Catholic Health World

Trinity Health gears up its community benefit activity

By JULIE MINDA

Approaching community benefit activity in a strategic way will have a much more significant impact than delivering services in a disjointed, piecemeal way.

That is the common sense philosophy behind steps that Trinity Health is taking to bolster its community benefit work and make it a strategic priority throughout the system, according to Daniel Hale, executive vice president of the new Trinity Institute for Health and Community Benefits at the Novi, Mich.-based system.

"It is a great moment in time to be in community benefit," said Hale, who heads Trinity's health reform activity and who, until recently, was Trinity's general counsel. "We are applying the same level of attention and discernment (to community benefit) that we've brought to other areas of the system like operations, evaluation of clinical work and best practices."

At Trinity Ñ as is the case throughout the ministry Ñ serving the community always has been central to the healing mission, Hale said. Yet, until recent years, that system Ñ like many others Ñ did not always approach community benefit work in a focused, intentional way. Community benefit departments at Trinity facilities often developed their initiatives in a patchwork fashion, not necessarily communicating with one another or using a standard approach.  

That is now changing, said Hale. "Recently Trinity and other health care organizations have been looking at community benefit with a more critical eye," he explained.

A changing landscape
Various shifts that have happened in the ministry and in health care in general within the last decade especially are behind this shift, said Hale. There has been increased public and governmental scrutiny into whether nonprofit hospitals can justify their tax-exempt status by the level of service they provide to the community. Ministry organizations have been responding by being more diligent in how they conduct and track community benefit.

Another contributing factor, said Hale, is that "as there is more pressure on financial performance, there is more need to ensure the money is spent wisely."

Also driving the change, he said, is a subtle shift in how society and health care providers see the role of hospitals in the U.S. "Over the past few years, it has become clear that health systems would become ever more accountable not just for providing acute care but also for managing the health of populations," Hale said. "What better place to start than with populations we serve most with community benefit: the poor and vulnerable?"

Empowered staff
The last five or six years have seen ministry systems and facilities reassessing how they plan for, track and evaluate their community benefit activity to ensure maximum effectiveness, said Hale. Trinity has been among the forerunners in this work, he said.

It has elevated the role of its community benefit staff systemwide and created the community benefit institute Hale heads. Hale is on the executive staff at the system level and reports directly to Trinity President and Chief Executive Joseph Swedish. Each facility within Trinity is naming a chief community benefit officer who has direct access to that facility's chief executive and who serves as that facility's authority on community benefit. In the past, community benefit staff did not always enjoy such clout.

Trinity has formed a community benefit council and subgroups for specific topics so that these workers can share ideas. The goal is to have more standardization in community benefit throughout Trinity.

Spreading best practices
The system is focusing its community benefit initiative on:

• Chronic disease prevention and management
• Eliminating inequities in care
• Providing seamless care of the underserved
• Promoting wellness

Operating within these categories, community benefit staffs at Trinity facilities are encouraged to share ideas on what works and to adopt the most successful practices. For comparative analysis purposes, it will be important to standardize how they measure and evaluate their programs.

Hale explained, "Say you have 30 different diabetes programs in play throughout your system, and no two are alike Ñ but you know which ones work best. You have to ask, "If you're not in the top tier, why are you still doing what you're doing?'"

The "why' behind the data
Key to standardization, said Hale, is using data to point the way toward best practices. Hale's institute will help Trinity facilities to extract information from patient and population data that can be used to enhance community benefit work.

"We have very rich data available to us, but raw data does not tell you why certain things are happening," he said. "We're looking at ways to access that data Ñ for instance by looking at verbal input and notes made by nurses Ñ to see if we can find clues to the "why'" programs meet or fall short of desired outcomes.

By looking at patient data and public health data for heart conditions, joint problems and lung disease, for instance, the institute hopes to unravel what contributes to or complicates these conditions. It hopes to use the data to identify successful approaches to managing these conditions.

Data also will be used to evaluate programs. "The institute will be trying to do research and innovate new ways to deliver services to our target audience of the poor and vulnerable," Hale added. "We'll be looking at how to use the strength and capabilities of Trinity Health to do that."

Copyright © 2010 by the Catholic Health Association of the United States
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