandemic, contributors reported data on telehealth services provided by their practices. While several preventative screening targets were predictably under target, this report demonstrates that central Ohio providers rose the challenge of using innovation to provide access to care at the height of the COVID-19 pandemic. On average, practices performed over 1,000 telehealth appointments with patients during this reporting period. This data demonstrates that providers in the region prioritize the safety and healthcare of their patients. Providing telehealth services to patients allows for a continuum of care, while ensuring the safety of central Ohio patients from preventable exposure to the coronavirus.
HCGC has decided not to include social determinant of health (SDOH) data as it has done in the past
two QT reports. Over the last year, HCGC has been working with a data analytics firm to combine our
SDOH and clinical quality data in a more comprehensive way that highlights regional trends and
improvement activities going forward. We look forward to sharing our progress with partners in 2021.
HCGC and the QILG are grateful to our contributing practices for their continued commitment to transparency and innovation to meet the needs of their patients. If you are interested in joining the QILG, or contributing data to the report please contact HCGC President & CEO, Carrie Baker at firstname.lastname@example.org.