Hospitals and health systems, particularly nonprofit ones, are challenged with providing top healthcare in ever changing and challenging financial, regulatory, and service environments. They manage thousands of staff and provide care to nearly every American at some point in their lives. Given these everyday operational challenges, what should health systems do to not just provide top-notch health services delivery, but also adopt an Anchor Mission that can deploy operational resources to build community wealth and better the long-term welfare of the community in which they are situated?
Where do you start? Who needs to be convinced? Who are the champions? What are the implementation steps? Drawing on our research and convening expertise, The Democracy Collaborative’s (TDC) healthcare and advisory teams have been working together to build processes that help healthcare anchors answer these critical questions in concrete ways.
Harvard University’s T.H. Chan School of Public Health recent article “Anchoring Health beyond Clinical Care: UMass Memorial Health Care’s Anchor Mission Project” provides a detailed look at one example of this work, in a case study on how TDC helped UMass Memorial Health Care (UMMHC) in Worcester, Massachusetts start and move forward on its Anchor Mission journey.
UMMHC’s most recent Community Health Assessment showed that the social factors —poverty and unemployment, food insecurity, housing, transportation, access to care, racism/cultural insensitivity, the need for health education, and safety and violence—were significant factors in community health outcomes. In February 2017, Doug Brown the President of UMass Memorial Community Hospitals and Chief Administrative Officer (CAO) of UMMHC, and Rick Siegrist, the chair of UMMHC’s Board of Trustees, became intrigued about the Anchor Mission framework after listening to a talk by Randy Oostra, President and CEO of ProMedica in Toledo, Ohio, whose work embracing new approaches to help tackle social and economic determinants of community health with anchor resources was the subject of a TDC report,Embracing an Anchor Mission: ProMedica’s All-In Strategy.
Brown’s and Siegrist’s next step? Looking for guidance on operationalizing this framework at their own institution. The case study discusses the resources they found, many of them provided by TDC:
"The Democracy Collaborative provided practical guidance for organizations getting started. These included the Healthcare Anchor Network, which provided periodic calls, annual conferences, and collected best practices across over 40 institutions around the country. They also provided case studies, including detailed descriptions of Anchor Missions at Rush Medical Center in Chicago and ProMedica in Toledo, and “toolkits” for each pillar."
UMMHC’s VP for Community Benefits, Monica Lowell underscores the way in which an Anchor Mission approach complements and deepens the impact of existing community benefit work:
"An Anchor Mission is another emerging strategy toward achieving health equity by leveraging the strength and assets of the organization to positively impact the social and economic factors that affect the health of the community. This complements existing Community Benefits’ longstanding work in that the Anchor Mission incorporates nontraditional approaches, partnerships, and institutional assets. For example, it uses the three pillars approach of: Investment, Procurement, and Hiring."
Armed with these resources, UMMHC engaged two Harvard T.H. Chan School of Public Health fellows, Ahmad Al Kasir and Eric Coles, to help study and assess whether and how UMMHC could adopt and implement the Anchor Mission framework at a system level. One of their findings was that UMMHC’s community-facing programs were viewed internally as charity and what UMMHC did for the community; whereas:
"[...an] Anchor Mission would push the organization to adopt community initiatives as a business strategy in which UMMHC would work with the community . . . . With an Anchor Mission strategy, UMMHC’s efforts could focus on decreasing social inequality not solely as a community benefit but because social inequality hindered the organization’s ability to improve the health of the community, and also impacted the system’s financial margins."
The fellows concluded that UMMHC was well-positioned to adopt an Anchor Mission strategy, but doing so would require the health system to not only reallocate institutional resources and realign institutional policy, but to make deep changes in its institutional culture. Brown agreed with these findings and recommendations and submitted a recommendation to Dr. Eric Dickson, UMMHC’s President and CEO, that UMMHC adopt an Anchor Mission, to be phased in gradually over three years. Dr. Dickson approved the proposal and shared it with the Board of Directors, which generated an unexpected response:
'When Rick Siegrist, the board chair, opened the Q&A session before the vote, Doug and Cheryl [Lapriore, Chief of Staff] were rather surprised to learn that several board members thought UMMHC should implement the Anchor Mission in less than the proposed three years. “It’s one thing to get a unanimous vote from the board that we should adopt the Anchor Mission strategy,” explained Doug, “but a quicker implementation was not the criticism that I expected.”'
With the unanimous Board approval, UMMHC’s next step was to form an internal Steering Committee overseen by Brown and Lapriore. Justine Porter, TDC’s Director of Advisory Services, and David Zuckerman, Director of Healthcare Engagement and the Healthcare Anchor Network at TDC, collaborated with UMMHC and the Harvard fellows to frame this committee’s work and design a participatory process to help launch it, culminating in an offsite half-day retreat. At this retreat, TDC helped UMMHC better understand best practices around Anchor Mission implementation and evaluate and prioritize a range of initial projects. Afterwards, Brown remarked “I do not recall the last time we witnessed as much excitement and engagement from our executives as we did today.”
The three projects approved by the Steering Committee—and later unanimously approved by the Board of Directors—were to:
1. Allocate 1% of their investment portfolio to targeted community investments with an expected return.
2. Provide targeted technical training for entry-level positions for current and prospective employees. The trainees would be from targeted neighborhoods.
3. Build a system for local purchasing and aid local organizations to increase their supply capacity.
The Harvard case study concludes with Dickson and Brown’s appreciation and surprise at the speed at which internal stakeholders have collectively aligned around a shared vision of what UMMHC’s Anchor Mission can be, and their reflections on the challenges to be overcome as implementation of this vision continues.
The Democracy Collaborative (TDC) can facilitate a variety of workshops to activate your Anchor Mission strategy and deepen your institution’s capacity to build community wealth. Connect with Justine Porter, Director of Advisory Services, at firstname.lastname@example.org for more information about how we can support your institution.