Denver Health Medical Center (DHMC) was recently ranked among the top 10 socially responsible hospitals in the country by the Lown Institute. DHMC received top A grades across the board for equity, value, outcomes, and overall social responsibility. Dr. Wittenstein, who will be stepping down from her role as CEO and retiring this summer, spoke to us about her work and the legacy she leaves at Denver Health Foundation.
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State of Reform: What does the national distinction of being socially responsible mean to your organization?
Dr. Robin Wittenstein: “Being named one of the more socially responsible hospitals is quite an honor. What’s really important is that this work is core to the mission at Denver health and has been since we were started. It’s really becoming more important now when issues of inequity and disparity [and] economic hardship are impacting our patients in our communities so deeply.
Having the Lown Institute do the analysis and help foster conversations about what it means to be socially responsible, [and] identify organizations that are providing good medical care but truly working to address the broad factors that impact health status, 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 that we’ve been doing all along and to help others engage in that conversation.”
SOR: How has Denver Health been committed to that social responsibility?
RW: “Denver Health has been focused on key elements that the Lown Institute looks at in their social responsibility measures. Things like patient outcomes, measured by readmissions, mortality rates, or some of the specific CMS and patient satisfaction measures. Those have been and will remain a core part of both our strategy and our everyday work. And it’s particularly important for an organization like Denver Health, a safety net that treats mostly a vulnerable population. That vulnerability is both from a clinical perspective, whether that’s due to a lack of insurance or access, chronic illnesses, stress, but also vulnerable from an economic perspective.
If you exclude our own employees, 85% of the patients are either uninsured Medicaid or Medicare, with the majority of them being Medicaid. Making sure that we provide integrated care especially with great primary care where the physical, behavioral, and oral health needs are met is critical. Keeping our costs as low as possible to make sure that patients can afford to get the care. Really focusing on making sure patients get what they need, when they need it in the right setting and not more than that. Those are all critical aspects of who we are. It’s part of our DNA.
But we’ve also really tried to focus our time, our energy, and our resources on community benefit activities. Not health fairs and things like that but on providing the right supportive services, most of the time in partnership with other community organizations because they have expertise but really addressing social and economic risk factors that impact health so significantly. This has really been a commitment that the organization has had for decades.
We’ve committed over the last three years in particular to addressing the economic challenges that our patients and our communities face. It became even more apparent during the COVID epidemic. As part of that, we established the Center for Equity, Diversity, and Opportunity that really takes all the work we’ve done as an anchor institution and organizes it around hiring and advancing employees so that they can earn a living to take care of their families. And that’s done through our workforce development center.
… We started with a workforce development center that pulls together a lot of services to help our lowest paid employees have a career path in front of them and have social and economic support services around them. Everything from a partnership with Operation Hope, which is a national not-for-profit for financial literacy education for 1-on-1 counseling for employees. How do you raise your credit score? How do you reduce your debt or effectively save for homeownership? We’ve partnered with Mile High United Way to look at what services are available in the community that we can hook our employees up with. It helps to 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 partnering with the Denver Housing Authority to put telehealth capabilities in their buildings. We’ve got a pilot [program] going on now, where we’ve set up a telemedicine suite and we go in and we do education for people living in the building and in the complex around it on things like controlling blood pressure etcetera. We give people Bluetooth enabled blood pressure monitors, whether they’re our patients or not. We can then set up telemedicine visits; we have a medical assistant there who can help with it.
We’ve got new mobile health vans which during COVID were incredibly important for testing and vaccination. But they’re full scope primary care clinics and so they can go to churches, synagogues, temples, rec centers, and public libraries and meet people where they are, including people who are homeless, so we go to a lot of shelters.
The other thing is we’re really looking at data as a way of understanding. We talk about health disparities and inequities all the time, but you really have good data to understand within your own community what’s going on. We’ve just completed a year-long program called REAL, which is Race Ethnicity and Language, a national program designed to improve the collection of data from patients.
People are sometimes reluctant to provide information but if you can explain to them why you need this information, what the uses of it are going to be to drive improvements, we found that people immediately provide the information. It really gives us a chance to understand down to some granular levels where there really are differences and why those are. 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 that we’re seeing a difference here.
The last thing that we’ve done, [and] I’m really proud of this, is focus on increasing the diversity of staff and faculty. There’s a lot of evidence out there that when patients are interacting with people who look like them, they’re more likely to open up and be honest about their conditions, about their concerns, etc. So we really focus on that. We’re a safety net; we take care of a wide diversity of patients. And if we can increase the diversity of the people who are caring for patients, we’re going to improve care right from the get-go.
SOR: Where is the focus of the organization right now at this critical juncture? And what are its immediate needs?
RW: The immediate focus is really around addressing economic challenges that people face that have impacted their health status … What are the things that are driving poverty? And what can we do, person by person, family by family to address it? So a lot of our work right now is getting to a better understanding of what’s driving the issues, what’s driving the underlying social and economic risk factors, and then [asking], ‘How do we solve them for [a given] person?’
If we can interrupt the cycle of poverty for a family, we are affecting not just that family right now, but future generations, so a lot of our focus is on people who want and need support and help that we can bring something to. So we’re partnering with pretty much anybody and everybody who will partner with us to solve that because we can’t do this on our own. Being that super safety net and helping educate federal and state legislators about [poverty] and saying we can do this.
We are committed to do this, but we need some help given the realities of funding for federal and state programs. That’s a real need. I’ve been chairing a group for the last three years that has been working on a designation for institutions like ours. I think there’s about 100 [institutions] or so around the country. That’s something that again, you’re not going to find a group of people 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 work. It is about the people who live in our communities that need a hand up. And honestly, it could be any one 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 that.
What we need is finding the right partners to help us advance this work because we are uniquely positioned. 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 contact with driving change. So we’re looking for partners to help us do this.”
This interview was edited for clarity and length.