In Southern California’s San Bernardino County, the community health team at St. Bernardine Medical Center knows that in order to keep their patients healthy, they need to address these social determinants of health. The hospital participated in a national initiative designed to increase investments in the social contributors to poor health, with an emphasis on affordable housing. The need in the community was significant, and growing, according to the hospital’s 2021 community benefit report: The number of homeless persons in San Bernardino County had increased 13.5 percent over the previous year, the majority of whom had no shelter at all.

“We’ve been in the community for nearly 100 years, so we’re here to stay and advocate for the poor and underserved,” said Kathleen McDonnell, director of mission integration. “You can’t have a healthy community without healthy and safe housing.”

Fortunately, McDonnell and her team were able to forge a partnership with National Community Renaissance (CORE), a nonprofit housing developer that was already in the process of redeveloping a former military barracks-turned-Section 8 housing complex. With funding from several community and government partners, including $1.2 million from Dignity Health’s Community Investment Program, which channels financial resources to organizations that promote the total health and health equity of communities, nearly 200 new housing units were built at Crestview Terrace in San Bernardino. The majority of the units qualify as affordable housing, but several market-rate units were included in the project as well, for those community members who need housing but do not meet income requirements for affordable housing.

The tree in the background was planted when the first military barracks were built in WWII. It is 80 years old and was saved during construction as a nod to our past.

“We know that people with unmet housing needs are more socio-economically disadvantaged, experience poor health, and are more likely to have serious chronic illnesses,” said Doug Kleam, president of St. Bernardine Medical Center, at the ribbon cutting ceremony in January 2022. “Quality, affordable housing can reduce stress as well as chronic and infectious disease, which leads to improvement in both physical and mental health. This project will not only bring much needed high-quality affordable housing, but it will also revitalize the neighborhood and help improve the health and quality of life for families in the surrounding community.”

The hospital’s commitment to supporting affordable housing options for the community didn’t stop there. Through collaboration with local community organizations, financial institutions, and nonprofit housing developers, Dignity Health will continue to address affordable housing needs in San Bernardino well into the future.

In 2021, Dignity Health approved a $1 million line of credit to nonprofit housing organization Neighborhood Partnership Housing Services, Inc., to support the development of 10 single-family homes for low-income families. The project is well underway. These dollars will be matched with an additional $1.5 million from other funders to ensure maximum impact for the community. The average home will feature 3 bedrooms and 2 baths and will be approximately 1,600 square feet in scattered land currently not used in the City of San Bernardino

“We are committed to this community, and if we can help stabilize housing, everyone will be healthier,” McDonnell said.

That’s why all Dignity Health hospitals in California participated in the Human Rights Campaign’s 2022 Healthcare Equality Index (HEI), the nation’s foremost benchmarking survey of healthcare facilities on policies and practices dedicated to the equitable treatment and inclusion of their LGBTQ+ patients, visitors and employees.

“As caregivers, we are always actively seeking tools to help us enhance the care we provide for all our patients,” said Marvin O’Quinn, President and Chief Operating Officer at Dignity Health. “Following the comprehensive framework outlined in the HEI application has helped us implement several best practices for LGBTQ+ care, including policy changes, staff training, and additional support for patients and families.”

Supporting the health of LGBTQ+ people has long been a priority for Dignity Health, which has a legacy of responding with urgency to the AIDS epidemic, supporting LGBTQ+ causes, and expanding services for these patients – like through Dignity Health’s Gender Institute in San Francisco, a leading provider of transgender health care services.

As part of the HEI process, Dignity Health worked with a nationally recognized LGBTQ+ health expert to undertake a comprehensive review of policies and practices supporting LGBTQ+ patients and staff. For example:

• Dozens of policies were updated to support LGBTQ+ health care outcomes,
• Training was expanded for staff and clinicians,
• IT processes and patient forms were updated to better capture preferred pronouns and solicit feedback from LGBTQ+ patients,
• Welcomed an LGBTQ+ patient advocate on staff,
• Clarified wording in employee benefits to be explicitly inclusive of LGBTQ+ employees. We also launched a website outlining our commitments.

“Every person deserves to have access to quality healthcare, be respected and heard by their doctor, and feel safe in the facility where they are receiving care. But LGBTQ+ people are often subject to discrimination in all spaces, including healthcare facilities, which leads to members of the community avoiding care and anticipating our voices will not be respected in an incredibly vulnerable environment,” said Tari Hanneman, Director of Health & Aging at The Human Rights Campaign. “The Healthcare Equality Index, at its core, strives to ensure LGBTQ+ people are protected and affirmed by their healthcare providers and feel safe seeking services. Our HEI active participants are truly pioneering the healthcare industry by implementing robust,  comprehensive LGBTQ+ inclusive policies that hopefully, because of their work, will become standard practice.”

This recognition from HEI is a testament to the dedication of Dignity Health’s compassionate care teams, who are committed to helping make sure that LGBTQ+ patients feel welcome, heard, and safe in Dignity Health care sites every day.

These individuals, who are severely immunocompromised, need nutritious, fresh foods in order to stay healthy – although many of the clinic’s patients do not have access to this resource. The food pantry provides fresh produce, lean protein, healthy dairy, vegetarian options, and even the occasional treat – including healthy recipes – tailored to patients’ needs and taking into account cultural preferences, thanks to Registered Dietitian Tammy Basile, who runs the pantry.

Over the years, the pantry has grown to feed more than 70 consistent clients every other week, the majority of whom identify as LGBTQ+. But when the COVID-19 pandemic hit, something changed. Suddenly, these immunocompromised patients, many of whom relied on public transportation to get to the food pantry, stopped coming because leaving their homes posed too great a health risk.

Basile knew these patients still needed fresh groceries to be healthy, so, nearly overnight, the food pantry went mobile.

“The staff really stepped up,” Basile said. “The case managers, mental health providers, medical providers all reached out to their patients to ask if they needed food. Before we knew it, our 70 patients had increased to 150.”

Daryl Dimaculangan is a medical case manager at the CARE Center who jumped at the opportunity to continue serving his patients during the pandemic. He said delivering food also gave the patients a chance to experience the social interaction and contact with a caregiver that they missed out on by not visiting the pantry in person.

“We got to see our patients at their place of residence and get a feel for what they’re really experiencing,” he said. “We were able to chat with them – from a distance – just to check up on them and see how they’re doing. The face-to-face interaction was really powerful.”

At the height of the pandemic, Dimaculangan said he was sometimes spending eight hours in the car each delivery day. Now that COVID-19 vaccines are available, the number of deliveries is much fewer, but both Basile and Dimaculangan said the experience was a highlight of their careers.

“This was probably one of the most rewarding things I’ve done in my 25 years with the CARE Center,” Basile said. “It just felt so good to give people food and watch them be able to eat. I can’t even explain the depth of how good it felt.”

What she did have, though, was CityServe. Through CityServe, Solis and her kids received groceries, a Christmas tree and a new dining room table with enough space for them all to sit together as a family.

CityServe, a nonprofit organization that began in 2017 as a project of Canyon Hills Assembly of God, empowers local churches to connect with people who are hurting in their neighborhoods and help them meet some of their health needs, including food, clothing and necessary household supplies. Fifty churches and 30 nonprofit organizations have partnered with CityServe so far.

Recognizing a need in the Bakersfield community, Dignity Health provided a $25,000 grant to CityServe to help with the costs of transporting donated goods from storage warehouses to family homes throughout the area. This is one example of Dignity Health helping to connect community partners to meet various community needs. Another example is a recent $154,000 donation made to Operation BBQ Relief. This enabled 35,000 meals to be served daily around the holidays to people in need at the Bakersfield Homeless Center, St. Vincent de Paul Bakersfield, The Mission at Kern County and CityServe.

“Health and wellness truly begin at home,” said Robin Mangarin-Scott, vice president of marketing and communications for Dignity Health in Southern California. “At Dignity Health, we actively seek out community partners who can help extend our reach beyond the walls of our hospitals and provide resources for families before they need medical care. Organizations like CityServe help prevent illness by addressing some of the socioeconomic barriers to health, including access to nutritious food and consistent safe, warm shelter.”

“There is strength in numbers,” said Robin Robinson, community development and church engagement director for CityServe. “When the local business community comes alongside nonprofit organizations like this, that’s when we see transformation happen. Together, we can truly change the lives of families in need.”

And it shows. In partnership with Dignity Health, CityServe and its network have helped contribute to:

• 15M+ Farmers to Families food boxes distributed
• $510M+ worth of goods in-kind distributed
• $749M+ in total resources distributed
• 62M+ people served

It’s this kind of relationship building that is a central focus of Dignity Health and CityServe. “Through this partnership, we’re able to foster relationships and help empower transformation in our communities,” said Mangarin-Scott.

“At its core, climate change is a health equity issue. We believe there is an unbreakable connection between the health of our planet and the health of our people,” said Lloyd H. Dean, CEO of Dignity Health. “We see the effects that climate change can have on the patients we serve, from trauma and emergencies to mental health, allergies, respiratory illnesses and infectious diseases.”

These factors, along with other natural and human-made health stressors, influence human health and disease and may continue to intensify, with new health threats emerging, according to the Centers for Disease Prevention and Control. As with other health inequities, vulnerable and underserved populations are the most affected.

As a result, Dignity Health recently announced a commitment to the environment and public health in line with the Paris Agreement, the international treaty on climate. Dignity Health plans to achieve net-zero greenhouse gas emissions by 2040 and is also targeting cutting its emissions in half by 2030.

It takes more than just knowing about the effects that climate change can have. It requires an understanding of the responsibility we have as a health care organization, said Dean.

“The U.S. health care system contributes 10% of the nation’s carbon emissions and 9% of harmful non-greenhouse air pollutants,” he said. “Our plan aims to move the entire sector forward by working with supply chain and our wider stakeholders to support their reduction in emissions.”

For the next 20 years — and beyond — Dignity Health is striving toward net-zero greenhouse gas emissions. It will achieve these goals through a comprehensive climate action plan that includes:

• Leveraging new energy-efficient technologies
• Engaging with suppliers to help them reduce their emissions
• Evaluating investment portfolios for climate impacts
• Using credible offsets only where emissions cannot be reduced through other measures, such as energy efficiency and renewable energy procurement

This commitment was shared at the UN Climate Change Conference (COP26) in Glasgow, Scotland, in November 2021.

“Urgent action is needed now to reverse climate change,” said Shelly Schlenker, executive vice president and chief advocacy officer of Dignity Health. “We are committing to an ambitious, science-based goal that leverages advances in the pace and scale of renewable infrastructure.”

In the U.S., public health can be affected by disruptions of physical, biological and ecological systems, including disturbances originating here and elsewhere. The health effects of these disruptions include increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious diseases, and threats to mental health.

This past spring, Dr. Dieter Bruno, chief medical officer of Sequoia Hospital, launched a dedicated vaccine clinic in partnership with the Bay Area Christian Church and the Hope Technology School, a private school catering to both neurotypical students as well as students with learning, developmental and physical disabilities, many of whom were experiencing barriers to getting vaccinated.

The clinic was specifically designed to be accessible for those with developmental disabilities, such as autism, and their family members and caregivers. The clinic provided a sensory-friendly environment and incorporated expertise from both therapists and teachers, along with the Dignity Health clinical staff, to help administer the vaccines.

“In the world of special needs, you don’t always see people reaching out or taking that extra step to meet someone where they are, and that’s what I’ll be forever grateful for,” Diane Thompson, a parent whose child received a vaccine through the clinic, told KPIX reporters.

Throughout the day, more than 100 patients were vaccinated. “Our nurses, who have been working so hard throughout the pandemic, found this experience so rewarding that they all wanted to come back,” said Marie Violet, director of health and wellness at Sequoia Hospital. “And parents were in tears because this happened. Everyone was so grateful.”

Partnering with community organizations like these has been key to reaching vulnerable communities during the pandemic. “Our Dignity Health team actively seeks ways to help the communities we serve, be it one-to-one outreach or partnerships with community organizations like this,” said Violet. “It is with the help of partners like these that we are able to reach populations who, for a variety of complex reasons, have limited access to care in traditional settings.”

Dignity Health continues to explore additional opportunities to help close the health care equity gap and make access to care easier, particularly for the special-needs community.

With roughly 20 percent of adolescents experiencing mental health issues—a much higher rate than adults^[1]—programs for younger patients are an especially critical community support.

The staff at the McAuley Adolescent Inpatient Unit at St. Mary’s Medical Center in San Francisco, led by Medical Director Dr. Yosra El-Menshawi, are working hard to provide a growing suite of mental health solutions for children between the ages of 11 and 17.

“Untreated depression in children and adolescents can lead to potential substance abuse, to not being able to function socially, occupationally, academically, and so on. It can impact a person’s ability to be a productive individual and even provide for their own families in the future,” said Dr. El-Menshawi. “Untreated depression is also one of the greatest risk factors for completing suicide.”

Through a combination of individual, group and family services—with both inpatient and outpatient program components—Dr. El-Menshawi and her team nurture healing, growth and hope, helping children and adolescent patients navigate their own unique pathways to healthier futures with more positive outcomes.

^[1]nih.gov.

The only inpatient adolescent psychiatry unit in San Francisco

“Our inpatient adolescent unit is truly a haven for kids in crisis. Oftentimes, the patients who are admitted to our unit have attempted to harm themselves or even potentially to harm others,” shared Dr. El-Menshawi. “Many have experienced acute changes in their behavior and even their ability to maintain reality. We deal with major depressive disorder, psychosis, and some kids who are also manic. This inpatient unit is a hugely important piece of the behavioral health continuum of care.”

In fact, the St. Mary’s adolescent inpatient unit is the only one of its kind in San Francisco, serving patients from all over the state—as far north as the Oregon border and as far south as Riverside. Sadly, the need for acute inpatient care among children and adolescents is much greater than the services available.

Expanding access to care through strategic partnerships

As the community need for behavioral health support grows, Dr. El-Menshawi and her staff are constantly thinking of ways to expand services and access to care for their patients.

The University of California Collaboration

Two years ago, Dr. El-Menshawi initiated a partnership between St. Mary’s and UCSF. Through this collaboration, UCSF’s psychiatry fellows rotate through the adolescent inpatient unit at St. Mary’s. The relationship has myriad benefits, increasing care touch points for patients while also providing training and an expanded view of the full range of mental health needs to doctors-in-training. This training partnership is especially important since inpatient units for adolescent mental health care are so rare, and the demand for more providers in this specialty is so great.

“Any time you have trainees, it raises the level of care that you can provide. Trainees are very inquisitive—they are curious, and they make everyone else even more curious. The UCSF fellows work quite hard to help support the staff and the treatment plans that the staff create. They also gather and share information on the latest evidence-based treatments. We have seen so many benefits, and that’s just in two years. I can’t even imagine what we’ll be able to do together down the road for these patients.”

The Counseling Enriched Education Program

The Counseling Enriched Education Program is another example of a collaboration that opens up access to support younger patients in need. Together with the San Francisco Unified School District and the department of public health, St. Mary’s runs a therapeutic day school program for children with chronic mental health issues. The program provides an individualized education plan (IEP) to support students in the public school system who are experiencing emotional disturbance or mental health impairment.

“This is a very unique program that offers intensive treatment in a school setting. The students who are enrolled are supported by a full team of psychiatrists, family therapists, recreational therapists, and others who can meet their mental health needs—in addition to the educators supporting them,” said Dr. El-Menshawi. “We see kids with histories of trauma, and also parents struggling with mental health illness and substance abuse issues themselves. These kids typically have multiple psychosocial stressors and truly benefit from the multidimensional support.”

There are very few adolescent mental health programs in California that combine counseling and education, and St. Mary’s is the only one located in San Francisco.

Together, the McAuley team embodies the mission of Dignity Health—to provide compassionate care for all Californians and provide a bridge to care when gaps exist.

When Margo Young, MD, a sister within the Catholic Church, served as director of community health at Dignity Health’s St. Bernardine Medical Center and Community Hospital of San Bernardino, she helped lead a partnership to expand access and support for the community. The result: the Lestonnac Free Clinic.

Lestonnac provides free comprehensive medical and dental care to uninsured patients, treating thousands of people who otherwise would not have access to affordable healthcare. Dignity Health’s support of this vital healthcare resource is part of a broader set of partnerships it has forged across the state to improve access to care for the immigrant community. The clinic provides supported, safe and secure primary care and dental services through the generosity of volunteers and donors, and proactively facilitates referrals from the clinic to hospitals and vice versa. “It’s about getting people what they need in order to be healthy,” said Dr. Young. “It’s about their quality of life.”

Dr. Young is no stranger when it comes to assisting immigrants gaining access to healthcare. She participated in Operation Bienvenida, a program through the Catholic Diocese of San Bernardino designed to assist immigrants who were released from ICE detention centers. Dignity Health provided food and other resources to help them on the next leg of their journey. Since launching in 2018, Operation Bienvenida has seen a fluctuation in need and numbers, but the program is gearing up again, says Dr. Young, and is presently partnering with county and nonprofits to accompany immigrants entering the United States from the Southern border.

Dr. Young continues to partner with St. Bernardine Medical Center to connect the dots for immigrants to find accessible healthcare and to help build trust within the community and healthcare providers. “This community needs a setting where they feel comfortable to learn about their healthcare,” said Dr. Young. “Lestonnac is one of those places, especially in partnership with Dignity Health.”

Building trust within the community through health education

For patients who have never had formal healthcare before, maneuvering the process can sometimes be overwhelming. Lestonnac Free Clinic provides a mix of volunteer health educators and health navigators (offered in both English and Spanish) to help patients fill out paperwork, understand their coverage, share best practices to help encourage immigrants to seek care and coverage, discuss where to find prescriptions, help find post-care housing for those who are homeless, and more.

“The Dignity Health partnership plays a great part in this, as they refer patients back to our community health educators and navigators,” said Dr. Young. Lestonnac Free Clinic and Dignity Health also partner to provide additional healthcare for patients, including outpatient surgeries for hernias or referrals for specialty consults for ongoing conditions, such as rheumatoid arthritis or diabetes—at no cost.

“These are vulnerable groups and populations, but Dignity Health really does seek to connect the dots for them to get what they need to live a sustainable life,” said Dr. Young.

The pandemic clearly illuminated inequitable health outcomes for people of color and showed that hospitals and health systems must prioritize health equity.

That’s exactly why Dr. Alisahah Cole came to Dignity Health. As the first vice president of population health innovation and policy, Dr. Cole is charged with “operationalizing” equity. She is leading a systemwide effort to rethink clinical practices and meet vulnerable communities where they are.

“Dignity Health recognizes different communities have different barriers to healthcare,” said Dr. Cole. “Our role as care providers is to create more equitable policies and engage in more equitable practices. We need to bring care to these communities and stop expecting them to come to us.”

Partnering with trusted community leaders and organizations is key to Dignity Health’s strategy for protecting underserved communities throughout the pandemic. Recent vaccination clinics, held in both urban and rural parts of the state, demonstrate how Dignity Health is putting this kind of thinking into practice.

In LA, Dignity Health recently collaborated with the city government, the LA Care Health Plan (Medi-Cal), the Charles R. Drew University of Medicine and Science, and the NAACP to host a massive vaccination clinic at the Dignity Health Sports Park. More than 20,000 people from high-risk communities were vaccinated. Knowing that transportation is a key barrier to access for communities of color, the initiative also included transportation to the park.

In Yolo County, where the predominantly Latinx farmers have continued working all throughout the pandemic, Dignity Health launched a similar field vaccination effort in Woodland to protect this vulnerable group of essential workers.

“One of the reasons I joined Dignity Health is the mission to care for the vulnerable,” said Dr. Cole. “Dignity Health lives out that mission every day in California by seeking out every type of population demographic and providing care with compassion and kindness.”

In a state as large as California, making that specialized care available to every patient who needs it is no small task. It requires innovative solutions, like the partnership between UC Davis and Dignity Health’s Mercy Medical Center Merced.

The Mercy UC Davis Cancer Center serves over 13,000 patients annually, providing radiation oncology and other critical specialized care that wouldn’t otherwise be available. Through the UC Davis Cancer Care Network, a collaboration of hospital-based cancer centers, patients can also get their care close to home — regardless of whether they live in a remote northern area like Redding, in Merced in the San Joaquin Valley or right in the heart of Los Angeles.

“Since 2000, this partnership has offered access to gold-standard cancer care that any community would welcome,” said Parminder Sidhu, an oncologist with Mercy Medical Center in Merced, and a UC-trained oncologist. “Today, our community knows that they can receive the best cancer care without leaving home. Any cancer patient or loved one knows how truly precious that is.”

^[1] https://www.chcf.org/wp-content/uploads/2017/12/PDF-CancerInCalifornia12.pdf

Patient-centered programming drives improved cancer outcomes

But what exactly is the “gold standard” when it comes to cancer care? It’s high-quality, multidisciplinary, patient-centered cancer care. It’s hitting the bar that the National Cancer Institute sets for quality, but it’s also offering a full spectrum of services for patients — everything from cutting-edge clinical trials to financial counseling and interpreter services.

It’s a variety of community programs, which together compose a holistic approach to cancer treatment that goes well beyond the clinical realm. In other words, it’s treating the person, not just the cancer.

Here is a sampling of the services offered to patients at the Mercy UC Davis Cancer Center:

• Cancer support groups: These groups offer a chance to share stories, learn from others who have been through a similar journey and even make new friends. The groups are free and open to anyone who is currently fighting cancer or who has survived the disease.
• Massage therapy: Studies of massage for cancer patients suggest that massage can decrease stress, anxiety, depression, pain and fatigue. This program offers patients free 15-minute massage sessions that can often be scheduled on the same day as treatment.
• Wig bank: For women in particular, the hair loss that often comes with treatment can be confidence-shattering. This program offers on-site, free wig-fitting consultations. Volunteers from the American Cancer Society help patients find a wig that fits their lifestyle and makes them feel more like themselves, in addition to offering tips on how to style wig alternatives such as turbans and scarves.
• Smoking cessation: Although the rate of new lung cancer cases in the state is significantly lower than the national rate, lung cancer is still one of the most common cancers for adults. This free four-week program offers education and free nicotine replacement therapy (patches).
• Support for navigating care: Cancer care is complicated, so the center provides an oncology social worker who is available for consultations at no charge to all patients with cancer diagnoses.

 These programs address not just the physical symptoms of cancer and cancer treatment, but also the emotional well-being of every Californian who comes through the doors of the Mercy Medical Center Merced.