In the current health care landscape, hospitals and health systems have been focusing their attention on tackling the social determinants of health in their communities. To achieve this, they are working hand in hand with community stakeholders, reaching areas where zip codes can often determine health outcomes. In this conversation, Joanne M. Conroy, M.D., CEO and president of Dartmouth Health and 2024 AHA board chair, talks with Lynn Todman, vice president of health equity and community partnerships at Corewell Health, about how care providers are reaching within their community to reinforce strong health habits and individual wellness. To listen to the full conversation visit https://youtu.be/mxmS4GuJCmY

Tom Haederle

Health equity - the drive to eliminate disparities in health and health outcomes, regardless of ZIP code - is a major goal across the U.S. health care system today. That's why hospitals and health systems are paying more attention than ever to tackling the social determinants of health that play such a large role in individual and community health outcomes.

Tom Haederle

Tom Haederle

As Todman notes, fantastic clinical work is great, but at the end of the day, people go home to their neighborhoods and that's where they spend most of their time. As she says, we have to make sure those environments support the wonderful clinical outcomes we're trying to generate.

Joanne M. Conroy, M.D.

I'm Joanne Conroy, CEO and president of Dartmouth Health, and I'm currently the chair of the American Hospital Association Board. I'm really looking forward to our conversation today as we talk about health equity. It is an imperative for hospitals and health systems to fully commit to not only building a diverse workforce, but to actually create a culture that promotes equitable care for all.

Joanne M. Conroy, M.D.

Hospitals and health systems have an important role in creating a culture that confronts disparities in health outcomes, by addressing the social and political drivers that can hinder an individual's ability to access or achieve optimal health. We know that these are issues that cross all geographies, although they're usually exacerbated in rural communities. At Dartmouth Health, we firmly believe that the diversity of our patients, people, and communities show our strength.

Joanne M. Conroy, M.D.

And it's something we're actively working towards to support and celebrate. And nationally, the American Hospital Association is certainly active through the Institute of Diversity and Health Equity in helping hospitals and health systems make impactful and sustainable change that increase equity and inclusion, and will build community partnerships that will improve access to equitable care. You know, I often say that some of these complex problems are so difficult, no one institution, no matter how well resourced or how well organized, can solve them alone.

Joanne M. Conroy, M.D.

And we absolutely we need our community partners. That's why I am thrilled to have as a guest today, Dr. Lynn Todman. Dr. Todman is vice president of health equity and community partnerships at Corewell Health. Corewell Health is an integrated nonprofit health system that's headquartered in Michigan, with a team of more than 65,000 dedicated professionals caring for patients at 21 hospitals and more than 300 outpatient and post-acute care facilities.

Joanne M. Conroy, M.D.

We're lucky to have Dr. Todman with us, as she's able to draw from many interdisciplinary as well as professional perspectives in her role. She has a background in urban planning, and has spent her career committed to addressing the needs of marginalized and disadvantaged communities, working to address the social and underlying structural determinants of health and wellness. So, Lynn, I'm sure I missed a lot, but I really want to kind of jump into our discussion.

Joanne M. Conroy, M.D.

And the first question is, tell us a little bit about yourself. How did you get to Corewell Health and how did you find your passion in diversity, equity and community partnerships?

Lynn Todman

Thank you, Joanne, for that. A little bit about myself. So I was born and raised in Chicago and come from a family...my father was a physician, and grew up in a setting where I was able to see disparate experiences every day. I went to a school on the north side of the city, but I lived on the south side of the city because of the segregation in the city.

Lynn Todman

It was apparent to me from a very young age that different groups had different access to quality housing and food and education. So my interest in this goes back to my childhood. And yes, I am an urban planner by training. My work has historically been in the field of community development. And so for a few decades I did work on education, public safety, housing, the natural environment, all those things that today we call the social determinants of health.

Lynn Todman

Lynn Todman

Lynn Todman

So that's what I do - is to round out our collective understanding on what drives health with a more robust appreciation for these social factors that play a role in shaping health outcomes, including health inequities.

Joanne M. Conroy, M.D.

That is really fascinating. The dean of the School of Public Health at Boston University used to talk about what poverty does to an individual. It creates almost an inability sometimes to focus affects their judgment, because when you're worried about do you pay your rent or do you pay for food, there are some incredibly difficult decisions that when people are living in poverty, they're having to deal with.

Joanne M. Conroy, M.D.

And we don't always appreciate the behavioral health impact of people that are constantly making those decisions. Yes. So let's shift and talk a little bit about your role at Corewell. Health equity and community partnerships. That seems like a lot of landscape to cover. So talk a little bit about the, you know, the relation between those two areas because they are different, but they do share a lot of the same real estate.

Lynn Todman

Yeah. So I think certainly in public health historically for, you know, probably 100 years now, we've understood that a lot of what determines our health outcomes has to do with the environment we're in every day. And in the last 15 or 20 years, that way of thinking has found its way into health care. So we know we can do fantastic clinical work and generate really wonderful clinical outcomes.

Lynn Todman

But people go home, they go back to their neighborhoods, they go back to their houses, they go back to the places of worship or work or school. And that's where they spend most of their time. And so we have to make sure that those environments support the wonderful clinical outcomes that we're trying to generate, and that these environments enable people to adhere to medical advice, or guidance and suggestions around eating or exercising or stress reduction, whatever.

Lynn Todman

So we don't have the levers for that in health care. But our community partners do. They know where the landmines are. They know who the key stakeholders are. They know the agendas. They're much more able to navigate that space than we are sitting inside the health care system. So in order to sustain clinical improvements, if we close, disparity gaps need to sustain the closure of those gaps.

Lynn Todman

We have to make sure that the communities that people go back to, you know, that are health promoting and health sustaining. We can't do that as health care. We have to work with people in the community settings to actually create those environments to sustain the great clinical outcomes that we're working to achieve in health care. So that's essentially it.

Lynn Todman

You know, we have to have those partnerships to do the work that we're actually not equipped to do ourselves.

Joanne M. Conroy, M.D.

You know, it is interesting, though, that at some level, some leaders and organizations think we do have all the answers. And I had a really great conversation with somebody that ran a homeless shelter here, a really big one. And she said, you guys don't understand homelessness. You just don't understand it. She goes, we do homelessness. She said, you need to work with us.

Joanne M. Conroy, M.D.

And I'm like, oh yeah, she's actually was so correct because we think we know. But unless you're really living in the environment and understanding the issues that your clients are facing every single day, you don't really get it. So talk a little bit more about community stakeholders, like how do you draw them in? Because every health system probably enters into some of these conversations with the "we have the solution for you."

Joanne M. Conroy, M.D.

It's like the IRS, we're here to help you. And and sometimes we're not very helpful! How do you create those partnerships that are really productive?

Lynn Todman

Yeah. So it takes a long time. Because there's a lot of trust building that has to happen to developing meaningful, authentic and productive relationships. The other thing that has to happen that's a little bit difficult for large organizations is there needs to be a shift in the balance of power. and so as a large organization, we have lots of people, we have lots of resources.

Lynn Todman

There's financial resources, human resources. And we have to be very careful as we engage with organizations that don't have the people that don't have the resources. Because we're not going to get the best out of those relationships if people feel...the word that comes to mind is overwhelmed. But it's not so much overwhelmed but overpowered in the relationship and feel that their voice isn't going to hold as much weight and much gravitas as the organization's.

Lynn Todman

So I would say, if you ask me how you do it: One is really work hard to be trustworthy, like earn the trust of community partners and then kind of check our power and recognize that we're often the biggest employer, we have the most resources, and we have to be very self-aware when we engage in these relationships. Because it's very easy to put ourselves in a position where the two stakeholders don't want to work with us.

Joanne M. Conroy, M.D.

Go into detail and describe maybe one of the partnerships that actually, had a real impact on health equity. So you can change the names to protect the innocent. But talk about something that you would consider real success.

Lynn Todman

When I first started doing the work with the health care system, I wanted to work with the local barbershops in town in a low wealth African-American community for a number of reasons. Men are late to get care. They don't answer the questions in our community health needs assessment. I really didn't know, kind of like where their heads were.

Lynn Todman

So I wanted to work with local barbershops. As an African-American, I went into this barbershop thinking, oh, I'm going to be trusted. They're going to, you know, they're going to embrace me and we're going to have this wonderful partnership. And it didn't turn out that way. And in fact, the barber and the owner said that he was risking his reputation just talking to me because I represented the health care system.

Lynn Todman

So then I had to kind of pull back there. And I had to reframe my ask, like, what can I do for you? What can I do for you? As opposed to, here's what I have for you. Here's what big health care system has for you. So once I reframed that question and became more humble and checked my own power, he told me what I could do for him.

Lynn Todman

And we ended up having nurses onsite doing blood pressure checks, stroke education. Even taught the barbers how to identify somebody who was having a stroke, which actually caught two strokes in the years subsequent to the training. But it also meant that I had to do things like I had to go get my haircut at the barber shop and sit in his chair and develop that relationship over time.

Lynn Todman

That was ten years ago, and we still have a great relationship. But that's a good example of a relationship with a community partner that could have gone south, where I had to step back, check my power, do the things that needed to be done to earn his trust. And then we were able to do some really meaningful things with the men in the barber shop, they engaged with the health care system in many instances, proactively. They they decided to go get a PCP.

Lynn Todman

They felt more empowered and, trust people to go get a PCP, for instance. So that's one example.

Joanne M. Conroy, M.D.

That's a great example. And, you know, when I was at the Association of American Medical Colleges, we brought blood pressure cuffs into the facility, Know Your Numbers week, and actually took them to the mail room. And we found some really high blood pressures there. But, you know, it's interesting, though, the men in the mailroom didn't want to continue taking their blood pressure because they felt like if it was high, they'd done something wrong.

Joanne M. Conroy, M.D.

I never thought about that. So we had to teach them to take each other's blood pressure. So we were totally out of the loop, and they could understand when their blood pressure got high that they would say, well, after I have two cups of coffee, my blood pressure goes up about ten. And I was like, wow, what a breakthrough.

Joanne M. Conroy, M.D.

Almost teaching them how to really embrace their health. I think investing in health equity, awareness of disparities, and working with community partners can be transformative to organizations. I mean, think back ten years ago, I don't think we thought about it very much. And yet now I realize that a town 12 miles away, you know, people are going to have a life span that's 15 years shorter than the town that's much more affluent in the same region.

Joanne M. Conroy, M.D.

You know, by just talking about it, we've kind of really elevated the awareness that wasn't there ten years ago. So talk a little bit about how this investment and how the visibility of disparities and access to care has changed Core- well.

Lynn Todman

Well, in many ways. So first of all, there's a workforce doing this work...a bigger workforce doing this work than there was ten years ago. There's somebody like myself and my peers across the organization that are doing it. The data. We're collecting and analyzing data in a very different way to what we were doing ten years ago. Certainly in the way we're thinking about hiring

Lynn Todman

maybe, is different from the way we we were doing ten years ago. Even something is, you know, our mission and vision and values are reflective of this emerged commitment to health equity. So there are many, many ways in which the emergence of a broader understanding of disparities and inequities have changed the way our health care system works.

Lynn Todman

H.R., data, vision, mission, even the way we're thinking about our programs, care management processes, a lot of internal processes are being reevaluated for their impact on disparities. Do they close them? Do they open them? Reevaluation of clinical algorithms, that kind of thing wasn't happening ten years ago. - looking at race based, algorithms and identifying whether they're helpful or not.

Lynn Todman

So it's innumerable the ways and that even as I listen to, you know, your question, I realize, oh my gosh, it's actually starting to be somewhat pervasive in the organization.

Joanne M. Conroy, M.D.

It's part of your fabric now.

Lynn Todman

Yes. It's it's it's becoming part of the fabric just the way we do business.

Joanne M. Conroy, M.D.

Yeah. Well, that that's awesome. I would say that is actually when you start to see that what you're doing actually becomes sustainable. And that's very fulfilling. Lynn, thank you for joining me today. Your insights and your expertise are really greatly valued. And you and I are both going to be at the AHA's Accelerating Health Equity Conference this next month, May 7th and May 8th in Kansas City, where attendees can learn from experts in the field and dive much deeper into these topics that we have just scratched the surface on today.

Joanne M. Conroy, M.D.

To register or learn more, you can visit www.equity conference.aha.org. I want to thank you again, Lynn. And for our viewers I'll be back next month for another leadership dialog discussion. So have a wonderful day. And again, thank you so much, Lynn for sharing your expertise.

Tom Haederle

Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.