Denver Health Medical Center (DHMC) was recently ranked among the top 10 socially responsible hospitals in the country by Lone Institute. DHMC received top A grades across the board for equity, value, results and overall social responsibility. Dr. Wittenstein, who will step down from her role as CEO and retire this summer, talks with us about her work and the legacy she is leaving at the Denver Health Foundation.
Status of the reform: What does the national distinction of being socially responsible for your organization mean?
Dr. Robin Wittenstein: “Being named one of the most socially responsible hospitals is a great honor. What’s really important is that this work is at the heart of Denver Health’s mission and has been since the beginning. Indeed, it is becoming more important now that the problems of inequality and inequality [and] economic hardship affects our patients so deeply in our communities.
By having the Lown Institute do the analysis and help foster conversations about what it means to be socially responsible, [and] identifying organizations that provide good medical care but really work to address the broad factors that affect health outcomes, that’s really a game changer and I think for us it’s important. Again, it’s great to be recognized, but it’s even more important to know that this is work we’ve been doing all along and to help others join that conversation.”
SOR: How does Denver Health commit to this social responsibility?
RW: “Denver Health focuses on key elements that the Lown Institute addresses in its measures of social responsibility. Things like patient outcomes as measured by readmissions, mortality rates, or some of the specific CMS and patient satisfaction measures. They have been and will remain a core part of both our strategy and our day-to-day work. And that’s especially important for an organization like Denver Health, a safety net that treats a mostly vulnerable population. This vulnerability is both clinically, whether due to lack of insurance or access, chronic illness, stress, but also economically vulnerable.
Excluding our own employees, 85% of patients are either uninsured on Medicaid or on Medicare, with the majority on Medicaid. It is critical to make sure we provide integrated care, especially with great primary care where physical, behavioral and oral health needs are met. We keep our costs as low as possible to make sure patients can afford to receive care. I really focus on making sure that patients get what they need, when they need it in the right setting and no more than that. These are all critical aspects of who we are. It’s part of our DNA.
But we’ve also really tried to focus our time, energy and resources on activities that benefit the community. Not health fairs and things like that, but providing the right support services, most of the time in partnership with other community organizations because they have the expertise, but really dealing with social and economic risk factors that affect health so significantly. This is indeed a commitment that the organization has had for decades.
Over the past three years, we have been particularly committed to addressing the economic challenges facing our patients and our communities. This became even more evident during the COVID outbreak. As part of that, we created the Center for Equity, Diversity and Opportunity, which really takes all the work we’ve done as a flagship institution and organizes it around hiring and advancing employees so they can earn a living to care for their families. And that’s through our Workforce Development Center.
… We started with a workforce development center that brings together many services to help our lowest paid employees have a career path in front of them and have social and economic support services around them. All from a partnership with Operation Hope, a national nonprofit financial literacy training organization for one-on-one counseling for employees. How do you improve your credit score? How do you reduce your debt or save effectively for home ownership? We partnered with Mile High United Way to look at what services are available in the community that we can connect our employees with. It helps reduce the cost of living for them.
SOR: Could you highlight some of Denver Health’s work to address health equity and access?
RW: “We’ve done things like partner with the Denver Housing Authority to put telehealth capabilities in their buildings. We have a pilot [program] it’s going on now where we’ve set up a telemedicine suite and we’re going in and doing training for the people living in the building and the complex around it on things like blood pressure monitoring and so on. We give people Bluetooth blood pressure monitors whether they are our patients or not. We can then arrange telemedicine visits; we have a medical assistant there who can help with that.
We have new mobile health vans which during COVID have been incredibly important for testing and vaccination. But they are full-scope primary care clinics and they can visit churches, synagogues, temples, recreation centers and public libraries and meet people where they are, including people who are homeless, so we go to many shelters.
The other thing is that we really look at data as a way of understanding. We talk about health care disparities and disparities all the time, but you really have good data to understand what’s going on in your own community. We just completed a year-long program called REAL, which is a race ethnicity and language, national program designed to improve patient data collection.
People are sometimes reluctant to provide information, but if you can explain to them why you need the information, what its applications will be to drive improvements, we’ve found that people immediately provide the information. It really gives us a chance to understand at some granular level where there really are differences and why they are there. What’s important here is not just having the data, but then being able to work with patient advocacy groups or community groups to say we’re seeing a difference here.
The last thing we did [and] I’m really proud of that, the focus on increasing the diversity of the staff and faculty. There is a lot of evidence that when patients interact with people who look like them, they are more likely to open up and be honest about their condition, their concerns, etc. So we really focus on that. We are a safety net; we care for a wide variety of patients. And if we can increase the diversity of people caring for patients, we will improve care from the ground up.
SOR: Where is the organization’s focus right now at this critical time? And what are his immediate needs?
RW: The immediate focus is actually on addressing the economic challenges that people face that have affected their health… What are the things that lead to poverty? And what can we do, person by person, family by family, to deal with it? So a lot of our work right now is to better understand what’s driving the problems, what’s driving the underlying social and economic risk factors, and then [asking]“How to solve them for [a given] person?’
If we can break the cycle of poverty for one family, we’re not just affecting that family now, but generations to come, so a lot of our focus is on people who want and need support and help that we can we help. So we’re partnering with pretty much anyone and everyone who will partner with us to solve this because we can’t do this alone. Being that super safety net and helping educate federal and state legislators about [poverty] and we say we can do this.
We are committed to doing this, but need some help given the realities of funding federal and state programs. This is a real need. For the past three years, I have been leading a group working on defining institutions like ours. I think there are about 100 [institutions] or so around the country. It’s something that, again, you’re not going to find a group of people who are more willing to put their hands up and say, “We want to solve these problems, and what we need are partners who can help us do that. ”
Organizational ego has no place in this job. It’s about the people who live in our communities who need a hand up. And honestly, it could be any of us if something went wrong, if we made a different decision along the way. We want to help our communities and we want people to help us do it.
What we need is to find the right partners to help us advance this work because we are in a unique position. No other organization in the city or county of Denver touches this group of patients, this group of people, the way Denver Health does. [We are] constantly in touch with the driving change. So we’re looking for partners to help us do that.”
This interview has been edited for clarity and length.