Goal / Mission

Dignity Health Systems hoped to support the people of Long Beach, CA in “meaningful and measurable ways” by creating a safety net health system with programs that addressed social determinants of health in order to create healthier communities. Dignity Health tasked St. Mary’s Medical Center’s Community Health Office with setting up programs and committees to identify community needs, engage underserved priority populations, create implementation strategies, provide social programs, and deliver access to health services. Families In Good Health (FIGH) is one of several outpatient services and social programs that St. Mary’s Medical Center created to deliver high quality, compassionate health care and health access for nearby communities. FIGH’s focus is on providing multilingual, multicultural health services and social education programs to build a healthy community for Southeast Asians, Latinos, and other communities in Long Beach, California.

Description

Health systems change begins with policy, protocol, and culture changes at an institutional level. Dignity Health Systems, a nonprofit health care provider, committed to a mission to support the health of communities as part of their desire to serve those in need and to fulfill requirements under the Patient Protection and Affordable Care Act. Dignity tasked community hospitals within their health system with identifying community needs and developing a health system of services and programming to ensure a healthy population in Southern California. Dignity supported the creation of internal policies, committees, and infrastructure to carry out tasks for an equity focused network of safety net hospitals and clinics to serve marginalized populations.

Each of the hospitals under the Dignity Health umbrella takes the time to study and “ascertain the most pressing health needs” of the communities they serve. This process was done through a comprehensive community health needs assessment, which is completed and represented as a report repeated every three years. The hospital then works with the community to create policy and programs to address the social, cultural, and economic needs identified and prioritized by the needs assessment. St. Mary’s Medical Center is a Dignity Health hospital that serves Long Beach, California. It used a process and criteria to identify signifciant health needs under the following categories: access to health services, chronic diseases, economic insecurity, environment, food insecurity, housing and homelessness, mental health, overweight and obesity, pregnancy and birth outcomes, preventive practices, racism and discrimination, substance use, and violence and injury. St. Mary’s adapted their internal policies to address social determinants of health and community demographics that they serve as identified by the needs assessment and created social programs, health services, and interventions to address these identified needs.

One of these programs, Families in Good Health (FIGH) was created in the mid 1990s to address the primary care, environmental, and socioeconomic needs of multi-ethnic communities in Long Beach. St. Mary’s needs assessment demonstrated a lack of resources and significant health disparities among underserved communities of color including Latino and Southeast Asian Americans. Dignity tasked St. Mary’s with creating FIGH to serve as a multilingual, multicultural policies, services, and education program to uplift health and leverage current health and social resources in Southern California. FIGH was created with input from the communities it served, partnerships and support from local community organizations, and the strong backing and buy in of leadership from the parent health system at Dignity to fulfil its mission to support the people of Southern California in a meaningful and measurable way. FIGH was tasked with setting up programming for physician and provider referrals, insurance and benefits enrollment, family planning and parenting, youth leadership development, mental health counseling, tailored community health education outreach, refugee services, tobacco prevention groups, and an adult coalition to assist communities in providing solutions to social issues and advocating for a healthier, safer city.

FIGH continues to provide and develop services and programming for referrals to community clinics and health services, help with insurance and benefits enrollment, affordable oral and dental health, and covid prevention and vaccinations to Latinos, Asian Americans, Pacific Islanders, and other priority populations identified by needs assessment. Community health workers are also utilized for outreach and education to Southeast Asian and Latino communities. Home visits and maternal/ infant/child health and family planning as well as nutrition classes are provided to the community by FIGH. FIGH also works with the California Tobacco Control Program to develop a stong tobacco control coalition to advocate for a smoke free environment and to empower adults and youth for tobacco policy change. FIGH offers a mentorship program for at risk youth to develop future leaders. FIGH’s Community Wellness Program (CWP) promotes wellness in the Long Beach Asian Pacific Islander Community by providing culturally and linguistically appropriate prevention and intervention services. FIGH also provides workshops on physical and mental health, refugee and trauma counseling, support groups, and wellness activities.

Through its educational content, FIGH provides an avenue for sustained leadership development, a voice to youth, access to care and services, and a place for engaging the community to build healthy communities in Long Beach California. Through FIGH, Dignity Health achieved its  goal to ensure more equitable and equal access to a safety net health network and programming for all people to lead healthy lives among all population groups.

Implementation Process

• Introduce health system wide policy at highest administration level to apply to health system and hospital institution aligned with mission to serve needs of community
• Make sure participating hospitals understand mission and vision
• Create team to steer policy and programming and claim policy ownership
• Hospitals each assess community through community health needs assessment every 3 years to identify populations of need and areas of need
• Interviews and surveys with community stakeholders were used to gather input and prioritize significant health needs.
• Criteria were used to prioritize the health needs included perceived severity of a health or community issue as it affects the health and lives of those in the community, improving or worsening of an issue in the community, availability of resources to address the need, and the level of importance the hospital should place on addressing the issue
• Key informant stakeholders and focus group respondents were asked to prioritize the health needs according to the highest level of importance in the community
• Each hospital develops an implementation strategy or strategies to address significant identified priority health needs based on the findings of the community health needs assessment and analysis of the primary and secondary data sources
• Build infrastructure based on disparities and social determinants of health
• Health systems policy and practice created to reduce disparities related to social determinants of health
• Develop a safety net health system via creation of tailored outpatient services and health center focused on the communities it serves for Southeast Asians, Latinos, and other priority communities of need identified by needs assessment
• Ensure care is given with mindset for socioeconomic lens for priority groups
• Hospitals report on the progress of program, service, and policy activities and continue to update strategic implementation plans each year. Each hospital produces an annual Community Benefit Report and Plan
• FIGH is one of several programs created to help the community make informed choices and gain access to needed health and social resources. FIGH was created to address social determinants of health, cultural and environmental barriers, and access to health care as defined by utilization of services that include the following:
  • health insurance coverage
  • regular source of care
  • difficulty accessing care
  • delayed or foregone care
  • lack of care due to cost or children
  • primary care physicians
  • access to primary care community health centers
  • dental care
  • quality care (culturally competent care or specialized care that can meet the specific needs of a subpopulation or better “meet people where they’re at” and provide health services that are more patient-centered, free of stigma, and aware of generational differences and cultural biases)

Impact / Results / Accomplishments / Outcomes

The impact of this project was that Dignity Health Systems created a set of safety net community clinics, health care providers, hospital services, and social programs to address social determinants of health, reduce disparities wiithin priority populations, and provide access to care to underserved communities in Southern California. St. Mary’s developed programs like Families In Good Health (a multilingual, multicultural health and education program) to help communities underserved by current health and social resources in Southern California. The success of these programs continues to uplift and propel diverse underserved communities towards better overall health and well-being.

Successful health systems begin with successful commitments to changes in policy at an institutional level to address the social needs of patients in order to create a healthier, safer community. Dignity Health was able to leverage its community relationships and resources to ensure that populations receive better quality health care and access to services and programming to address various socioeconomic and cultural needs. By eliminating barriers that normally hinder access, Dignity allowed for hospitals like St. Mary’s to create more equitable services and programming for Southern California.

Lessons Learned

The successful strategies of developing a safety net health system with more equitable policies, programs, and services by FIGH/Dignity can be applied and adapted from the following lessons learned:

• Policy change comes from a coordinated effort between administration and management at all levels of an institution
• Identifying community needs and stakeholders are crucial for creating community safety network services and programs
• Leveraging community contacts and agency partnerships are key for creating a comprehensive safety net of health services and programs to address social determinants of health
• Earning community trust and incorporating their input ensures sustained community participation

About this Promising Practice (Contact information)

1. Organization(s): Families in Good Health (FIGH/ Dignity Health Systems, APPEAL
2. Primary Contact(s): APPEAL staff, Rod Lew [email protected] and Michelle Jeu [email protected]; FIGH staff, Ladine Chan [email protected] and Veasna Mai [email protected]
3. Authors: APPEAL Staff with informant interviews from FIGH staff Ladine Chan and Veasna Mai
4. Topic(s): Health Systems, Safety Net Hospitals, Social Programs, Multicultural Health Access, Health Care Delivery
5. Source: APPEAL Staff with informant interviews from FIGH staff Ladine Chan and Veasna Mai
6. Date of Publication: N/A
7. Date of Implementation: 1995
8. Location: Long Beach, CA and Greater Los Angeles, CA metropolitan area
9. More details (web address for study):
   1. https://www.dignityhealth.org/socal/locations/stmarymedical/about-us/community-benefits
   2. https://www.dignityhealth.org/socal/locations/stmarymedical/about-us/community-benefits/families-in-good-health
10. Target Audience: Policy makers, Hospitals and Clinics, Health Systems