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Measuring What Matters: Introducing a New Action Framework

Nov 11, 2015, 11:30 AM, Posted by Alonzo L. Plough

It's time to change our culture into one that values health everywhere, for everyone. Introducing a new Action Framework and Measures to help us get there.

A Culture of Health is where communities can flourish and individuals thrive.

Our nation is at a critical moment. There is plenty of data that reveals discouraging health trends: We are living shorter, sicker lives. One in five of us live in neighborhoods with high rates of crime, pollution, inadequate housing, lack of jobs, and limited access to nutritious food.

But there is other data that gives us glimpses of an optimistic future. There’s increasing evidence that demonstrates how we can become a healthier, more equitable society. It requires a shared vision, hard work, and the tenacity of many, but we know it is possible.

Starting with a Vision

Last year, the Robert Wood Johnson Foundation (RWJF) shared our vision of a country where we strive together to build a Culture of Health and, every person has an equal opportunity to live the healthiest life they can—regardless of where they may live, how much they earn, or the color of their skin.

As my colleagues and I traveled throughout the country, we met many of you and heard your views on an integrated, comprehensive approach to health. You told us that in order to achieve lasting change, the nation cannot continue doing more of the same. Realizing a new vision for a healthy population will require different sectors to come together in innovative ways to solve interconnected problems. 

A First Friday Google+Hangout discussion on "Measuring What Matters in Building a Culture of Health" took place on Friday, November 6

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Disrupting the Status Quo: Seeking Innovations from Low-Resource Communities

Nov 4, 2015, 3:03 PM, Posted by Catherine Arnst

A call for proposals seeks to support evaluation of disruptive innovations that improve the health of low-resource communities—without increasing costs.

YouthBuild students work at the Belden Community Garden in Brownsville, Texas.

Many of the resources that influence whether or not people are healthy vary widely from one community to the next. Income, education and employment levels, access to quality, affordable health care, the availability of social services, and the cultural and physical environment—all have a significant impact on health outcomes. Poorer communities, lacking in resources may struggle to offer all the components that create a healthy environment to live, learn, work and play.

By necessity, however, these low-resource communities often find new and creative ways to do more with less to promote health.  In an effort to uncover such fresh and disruptive approaches to improving health in these communities, the Robert Wood Johnson Foundation (RWJF) is issuing a call for proposals.

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Open Enrollment: One Step Closer to Coverage for All

Nov 2, 2015, 9:00 AM, Posted by John Lumpkin

Let’s build upon the success of the Affordable Care Act with this year’s open enrollment.

A pediatrician makes a house visit to check on an infant patient.

Open enrollment is here again—the annual opportunity for Americans to find and enroll in a health plan through HealthCare.gov or their state-based health insurance marketplace. In three short years, millions of Americans have gained access to health plans that cover important services like doctor’s visits, prescriptions, hospital stays, preventive care, and more. As a doctor, I’ve seen the difference health coverage can make in the lives of families. Quality, affordable health insurance means new access to care—care that can have a huge impact on health, equity, financial security, and a better quality of life. It moves us closer to a Culture of Health, where people can access care when they’re sick and when they’re well, making prevention the priority.

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What Right Care Means to Me: The Physician’s View

Oct 21, 2015, 1:11 PM, Posted by Kathleen Grimm, Vikas Saini

Two physicians describe how they are mobilizing patients, providers and others, to change the culture of overuse in health care, to one that is individualized, compassionate and just.

Two doctors standing in a corridor consult together over some paperwork.

The end of life can be fraught with emotion and excruciating decisions for families. It is a time when overuse of treatments and interventions occurs far too frequently. The culture of medicine teaches physicians to “do everything you can” to keep patients alive, with an underlying message that more is better when it comes to treatments and interventions. For doctors, patients and their families, making the decision to refuse extraordinary measures can feel like giving up.

As physicians who are active in the Lown Institute’s RightCare Alliance, we are dedicated to changing this culture. We know that a range of practices persist as standards that don’t improve the length or quality of life. Overuse and inappropriate care are baked into how we do things to the point that they are almost invisible. From frequent blood draws in the hospital to unneeded imaging for a normal pregnancy and futile chemotherapy in end-stage cancer, our goal is to keep patients safe from unnecessary diagnosis, treatment, and ultimately, harm. We think that it is critical to combine an understanding of the true benefits and risks of procedures and therapies with a respect for a patient’s wishes. Such a thoughtful approach that individualizes care, promotes doing more for the patient and less to the patient.

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Is More Always Better? Not Necessarily When It Comes to Health Care

Oct 19, 2015, 8:00 AM, Posted by Emmy Ganos, Tara Oakman

Health care professionals, patients, and allies across the nation are banding together to promote an understanding of what good medical care can and should be with RightCare Action Week.

Red buttons display the motto, "Right Care Right Now."

Sometimes, more is definitely better. Getting that extra hour of sleep can greatly benefit your mind, body and day. Cars that get more miles per gallon are cheaper and cleaner to run. And who would argue against more vacation time?

But when it comes to health care, more is not always better. Unnecessary diagnostic tests, treatments or hospitalizations can drive up health care costs, and in some cases, actually harm patients. For example, excess imaging increases exposure to radiation. Overuse of screening and diagnostic tests can lead to stressful false positives. And unnecessary treatments, drugs or procedures increase the risk of serious complications. In the larger picture, the estimated $200 billion spent on inappropriate care each year diverts resources away from services that are actually needed both within and outside of the health system—in mental health, housing, and infrastructure, for example—that can help all Americans lead healthier lives.  

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Why Nursing is Key to a Culture of Health

Oct 9, 2015, 1:38 PM, Posted by Susan Dentzer

Nurses taking blood pressure

If a Culture of Health means recognizing health’s central importance in our lives, then nurses can be among that culture’s leading ambassadors. More often than not nurses are fully immersed in their patients’ lives, and there are case studies throughout the nation of nurses using that involvement to guide patients in innovative ways to better health.

Consider Stephen and Sandra Sheller 11th Street Family Health Services, a nurse-led Philadelphia clinic serving residents of four low-income public housing projects. Their health center was created in direct response to residents’ requests, and includes not just primary care, but also mental and behavioral health, dental health, and couples and family therapists. There’s a small urban farm producing fruits and vegetables, and a “teaching kitchen” where residents can learn healthy cooking techniques.

At the 11th Street Clinic, nurse-led teams carefully consider each patient’s unique needs. “We don’t ask, ‘What’s wrong with this person?’,“ the clinic’s founder, public health nurse Patricia Gerrity, said at a recent Robert Wood Johnson Foundation Google+Hangout. “We ask, ‘What’s happened to this person?“ that could affect his or her health.

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How Public Health Sharing Arrangements Fit Into the Value Equation

Oct 6, 2015, 11:05 AM, Posted by Meshie Knight

In recent years, cross-jurisdictional sharing has been a focus for policymakers and public health officials wishing to increase effectiveness and efficiency in the delivery of public health services. Measuring its impact is next.

public health nursing banner

Well-functioning, high-value public health departments are critically important to ensuring the conditions for good health in communities. In recent years, however, health departments have been faced with exceptional financial challenges mostly in the form of repeated reductions in state and local funding for public health budgets. At the same time, expectations for their roles and responsibilities—as monitors and chief health strategists for communities and as partners within and beyond the health sector—are growing.

In 2012, RWJF launched a program to investigate a potential strategy for strengthening health departments that could be especially effective in times of financial or administrative hardship, and importantly, could also help to augment the capabilities of health departments serving particularly small or rural jurisdictions: cross-jurisdictional sharing (or more simply, publicly authorized sharing of public health services across jurisdictions). The Center for Sharing Public Health Services (CSPHS) was designed to help build the evidence for how cross-jurisdictional sharing (CJS) arrangements can be planned for and implemented in different environments.

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Collaborating Across Sectors to Grow Healthy Kids

Sep 30, 2015, 1:21 PM, Posted by Alonzo L. Plough

Schools are usually considered to be part of a system separate from the health care system, but they play an important role in building a Culture of Health. See how cross-sector collaborations can ensure children strong starts to healthy, productive lives.

A child eats his lunch at school.

At Cincinnati's Oyler School, I watched as a third-grader received a free eye exam and then pored over the selection of eyeglasses, trying on several pairs, eventually settling on a pair of funky blue frames. He shared that he was looking forward to receiving his glasses, which he'd be able to take home for free the following week. The student’s teacher had noticed that he was having trouble seeing the board in their classroom and was empowered to do something about it. By forging partnerships with nonprofits and government agencies, Oyler has created a vision center, health clinic and dental clinic—all within the school.

Oyler has undergone a transformation over the last decade—from a school plagued by increasing poverty and declining enrollment to a school that is boosting graduation rates and helping improve the surrounding community. Oyler ensures students and their families have access to healthy meals by providing kids breakfast, lunch and dinner and sending them home with food on the weekends. It is part of a movement to create "community schools" that address kids' health needs and get them access to resources that allow them to succeed in the classroom and for years to come.

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Bringing the Technology Revolution to Caregiving

Sep 17, 2015, 10:32 AM, Posted by David Adler

The Atlas of Caregiving is using new methods to uncover the unique challenges and rewards that caregiving presents, from economic, emotional, and mental stressors to the moments of compassion, joy, and intimacy.

An elderly couple, the woman in a wheelchair sitting in front of a large window showing a view of mountains.

We are at a moment in history when technology is allowing us to collect information about ourselves more effectively and reliably than ever before, from the cell phone in our pocket to the Fitbit on our wrist. This technology can help us device wearers—and even the health care providers, researchers and designers we share our data with—track behaviors related to health and figure out how to improve them. But how can this technology be used to help all of us understand and shape the work of family caregivers?

It is widely believed that family caregivers frequently underestimate how long they spend caring for loved ones and the level of stress induced. This is why RWJF is supporting the Atlas of Caregiving project, which will work with 12 families to collect data using technology with the goal of getting a more accurate picture of how caregivers spend their time, and the physical and mental impact of those activities.

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Three Lessons on Improving Quality of Care in Communities

Sep 15, 2015, 10:16 AM, Posted by Anne Weiss

Aligning Forces for Quality not only transformed care in 16 communities, but it provided insights to help shape efforts building a national Culture of Health through high value care.

In a Culture of Health, how can communities improve the quality and value of health care? What happens when people who get, give, and pay for health care locally work together? In 2007, the Robert Wood Johnson Foundation (RWJF) set out to answer these questions when it launched Aligning Forces for Quality with an audacious goal: To transform the quality, equality, and value of regional health care markets.

Along the way, we explored what happens when the people who get, give, and pay for health care locally, work together. Our investment sparked deep and meaningful change in 16 very different communities across America, and important lessons learned in each and every one. But three lessons in particular helped drive success and can be applied to our work to build a national Culture of Health.

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