August 13, 2019 – Two doctor of public health (DrPH) students at Harvard T.H. Chan School of Public Health worked with UMass Memorial Health Care (UMMHC) in Worcester, Mass. to develop an ambitious new strategy aimed at addressing social determinants of health among the communities it serves.
Ahmad Al Kasir and Eric Coles, both DrPH ’20 students, helped assess the feasibility of UMMHC moving beyond its traditional role of providing clinical care by establishing a so-called “anchor mission” aimed at tackling problems such as homelessness, social inequality, and racism—all factors that play a significant role in the health of the Worcester-area community.
Last year, to fulfill their DrPH field immersion requirements, Coles and Al Kasir spent the winter and summer sessions on the project at UMMHC. By June, the health system’s board had unanimously approved the plan, and by the fall, Al Kasir and Coles had identified first steps for implementing it. Since then, Al Kasir and Coles have continued to work with UMMHC as consultants, and co-wrote a case study about the project that was first taught this spring to over 100 graduates of the Harvard Chan master in health management program and will be taught in several courses this coming academic year.
Douglas Brown, UMMHC’s chief administrative officer, called the students’ work pivotal. “We had this great idea but no way to assess it and implement it,” he said. “They helped us operationalize it. They were instrumental at every phase.”
Local lift
An anchor mission—as defined by the Washington think tank that developed the idea, the Democracy Collaborative—is an institution’s commitment to improve the long-term welfare of the community in which it is anchored. Institutions with anchor missions try to use local vendors, hire locally, and make investments that will benefit the community.
Brown became interested in an anchor mission for the health system after hearing a presentation at a 2017 conference from Randy Oostra, president and CEO of the health system ProMedica, about its experience instituting an anchor mission in Toledo, Ohio. Richard Siegrist, director of Harvard Chan’s DrPH program and chair of UMMHC’s Board of Trustees, was also at the conference. He suggested to Brown that DrPH students, as part of their field immersion requirement, could help his organization figure out if an anchor mission was worth taking on.
Al Kasir and Coles enthusiastically volunteered for the assignment. “I feel like we were given a winning lottery ticket—a really good idea to work with,” said Coles. The two brought complementary expertise to the project. Al Kasir has an entrepreneurial background, having co-founded a health care consulting firm four years ago in the United Arab Emirates. Coles has public sector experience as a management analyst at the National Heart, Lung and Blood Institute.
The pair assessed the feasibility of an anchor mission project at UMass Memorial from various angles. They met with internal and external stakeholders of the health system. They toured neighborhoods in the Worcester area and learned about the city’s recent economic uptick as well as its high poverty rate, struggles with the opioid crisis, and disparities in life expectancy from one part of town to another. They also interviewed staff from other organizations who had implemented an anchor mission.
After determining that UMMHC was well-positioned to proceed, Coles and Al Kasir made multiple presentations to the organization’s leaders about their findings and offered ideas on where to start. For example, investing in local housing initiatives could help in two ways, the students said. It could reduce homelessness, which can worsen existing health issues and cause new ones, and strain emergency rooms. It could also lessen financial strain on residents, allowing them to afford healthier food and decreasing stress about not having enough disposable income.
Some on the health system’s management team were initially skeptical about taking on the anchor mission, worrying that it wasn’t financially prudent. But that concern dissipated after Al Kasir and Coles explained how health factors occurring outside clinical settings—social determinants of health—were causing a lot of the disease burden in the Worcester area. They also pointed out that addressing social determinants could actually improve health system finances, for example, by decreasing the number of so-called “boarders” in the emergency department.
Further, the project wouldn’t rest solely on UMass Memorial’s shoulders, because it could involve partnering with local institutions, the students said. For example, UMMHC could partner with a community development corporation to create new housing, or with a transportation company to create better commutes for employees. “A lot of this project is about finding partnerships, because a health care organization can’t do it alone,” Coles said.
President and CEO Eric Dickson was also cautious about the project at first, but after seeing how the idea galvanized employees he “switched 180 degrees,” Al Kasir said. “We’ve heard comments from people who’ve worked [at UMMHC] for 20 years saying that this is one of the most impactful projects they’ve seen at UMass Memorial,” he said.
Coles’ and Al Kasir’s contributions were “invaluable,” said Mónica Lowell, vice president of community relations for UMMHC. “During a very short period of time, our staff engagement has grown exponentially and is changing the culture of our institution as we move forward to improve the health of the community.”
Siegrist said that the project “would not have happened without Ahmad’s and Eric’s astute application of the principles of teamwork and large-scale change leadership that they embraced during their DrPH program educational experience.”
UMass Memorial has already begun implementing aspects of the anchor mission, Brown said. The organization plans to participate in a major initiative in Worcester to address chronic homelessness, to hire people for some entry-level positions from parts of the city that have experienced pervasive inequality and chronic underinvestment, and to encourage local purchasing when possible.
At a recent conference of the Healthcare Anchor Network—a growing national collaboration of more than 40 health care systems working to build more inclusive and sustainable local economies—“all the talk was about how fast UMass Memorial is moving on its anchor mission,” Brown said. He added, “Frankly, I doubt we’d be anywhere close to where we are today without Ahmad and Eric. They have been the critical ‘secret sauce’ in all of this.”
photo: Kent Dayton