In order for health systems to take up community investment as a way to fulfill their mission of promoting health, senior health system leaders need to make visible commitments and follow through by dedicating appropriate resources and staff and engaging partners. This lesson is one of the most important that CCI learned from our research and our recently-concluded Accelerating Investments for Healthy Communities (AIHC) initiative. In 2020 and 2021, CCI conducted interviews with three dozen hospitals and health plans engaged in community investment. One of the persistent findings was how often hospital investments are driven by chief executives energized by the idea of improving health and reducing health care costs in a manner that promises both strong outcomes and financial sustainability.
Engaged CEOs motivate their staff and hold them accountable. They draw from community data to identify hospital priorities. They support and foster the internal and external collaborations upon which successful community investment depends. And they authorize the deployment of diverse health system assets—including investment capital, land, balance sheet, influence, and relationships—which they understand are needed to address issues like affordable housing in a systemic way.
The importance of committed leadership was underscored on May 26, 2021 at CCI’s virtual roundtable, Investing Upstream for Community Health Equity: Lessons from CEOs, which was attended by CEOs, board members, and other leaders from 28 health institutions across the nation. Rich Besser, CEO of the Robert Wood Johnson Foundation, which funded AIHC, opened the event. Following his introduction, leaders of two health systems that participated in AIHC, Tim Robinson, CEO of Nationwide Children’s Hospital (NCH), and Kate Walsh, CEO of Boston Medical Center (BMC), shared their experiences and insights.
Robinson and Walsh both emphasized the centrality of community partnerships to successful investment efforts. When BMC’s campus expansion triggered the Massachusetts Determination of Need provision, Walsh said, “we announced that we were investing our entire $6.5 million obligation in affordable housing partnerships with the goal of improving community health and patient outcomes and reducing medical costs.” She added, “Partnership is the key. Across all [our] partnerships, we have catalyzed funding for over 1000 affordable housing units in the Roxbury and Dorchester neighborhoods. That success inspired Boston Children’s Hospital to make a similar investment to focus on upstream policy to preserve, protect, and make affordable housing.”
Robinson confirmed this fundamental principle. “Partnerships are imperative,” he said. “We have a faith-based group working in the community and they have tremendous knowledge. We also have a land bank in the community. We do this work WITH the community and they need to lead the charge.” Being proactive and action-oriented are key to successful partnering. As Robinson explained, “We are trusted partners because we have stepped forward. We advocate from a position of solutions, and it makes relationships work.”
Flexibility and creativity, which often come hand in hand, are also critical to success. Robinson’s account of NCH’s investments revealed how they used creative financial strategies to unlock investment from others: “You can leverage your resources in this work. We committed a few million to this effort in 2008, and we leveraged stimulus dollars and a land bank to acquire properties. As we grew, we developed a stack of low interest loans set on top of equity from the city and a guarantee from Nationwide Children’s Hospital. [This added up to] a $20 million investment.”
NCH also responded strategically to shifting conditions on the ground, while keeping a sharp focus on their priorities. “We had success as we made improvements,” said Robinson. “[The neighborhood] had private investors coming in and gentrification happened, so we pivoted to affordable rentals. We had a goal of keeping [at least]15% to make sure that, no matter what, we have affordability and a balanced neighborhood.”
Walsh noted how important it is to “understand that the work evolves and always work to address the community needs.” The COVID-19 pandemic was the greatest challenge AIHC participants faced, but it also reminded them—and the world—of the importance of their work. “Covid illuminated how much farther we have to go and it illuminated the role equity plays. Covid doubled our commitment to our communities, [for] it showed how impacted certain populations were.”
Finally, both leaders emphasized the importance of ongoing board engagement. Executives and staff can help board members understand how community investment connects to mission and to see the difference it makes. “Our focus on wellness for children set the stage and helped create the culture for the board to consider this,” said Robinson. “During one of our board meetings, we took a tour of the areas [where we are investing in housing] and they were overwhelmed around the impact.” Walsh underscored the importance of responsiveness and flexibility with the board as well as other aspects of the work: “Keep your board involved so they are with you on the journey. Continuous communication with the board is important because the story is changing over time.”
At the end of the event, Besser noted that “health is about more than just high quality health care.” Embarking on community investment changes hospitals as much as communities. As Robinson put it, “This is part of a culture shift and has become part of the hospital’s DNA.” As the health care sector makes this shift, visionary executives like Robinson, Walsh, and the leaders of our other AIHC hospitals and health systems are leading the way.