Safety-net hospitals are like the Cinderellas to their suburban stepsisters, and The Nicholson Foundation is their fairy godmother in New Jersey.
The foundation, in a partnership with the California-based Center for Care Innovations, hosted an innovation fair at the Panasonic U.S. headquarters in Newark last week as part of a multiphase process to identify solutions to common safety-net problems.
Problems include low literacy, low income, language barriers, senior health issues, those without access to personal transportation, as well as identifying vulnerable populations by ZIP codes, according to Veenu Aulakh, co-director of CCI. It also includes those populations that aren’t the best payers for health care, including Medicare, Medicaid and charity care patients.
Aulakh said that, though the efforts were good, many projects were reinventing the wheel.
Joan Randell, chief operating officer of the foundation, said it was interesting watching the New Jersey organizations transition through the process of first identifying an issue, and then later discovering their problems were different from what they first thought.
“For innovation, you don’t have to be a rocket scientist, you just have to think of things in a different way,” Randell said. “We want them to begin to change the culture in their institutions, to find a different way to solve their problems.”
The “New Jersey Innovation Catalyst Initiative” is designed to help safety-net health care organizations solve problems by thinking and working differently, considering what’s possible rather than just what’s feasible, according to the CCI website.
Eight teams, from eight safety-net health systems and organizations, presented their first phase, funded by a $10,000 grant, and were competing for passage into the second phase of implementing their ideas with an additional $25,000 in funding.
Participants include CompleteCare Health Network, Henry J. Austin Health Center, New Jersey Primary Care Association, Robert Wood Johnson University Hospital, St. Joseph’s Regional Medical Center, Trinitas Regional Medical Center, Visiting Nurse Association Health Group Inc. and Hospital Alliance of New Jersey. Newark Beth Israel Medical Center was originally a participant, but did not present at the fair.
RWJUH focused on the language barriers that exist and wanted to provide electronic, multilanguage forms for their emergency rooms, a practice it knows exists in other hospitals in the region.
It is also seeking to find ways to pay language translators for their work, since the current system doesn’t recognize the time they take away from their daily duties to help out in the emergency department, according to Mariam Merced, the director of community health promotions.
On the low-tech end, Trinitas Regional Medical Center wants to go door-to-door with community paramedics and help the vulnerable populations manage their diets and have access to a person familiar with their community. The paramedics would be equipped with basic tools like blood pressure cuffs, portable weighing scales, pill organizers and stethoscopes.
The analysis of its population raised some eyebrows at the fair. The team identified “personas” of the various types of patients who walk through the door, and some found the samples to be far too stereotypical.
Cheri Wilson, director of diversity and inclusion at RWJUH, said the descriptions jumped out at her because she deals with them on a daily basis in her work to help scrub unconscious biases out of the workplace.
Cultural sensitivity is still a big issue in health care, Wilson said.
Aulakh said part of the problem is the approach to these situations.
“In health care, we often jump to the solutions without really understanding what the problem is, so this process helps you slow down a bit,” Aulakh said.
Other projects focused on communication methods, whether it was upgrading medical record systems or using electronic communication to talk to patients or deliver useful information typically found in pamphlets.
“I think sometimes people equate innovation and technology, and that doesn’t always have to be the case,” Aulakh said.
One of the glaring problems at the fair was the lack of background research done into existing solutions. Some projects mirrored or were one step behind current methods or best practices to address an identical problem, Aulakh said.
The culture of health care in New Jersey is also very different from California, she noted.
“You don’t have public hospitals here, which I think makes it more challenging. Because, in California, the public hospitals, all their patients are vulnerable,” Aulakh said. “In California, all the clinics have interpreter programs and language lines and health interpreter networks, because that is all their patients. Here, they are only having to focus on subsets.”
And, while some similarities do exist in the use of technology, New Jersey’s managed care environment is behind, compared with California, Aulakh said.
“It’s definitely more hospital- and specialist-driven here, whereas the emphasis is more on primary care … in California,” Aulakh said.