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Scott Webb (Host): Today, we're going to learn about Emerson Hospital's Community Health Needs Assessment, or CHNA, how the data was collected. And most importantly, how Emerson plans on addressing community needs and concerns. And joining me today are Christine Gallery. She's a Senior Vice-President Planning and Chief Strategy Officer for Emerson Hospital and Kelsey Magnuson, she's a Community Benefits and Events Manager for Emerson Hospital. This is The Health Works Here podcast from Emerson Hospital. I'm Scott Webb. So, first off I want to thank you both for joining me today. We're going to learn about the Community Health Needs Assessment. Sometimes abbreviated as CHNA and Christine, I'll get started with you here. So let's talk about some of the main findings, the key focus areas. And were you surprised by the results?

Christine: Yeah, I don't think we were surprised because many of the themes carried forward from years past. And then certainly in the case of mental health, I think in light of, you know, what we've all been through for the Almost past two years with COVID and the pandemic, certainly we are all very aware that mental health is an issue, really across all age groups.

So not surprised, but I think that the process that we went through, in terms of prioritization was really important because we wanted to make sure that we could go deep in each area. So if we chose 10 priorities, for instance, we knew that we just didn't have enough bandwidth or resources to make an impact. So better to choose fewer priority areas where we thought we could really move the needle and have an impact. So, we were very pleased with the process that we went through, and again, the collaboration that we received with the 21 people on our committee, most of whom were doing it on a volunteer basis, which, which was amazing, and then having the 3,500 responses to the survey, which, in all of my years at Emerson, is just really the most engaged we've ever had the community.

So, really a rigorous process. And I feel good about the four priority areas. So in terms of mental health, that really came up the most often among the interviewees, the focus groups, as well as the survey, as a top health issue, it was, you know, number one or two across all people who responded to the surveys and in all the focus groups.

And this is mental health across not just the aging population. Not just among youth and teens, but this really cut across all members of our community, regardless of income level, regardless of race or ethnic groups. This is something that's really top of mind obviously always been important and even more of an acute issue over the past couple of years. The next area and transportation, that's actually something that we focused on in the past three years, it's something that really rose to the top. This is a real struggle in the areas that the towns that we serve, because there are not a lot of public transportation options. And as we know, transportation is a social determinant of health, so it impacts people's ability to access employment, food, getting to medical appointments, getting to pharmacies to fill prescriptions. Most of the respondents, the interviewees and the survey respondents said, you know, there's really not a lot of options if you don't own your own car or have the ability to drive your own car, there's not a lot of options to get around these towns. And even though some towns and some social agencies, some councils on aging have tried to create systems, for their communities or for their target population, like the elderly, they've run into some significant limitations, like, funding, like geographic perimeters or just not being able to use a van that's being paid for in one town to go sort of outside of those town limits and getting to another town. So there's limited usability. And that obviously was also impacted by the pandemic because people are more hesitant to get onto a van or a bus. Or even public transportation, right. Because of their concerns about transmissibility of the virus. So that sort of put another barrier up, right, in terms of trying to make transportation options more widely accessible. But we do know how much it impacts, you know, somebody's health outcomes, particularly getting to appointments, filling your prescriptions.

So, we want to keep transportation front and center. So that's definitely one of our priority areas. And then I'll turn it over to Kelsey to talk about the other areas.

Kelsey: So the next key priority is the aging population and our region has a high number of older adults compared to the state and even the county level. So aging health concerns, were among the top five health concerns from survey respondents. Some people said for themselves, as well as the community. And they also, survey respondents said that increasing the number of services to help elderly stay in their home and expanding the health and medical services focused on seniors were top priorities.

So when we broke down and said, what areas do survey respondents want us to focus on? This was, you know, top of mind, for respondents. And then, the next priority area is economic insecurity. And what we mean by that is we're looking mostly at food insecurity, but also looking at housing and financial security.

And these came up as top social issues among survey respondents. There's a growing need for food resources, especially over the past year or two, throughout COVID many of our community partners who provide food to the community, saw increasing numbers and in our youth risk behavior survey, which also tied into our needs assessment, we saw a strong association between food insecurity and risky behaviors among youth.

And that was the first time that we had really tried to measure food insecurity among our youth respondents. And it was fascinating to see that correlation and just see what we could learn from students who may be struggling with food insecurity and how people could use it to address other risky behaviors.

And then lastly, as we said, an overarching theme of all of these is the systemic racism, racial injustices, and discrimination. Nearly all of the interviewees, and even the focus groups brought up issues around racism and discrimination that they had experienced themselves or witnessed in their communities, and individuals and focus group participants reported instances of racial slurs and an insignia being used and directed at people of color and the Jewish population in our community. And we know how race has an impact on health outcomes. And so in our communities, we want to be aware of that and look to see how as a community partner, we can make a difference in this area and being aware of those differences.

Christine: One of the other interesting things about this theme, this is overarching theme is that people mentioned discrimination based on age, based on gender, based on ability. So it's not its own, priority area, but we felt like it really cut across all of the other priority areas that we're talking about. So it's sort of a circle around all four of them. And it's something that we really want to try to keep front and center as we're thinking about solutions in the other four priority areas.

Scott Webb (Host): So what is Emerson Hospital's Community Health Needs Assessment, or CHNA?

Christine Gallery, JD (Guest): So, to explain the community health needs assessment,

I have to first explain what our community benefits program is. Because the community health needs assessment is part of our community benefits program. So all nonprofit hospitals in Massachusetts and probably across the country, are required to undertake what we call community benefits.

And a very simple definition of community benefits are activities that we undertake to improve the health status of the communities we serve that are unreimbursed. So, nothing that we charge for it, nothing that we bill insurance for, but we do them because it's part of our mission and part of our ability to improve the health and wellbeing of the residents in our region.

A key tenant of our community benefits program is collaboration and collaborating with our community partners. So, it's improving their health status. It's educating people in prevention, wellness, self-care, and also really trying to dig deep, to look at the root causes of health disparities in outcomes.

We have to, according to our attorney general, undertake a community health needs assessment every three years. And we very much agree that this is a great thing to do. Community health needs assessment is exactly what it says. It's a planning process that helps you identify where there are gaps and needs in the health of the community.

So we may be sort of knocking it out of the park in certain areas, but there may be areas where there are real gaps or there may be target, residents or certain groups of residents that may be overlooked, in terms of addressing their health needs. So, a community health needs assessment is a planning process done collaboratively with our community partners to identify health and wellness related needs and strengths of our region. Once we understand, where the health needsare and where the gaps may be, then that really informs what our community benefits program is going to be and where we're going to be spending our community benefits dollars over the next three years.

And this really creates a foundation for what we call our strategic implementation plan. And that plan is very detailed. It outlines what are the major health priorities. What are the goals and strategies under each of those priorities? How are we going to measure our success? And who are we going to collaborate with? Who are our partners that we're going to work with to address these priority areas? So that's what a community health needs assessment is Scott.

Host: Yeah, and Kelsey, when we think about all of this and the collaborative nature and spirit of this and putting together the plan, how is the CHNA conducted?

Kelsey Magnuson, MPH (Guest): Yeah Our methods include a combination of quantitative and qualitative data collection. And as we keep saying, it was an extremely collaborative process. So first, we collected econdary health data that was gathered to understand many different health outcomes, birth rates, what are the major health issues in our community?

And we used state and local data on that. And then we also administered a community health survey, to the community residents and providers. And we received over 3,500 responses, which was huge. And we were so thankful for everyone who participated in the survey. We asked respondents to identify health concerns as well as social concerns, because we know that, social determinants of health, things like housing, transportation, education, all impact our health. And the survey itself separated out responses for individual's own families and themselves, as well as what they thought of the community. And we then asked respondents to rank issues in the order of importance and what they wanted to see addressed in the community.

And this whole survey process really was a key informant process for our needs assessment. The qualitative data collection included 10 key informant interviews and four focus groups, again, that collaborative process. So we engaged community members and leaders across many different sectors, to understand these health and social issues. In the focus groups, we looked at older adults, caregivers, teens, and general community members, and these focus groups and interviews dove deeper into community experiences and how these various groups are affected by issues. We then had a work group of 21 people that was made up of Emerson employees, board members, and community members, who participated in the prioritization and strategic planning process. So all of the data was compiled and this group narrowed down the focus into four key priority issues, which we're going to talk about. And those are mental health, transportation, the aging population, and economic insecurity, and then overarching all of these issues is the theme of systemic racism, racial injustice and discrimination.

And that work group was split up into these work groups, looking at each priority to guide the strategic implementation plan.

Host: Yeah, and Kelsey, when we think about the solutions what are some of the ways Emerson is planning to address these areas for community health?

Kelsey: We use our strategic implementation plan, which Christine mentioned, and it is our three-year plan to both identify these health issues. That's the first part of it. And then how we can address them. So it focuses on developing goals and measurable objectives, and selecting strategies, developing performance measures. It really lays everything out. Who we can be working with and collaborations is a huge aspect of addressing all of these. We know that we cannot do it on our own. So we must work with different community partners. And we really want to focus on strengthening our current partnerships as well as building new partnerships to identify who in our area has needs and how we can connect them to the existing resources. So many times there are existing resources in our community, and it's just identifying and connecting people to those services and resources. So, we want to really further understand barriers and break those down, and connect people to the services that can help to improve these various issues.

And we also hope to reduce stigma, specifically around mental health and food insecurity. We've heard over and over that stigma can prevent people from reaching out to accessing the services that exist in our communities, as well as, being aware of what can help them improve their health. And we also plan to continue grant programming and supporting various initiatives in improving overall health. A full detailed description of the plan can be found on our website. And that website is Emersonhospital.org/chna.

Christine: And just a couple of things to emphasize, you know, we talked about how important collaboration is and as Kelsey said, you know there are a lot of great resources that already exist out there. And sometimes it's just a matter of making people aware of the resources and making that connection. We know that Emerson cannot solve all these issues on our own. So we need community partners to do this. And sometimes it's just a matter of a lot of our first steps in our strategic implementation is doing a gap analysis or we're trying to do an assessment of what services exist out there. And I think there's going to be a lot of sort of aha moments for all of us saying, gee, I didn't know that this agency was doing this with food donations or whatever it might be.

So, a lot of our work to start, is going to be uncovering what's out there and then saying, okay, how can we bring this together? How can we make people aware of the resources that already exist and how can we make the connections? Not everything has to be built from the ground up or be brand new. So we do understand that there are some great assets out there that we just have to discover and connect.

And just another comment about the stigma issue. I think, if we can say silver lining of COVID, I'm not sure we can, but I think that because so many people have been affected with their mental health, a lot more people are talking about it and saying, yeah, I'm really struggling. And I think it's brought some of that stigma and those barriers down. So that's a good thing, and while people are opening up and having those conversations, we want to kind of get in there and really help folks connect to resources to help for sure.

Host: Yeah, it does seem like the perfect time as you say. And I think it's appropriate to say silver lining. I know it's hard to think of it in those terms, in the middle of a global pandemic, but you're right. We are talking more about mental health, which is a good thing. And we've also learned how to communicate electronically like we are today, certainly, but also through Zoom and Telemedicine and virtual visits.

And as you said, earlier, when you were talking about the key focus areas, it's really about, you know, removing the barriers, figuring out what the barriers are, and then trying to tear them down. And one of them, as you said, is about transportation and access and all of that. So good that we're doing virtual visits and Telemedicine. And as we wrap up here, Christine, this has been really enlightening, really fascinating. Are there ways that members of the community average, you know, members of the community can get involved to help with some of these projects?

Christine: Yeah, we always welcome community involvement. We have many members of the community on our community benefits committee. So, it's a formal committee of our board. And we very thoughtfully and deliberately really try to involve community members that are representative of some of our key focus areas or our target residents. So, people that work in the schools, people that work with the Councils on Aging, people who are town administrators dealing with housing or with transportation. So we really always try to think of who can we put on the committee that represents the voice of the community and in some of these target areas. They're sort of the content experts, right? We really rely on that. And then certainly in terms of community organizations, and agencies, schools, you know, again, we really do encourage them to use the findings of our community health needs assessment. Kelsey mentioned how you can access it.

There's a lot of rich data, particularly from that survey, that could be very interesting to others. And we've made that available. So they can use that data as they're thinking about their own agency or their own planning. And we also want them to look at our grant programming, that, you know, more information will be coming out in January about that. But if they can tap into some of the dollars that we grant every year and use that to advance their own services, you know, we think that's terrific. So yeah, we always welcome community involvement for sure.

Host: That's great to hear. As I said, this has been really enlightening. And one of my key takeaways today is really going to be just the collaborative spirit, the collaborative nature, you know, tearing down the barriers, really working with the community, both partners and community members and, you know, just trying to get this right, which is great.

So again, that's an Emersonhospital.org/chna. And thank you both for being here. Both stay well.

Christine: Thanks so much, Scott. We appreciate it.

Kelsey: Thanks so much.

Host: Visit Emersonhospital.org/chna for more information and thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb and make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple, Google, Spotify, or wherever podcasts can be heard.