Community Voices are the Key to Advancing Health Care Reform

Pamela Brier is former Chief Executive Officer and President of Maimonides Medical Center and a new Senior Fellow in Residence at the Academy.

As the CEO of three hospitals over more than 25 years, and most recently, at Maimonides Medical Center, a big teaching hospital in Brooklyn serving more Medicaid patients than any other hospital in the borough, I tried to keep in mind a few core principles to create a high-quality, safe, humane and financially stable hospital, with good clinical outcomes and satisfied patients and staff. 

That's an omnibus, overarching set of goals, to be sure, but no different from what other hospitals aspire to. For me, a high quality hospital requires a culture of respect and teamwork, and it also rests on the assumption that it's important to listen to the voices of our employees as well as those of our patients, their families and other community members.

For more than a decade, I focused on finding ways to do that, but we didn't truly figure out how to tap community views in an organized and effective way until we began working with The New York Academy of Medicine on our first Community Health Needs Assessment (CHNA) and public deliberation program.

To help lead New York into the future for health care reform, while achieving the Triple Aim: improving health and providing better care, while lowering costs, the Academy’s  approach is to bring the voices and views of community members to policy makers and health providers throughout the city.

Learning from the ACA

Until the enactment of the Affordable Care Act (ACA), which requires that all nonprofit hospitals complete a community health needs assessment every three years, the conversation among health providers and those running hospital systems seldom included the community.   

I've heard other senior hospital executives disparage efforts to engage community participation by saying: "I'm an expert in my field." or "I'm a doctor or a planner and I know what this community needs. It's a mistake to solicit community views because people want everything, and that's not affordable."

Recognizing the importance of engaging community members, the Academy uses the CHNA and public deliberation process as tools give health care administrators and providers an effective way to insure that patients, their families and other community members can participate in improving health care delivery in and outside the hospital.

Extending our Reach

Maimonides serves one of the most racially and ethnically diverse communities in the city, with significant numbers of Orthodox and Hasidic Jewish, Italian, Latino, Chinese, Russian, Ukrainian, West Indian, Arab and South Asian residents. It's a community with a high number of limited English speakers, families living in poverty and uninsured people, compared to NYC overall. There are also many community-based organizations. Over the years, we actively worked to learn more from our patients and their families. 

We publically let people know that we were interested in hearing about bad hospital experiences. We worked to resolve these issues and share the information.

We also held seminars and social events. Once or twice a year, we’d also host a meeting of our Council of Community Organizations [COCO], a group of nearly 100 community members and leaders. It was at a COCO meeting four years ago that we announced that we were going to work with  the Academy on a special program to help us better understand the health needs of the community.

Over almost a year, we conducted interviews with community stakeholders and focus groups with residents representing a range of groups. Based on what we heard from our sources and the reactions to that information from members of our Brooklyn Health home and other Maimonides health partners, we decided to focus on three priorities: preventing chronic diseases; promoting healthy women, infants and children, and promoting mental health and preventing substance abuse.

Now, if I had been asked, without listening to our community, I don't believe that I would or could have selected those three priorities. The CHNA was an absolutely invaluable tool in helping us understand the importance of these three areas to community members.

Because of the CHNA information and process, we selected our major focus areas for the next few years and engaged community members as active supporters and hopefully users of our services. Eventually, the report was used to develop a successful, strategic trajectory for Maimonides.  

The public deliberation sessions that began in 2015, will expand the community engagement component of the CHNA. That information will help the hospital identify preferred approaches to preventing chronic disease, targeting populations with pressing needs.

Joining the Academy as a visiting Senior Fellow, after my previous role as a leader in the health and hospital environment, gives me a wonderful opportunity to encourage other providers to learn from the richness and depth of community voices—and conversely, to learn why more community members opt to go elsewhere for their care. Ultimately, the power of community-informed care management can be measured in hugely-reduced hospital admissions and ER visits, providers who have closer relationships with their patients, and enhanced community wellbeing.