When we think of century–old health systems, we often think of slow-to-change organizations that follow the “because we’ve always done it that way” motto. They are so tied to maintaining the status quo that nothing changes unless forced. These organizations likely spend all their efforts on achieving and maintaining regulatory requirements, checking boxes on the Joint Commission survey, and keeping the doors open. However, one hospital is rewriting the rules and debunking this stereotype. The Nashville General Hospital leadership team has embarked on an inspiring transformation journey, challenging what it means to serve its community.
For over a century, Nashville General has been a pillar of care and a beacon of hope for the Nashville community. Throughout its history, the hospital has served as a safety net hospital committed to providing care regardless of a patient’s ability to pay, which means it has had to rely heavily on state and local funding. Every improvement, expansion, new service, or update necessitates resource-intensive requests to local and state agencies, a testament to the hospital’s challenges.
Another challenge the hospital faces is a lack of health equity among its patient population. Davidson County, where Nashville General is located, has the highest level of food insecurity in the state of Tennessee with more than 12% of the population finding it difficult to access healthy food. Other social determinants of health (SDOH) like income, education, affordable housing, and access to transportation, also have a significant impact on Nashville General’s patient population.
Dr. Joseph Webb, DSc, FACHE, who joined Nashville General as CEO in 2015, decided that caring for the hospital’s population meant going beyond its doors. He took an innovative approach to improving the health of individuals in the community by creating a holistic, proactive, patient-centered care model. The foundation of this effort was the Webb Health Equity Model (WHEM), a hub-and-spoke healthcare delivery process based on the “principles of evidence-based management.” Webb says that this evidence-based approach to care is statistically, scientifically, and empirically proven to produce desired outcomes.
As part of the Webb Health Equity Model, Nashville General implemented innovative initiatives like food pharmacies and faith-based community partnerships to address social determinants and barriers to care.
Hippocrates is credited as saying, “Let food be thy medicine and medicine be thy food.” This is the underlying tenant in Nashville General’s “food pharmacy.” When patients enter the hospital, they complete a food insecurity survey. If they answer positively, the information goes into their patient record and to their provider who will write a prescription that is passed to the care team. The prescription indicates the patient’s conditions and what type of food they should receive. For example, someone undergoing cancer treatment will receive healthy, high-caloric food to keep them strong. Someone with hypertension or heart disease will be provided with low-fat, salt-free choices.
The food pharmacy is set up like a grocery store, with abundant fresh foods patients may not get in their local store. When they arrive, a dietician accompanies patients through the store, educating them about how to read labels, what to look for, and how to choose the food that will help them improve their health. Individuals stay in the program until there is a reasonable time to transition off.
Improving health literacy is essential for helping individuals understand how lifestyle and other factors impact their health. It is also vital for assisting them to better navigate our complex healthcare system. Webb reached out to faith-based organizations to help educate and support individuals where they live. As part of this effort, Webb established the Congregational Health and Education Network (CHEN)—a 501c3 that includes educational institutions and local faith-based organizations. The mission of CHEN is to reduce health disparities among Nashville’s African American community by elevating education attainment and health literacy through faith-based partnerships.
Webb says that African Americans, in particular, rely heavily on their faith-based organizations to meet their needs, whether social, economic, emotional, or psychological. CHEN helps improve health literacy and remove barriers, enhancing lives and delivering downstream benefits.
Learn more from Webb in an episode of The Spark here.
Innovative initiatives like food pharmacies and faith-based collaboration act as “cost avoidance” programs by reducing medical consumption on the back end. Because of his forward-thinking approach, Webb has been able to create a more sustainable financial model that has allowed Nashville General to expand its services and reach even more Nashvillians. Additional achievements include the following:
Nashville General may be 134 years old, but it leads the way in innovation and accessibility. It has become an example for other hospitals wanting to break free of the status quo and create meaningful health improvements in their communities. It’s proof of what “innovation in action” truly means.
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