Improving community health beyond the hospital walls
We spoke with Medell Briggs-Malonson, MD, MPH, MSHS, the chief of Health Equity, Diversity and Inclusion (HEDI) at UCLA Health, Mikel Whittier, the director of HEDI and Aubree Larson, program manager, UCLA Business Development Patient Navigation and Business Services, about what an anchor institution does, and what this designation will mean for employees at UCLA Health, vendors, partners and members of the community.
First, what is an anchor institution?
Dr. Briggs-Malonson: The idea behind an anchor institution is that if we really want to improve health and overall well-being, we need to do more than just provide clinical services inside the walls of our clinics, emergency departments, hospitals and surgical centers. We have to be part of community and help influence the various social-structural drivers, such as economic opportunity, education attainment, and housing and food security, that we know contribute directly to one's overall health and wellness. We have to shift from solely being facilitators of health care to being partners of health. That's why this is imperative.
Our commitment is to partner with our communities to hear their voice and improve the health of our most vulnerable communities together. However, first step for this partnership is to identify the specific health, economic, educational, and social needs from the community’s perspective.
What is the Healthcare Anchor Network?
Dr. Briggs-Malonson: It is a network of over 70 health systems throughout the United States. Members of the network commit to using their various human, operational and financial resources to improve community wellbeing, advance economic empowerment – especially in the most divested and under-resourced communities – and also to advance racial equity.
It was important for us to become an anchor institution, because it's our obligation as a leading academic medical center. Our mission at UCLA Health, which includes the health system and the School of Medicine, is to provide exceptional clinical care, be a leader in medical education, advance scholarly pursuits and research, and engage our community. There is a significant opportunity to strengthen our connections, investment, and partnership with our communities. And this is what our anchor institutional mission will focus on.
What is the UCLA Health anchor institutional mission and commitments?
Dr. Briggs-Malonson: Our UCLA Anchor Institution Mission (AIM) is: UCLA Health’s responsibility to advance health equity and justice extends beyond our four walls. We commit to building strong community partnerships rooted in trust and collaboration while leveraging our assets to impact the socio-structural drivers that contribute to the wellbeing of our diverse communities.
We pledge to achieve our mission through five primary pillars that serve as our guiding principles. They include:
- Local inclusive hiring - making sure that we are providing employment and professional development opportunities to our surrounding communities with a goal to create a UCLA Health workforce that represents the diversity of our Los Angeles community.
- Inclusive procurement - making sure that we are intentional in the selection of our vendors to ensure they are representative and inclusive. We must ask ourselves, how many of our vendors are truly from our local community or region? How many are minority-owned, women-owned, veteran-owned? Are they small businesses? Do they produce sustainable goods or not, especially from our local environment?
- Place-based investment - making sure that we leverage and invest our human capital and financial assets into our local community. In the future, this may include grants or loans provided to small community-based organizations. Or, building co-ops with organizations that have an established history within our under-resourced communities.
- Environmental justice - UCLA and the UC system are leaders in climate sustainability and environmental justice efforts. We know that under-sourced communities of color tend to have higher exposures to environmental toxins and elements that impact health. Therefore, we decided as UCLA Health to make sure that environmental justice is a key pillar in our anchor work.
- Community partnership - We cannot improve community health and wellbeing without forming strong, trusting partnerships with the communities that we desire to serve. Our AIM is not to go into communities and say, “we think you need this.” Our mission is to stand side by side with community leaders and organizations and ask, “What do you think is important for your community? What can UCLA Health do to help? Let’s partner to achieve change.”
How did we determine which communities to partner with?
Larson: The approach that we took was very data-driven. We looked at vulnerability indices across the entire county and then we looked at clusters of census tracks with higher vulnerabilities. Then, we looked at how many patients reside in those areas and how many visits they’ve had. Next, we looked at our partners that were already in those designated areas. And finally, we looked at UCLA locations.
It's this multiple layer data approach that led us to the communities that we'll start with, because we feel that we can have the highest impact right away. The areas are: Inglewood, Compton and high-need cities in the San Fernando Valley.
What’s the timeline?
Larson: We spent the past year setting a strategic vision. Because this is so new, we really needed 12 months to figure out what it could look like. This next year is going to be focused on community member engagement, because we need to keep the voice of the community centered for anything that we do.
What will this work mean for the communities involved?
Larson: We know that there are other organizations in communities across LA who have been historically doing this work that we are just now stepping into. There's also some reconciliation work that comes with that. We haven't been in this space before and we're owning that now, but we want to do better moving forward and we need to understand from the community member perspective – how can we do better?
We know that some of the communities we've identified have such incredible leaders who are ready to provide that level of education, who want to consult and advise, who want to be directly involved in decision making and that's really what we need.
This work isn't just, “Hey, UCLA health is going to come into your community and do this.” That's not what this work is about. It's, “Hey, UCLA has a lot of economic power as an organization. How do we realign our assets to better meet the wants and needs of your specific community?” We want them to tell us what they want, what they need, what they think that we should be doing.
Before, some of the work that we were doing was unintentionally harmful to these communities because they didn’t have a voice. We need their voice because it has to be community centered. If it's not community centered, it doesn't really get at the crux of what we're trying to do.
We know that people in Los Angeles feel very passionate about their communities – it's their home, they're proud to live there. We want that to come forward in this work, too.
What should the greater UCLA Health community know about this work?
Larson: It ultimately comes back to this being part of our mission. If we're focused on healing humankind, one patient at a time, this is where it starts. We know that 80% of a person's health is driven by socio-structural factors. Only 20% is dictated by the healthcare that they receive.
If we, as a healthcare institution, are truly focused on the health and well-being of our patients, that means we do need to impact some of that 80% – things like education, housing, income, the technology gap, all of these things that we know very much impact your patients’ abilities to sustain their health – we need to focus on those like we haven't before.
What are the next steps?
Whittier: We are determining how we can integrate the UCLA-Anchor Institution Mission into everything that we do. We began by presenting this new initiative to the Health System Executive Leadership team, management forum and the Equity Council. Next, our goal is to begin a “road show” where we can introduce the mission to various departments.
This will consist of a multi-layered, multi-year effort. It is so vast that it requires us to be intentional about our internal practices and processes in ways that we can articulate them, share them and also be transparent.
How can people get involved?
Whittier: We’re spending the next fiscal year to define what success looks like to us and our communities. We established the new, multidisciplinary UCLA AIM Committee that includes stakeholders from across the health system, DGSOM, and UCLA campus. There will be future volunteer opportunities, various projects, and ways for people to become involved. We look forward to engaging the entire UCLA Health community soon.
Learn more about the Healthcare Anchor Network. See our sister-systems, UCSF and UC Davis, in action.
New curriculum for anesthesiology residents offers tools to provide more equitable patient care
For incarcerated people with disabilities, making space in health equity