During this era of reform, it is becoming increasingly important for healthcare systems to extend their commitment to the community beyond health fairs and education to programs that offer solutions to the largest health-related challenges their communities face.
These interventions must be based on the community's needs, not the institution's priorities. Building bridges to the community will help position health systems as true partners for better health.
In this spirit, UniHealth America, Burbank, CA, one of the nation's largest not-for-profit healthcare systems has undertaken two major community health interventions in the last two years under the auspices of the UniHealth America Foundation.
Heal L.A.
As the aftershocks of the April 1992 Los Angeles riots continued to rock the community for several months after the flames were extinguished, a UniHealth survey revealed that food, baby supplies, and in some cases even basic clothing were not available to riot victims. To address this situation, the system mounted Heal L.A., a program that raised more than $150,000 to help people suffering from riot-induced problems. Every dime went directly to help an individual or family in need.
"The survey showed that the overwhelming majority of food shelters helping riot-affected families were losing the battle to provide enough for the community," says Greg Waskul, UniHealth vice president. As a result of the survey, the problem, which had been virtually ignored by the media for months received massive coverage by the local press.
As part of its long-term intervention, UniHealth became the first company to commit to building houses with the Los Angeles Chapter of Habitat for Humanity. Two homes, one paid for by the company and one by contributions from UniHealth employees, will be built this winter in south central Los Angeles.
It is believed that UniHealth's Heal L.A. program was the most extensive person-to-person intervention conducted by an organization following the riots. The program has received more than a dozen regional and national awards and has become a prototype for intervention programs throughout the nation.
How It Worked A community outreach team, including members from throughout the company, was formed to determine what UniHealth could do to help heal the city. This team developed the month-long Heal L.A. program to provide aid to the community in three major areas — goods, money, and volunteer time. The program was designed to provide both short-term and long-term support to people in need.
The Heal L.A. project received final approval on August 20, 1992. Because the launch date was September 1, the program had to be quickly and effectively announced to more than 20 UniHealth America hospitals, health maintenance organizations, and other operations. Plans also had to be developed to collect and distribute food and baby goods.
In three days, Waskul wrote and designed more than 20 pieces, ranging from letters and flyers to a commemorative T-shirt to a prototype newsletter. Vendors agreed to donate services at cost, reducing the total cost of providing program materials to UniHealth's 13,000 employees to less than $10,000.
The program's success was the result of several key factors:
- Endorsement by senior managers. Top managers showed their commitment by agreeing that the company would match all employee monetary contributions.
- Personal recognition for participants. Every contributor received a button, while everyone giving a significant donation of food, baby goods, volunteer time, or money received a commemorative T-shirt, as well as a letter from the chief executive officer (CEO).
- Rapid dissemination of information. A one-page newsletter was sent by modem or Fax to every UniHealth operating unit each morning, where it was immediately photocopied and distributed. Every operating unit was contacted daily to dig up news. If something important happened anywhere in the system on Tuesday, it was certain to appear in Wednesday's newsletter.
- Special donation days. Donations picked up dramatically on "Deposit Day" for food and baby goods and on "Payroll Deduction Day," when employees were asked to fill out payroll deduction forms if they wished.
- The appeal of the home-building project. The "UniHouse" concept struck a responsive chord with UniHealth employees. Not only did contributions increase significantly when the project was announced, but more than 200 people volunteered to help with the construction.
- The impact of the survey. By showing that conditions had worsened greatly since the riots, the survey mobilized UniHealth employees and alerted the media to the extent of the problem.
The Results The results of Heal L.A. were extraordinary:
- The program raised total contributions of more than $152,000, according to Waskul. "UniHealth will be the first company in Southern California whose employees raised the money to build a house in South Central L.A. for people in need. In addition, employees donated enough food to feed more than 1,000 families (4,000 people) and to feed and clothe more than 3,000 babies for a week."
- News coverage was extensive. Stories appeared in the Los Angeles Times and more than 20 other newspapers, as well as on the Associated Press newswire and a number of television and radio news programs.
- The survey moved others to help. After UniHealth's findings were announced, a number of groups, including a major television station, initiated food drives that increased the flow of food to the community until food banks could pick up the slack.
By stepping forward when others were silent, the people of UniHealth America became leaders in the battle to help solve a critical community health problem. The program succeeded because it addressed a simple question, What is most needed in the community?
Operation Immunization
During the summer of 1993, UniHealth America embarked on another major community-based initiative called Operation Immunization. The program, undertaken in partnership with the Los Angeles Times Valley Edition, is becoming one of the most comprehensive private-sector health initiatives ever undertaken.
"Next to AIDS, the shortfall in proper immunization of children is perhaps our greatest public health problem," says Waskul. He points out that less than 50 percent of American children under age two are properly immunized. In Los Angeles County, the numbers are even worse. Even though it spent more than $75 million on immunization in the last five years, the county has an immunization rate for two-year-olds of only 41 percent.
The support of Operation Immunization by UniHealth President and CEO Terry Hartshorn and Los Angeles Times Valley Edition President Jeffrey Klein has been a key to its success. The program was created by a team that included Waskul and Los Angeles Times executives Charmaine Alexander, Diane Kowalski Weegar, and Kay Heitzman. The effort has attracted the support of a number of leading organizations, including Thrifty Drug Stores, the Permanent Charities Committee of the Entertainment Industry, Heal the World Foundation, Heal L.A. Foundation, Operation USA, and the Los Angeles Immunization Coalition.
Operation Immunization is being conducted as a pilot project throughout the San Fernando Valley, which has a population of 1.9 million people. Within three years, it is expected to be operating throughout Los Angeles and Orange counties.
The UniHealth-Los Angeles Times effort is designed to inform parents about the importance of immunization for their children. All materials will be written in English, then recreated in Spanish for the valley's large Hispanic community (more than 35 percent of the population). This important work is being done on a pro bono basis by an Hispanic advertising agency, Cruz/Kravetz Ideas, the California Hispanic/American Medical Association, and Louey Rubino Design Group.
Educational Components In addition to an ongoing public service campaign, which began in August, Operation Immunization includes educational components targeted at three major groups:
- Schools. In more than 500 elementary school classrooms in the San Fernando Valley, fourth- through sixth-grade students are receiving a four-week health education course on immunization. A second health education unit will be made available to teachers in the spring. UniHealth and the Times sponsored a poster contest, with cash prizes for winning classrooms. Immunization presentations from nurses and other healthcare professionals are also available to teachers who request them. In addition, education materials are being sent home to parents. This cooperation between Los Angeles Schools and the business community is the linchpin of the program.
- Businesses. Operation Immunization materials are being made available to more than 3,500 businesses in the San Fernando Valley. UniHealth and the Times are also placing immunization information throughout the valley business community.
- Churches and synagogues. All churches and synagogues throughout the area will be contacted through the Valley Interfaith Council. Special emphasis is being placed on the Catholic Church, in an attempt to reach members of the Hispanic community.
Immunization Clinics
Immunization clinics began operations in early 1994, with all immunization materials donated by the Los Angeles County Department of Health. Three types of sites are being used to determine their effectiveness in reaching target populations:
- Schools. Four elementary schools have been chosen as sites for the clinics. School nurses who oversee the clinics are assisted by UniHealth physicians and nurses, as well as nurses affiliated with other area hospitals. The clinics will be opened periodically throughout the year to build confidence within the community.
- Discount stores. The Operation Immunization team is setting up periodic clinics at a major discount store in an area with a large Hispanic population in an attempt to reach parents who cannot be reached through the schools.
- Door-to-door program. In one ZIP code, volunteers will go door-to-door to tell parents about special clinics in their neighborhoods. This tactic has been especially successful in developing countries, but has seldom been used in the United States.
Be a Leader
"In every community across the nation, there is something important a healthcare institution can offer to improve the community's health," Waskul says. "Find it and lead the effort to do something meaningful about it. You'll inevitably touch the hearts of those you serve in a way you'll never be able to do simply by providing quality healthcare."
The success of the Heal L.A. and Operation Immunization programs is that they addressed major community healthcare needs. The company believes that the future success of its healthcare business will depend in large part on the strength of its relationship in its local areas. There is no way to better strengthen these ties than for the healthcare institution to help solve the real health problems of the community it serves.
Ms. Weiss is a Santa Monica, CA-based healthcare consultant.