Pulse
In Their Backyard
Allina set out to help its neighbors improve their health. Now, it’s helping its neighbors help themselves.
When Dick Pettingill came to Allina Hospitals and Clinics more than six years ago from Kaiser Permanente in California, he literally could see disparities in health care from his office window. From Allina’s corporate headquarters, he could glimpse the high-tech Abbott Northwestern Hospital and easily walk to the renowned Children’s Hospital of Minnesota and the eminent Phillips Eye Institute. At the same time, the Allina president and CEO could see neighborhood residents who appeared to be impoverished and looked as if they weren’t getting health care or much-needed social services.
In the fall of 2007, Pettingill heard a bold suggestion. At the end of a long meeting on not-for-profit, tax-exempt hospitals that included discussion of topics ranging from charity care to community benefit, he was challenged “to think more broadly and more thoughtfully about what it means to be a leader in improving the health and well-being of people beyond the walls of the institution,” he recalls.
Pettingill thought about the residents of the neighborhood surrounding his office, many of whom are immigrants and poor, and took the challenge to heart. Last spring, Allina, whose network of 11 hospitals and 65 clinics extends throughout Minnesota and western Wisconsin, established the Center for Healthcare Innovation, kicking in $50 million and making a commitment to raise a matching amount from individual donors, corporations, and granting agencies. The center’s mission is to create and study new models of care, particularly addressing economic and lifestyle deterrents to good health.
Although it may seem unusual for a hospital and clinic system to think about tackling social issues like poverty and joblessness, the notion that health institutions ought to address such problems undoubtedly is ripe for its time. In 2008, the World Health Organization’s Commission on Social Determinants of Health concluded that there are “glaring defects in human society” that cause and perpetuate disease. More and more these days, groups across the country are beginning to think about how to affect the health of entire communities.
Allina’s center embarked recently on two heady initiatives in two distinct Minnesota communities, the urban area in the shadow of its headquarters and a small town southwest of the Twin Cities. But what Allina leaders quickly learned is that changing health on a large scale requires more than a plan—it requires buy-in from the residents of those communities.
Close to Home
One of the first programs proposed by the center was the Backyard Initiative, which addresses the needs of people living within a mile of Allina’s corporate offices. In two of the surrounding neighborhoods—Phillips and Powderhorn Park—nearly 44 percent of residents are poor, the high school graduation rate is 64 percent, and the unemployment rate is nearly twice that of the state, according to University of Minnesota epidemiological studies. Health problems such as obesity, diabetes, and childhood asthma loom far above the state average. The issues are “concerning,” Pettingill says.
But when community leaders heard that Allina was interested in improving the health of residents, some were skeptical. Founder and executive director of the Cultural Wellness Center, Atum Azzahir, acknowledges her initial reaction to the Backyard Initiative was “a little bit reserved.” Her 15-year-old community-based organization draws area residents for cooking and nutrition classes, prenatal health workshops, and cancer support groups. She was concerned that Allina’s program “was going to be top down” and wasn’t going to come to what people she works with call “the ground.”
However, Allina leaders met repeatedly with Azzahir and others from the surrounding neighborhoods. They asked residents about their health needs and how they defined “health” in the first place. Azzahir was won over and, along with her board of directors and other activists in the community, wanted to help steer the initiative.
What has evolved, to the satisfaction of Azzahir, is a program that’s being tailored to the community by the community. Allina’s Anna Thompson serves as the program’s director, coordinating the involvement of local organizations and initiating conversations with community members who would like a say in the types of issues addressed. “We really want the ideas to grow out of the residents,” Thompson says, noting that health concerns she’s heard have ranged from how to find a doctor to having safe places for kids to run around.
As an early step to gauge some of the health needs of community members, staff from the Phillips Eye Institute conducted vision screenings for school children and found 20 percent of the kids tested needed corrective lenses. Residents are now working with community organizations to come up with ways to provide eyeglasses to kids who need them.
Additional plans are on the table for improving early childhood education. They include establishing a rating system for childcare centers in the area and having educators visit families in their homes to teach them stimulating activities for babies and toddlers.
Ultimately, Allina may help residents better utilize services that already exist and find partners to implement new ones. Recently, Allina invited Fairview Health Services, Children’s Hospitals and Clinics of Minnesota, and Hennepin County Medical Center to get involved in the Backyard. “We don’t see improving health as a competitive thing,” Thompson says.
Heart of the Heartland
About 100 miles southwest of Minneapolis, in New Ulm, community members have responded enthusiastically to Allina’s invitation to participate in an initiative to eliminate heart attacks in 10 years. The town of 15,000 offered a good proving ground for research and subsequent prevention programs because more than 90 percent of its residents are patients of Allina clinics and physicians, explains Pettingill. “They’re all in our very sophisticated clinical information system that we’ve implemented over the past five years.”
In partnership with the Minneapolis Heart Institute Foundation, Allina initiated the program, called the Heart of New Ulm. The initial plan is to establish a cardiac profile of the entire community. Patients will have to agree to have their records be included in the study, which will track the occurrence of conditions such as hypertension and congestive heart failure and associated risk factors. The data will help to delineate subgroups of the population with cardiac problems and then guide plans for clinical interventions. Ultimately, Pettingill says, they want to be able to keep people who are at risk for or have early-stage disease in compliance with preventive measures in order to keep them as healthy as possible.
As it initiated the New Ulm program, Allina established a community advisory committee that included everyone from physicians to chamber of commerce leaders. “Part of the trick is to get business leaders, teachers, clergy, regular folks, and restaurant owners involved,” says David Kanihan of Allina’s communications office, noting that those members not only steered the program but fueled others’ enthusiasm. When the program launched in September 2008, Allina leaders expected 200 New Ulm residents to show up for a community meeting and were astounded when 450 came to voice their support for the effort and find out how their organizations, schools, and church groups could get involved. “People are really excited about this,” Pettingill says. Residents are beginning to sign up (or opt out) of the research stage of the community risk assessment.
Allina will continue working with New Ulm residents after the cardiac profile is established to design education, nutrition, and exercise programs aimed at helping reduce their risk for heart disease. Having the residents themselves formulate plans may lead to a wide range of cultural changes from encouragement at church to get more exercise to greater transparency in nutritional information provided by restaurants.
“This isn’t about Allina or the Minneapolis Heart Institute Foundation coming to rescue the New Ulm community,” Pettingill says. “This is about being in a partnership with the community where they have as much ownership in the design and the direction of this as we do.”—Kate Ledger