1. System wide Efforts to Improve Everyday Clinical Practice and Health Equity Saint Francis Hospital and Medical Center Jeri Hepworth, Ph.D., DIO Marcus McKinney, PhD., VP, Community Engagement Rebecca Crowell, Ph.D., Research Director

2. Align resources, policies, procedures, governance and scholarly activity to inform, engage and promote quality  Improve outcomes through continuous/iterative learning Strengths – Community-based academic medical center committed to improving population health. Barriers – Community-based academic medical center committed to improving population within the current healthcare environment. Overall Goal

3.  History and Mission of Saint Francis Hospital  1897 by the Sisters of St. Joseph of Chambéry as a response to poverty.  $75M each year in Community Benefit Care.  Community Based  Hartford has the highest concentration of adult and child poverty in Connecticut.  Over 31% of Hartford residents live below the federally established poverty level (US Census, 2010)  42% of Hartford residents are Spanish dominant with low English fluency.  Educational Commitments  Has independent ACGME accredited residency and fellowships  large teaching hospital for UCONN with over 500 residents (120 FTE) and 200 students  Interprofessional education Integration of Practice Improvement, Health Equity, Research and Education

4.  In 2011 the Saint Francis Board resolved to “raise awareness of equity of care and implementing improvements to reduce disparities in care.” Our Equity Goals:  Increase Diversity in governance and management  Increase Cultural Competency Training  Increase Collection & use of Health Equity Data to reduce disparities Much of this work comes out of the Curtis D. Robinson Center for Health Equity:  cultural/diversity inclusiveness training  relevant disparity data for patients  resources for patient navigation  Inclusion of community organizations in patient care  Health Equity Research Healthcare Quality/Disparities

5.  Build on Institutional Commitment and Mission  Community members and organizations full partners – Collaborative Engagement  Build collaborative relationships with educators, nursing, QI, research  Health Equity can not be separated from Quality and Safety Initiatives  Start small, with activities that impact daily practice, patients and clinicians  Maintain a Scholarly approach – develop metrics, assessment of education  Leverage capacity of the new EPIC electronic health record Guiding Principles

6.  Community and Provider Focus Groups – What do we know?  Learning Health System – Framing communication as a clinical, quality/safety and compliance issue  Equitable care depends on good communication  Collaborate with Clinicians to shape needs assessment  Pool disparate language services resources to Center for Health Equity  MARTI implementation –  8 - 26 units  Educational simulation pilot program  Broad training processes Meaningful Change: Enhanced Access to Language Services