Hospitals need community conversations to ensure essential services remain available
Our nation is in the midst of unprecedented change, and healthcare is in the thick of it. To better serve the needs of individuals we are placing greater emphasis on improving the patient experience; we are focused like a laser beam on enhancing quality and patient safety; and we are striving to increase value and make care affordable.
At the same time, we are transforming the delivery system to provide care in more seamless ways across all settings. Adding to the challenge, as we implement these changes, 1 out of every 3 hospitals is fighting to survive. Often these hospitals are in small towns and inner cities, and their closure would put residents at risk of losing access to local healthcare services. As we strive to improve the health of our communities and ensure access to care, such loss is of great concern.
The American Hospital Association recognized an urgent need to provide a path forward for preservation of essential healthcare services—including local primary care, psychiatric and substance abuse treatment as well as emergency services—in vulnerable rural and urban communities. As a result, the AHA board of trustees appointed a 29-member task force, which spent over a year researching and talking with communities across the country to identify ways hospitals can partner with their community leaders to meet these challenges.
Clearly, although there are some similarities, the needs of a rural hospital in North Dakota and an inner-city hospital in Baltimore differ. Therefore, after much study, our task force identified nine emerging strategies. We believe each is a viable option for preserving essential health services that foster good health and for giving every hospital—regardless of how you define the “H”—to serve as an access point, or anchor of service, in their communities.
Our report, Ensuring Access in Vulnerable Communities, to be released this week, outlines options for how hospitals can best adjust to meet community needs. For example, one strategy would bridge the gap between clinical care and community services to address social determinants of health such as housing instability, food insecurity, lack of transportation or lack of family and social support. Another would require the creation of a new emergency medical center designation that allows communities to maintain access to emergency services without having to maintain a full inpatient hospital. Hospitals can use the report and the real-world case examples it includes as a guide while taking into account the specific challenges, needs and support structures available in their communities.
From here, our goal is to provide the hospital field with tools so communities can determine what constitutes essential healthcare services for their area. What must be maintained locally? What is the right delivery system that will preserve these services for patients?
These questions and the related community conversations will be not be easy; they also are not conversations exclusive to vulnerable communities. Indeed, the strategies outlined in the report are applicable beyond these vulnerable areas and can help all hospitals as we redefine the hospital and provide more integrated care.
Every health leader must have candid discussions with patients, employees and communities regarding the changes in healthcare—how these changes affect patients and the local area. As hospital leaders we must be transparent about the challenges we face, how our organizations are adapting, and while perhaps unfamiliar, the benefits such change can bring our communities.
We hope that this report will also provide concrete solutions to policymakers in order to ensure access in vulnerable communities. In fact, as noted in the report, some strategies involve congressional or regulatory action, whereas others require harmonization among state requirements. But all solutions demand the health field embrace new ways of thinking—aligning in new ways, considering new partnerships and, above all, promoting health.