Hospitals are under a lot of pressure. They are facing what we call a problem of “balancing two boats” at the same time, while the stream is moving really fast. For example, hospitals are transitioning from fee-for-service to value-based payments. And they are moving from a provider-centered mindset to patient-centered mindset. These are big transitions, and they bring up a lot of questions about how to handle the tension between where we are now, and where we’re going.
What’s producing all of this tension? Well, hospitals often feel caught between the business models that keep them afloat and the realities of what we understand about what produces health—what keeps the people living in their regions afloat. Hospital systems are forming their own interpretations about how to respond to these pressures. But we believe there’s an emerging, all important, question that is being overlooked in these interpretations; and it’s a question that needs to be answered first. That is, what role should hospitals play in their regions? If the answer to that question turns out to be something different than what the role hospitals currently play, then there are more questions. For example, what new business models, work cultures, and responsibilities will be needed for any new role? Without clear roadmaps and endpoints, many hospital leaders are understandably reluctant to begin a journey like this. Yet, some are finding the courage to take the lead. These leaders among leaders are stepping up and finding a way to determine the desired endpoints so they can construct the roadmaps themselves. ReThink Health’s Hospital Systems in Transition project team is identifying a handful of them as project partners who are ready to stand at the forefront of this challenge and begin to pave the way forward.
Looking back to see forward
In a quick look into the history of hospitals, we found that US hospitals have transformed themselves at least four times in the eyes of the people they serve. They’ve gone from being perceived as almshouses and “Houses of Death” in the 1700s, when they were mostly funded as charities, to the “Homes of Science and Knowledge” a hundred years later when nursing and surgery came to the forefront. After the Great Depression, there was a period of substantial regional and national investment in “Our Community’s Hospitals.” Then in the 1970s and 80s a new perception came about. Hospitals started being associated with “Big Business,” an idea that has continued until present day. We see, however, that hospitals are on the precipice of another big shift in this new era of population health.
What will be the next dominant perception?
Who will decide and shape this perception?
And, how will hospital system leaders bring that new perception forward?
At ReThink Health, based on a decade of high-profile work identifying how stewards can equitably transform health and well-being in their regions, we believe hospital leaders will want to be seen as stewards. Stewards are people and organizations who take responsibility for working with others to drive transformative change in regions—in this case, they’re pursuing the health and well-being of all people. ReThink Health’s best hypothesis is that active stewardship among key players in a region is the only effective path to population health. Professionals from many sectors are already beginning to take on this role, partnering with others to transform health and well-being—hospital leaders included. For example:
- Some hospitals have defined themselves as so-called anchor institutions, and are committed to the responsibilities that entails. Such institutions affect their region’s health and well-being by recognizing that as large institutions, they have a major economic imprint in a region, and they must act accordingly to benefit the region’s economy and people. Their actions might include hiring or sourcing locally, or investing in local communities.
- Some hospitals have started initiatives to improve aspects and conditions that influence health outcomes of individual patients to maximize population health (housing, transportation, food access, and more).
- Some hospitals are investing in environmental sustainability and renewable energy.
Early innovations like these are beginning to shape what it would mean for a hospital to embrace its role as a regional steward. But without a clear way to engage both internal and external stakeholders and understand their perspectives and constraints, these innovations could be either short-lived, anemic, or even contribute the existing health inequities. To that end, ReThink Health is partnering with three pioneering hospital systems in which leaders are ready to embark on the journey of Becoming Stewards and explore and define their role in creating their region’s health and well-being. We are working together with these partners, and in relationship with the hospitals’ internal and external constituencies, to determine any new role and what it might 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 for their own hospital system to become a steward working in collaboration and alignment with other people and organizations in their region to create lasting change. What we find will serve as a guidance for pioneering hospital leaders in other regions, who can build on the early lessons of what’s involved in shaping and transitioning to a new regional role.
ReThink Health is partnering with leaders from three pioneering hospital systems, representing diverse regions across the United States, who are ready to explore and define their role as stewards of their region’s health and well-being. As they sign on, we’ll update this page.
We are honored and excited to be working with ReThink Health in this three-year engagement. The exchange of perspectives and concepts is already enriching our understanding of ourselves and our communities. Our goal is to affect community health through the development of a community-based mental health model that is scalable and sustainable.
We’re incredibly excited to participate in this transformation project in partnership with ReThink Health, to guide our health system in how to interact with the communities we serve, with the goal to improve health. Our partnership will write the playbook of how hospitals and health systems interact with communities to achieve health equity.
“My experience working in a part of Brooklyn where the life expectancy is 11 years shorter than in the neighboring Financial District—and infant mortality rates almost double NYC’s rate as a whole—made me want to change the system at the regional level to help improve these disparities.”—Anna Marie Creegan, Project Director
Joined Rippel: 2014
Current Roles: Anna is project director of the ReThink Health initiative’s Portfolio Design for Healthier Regions project.
Career: Anna led design and implementation for Rippel’s enterprise-wide evaluation framework, and has contributed to many R&D and place-based projects for the ReThink Health initiative. She also led the development of an assessment tool to measure regional progress along ReThink Health’s Pathway for Transforming Regional Health. Anna has over ten years of experience working with local and international health efforts across the US and Latin America, including as program manager for Community Planning and Health at nonprofit Community Solutions, where she led a health impact assessment and developed plans for revitalization, sustainability, and care coordination.
More about Anna: Anna loves traveling and the outdoors—especially hiking and skiing in her native Colorado Rocky Mountains—and seeing her young children growing to love it as well.
Education: University of Denver (MA), Fordham University (BA)
“I believe that the health of communities is ultimately shaped by who is and isn’t at ‘the table.’ I’m excited to be part of a team that is boldly imagining a more equitable future while also developing tangible steps to take towards that future.”—Iueh Castro Soh
Joined Rippel: 2019
Current Roles: At ReThink Health, Iueh has and continues to lead RWJF projects focused on transforming our healthcare systems, including more recently the Hospital Systems in Transition, a partnership with Jefferson Health, Trinity Health and the Carilion Clinic. He is currently the principal investigator for a RWJF project focused on advancing the dignity of low-wage caregivers. In addition to healthcare, Iueh is passionate about storytelling. He produced and hosted the first season of Unsung Stewards, the Rippel/ReThink Health podcast series, which focused on spotlighting leaders taking courageous action during the pandemic.
Career: Iueh is dedicated to creating a healthcare system that is equitable to its customers, workers and communities. He embraces his experiences working in management consulting, healthcare, and broad-based organizing to advance health and well-being. As a consultant at Oliver Wyman, Iueh worked with provider, payer and life science clients that are embracing a value-based care and population health strategy. As he sought to enlarge his professional focus on health to encompass the realities of his working-class neighbors, he embarked on a journey beyond the healthcare sector and into the sectors of community organizing, public policy, local government, and non-profits.
More about Iueh: Outside of work, Iueh volunteers as a community organizer most recently with the Greater Boston Interfaith Organization. He has chaired state and local campaigns on healthcare, criminal justice and re-entry from incarceration as well as efforts to build leadership within congregations of color. In his spare time, he loves to play pick-up basketball, hunt for tasty street foods and (attempt) to keep his new baby Mateo entertained.
Education: Haas School of Business, University of California Berkeley (BS), Harvard University Kennedy School of Government (MPP)
“Before joining Rippel, my work was confined to individual nutrition and health interventions with specific populations, funded solely by grants. At Rippel, I get to be part of work that breaks through the silos to help stewards move down the path towards sustainability—both of their finances and their mission.”—Katherine Wright, Associate Director, Stewardship Practice
Joined Rippel: 2016
Current Roles: Katherine leads the cross-coordination of Rippel’s three ReThink Health initiative project teams focused on jumpstarting transformative change, and provides high-level research and content support to ReThink Health’s Portfolio Design for Healthier Regions and Hospital Systems in Transition teams. She also continues to promote and present on Beyond the Grant: A Sustainable Financing Workbook (published in 2018).
Career: Katherine previously worked on multiple sustainable financing and R&D projects for Rippel’s ReThink Health initiative, where she explored topics like social impact investing, resident engagement, and the potential of tax credits as a source of sustainable financing for population health. Notably, she co-authored Beyond the Grant: A Sustainable Financing Workbook. Katherine led the design of the workbook’s Financing Wizard that lets users create and practice the art of financial planning for their collaborative population health work. Before joining Rippel, Katherine coordinated and provided research and evaluation support for interventions focused on healthy eating, SNAP-ED, and women’s heart health with Tufts Friedman School of Nutrition Science and Policy, the Jean Mayer USDA Human Nutrition Research Center on Aging, and Michigan State University Extension.
More about Katherine: Katherine was ranked second in the Indiana SkillsUSA Commercial Baking competition, which helped inspire her career path to health and nutrition work.
Education: Friedman School of Nutrition Science and Policy at Tufts University (MS), Michigan State University (BS)
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