[Adapted from: Simendinger, E. (2003). In Search of a Course Design and Teaching Methods to Improve Critical Thinking. Journal of Health Administration Education, 20(3), 197-213.] See attachments
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22
Evolution of the Healthy Communities Initiatives
Barry Ross
St. Jude Medical Center, Fullerton, CA
CASE HISTORY/BACKGROUND
Barry Ross has served as vice president, Healthy Communities, at St. Jude Medical
Center (St. Jude) for the last 15 years. His role has been to provide leadership to
implement two key parts of St. Jude’s vision—promote health improvement and create
healthy communities. While many not-for-profit hospitals have a manager to oversee
their community benefits efforts, St. Jude is somewhat unique in having this position at
the executive team level. Over the last 15 years, Ross has been instrumental in forming or
building the capacity of four community collaboratives that partner with St. Jude to create
healthy communities. He recognizes that to increase effectiveness of the collaboratives on
the health and quality of life in the region served by St. Jude they must have a greater
collective impact.
As part of the hospital’s strategic review of programs and their effectiveness, St.
Jude’s community benefits committee asked Ross to respond to the following questions:
1. What are the strengths and weaknesses of our efforts to date?
2. How might the effectiveness of our programs be improved?
3. Within existing resources, what changes might provide a greater impact on
improving community health status?
ST. JUDE MEDICAL CENTER
To provide a context to the community health initiatives undertaken by St. Jude, it is
important to understand how the values of its founders, the Sisters of St. Joseph, have
influenced the hospital’s approach and emphasis on serving the community. The Order of
the Sisters of St. Joseph was founded in 1650 in southern France by a Jesuit priest who
asked them to go into the community, find problems of concern, and work with the
people to solve those problems. Initially, the Sisters of St. Joseph helped the poor and
sick in their homes. Over the years they expanded throughout France and arrived in the
United States in 1836 (Sisters of St. Joseph of Orange, 2015).
In 1912, the Bishop of Sacramento invited a group of sisters from LaGrange, Illinois,
to establish a school in Eureka, California. In response to the Spanish flu epidemic of
1918 the sisters provided basic healthcare. This led to establishment of their first hospital
in California, which further expanded their role in healthcare. In 1922, the sisters
determined they could pursue their ministries more effectively by moving the
motherhouse to Orange, California. The first ministries of the Sisters of St. Joseph of
Orange were in education and healthcare. Today, the congregation engages in ministries
beyond healthcare and education: distributing food, providing shelter for the homeless,
helping new immigrants, and fostering spiritual development (Sisters of St. Joseph of
Orange, 2015).
St. Jude Medical Center, founded in 1957 by the Sisters of St. Joseph of Orange, is
one of 14 hospitals in St. Joseph Health (St. Jude Medical Center, 2015). The mission of
the St. Jude Medical Center is to bring the healing ministry of Jesus in the tradition of the
Sisters of St. Joseph and improve the health and quality of life in the communities it
serves. This mission is emphasized by the vision of the organization; vision that brings
people together to provide compassionate care, promote health, and create healthy
communities. The values of dignity, service, justice, and excellence are achieved through
centers of excellence in cardiology, stroke, oncology, orthopedics, rehabilitation, and
perinatal services. St. Jude is a 320-bed community hospital with over 13,000 inpatient
admissions and over 450,000 outpatient visits. Its annual budget is more than
$466,000,000 (St. Jude Medical Center, 2015).
THE COMMUNITIES SERVED BY ST. JUDE MEDICAL CENTER
The focus of St. Jude’s community benefits activities is primarily in low-income
neighborhoods in four California cities—Fullerton, La Habra, Buena Park, Placentia—as
well as the broader communities in Brea and Yorba Linda. These cities have a population
over 443,000 and have pockets of wealth and poverty. The cities are home to thousands
of undocumented immigrants from Mexico and Latin America who struggle with daily
needs. The cities have various community assets: St. Jude, several colleges, strong notfor-profit organizations, service clubs, and chambers of commerce. While considered a
part of suburban Orange County, each city has a history and infrastructure that are at least
100 years old. Table 22.1 provides an overview of the demographics of the St. Jude
community benefits service area.
Table 22.1. Service area demographics—20XX
Figure 22.1 identifies community needs by zip code using an index developed by
Dignity Health and Solucient, a healthcare information content company. The index
aggregates five socioeconomic indicators: income, primary language, education,
insurance status, and housing situation rated on a scale of 1 (low need) to 5 (high need).
Figure 22.1. Highest-need areas in the service area (1 = lowest need; 5 = highest need).
ST. JUDE MEDICAL CENTER COMMUNITY BENEFITS EFFORTS
Consistent with the mission, vision, and values of the Sisters of St. Joseph of Orange, St.
Jude’s community benefits program focuses on meeting needs of the community.
Initially, St. Jude’s community benefits program was the responsibility of the director of
outreach whose primary role was to manage the medical center’s mobile health clinic
program. After St. Joseph Health revised its vision to incorporate promoting health
improvement and creating healthy communities, St. Jude expanded its definition of
community outreach.
When Ross became responsible for overseeing the St. Jude Community Benefits
Program he embraced the vision developed by the Sisters of St. Joseph of Orange and
adopted by the parent organization, St. Joseph Health. The focus on improving health
through healthy communities meshed with his educational background in public health
and nursing. However, the pragmatist shaped by his MBA recognized that funds available
for community benefits were limited, and the current emphasis on cost containment made
it uncertain that funding existing programs could be sustained long term. As a result, he
wondered if others in the community might be interested in working with St. Jude on its
healthy communities initiatives.
BUILDING HEALTHY COMMUNITIES THROUGH COLLABORATION
For 15 years Ross provided leadership and technical assistance to develop several local
city collaboratives to partner with St. Jude on its healthy communities’ goals (see Table
22.2).
The Fullerton Collaborative
In discussions with the hospital’s community outreach program Director Ross learned the
Fullerton Public School District had received a healthy start grant that funded a family
support center at a local school. As part of the funding requirement, the school district
agreed to establish a community collaborative. At the time, the collaborative leader was a
part-time teacher assigned to this project; representatives from the school district, city
government, local colleges, and social service agencies were also included. As Ross
began attending meetings he learned Fullerton was a very divided city of 135,000. Lowincome residents, primarily Hispanic immigrants, lived in the southern part of the city;
upper middle income white and Korean families lived in the north. School performance
and health and socioeconomic indicators were strikingly different in these two parts of
the city. He concluded that the collaborative should be much more than a grant manager;
it could play a role in solving problems facing the city and its residents. He found that
others on the board shared his view.
Table 22.2. Summary of work in the collaboratives
Name of
collaborative
Fullerton
Collaborative
La Habra
Collaborative
Year established as
community collaborative
2005 (previously an
education collaborative)
2006
Key outcomes
Move More Eat Healthy Campaign; Faces of Fullerton
Richman neighborhood revitalization; Summer of Lov
Move More Eat Healthy Campaign Teen pregnancy p
Buena Park
Collaborative
Placentia
Collaborative
2007
Move More Eat Healthy Campaign
2006
Move More Eat Healthy Campaign Community Buildi
To explore the range of possibilities for the collaborative, Ross invited the
collaborative director to join him at a healthy cities conference. The conference
broadened their vision as to what was needed to create a healthy city, as well as the role
of the collaborative. When the school district grant ended in 2004, members of the
collaborative wanted to continue working together, and Ross helped them establish a
501(c)(3) not-for-profit organization. This change in legal status required the
collaborative—which had about 20 members at the time—to form a board of directors
and raise funds to pay the director’s salary. Ross became chair of the collaborative board
and St. Jude provided a community benefits grant to fund the group and facilitate its
strategic planning.
The original leader Ross worked with entered city politics and, eventually, became
the mayor of Fullerton. Later, she became a state assemblywoman. The path to political
leadership continued when a subsequent director ran for city council. With this pattern of
political engagement, the collaborative began to be viewed as a threat by some in city
politics and, by others, as a place for new leadership to emerge.
Today, the collaborative focuses on reducing childhood obesity (also a hospital
priority), gang prevention, homelessness, reducing achievement gaps in schools, and
bringing together the diverse communities of Fullerton. In its 10th year as a not-forprofit, the collaborative has about 40 organizations that attend regularly, a young and
passionate chair who leads a faith-based social services group, and a new executive
director who is also a part-time faculty member. While the school district no longer
employs the director, it remains active on the board and in the collaborative.
La Habra Collaborative
The effectiveness of the Fullerton Collaborative caught the attention of a community
activist from the city of La Habra, another high-need city of 60,000 adjacent to Fullerton.
At the time, she was involved with a small networking group formed by the La Habra
school district. She asked Ross if he could come to one of their meetings to share what
the Fullerton Collaborative was doing. After his presentation he offered to work with the
La Habra Collaborative. A strategic planning process Ross led identified their top
priorities. With a strategic plan, the head of a small not-forprofit foundation in La Habra
agreed to take the lead as chair of the La Habra Collaborative. Ross served as vice chair.
To provide stability during this period, the collaborative contracted with a retired
public school principal to be a part-time director of the collaborative. Initially, the school
district was displeased with the decision to form a community collaborative from the
education collaborative. It felt the actions suggested the education collaborative was
taken over. Efforts by the former principal and her previous service as a school board
member caused the school district to change its view of the transformation of the
educational collaborative.
For the first few years, the collaborative used a local community foundation as its
fiscal intermediary. In 2014, the collaborative filed papers to become a 501(c)(3) not-for-
profit organization. Today, its priorities are to reduce obesity, prevent gangs, prevent teen
pregnancy, and increase reading competence in children. Currently, the collaborative has
50 active members and a board of directors, and it is viewed in La Habra as an asset by
all organizations. Annually, St. Jude provides a small grant to support the collaborative’s
work on obesity.
The City of Buena Park Collaborative
The head of a small Head Start program in Buena Park, which is adjacent to La Habra,
came to one of the La Habra Collaborative meetings. She saw the benefit a collaborative
involving other organizations could bring to Buena Park. She invited Ross to attend one
of her meetings and share his experience and knowledge in developing collaborative
relationships with other organizations. Building on his work elsewhere, he assisted this
small group of community activists to form the Buena Park Collaborative. To support
establishing and developing their collaborative, he secured a community building
initiative grant from St. Joseph Health and facilitated development of their strategic plan.
To strengthen their role in the city, the Buena Park Collaborative merged recently with a
collaborative that works to feed the poor.
The City of Placentia Collaborative
Ten years ago, Ross worked with a small networking group in Placentia, a city of 50,000
with few not-for-profit organizations. He assisted the networking group to obtain a
community building initiative grant from St. Joseph Health and facilitated their strategic
planning process. As they struggled to become more than a networking group, they
became aware of a group in the city that was made up largely of service clubs. A former
chair of the Fullerton Collaborative asked Ross to help bring the two small groups
together. Ross agreed and asked his healthy communities manager to help the two groups
work more closely together. Through the efforts of the healthy communities manager, the
groups decided to merge. After merging, the next step was to align their efforts and have
the positive impact on their community that both wanted.
THE HEALTHY COMMUNITIES—A JOURNEY GUIDED BY A VISION,
VALUES, AND ENLIGHTENED LEADERSHIP
As he reflected on the 15 years he has dedicated to improving the health of communities,
Ross is proud of his hospital’s and its partners’ accomplishments. Yet he wonders about
the sustainability of these efforts. For more than 27 years St. Jude has been on a
community benefits journey that has resulted in nationally recognized programs and
outcomes, including the following:
• Providing more than one million healthcare encounters with low-income persons
in 27 years
• Establishing a federally qualified health clinic with five sites in Orange County
• Implementing a model program to serve the homeless
• Acting as a catalyst for four local community collaboratives and a county-wide
collaborative to address health disparities
•
•
•
•
•
Developing a long-term care partnership initiative
Implementing a population-based obesity prevention initiative focused on policy,
system, and environmental change
Reducing rates of asthma, heart disease, osteoporosis, and tobacco use
Increasing rates of breastfeeding and self-rating of health status
Revitalizing the Richman neighborhood of Fullerton
At the same time, Ross is concerned about continued success of the community-based
collaboratives. Each is at a different stage in its evolution; all are seen as community
assets by members and key stakeholders. Each collaborative reflects the unique culture
and personality of its city. They have common characteristics, but all depend on their
members seeing the value they bring to the organizations they represent and their
communities. To be effective, they need more members who will devote time and
resources to them. Many collaboratives have memberships that overlap with regional
groups, and participation fatigue must be considered. The challenge in years ahead is
engaging more community leaders and members and securing funding to sustain the
collaboratives’ work.
As Ross reflected on his experiences and the need for a strategy to sustain and expand
the healthy communities initiatives, he considered the next steps for the collaboratives
and the St. Jude Medical Center if they are to achieve the goal of creating healthy
communities in the long term.
DISCUSSION QUESTIONS
1. What are the strengths and weaknesses of St. Jude’s community benefits
strategies?
2. Would the collaboratives have a greater impact on the region if they cooperated?
Why? Why not?
3. What strategies do you recommend to Ross to give the collaboratives a greater
local and regional impact?
4. Within the limits of existing resources, what changes might Ross consider to have
a more notable impact on improving the community’s health status?
HAD509 Written Case Analysis Content and Format
[Adapted from: Simendinger, E. (2003). In Search of a Course Design and Teaching Methods to Improve
Critical Thinking. Journal of Health Administration Education, 20(3), 197-213.]
Do each case analysis without discussing it with other HAD 509 students prior to the due date.
For each case, write the following information and number it 1 though 8 and use section headings:
1.
Your name.
2.
The case number, case title, and class date.
3.
A summary of the case. [1 paragraph] This will require you to read the case several times. Do not just
copy sentences from the case. Instead, express in your own words the essence of the case.
4.
A list of what you think are the 10-15 most important facts/factors in the case [1-2 pages].
5.
The most important health administration problem/issue to be solved in the case. [1 sentence].
List other secondary problems in the case [1-2 pages].
6.
Your recommended solution for the case (a.-d. below). Make clear specific realistic
recommendations. There must be a clear logical sequence to your thoughts and recommendations. [45 pages]
a. At least three possible realistic alternative solutions for the most important problem (stated
above for 5).
b. Criteria to evaluate possible alternative solutions. For example: acceptability to stakeholders,
needed resources, legality, timing, cost-effectiveness, ability to implement, side effects,
qualifications, statistical data, financial data, ethical considerations, fit with case facts,
likelihood of actually solving the problem, etc.
c. Evaluation of the possible alternative solutions (6a) using the criteria (6b).
d. Your recommended solution for the problem, based on 6a, 6b, and 6c. Justify your
recommendation.
7.
Specific MHA tools, methods, techniques, principles, theories, models, etc. from MHA courses that
you used for this case. List specific tools (e.g., cost-benefit analysis, market segmentation, etc.). Do
not list general subjects (e.g., finance, leadership) [1-2 pages].
8.
Answer any case study questions that accompany the case. If a case question is answered by what you
already wrote for 3-7 above, then just note which part of your case analysis provides the answer.
Submit your written reports by 11:55 pm on the Sunday of each week.
HAD 509 Written Case Analysis Rubric
Requirement
Summary (1 page)
Important Factors (2 pages)
Critical Issues (2 pages)
Recommended Solution (5-6
pages)
Identification of Relevant MHA
Concepts and Tools (1-2 pages)
Instructor Questions (pages as
needed)
Description
The student has expressed the
essence of the case in his or her
own words in a one-sentence
paragraph.
The student has clearly
articulated the 10-15 most
important factors in the case.
The student has clearly identified
the most important health
administration problem/issue to
be solved, and, if applicable,
identified secondary problems.
• The solutions are clear and
realistic;
• The solutions and rationales
are presented in a logical
sequence;
• The writer has considered at
least three realistic
alternative solutions;
• The writer has clearly
identified and applied
criteria for evaluating the
alternative solutions;
• The recommendations and
their rationales clearly follow
from the writer’s careful
consideration of the
alternative solutions.
The writer has clearly and
comprehensively identified
useful tools, methods,
techniques, principles, theories,
and/or models from prior MHA
courses.
The writer has answered
assigned questions clearly,
comprehensively, and
coherently.
Total Possible Points
2 pts.
5 pts.
2 pt …
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