Participants at one of several community workshops sponsored by the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai

There is wide acknowledgement that health care and social services need to be better integrated to achieve community health, especially for the most vulnerable. The best way to do this is not always clear. Health systems and community-based organizations need to better understand how to create these successful, sustainable partnerships.

The Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai has taken up this challenge.

The Institute recently convened representatives from community organizations and Mount Sinai Health System, along with philanthropic donors and thought leaders.

During a panel on August 1 at the New York Academy of Medicine, participants discussed the benefits of participating in a year-long initiative led by the Arnhold Institute for Global Health and ideas on how multi-organization collaborations can be improved to better serve community members. The participants included Maxine Golub, Senior Vice President, Planning and Development at the Institute for Family Health; Stephanie Wang, MD, Assistant Professor, Medicine (General Internal Medicine) and a primary care physician at Mount Sinai Saint Luke’s; Shoshanah Brown, Chief Executive Officer at AIRnyc; and Judy Secon, Senior Director of Programs and Operations at New York Common Pantry. The panel was moderated by Principal Investigator Natalie Privett, PhD, Assistant Professor, Global Health, Medicine (General Internal Medicine).

Panelists highlighted that building relationships and having candid conversations with people from other organizations is a critical initial step. Ms. Golub emphasized the importance of making a long-term commitment to working in a community to truly effect change. Participants felt strongly that as the work progresses, it is vital to incorporate members of the community into the process. An important aspect of this will be looking at how care can be better coordinated across health care systems and community-based organizations.

Laurie Zephyrin, MD, MPH, MBA, left, Vice President, Delivery System Reform, the Commonwealth Fund, and Rachel Vreeman, MD, MS, Interim Director of the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, Vice Chair of Research for the Department of Health System Design and Global Health, and Director of the Global Sites Network. Photo credit: Andrea Archer

In 2018, the Institute received support from the Commonwealth Fund to develop and implement a participatory process to bring together community health stakeholders to identify and brainstorm how to collectively improve a community health issue in Central Harlem. The Institute facilitated several workshops that included leaders from Central Harlem-based community organizations and health systems.

Stakeholders included AIRnyc, New York Common Pantry, City Health Works, the Institute for Family Health, Mount Sinai St. Luke’s, and the Mount Sinai Performing Provider System (MSPPS), a population-health focused, integrated delivery system in Manhattan, Brooklyn, and Queens. Through design and facilitation techniques, stakeholders identified potential challenges, opportunities, and shared value. Stakeholders began strategizing about potential implementation steps.

Lessons from the initiative workshops were captured and generalized in a guide that is now available for implementers to support community health transformation efforts.

The guide is designed for anyone who wants to improve community health through collaboration across health systems and community-based organizations. It will help people build meaningful partnerships, achieve consensus, and scope out a strategy for community health issues. It is meant to be instructive in thoughtfully convening community-based organizations and health care systems to work towards a collaborative goal while building trust. The guide offers exercises, instructions, and tips to help others create a successful collaboration. It is rooted in the Institute’s experiences developing the collaboration and incorporates lessons learned from leading the collaborative. It was developed with support from the Commonwealth Fund.

Experts agree it is clear that systematic change is needed to improve collaboration. It is complicated and will require dedicated involvement from community organizations, health systems, health information technology experts, policy makers, and payers.

As Arthur Gianelli, President of Mount Sinai Saint Luke’s, noted, “The only way to make change is to change policy at the top and piece-by-piece make improvements at the bottom. We look forward to deepening collaborations across health systems and community organizations.”    

Roshi Joan Halifax, right, with Deborah Marin, MD, Director, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai; and the Reverend David Fleenor, STM, BCC, Director of Education, Center for Spirituality and Health.

Show compassion for patients, for co-workers, and most important, for yourself. That was the central message of the recent Spiritual Health Symposium, sponsored by the Mount Sinai Center for Spirituality and Health and the Department of Nursing. About 125 faculty, staff, and students attended the event in Goldwurm Auditorium, receiving a detailed road map to cultivating compassion in the practice of health care.

A keynote speaker of the event was Roshi Joan Halifax, PhD, founder of the Upaya Institute and Zen Center in Santa Fe, New Mexico. Roshi Halifax— whose title means she is the spiritual leader of a community of Buddhist monks—consults with health systems around the world on compassionate care, but she began her life as a “good Christian girl” in Savannah, Georgia. Her grandmother was a trusted figure in the community who cared for sick neighbors and helped prepare the dead for burial. Roshi Halifax said that listening to her grandmother’s stories taught her three things: that death is normal, that death is a mystery, and that caring for people who are profoundly ill “is sacred work.”

Compassion is essential in health care, Roshi Halifax said, and instead of leading to “compassion fatigue,” it generally gives providers a sense of well-being and purpose. But still, they are at risk of falling into the “shadow” side of altruism and empathy—neglecting to take care of themselves, or empathizing so strongly that they become distressed and ineffective. To help strike a balance in compassion, Roshi Halifax has developed a process called GRACE to use in challenging situations, or in day-to-day patient care. She explained: The “G” of grace is gathering your attention, pausing for a moment. The “R” is recalling your intention, generally to alleviate suffering. The “A” of grace is attuning to yourself, assessing your physical and emotional state and how it may be affecting your interaction with the patient. The “C” is considering what will serve the patient best, and trying to do it. And the “E” is ending the process, perhaps with a thank you or an expression of appreciation.

The other keynote speaker was Shane Sinclair, PhD, Director of the Compassion Research Lab, University of Calgary in Canada, who is a  leader in the study of compassion in health care. “Compassion is like empathy on steroids,” Dr. Sinclair said. “It not only requires action but it extends beyond individuals we can relate to, or we feel are worthy of our care. It targets those we may not easily relate to: the disenfranchised, the homeless, the vulnerable, our enemies, and even to the proverbial ‘difficult patient.’”

Panelists included members of the departments of Nursing, Psychiatry, and Spiritual Care and Education, and leaders of initiatives to improve well-being, such as the Employee Assistance Program, Mount Sinai Fit, and Mount Sinai Calm. “The single most important thing that we can do is listen to the people in our lives and in our work space,” said panelist Jane Maksoud, RN, MPA, Chief Human Resources Officer and Senior Vice President of Human Resources and Labor Relations, Mount Sinai Health System. “If you are ready to listen, without ego, to what the other person has to say, you will make tremendous strides in personal and professional growth and interpersonal connection.”