Volume 3, Issue 1
Walk a Mile in Their Shoes
Kaiser Permanente’s (KP) excellence is attributed to its innovative delivery of high-quality, patient-centered care. KP is rapidly increasing its attention to the non-medical social determinants of health. To remain at the cutting edge of health care, KP and other health care systems must look outside the walls of our hospitals and clinics, beyond traditional medicine, therapies and surgeries offered. Identifying and addressing social needs requires specific competencies which can be learned from community-based organizations. The Southern California Permanente Medical Group (SCPMG) Health Innovation Team recently arranged visits to three Los Angeles-based community organizations to share our respective journeys in improving community health; we left these visits learning far more than we shared.
What's going on?
We first visited L.A. County/University of Southern Californa's The Wellness Center, located at the historic General Hospital. Walking distance from the LAC and USC's emergency department and outpatient clinics, the Wellness Center is a place where medical staff can refer patients for assistance with social needs. The Center offers free office space to approximately 20 different community organizations. The proximity facilitates collaboration among community organizations. Wellness Center leadership found that community partners must be well established and trusted in the area(s) they serve. Some national organizations, without grassroots connections, failed to achieve measurable impact, such as the case with Boyle Heights. Experienced, local community partners are invaluable to successful, sustainable collaborations.
We next visited Homeboy Industries. Homeboy Industries “provides home, training and support to formerly gang-involved and previously incarcerated men and women.” A variety of social services are offered daily at this East LA establishment. The lasting lesson we took away was voiced by our tour guide, a previous gang member and ex-convict who had physical limitations from a gang-related gunshot wound. This humble man started our tour by stating, “Homeboy Industries is a place of healing.” The healing he referred to came from incredibly intentional and personal relationships and a safe place that allowed him, and others like him, to continually process and grow. He shared how Father G, founder of Homeboy Industries, personally pursued and never gave up on him. Those of us who heard this testimony will not forget the poignant lesson that healing requires far more than medical care, and that healing starts with caring.
Our final visit took us to Skid Row, Housing for Health offices. Here we learned how prioritizing housing has improved health and provided substantial savings to the L.A. community, primarily by improving the health of the homeless and avoiding emergency department visits and hospitalizations (https://www.rand.org/blog/2018/01/housing-for-health-los-angeles-countys-department-of.html).
After moving into permanent supportive housing, residents' use of county services dropped substantially. In particular, the use of health care and mental health care declined the most, with fewer inpatient stays, emergency room visits and less use of acute mental health care.
We also saw an amazing way to assist people with substance abuse problems through their innovative Sobering Center. The Sobering Center provides a safe and efficient alternative to emergency departments when patients are acutely intoxicated but have no medical needs. The efforts and results achieved by Health Services of Los Angeles County imparted a new appreciation for our community partners. Our most memorable experiential learning came from our walk through the tents on urban sidewalks. The lack of hygiene, that permeated the air, gave witness that health cannot begin without housing. This same principle was taught long ago in a poem:
Just walk a mile in his moccasins
Before you abuse, criticize and accuse.
If just for one hour, you could find a way
To see through his eyes, instead of your own muse.
Why is this important?
Expanding the vision of the health care system requires getting outside the walls of the clinic and hospital. Doing so allows us to see innovative opportunities that may improve our practice, expand our vision and enliven our health system. To help others thrive, we must get involved in our communities and listen to the success stories of our local partners. Only then can we foster genuine empathy and begin to design solutions that truly enrich the lives of the people and communities we serve.