Rush sets example of how ‘anchor’ hospitals can help neighborhoods as well as patients
For nearly 150 years, Rush University Medical Center has helped make people healthier by providing world-class health care. As clinical research has made increasingly clear, however, factors other than genetics and lifestyle choices have a major impact on health. Pervasive social issues such as poverty, lack of access to quality education, systemic racism and unemployment contribute to many illnesses — including diabetes, asthma, cardiovascular disease and depression — that shorten the lives of people who live in urban areas like those that surround the Medical Center’s campus.
As the largest non-governmental employer on Chicago’s West Side and a hospital with deep, longtime roots in the community, Rush is well-positioned to address these social and structural determinants of health. The Medical Center employs more than 9,700 people and spends more than $557 million on goods and services each year.
During its 2017 fiscal year, Rush crafted its Anchor Mission strategy: a plan to align those resources to improve health in nine West Side neighborhoods that are home to nearly 500,000 people. Instead of just treating the illnesses that arise from inequities, Rush is working to create healthier communities — in part by making sure that its economic power helps to boost the economic vitality of neighborhoods where poverty is concentrated.
"As a hospital, we were organized to heal and prevent suffering,” says David Ansell, MD, Rush’s senior vice president for community health equity. “Our healing now has to extend to neighborhoods and the root causes of inequity.”
Rush’s Anchor Mission strategy focuses Rush’s economic impact on the following five commitments:
- Hire locally and develop talent
- Use local labor for capital projects
- Buy and source locally
- Invest locally and create financial stability for employees
- Volunteer and support community-building
Shaping and sharing a useful playbook
According to experts, Rush is a national leader of the anchor mission movement that’s taking shape among health systems. “The comprehensiveness of Rush’s approach is what’s novel,” says David Zuckerman, who directs health care engagement at the Democracy Collaborative, a research and advisory nonprofit with offices in Cleveland, Ohio and Washington, D.C. Zuckerman organized the nationwide Healthcare Anchor Network collaborative, of which Rush was a co-founder.
Many health systems have taken on one or two of the commitments Rush has made, Zuckerman explains, but Rush is “the first example I can point to of a system that was all-in on these strategies in a comprehensive, intentional way — and put internal infrastructure in place to support them. Elevating Rush’s anchor work to an institutional priority has helped other organizations see this as a real strategy rather than as a couple of projects here and there.”
To share what it learned in the process of developing the strategy, Rush released an Anchor Mission Playbook — a roadmap of how the organization examined its operations and collaborated with local and national experts as well as Chicago-based nonprofits that also focus on building sustainable, healthy communities.
Zuckerman says that the Rush playbook is a candid, useful guide that has inspired other health systems to create similar documents. “The playbook took anchor mission work from the 10,000-feet level to something really practical,” he says — with actionable ideas around Rush innovations such as convening West Side United, a collaboration among Chicago health care institutions, civic leaders and community residents to address health disparities. It also provides some frank truths about realistic expectations organizations need to have (for example, recognizing that not all nonprofit partners are aligned or move at the same pace).
A bus ride across a 16-year gap
Sharing its process, learnings and results has positioned Rush as a national anchor mission leader. In August, 35 executives attending the Academy of Management (AOM) annual meeting in Chicago climbed aboard a bus for a tour led by Rush’s Andy Garman, PsyD, professor of health systems management, and Shweta Ubhayakar, MS, manager of anchor mission initiatives. The group was headed to lunch at Inspiration Kitchens, a restaurant and catering company that provides job training, housing and social services to people who are affected by homelessness and poverty.
The trip took participants from Chicago’s downtown Loop — where the median income is $107,000 and life expectancy is 85 years — past Rush’s campus to West Garfield Park, one of the West Side neighborhoods where many Rush patients and employees live. There, the median income is $25,000 and life expectancy is just 69 years.
AOM’s meeting this year focused on the theme “Improving Health and Well-being in Society: How Can Organizations Help?” The bus tour participants were looking to Rush for answers to that question as they heard about Rush’s work to shrink the 16-year life expectancy gap between the neighborhoods at the two ends of their trip.
In addition to leading the AOM bus tour, members of the Rush anchor mission team have shared the strategy and playbook with large audiences at meetings of the Association for Community Health Improvement (part of the American Hospital Association), the Association of American Medical Colleges, the CleanMed sustainability conference and the Healthcare Anchor Network. In October, they brought their message to a global audience, presenting in Brisbane, Australia, at the World Hospital Congress of the International Hospital Federation.
Snapshots of the Anchor Mission Strategy in action
In fiscal year 2018, Rush began to measure its progress in each of the Anchor Mission Strategy’s five focus areas. The following are a few highlights from year one and glimpses of what’s ahead for the rest of Rush’s 2019 fiscal year.
- Hire locally and develop talent: As a patient care technician at Rush, Charles Griggs works closely with the nursing staff — a team he plans to join by pursuing a bachelor’s degree in nursing. Griggs, who is from the Austin neighborhood, was a client of Skills for Chicagoland’s Future, one of three Rush nonprofit partners that work with people who have previously been shut out of the job market, helping them acquire job skills and matching them with employers. In fiscal year 2019, Rush aims to work with these partners as it seeks to hire 18 percent of new employees from anchor communities. Helping employees build long-term careers at Rush is another focus, with initiatives such as a program that provides front-line employees training to become certified in clinical roles. Twelve Rush employees currently in jobs ranging from food service assistant to clinic coordinator are enrolled in a new medical assistant certification program that was created in partnership with other Chicago health systems, community nonprofits, Malcolm X College and external funders. A patient care technician certification program also launched this fall.
- Use local labor for capital projects: In fiscal year 2018, residents and a construction company from anchor communities helped Rush complete its new South Loop outpatient health center. This year, local telecom, utility and repair contractors are slated to work on three capital projects. These projects are warm-ups for an enormous effort that lies ahead: Rush University Medical Center has submitted plans for a new $473 million outpatient care center on its main campus, with groundbreaking scheduled for spring 2019 and completion in 2022. To help West Side residents acquire the skills that will qualify them for jobs on this construction project and others, Rush is developing a partnership with local trade unions and a general contractor to create apprenticeship programs in trades such as construction and plumbing. In addition, Rush is working with West Side job-training organizations to increase local hiring through community outreach.
- Buy and source locally: Through its strategic sourcing program, Rush has long purchased products and services from Chicago businesses that are certified minority-owned and woman-owned. Now, the focus is on increasing the amount of goods and services sourced from West Side communities. For example, on-campus food tastings have connected employees who purchase food for meetings and events to West Side restaurants and caterers (including Inspiration Kitchens, the lunch destination for the AOM bus tour). Twenty West Side food vendors are part of this vendor list, which also includes a wide range of vetted and approved vendors for everything from flowers and vehicle repair to plumbing supplies and promotional items. Business-development nonprofits Chicago Anchors for a Strong Economy (CASE) and Together Chicago help Rush source and vet vendors for its list.
- Invest locally and create financial stability for employees: To help people who work at the Medical Center achieve financial health, experts from Working Credit — a nonprofit organization that helps people improve their credit scores — came to Rush’s campus to provide financial counseling to more than 800 employees. Outside Rush’s walls, a partnership with local community development finance institutions is helping Rush invest capital in projects led by organizations that serve community needs (e.g., affordable housing), but lack access to traditional lenders — a first for an academic medical center, says David Zuckerman of the Democracy Collaborative.These impact investments, as they’re known, are not donations or grants, but are business loans that are expected to return a small profit and an even greater social impact. To date, Rush has invested more than $2 million in three projects, including the Chicago Neighborhood Rebuild pilot program rebuilding 50 homes on the West Side and providing job training for residents. In fiscal year 2019, Rush is partnering with another Chicago hospital to invest $2.5 million in similar projects.
- Volunteer and support community-building: Rush employees and students have always volunteered thousands of hours in dozens of organizations each year; for example, employees in Chicago and Oak Park volunteer to pack surplus cafeteria food for donation to local nonprofits that feed the hungry, and to perform health screenings and education when people come to pick up their meals. To enable more employees to participate, Rush is creating a new volunteer program that will include system-wide days of service.
The Rush team has learned a number of valuable lessons on the way to these accomplishments, says Ubhayakar, and freely shares tips and best practices with peers nationwide.
"When we joined the Healthcare Anchor Network three years ago, all of this was brand-new," she explains, "but now we're often asked to present at network meetings" about Rush innovations such as creating a full-time role for a manager of anchor mission initiatives. And in monthly conference calls, the team fields questions from other hospitals about how they’ve implemented processes and accountability in areas such as procurement and hiring. "We're learning as we go, and we’re not the experts yet, but we’re happy to share whatever we can to help other organizations build their own anchor mission strategies," she says.