The Stew BLOG

Insight Spotlight Series: Hospital Systems in Transition

Jane Erickson, Project Director and Pedja Stojicic, Project Director | 01/06/2021

What is the Hospital Systems in Transition project?

This month, ReThink Health is sharing what we are learning across our projects through this Insight Spotlight blog series. This week, the spotlight is on the Hospital Systems in Transition project.

ReThink Health’s best hypothesis is that active, interdependent stewardship by people and organizations in a region is the most promising path to equitable health and well-being. Stewards are people and organizations who take responsibility for working with others to create the conditions that all people need to thrive, beginning with those who are struggling and suffering. Professionals from many sectors are already beginning to take on this role, partnering with others to transform health and well-being—hospital leaders included. To this end, ReThink Health is partnering with three pioneering hospital systems whose leaders, with others, are becoming stewards of regional health and well-being. Those hospital system partners include: Carilion Clinic in Roanoke Valley, Jefferson Health in Philadelphia, and Trinity Health in Detroit.

What is ReThink Health seeking to learn through this project?

Across ReThink Health projects, we are learning how the partners we support take up the practice of stewardship, how their mindsets and actions shift as their stewardship journeys progress, and how they influence the mindsets and actions of those with whom they work.

All partners in the Hospital Systems in Transition project are immersed in an intricate set of relationships with each hospital’s internal and external constituencies. Together, we are exploring what roles the hospital as an entity is best positioned to play to advance equitable health and well-being in their communities and what it will take to transition to that role, including the possibility of:

  • negotiating a new set of community relationships and partnerships; and
  • mapping and navigating internal organizational obstacles and responses.

With these new relationships and understandings, hospital leaders will be able to determine what it means to become a steward working in collaboration and alignment with other people and organizations in their regions to create lasting change. What we find will inform pioneering hospital leaders in other regions; they can build on early lessons learned about transitioning to a new regional role.

What patterns are emerging so far?

As we mentioned in our first Insight Spotlight blog, ReThink Health’s approach to learning and evaluation focuses on surfacing patterns within complex adaptive systems. By looking at patterns across multiple, intertwined scales—at the individual human level, the organizational level, and the network level—we can paint a picture showing what works, for whom, how, and under what conditions. Here is a snapshot of some catalytic stewardship practices we’re starting to see in the Hospital Systems in Transition project.

  • Developing an orientation around shared stewardship for health and well-being in whole communities. Hospitals often feel caught between the business models that are keeping them afloat and the realities of producing health and well-being in the communities where they operate. For many leaders, significant tensions exist between developing a sound strategy for unlocking people’s potential to thrive versus creating a strong business case and structure for institutional sustainability. Though it is no easy task, hospital leaders can use the mindsets and actions of shared stewardship to navigate these tensions more effectively.

For a hospital, developing an orientation around shared stewardship means expanding its organizational purpose beyond maintaining the hospital itself to instead positioning the hospital as one part in a network of stewards who care about the health and well-being of everyone in the community. This expanded purpose means building power with other organizations and residents, rather than consolidating power within an organization. It also means investing resources in ways that generate long-term value for the community while also meeting the hospital’s organizational needs. All of this requires significant shifts in internal culture, operating structures, and leadership capabilities.

Sharing power with other community organizations and residents is a key step toward developing a new stance as effective and equitable system stewards. This requires that hospital system leaders acknowledge the significant power they often have so that they may intentionally step back at times to let others take on more prominent roles. We are observing that many hospital leaders express a strong desire to share power in this way, but they are often challenged by their organizational cultures and routine practices to do so.

For example, when Jefferson Health decided to address health inequities in Philadelphia, it formed the Philadelphia Collaborative for Health Equity (P-CHE). Breaking with tradition, it chose not to brand the effort as a Jefferson Health initiative. That simple act sent a signal that Jefferson Health’s leaders are willing to share power in new ways. Furthermore, one of the first programs of the collaborative was P-CHE Catalyst Grants, which distributed over half a million dollars to community organizations. The main difference between the P-CHE grants and traditional hospital grantmaking was that the decision about who will receive grants was made by an external advisory panel of community organizations and other relevant stakeholders and based on a community needs assessment.

  • Balancing thin and deep partnership approaches: Many hospital leaders highly value engagement with community residents and organizations and have long histories of partnering with others in their communities to advance population health goals. However, we have observed that these partnerships tend to be short lived and often are transactional in nature (giving grants, for example). Additionally, as a part of their population and community health strategies, hospital leaders often participate in many collaborative groups, including multisector partnerships focused on inventorying and discussing health needs across a community or large collaborative efforts focused on addressing a particular health issue. When taken together, we see that hospital leaders spread their time and resources thinly across many engagements to foster community health and well-being. They are less likely to engage deeply over long periods of time with particular community organizations or residents to strategically advance shared goals.

It could be useful for hospital leaders to broaden their approach by intentionally developing a set of deeper and longer-term relationships with other organizations and residents seeking to advance equitable health and well-being in their communities. Transformative change requires trust, commitment, and openness, all of which relies on strong relationships. These conditions could be fostered more effectively through a smaller set of deeper-touch relationships where partners can more openly discuss interests and values and drive targeted actions toward specific goals. This type of relationship-building and action-oriented approach is quite different from the traditional tactics hospital leaders have relied on to foster population health with others in their communities. Broadening their approach will require new leadership capacities and careful navigation of existing relationships.

  • Expanding how hospital leaders think about investing in their communities. Decision makers in health care organizations are conscious of pressure from other organizations to provide deeper support for efforts to advance community health and well-being. We have observed that hospital leaders tend to assume that community needs are primarily financial. This might be further amplified by perceptions and expectations from community organizations themselves. However, our in-depth network analysis indicates that hospitals can go beyond funding and provide a range of resources and supports to foster well-being in their communities, such as convenings, services, and expertise. Hospital leaders are exploring the different types of value they can provide to community efforts for well-being (beyond financial value) outside of traditional reimbursable health care service transactions. This has become increasingly true as many hospitals experience extreme financial constraints related to COVID-19. While some hospitals may be inclined to retreat from community relationships precisely because they are not able to provide financial resources in the same way they had before the pandemic, there also are new avenues for hospitals to invest in their communities that extend beyond financial resources.

Want to keep up with what we are learning?

You can follow our learnings on our blog, The Stew, where you can find practical tools and ideas for stewards.