Community Health Improvement Plan 2019 - 2021 First Hill and Cherry Hill (Seattle) Campus - Swedish Medical Center

Community Health Improvement Plan 2019 - 2021 First Hill and Cherry Hill (Seattle) Campus - Swedish Medical Center

   First Hill and Cherry Hill
       (Seattle) Campus
  Community Health
  Improvement Plan
     2019 – 2021
Community Health Improvement Plan 2019 - 2021 First Hill and Cherry Hill (Seattle) Campus - Swedish Medical Center

CEO LETTER                          1     Summary of Community Health
                                          Improvement Planning Process       10
EXECUTIVE SUMMARY                   2
                                          Addressing the needs of
MISSION, VISION, AND VALUES         3     the Community:
                                          • Mental Health                    10
INTRODUCTION                        4     • Drug Addiction                   12
  Who We Are                        4     • Obesity and Diabetes             13
  Our Commitment to Community       4     • Homelessness                     15
                                          • D iabetes and Obesity –
OUR COMMUNITY                       6        Prediabetes Screening           16
  Definition of Community Served    6     • H omelessness – Medical Care
  Age                               6        in Homeless Encampments         17
  Ethnicity                         6     • M ental Health – Depression
  Median Income                     7        Screening and Mental Health
                                             First Aid                       18
  Poverty                           7
                                        	Other Community Benefit Programs
COMMUNITY NEEDS AND ASSETS                and Evaluation Plan                19
                                        PLAN APPROVAL                        20
IMPROVEMENT PLAN                   10   APPENDIX                             21
Community Health Improvement Plan 2019 - 2021 First Hill and Cherry Hill (Seattle) Campus - Swedish Medical Center

      To Our Communities:

      As outlined in our 2018 Community Health Needs Assessment, the following social determinants of
      health emerged across the communities of all Swedish locations during the assessment process:
      mental health, drug addiction, homelessness, obesity and diabetes, and joint or back pain.

      We have completed the development of a Community Health Improvement Plan (CHIP) to specifically
      address many of these barriers, including strategies and measures, towards making our community
      a healthier place. The CHIP outlines the process of strengthening our existing programs across the
      Swedish system along with identifying new programs and resources to support those, and build
      and sustain our partnerships with key organizations to collaborate on solutions.

      The next phase will involve broad implementation of the action plans details included in this
      2019- 2022 CHIP, and monitoring and evaluating its short-term and long-term outcomes.

      As CEO, I am proud to lead Swedish in creating health for a better world.

                                 R. Guy Hudson, M.D., MBA
                                 Chief Executive Officer
                                 Swedish Health Services

1 |                                                                    CHIP First Hill and Cherry Hill Campus — 2019-2021

  About the Community Health Needs                             2019 - 2021 Community Health Improvement
  Assessment Process                                           Plan Priorities
  Nonprofit hospitals, public health agencies, accountable     As a result of the findings of our 2018 Swedish First Hill
  communities of health, and others are required by federal    and Cherry Hill Community Health Needs Assessment
  law, state mandates, or agency policy to conduct             (CHNA) and through a prioritization process aligned
  community health needs assessment every three to five        with our mission, resources and hospital strategic
  years. This process involves reviewing community             plan, Swedish First Hill and Cherry Hill will focus on
  health data, identifying and prioritizing community health   the following areas for its 2019-2021 Community
  needs, and developing a community health improvement         Benefit efforts:
  plan. Historically, community health needs assessments
  have been planned and conducted independently, but              • Mental Health
  for the first time, stakeholders in King and Snohomish          • Drug Addiction
  Counties have aligned planning and assessment cycles
                                                                  • Obesity
  to leverage resources and improve collaboration for
  collective impact.                                              • Homelessness
                                                                  • Diabetes and Obesity (campus specific)
  Goal of the Community Health Needs Assessment
                                                                  • Homelessness (campus specific)
  In April 2018, community members selected three to
                                                                  • Mental Health (campus specific)
  five priority areas of focus through a county-wide,
  coordinated community health needs assessment
  process. This process provides us with the opportunity
  to collaborate, identify community needs, and move in
  the same direction as other organizations. By aligning
  our resources with and leveraging the expertise of
  community partners, our collective impacts in King
  and Snohomish Counties is even greater. Additionally,
  partners are well-positioned to align timelines and
  coordinate future improvement cycles.

2 |                                                                        CHIP First Hill and Cherry Hill Campus — 2019-2021

      Our Mission                                            EXCELLENCE: We set the highest standards for
      Improve the health and well-being of each              ourselves and our services. Through transformation
      person we serve.                                       and innovation, we strive to improve the health
                                                             and quality of life in our communities. We commit
      Our Vision                                             to compassionate and reliable practices for the
      Health for a Better World                              care of all.
      Our Values                                             DIGNITY: We value, encourage and celebrate
      COMPASSION: We reach out to those in need.             the gifts in one another. We respect the inherent
      We nurture the spiritual, emotional, and physical      dignity and worth of every individual. We recognize
      well-being of one another and those we serve.          each interaction as a sacred encounter.
      Through our healing presence, we accompany             INTEGRITY: We hold ourselves accountable to
      those who suffer.                                      do the right thing for the right reasons. We speak
      JUSTICE: We foster a culture that promotes unity       truthfully and courageously with respect and
      and reconciliation. We strive to care wisely for our   generosity. We seek authenticity with humility
      people, our resources, and our earth. We stand         and simplicity.
      in solidarity with the most vulnerable, working to     SAFETY: Safety is at the core of every thought
      remove the causes of oppression and promoting          and decision. We embrace transparency and
      justice for all.                                       challenge our beliefs in our relentless drive for
                                                             continuous learning and improvement.

3 |                                                                   CHIP First Hill and Cherry Hill Campus — 2019-2021

  Since 1910, Swedish has been the region’s standard-         Our Commitment to Community
  bearer for the highest-quality health care at the best      Swedish Health Services dedicates resources to im-
  value. Our mission is to improve the health and             prove the health and quality of life for the communities
  well-being of each person we serve. Swedish is the          it serves, with special emphasis on the needs of the
  largest nonprofit health care provider in the greater       economically poor and vulnerable. In the last five years,
                                                              Swedish spent more than $900 million in community
  Seattle area with five hospital campuses: First Hill,
                                                              benefit. We are making investments that go beyond
  Cherry Hill, Ballard, Edmonds and Issaquah. We also         just the need for free and discounted care by improving
  have ambulatory care centers in Redmond and Mill            access to care and developing new ways to help people
  Creek, and a network of more than 118 primary care          stay healthy. In 2017, we spent almost $200 million on
  and specialty clinics throughout the greater Puget          community benefit programs, including $23.9 million
  Sound area.                                                 on free and discounted care. The communities served
                                                              by Swedish hospitals are defined by the geographic
                                                              origins of the hospitals’ inpatients. The Primary Service
  Who We Are
                                                              Area (PSA) was determined by identifying the ZIP Codes
  Swedish Health Services is an affiliate of the Providence   for 70% of the hospitals’ patient discharges (excluding
  St. Joseph Health. Providence St. Joseph Health is a        normal newborns). The Secondary Service Area (SSA)
  new organization created by the association between         was determined by identifying the ZIP Codes for 71%
  Providence Health & Services and St. Joseph Health          to 85% of the hospitals’’ patient discharges. The service
  with the goal of improving the health of the communities    areas for all Swedish campuses focus on King County
  it serves, especially those who are poor and vulnerable.    and Snohomish County.
  Together, our 111,000 caregivers (all employees) serve         • Swedish Ballard is located at 5300 Tallman Avenue,
  in 50 hospitals, 829 clinics and comprehensive range              NW, Seattle, WA 98107. The PSA consists of 8 cities
  of services across Alaska, California, Montana, New               and 36 ZIP Codes. The SSA consists of 18 cities
  Mexico, Oregon, Texas and Washington. In addition                 and 33 ZIP Codes.
  to Swedish, the Providence St. Joseph Health family
                                                                 • Swedish Edmonds is located at 21601 76th Ave. W.,
  includes: Providence Health & Services, St. Joseph
                                                                    Edmonds, WA 98026. The PSA consists of 5 cities
  Health; Covenant Health in West Texas; Facey Medical
                                                                    and 9 zip codes. The SSA consists of 6 cities and 9
  Foundation in Los Angeles; Hoag Memorial Presbyterian
                                                                    ZIP Codes.
  in Orange County, California; Kadlec in Southeast
  Washington; and Pacific Medical Centers in Seattle.            • Swedish First Hill is located at 747 Broadway, Seattle,
                                                                    WA 98122 and Swedish Cherry Hill is located at 500
  Bringing these organizations together increases access
                                                                    17th Avenue, Seattle, WA 98122. These hospitals
  to health care and brings quality, compassionate care to
                                                                    share the same service area. The PSA consists of
  those we serve, with a focus on those most in need.
                                                                    13 cities and 53 ZIP Codes. The SSA consists of 23
                                                                    cities and 35 ZIP Codes.
                                                                 • Swedish Issaquah is located at 751 NE Blakely
                                                                    Drive, Issaquah, WA 98029. The PSA consists of
                                                                    12 cities and 19 ZIP Codes. The SSA consists of
                                                                    16 cities and 28 ZIP Codes.
                                                                                                 Continued on the next page...

4 |                                                                       CHIP First Hill and Cherry Hill Campus — 2019-2021

  Planning for the Uninsured and Underinsured                    One way Swedish Health Services informs the public
                                                                 of FAP is by posting notices in high volume inpatient
  Our aim is to provide quality care to all our patients,
                                                                 and outpatient service areas. Notices are also posted
  regardless of ability to pay. We believe that no one should
                                                                 at location where a patient may pay their bill. Notices
  delay seeking needed medical care because they lack
                                                                 include contact information on how a patient can obtain
  health insurance. That is why Swedish Health Services
                                                                 more information on financial assistance, as well as
  has a Patient Financial Assistance Program (FAP) that
                                                                 where to apply for assistance. These notices are posted
  provides free or discounted services to eligible patients.
                                                                 in English and Spanish and any other languages that
  Our charity care program provides a 100 percent                are representative of 5% or greater of patients in the
  discount to individuals and families between                   hospital’s service area. All patients who demonstrate
  0-300 percent of the federal poverty level (formerly           lack of financial coverage by third party insurers are
  0-200 percent.)                                                offered an opportunity to complete the Patient Financial
      • For example, a family of four with a household income   Assistance application and are offered information,
         of approximately $75,000 or less would qualify.         assistance, and referral as appropriate to government
                                                                 sponsored programs for which they may be eligible.
  In addition, for individuals and families between 301-400
  percent of the federal poverty level, Swedish provides a
  discount of at least 75 percent.
        or example, a family of four with a household
       income of approximately $75,000 - $100,000
       would qualify

5 |                                                                         CHIP First Hill and Cherry Hill Campus — 2019-2021

  Definition of Community Served                                         Among the Swedish campuses, the Edmonds service
                                                                         area has the highest percentage of residents who are
  Population for Total Service Area, 2017
                                                                         non-Latino White (65.2%) and Hispanic or Latino (9.6%).
                                                First Hill/              The Issaquah service area has the highest percentage
                      Ballard        Edmonds                  Issaquah
                                                Cherry Hill              of Asians/Pacific Islanders (20.3%), and the Ballard
                                                                         service area has the highest percentage of Blacks/African
      Population 2,373,420 651,452 2,846,268 1,451,299
                                                                         Americans (7.4%).
  Source: Intellimed, ESRI, 2017

  Among Swedish campus service areas, Issaquah has the                   Race/Ethnicity*
  highest percentage of children (22.5%). Edmonds and
  Issaquah service areas include percentages of children                                                                 First Hill/
                                                                                                Ballard     Edmonds                    Issaquah
  higher than that of the county (21.1%). Edmonds has the                                                                Cherry Hill
  highest percentage of seniors (14.1%) among Swedish
  hospital campuses, which exceeds the percentage of                                            61.6%        65.2%         61.4%        59.7%

  seniors in the county (13.6%).
                                                                                                17.2%        16.4%         18.1%        20.3%
  2017 Population by Age, King and Snohomish Counties                     Islander
                                                                          Hispanic or
                                                                                                9.4%          9.6%         9.1%          8.4%
                            21.1%                    0-17 years           Black/African
                                                                                                7.4%          5.4%         7.0%          6.8%
                                                     18-29 years
                                                                          Two or more
        26.9%                                        30-44 years                                6.0%          5.9%         5.8%          5.3%
                                                     45-64 years          Other races/
                                                                                                3.6%          3.3%         3.5%          3.2%
                   21.8%                             65 and older
                                                                         Source: U.S. Census Bureau, American Community Survey, 2016; DP05
                                                                         *Percentages total more than 100% as some persons selected more than one
                                                                         race or ethnicity category.

                                                First Hill/              Income Poverty
                        Ballard       Edmonds                 Issaquah
                                                Cherry Hill
                                                                         In the Swedish campus service areas, the median
                        20.5%          21.8%      21.0%       22.5%      household income ranges from $69,153 in the Edmonds
      ages 0-17
                                                                         service area to $93,153 in the Issaquah service area. This
      Adults,                                                            disparity in income might influence health outcomes.
                        65.9%          64.1%      65.5%       64.6%
      ages 18-64
                                                                                                                    Continued on the next page...
                        13.6%          14.1%      13.5%       12.9%
  Source: US Census Bureau American Community Survey, B01003, 2016

6 |                                                                                     CHIP First Hill and Cherry Hill Campus — 2019-2021

  Median Household Income and Unemployment Rate                   Personal/Households Living at or Below Poverty Level
  Summary of Community Needs Assessment                  Identification and Selection of Significant
  Process and Results                                    Health Needs
  Secondary Data: Secondary data was collected           Significant health needs were identified from the
  from a variety of local, county, and state sources.    Community Health Needs Assessment process.
                                                         Swedish then identified priorities for the Community
  Data analyses were conducted at the most local level
                                                         Health Improvement Plan associated with the 2018
  possible for the hospitals’ service areas, given the   Swedish Seattle (First Hill/Cherry Hill) CHNA. The
  availability of the data.                              priority health needs were: Mental Health, Homelessness,
  Primary Data: Stakeholder surveys and listening        Drug Addiction, Obesity, and Diabetes.
  sessions were used to gather data and information
                                                         Community Health Needs Prioritized
  from persons who represent the broad interests of
  the community served by the hospitals. Swedish         Swedish First Hill and Cherry Hill will focus on the following
                                                         areas for its 2019-2021 Community Health Improvement
  conducted surveys to gather data and opinions
                                                         Plan (CHIP):
  from community residents, and hospital leaders
                                                            • Mental Health
  and staff who interact with patients and families in
                                                            • Drug Addiction
  the ED and specialty clinics.
                                                            • Obesity
  The full report and results of the 2018 Swedish
                                                            • Homelessness
  (Seattle) Cherry Hill/First Hill Community Health
                                                            • Diabetes and Obesity (campus specific)
  Needs Assessment can be accessed at: https://
                                                            • Homelessness (campus specific)
  Swedish/PDFs/Mission/2018/CHNASeattle21419.pdf            • Mental Health (campus specific)
                                                                                            Continued on the next page...

8 |                                                                  CHIP First Hill and Cherry Hill Campus — 2019-2021

  Needs Beyond the Hospital’s Service Program
  The following community health needs identified in the 2018 Swedish CHNA campus reports may not be addressed
  as part of the current CHIP. An explanation is provided below:

                BALLARD                  EDMONDS            FIRST HILL/CHERRY HILL                ISSAQUAH

      Alcohol overuse           Alcohol overuse            Joint or back pain            Homelessness
      High blood pressure       High blood pressure        High blood pressure           Cancer
      Joint or Back Pain        Joint or back pain         Cancer                        Age-related diseases
      Cancer                    Cancer                     Alcohol overuse               Texting while driving
      Smoking                   Stroke                     Age-related diseases          Alcohol overuse
      Age-related diseases      Smoking                    Teeth/oral health issues      High blood pressure
      Stroke                    Asthma                     Smoking                       Environmental factors
                                                                                         Alzheimer’s disease/
      Environmental factors     Environmental factors      Environmental factors
      Texting while driving     Texting while driving      Stroke                        Teeth/oral health issues
      Asthma                    Heart disease              Asthma                        Asthma
                                                                                         Lack of access to
      Teeth or oral issues      Teeth/oral health issues   Heart disease
                                                                                         needed medications
      Crime                     Age-related diseases       Texting while driving         Stroke
                                                           Alzheimer’s disease/
      Heart disease             Crime                                                    Child abuse and neglect
      Alzheimer’s disease/      Lack of access to          Lack of access to             Lack of access to
      dementia                  medical providers          healthy food                  medical providers
      Lack of access to         Alzheimer’s disease/
                                                           Crime                         Smoking
      needed medications        dementia
      Lack of access to                                    Lack of access to
                                Child abuse and neglect                                  Heart disease
      medical providers                                    medical providers
                                                           Lack of access to             Sexually transmitted
      Child abuse and neglect   Domestic violence
                                                           needed medications            infections
      Lack of access to a       Lack of access to
                                                           Child abuse and neglect       Domestic Violence
      grocery store             needed medications
      Sexually transmitted      Lack of access to
                                                           Domestic violence
      infections                needed medications
                                                           Sexually transmitted
      Domestic violence

  Some of these areas are out of our scope of our           No hospital facility can address all the health needs
  current community health program expertise, and           present in the community. We are committed to
  other non-profits in the community are providing          our mission through Swedish Community Benefits
  robust services. However, we see the interconnected-      granting program and partnering with like-minded
  ness of health, housing, education, and income. If we     organizations in service to our community.
  can improve the health of our workforce, they will be
  better caregivers and more able to contribute to the
  economic vitality of our service area.

9 |                                                                     CHIP First Hill and Cherry Hill Campus — 2019-2021

  Summary of Community Health Improvement Planning Process
  Swedish Medical Center, First Hill and Cherry Hill participated in the King County Hospitals for a Healthier
  Community (HHC) as part of a countywide Community Health Needs Assessment. HHC is a collaborative
  of hospitals and/or health systems in King County and Public Health-Seattle & King County.

  Goal (Anticipated Impact): Implement a new program              Develop a psychology postdoctoral fellow training
  that provides mental health peer support in Swedish             program that provides mental health care in the Swedish
  emergency departments (ED). This program will be                community irrespective of patient’s ability to pay, while
  adapted from the ED Connect program implemented                 creating a much needed workforce to support integrated
  by Hoag Hospital Newport Beach ED in partnership                behavioral health (BH) care.
  with the National Alliance on Mental Health (NAMI). To          Scope (Target Population): People in the Seattle
  accomplish this goal and implement a pilot project,             community
  Swedish will explore partnering with Navos, one of the
  largest providers of community mental health services in
  Washington State.
   OUTCOME MEASURE                                                       BASELINE      FY19 TARGET            FY21 TARGET

   Facilitate full implementation of Mental Health peer support                         1 selected           Swedish-wide
   program in ED                                                                         campus                roll-out
   Integrate program at Swedish recognized clinics without               N/A (new
                                                                                         2 clinics             2-4 Clinics
   behavioral health services (BHS) at a reduced cost                    measure)

          STRATEGY(IES)                  STRATEGY MEASURE                BASELINE      FY19 TARGET           FY21 TARGET

   Construct a Swedish
                                        Complete Swedish ED                                                Plan for Swedish-
   NAMI ED Connect                                                           0       1 approved plan
                                           Connect Plan                                                       wide roll-out
   implementation plan
                                      Swedish ED Connect plan                                              Plan for Swedish-
   Explore pilot with Navos                                                  0       1 approved plan
                                       collaborates with Navos                                                wide roll-out
                                                                                                               Initiate full
   Set up for Swedish-wide            Unfold ED Connect to the                         1 campus in
                                                                             0                               Swedish-wide
   system                              Swedish-wide system                             2019-2020
                                                                                                            roll out in 2021
                                    2019- Develop plan and have
   In 2019, develop a                 successful recruitment of 2
   psychology postdoctoral           post-doctoral candidates to                                               TBD – but
   program for primary care         provide services in 2020-2021                                             anticipate if
   that will serve anyone in         Identify Swedish Primary Care                                            program is
                                                                                     patient visits per
   the Swedish community            clinics in high need communities                                        successful, we
                                                                             0         postdoctoral
   irrespective of their ability   that do not currently have access                                        can continue to
                                                                                      fellow per year
   to pay, while creating a         to BH services (and have space                                         expect 800-1000
   much needed workforce                   for them to practice)                                           patient visits per
   to support integrated            Visits with postdoctoral fellow                                         fellow per year
   BH care                          will be provided free of charge
                                             for all patients
                                                                                                     Continued on the next page...

10 |                                                                         CHIP First Hill and Cherry Hill Campus — 2019-2021

          STRATEGY(IES)                    STRATEGY MEASURE                 BASELINE       FY19 TARGET         FY21 TARGET

                                    Adapt a workshop series that can
   Conduct mental
                                     be offered at hospital campuses                                         5 workshops per
   health workshops in                                                           0         5 workshops
                                   for any individual in the community                                        year per fellow
   the community
                                             to attend for free
                                     Each year postdoctoral fellows
                                                                                                               recruitment of
                                     will be trained in a system that
                                                                                                               2 postdoctoral
                                     provides high quality BH care.                       Recruitment of
   Assemble next generation                                                                                   fellows per year
                                     They will be a generalist that is           5        2 postdoctoral
   of mental health providers                                                                                  (with hopes of
                                     capable of meeting the needs                            fellows
                                                                                                              accepting more
                                    of all patients with a behaviorally
                                                                                                               with adequate
                                            influenced concern

  Evidence Based Sources                                           Key Community Partners
  Pingitore, D. P. (1999). Postdoctoral training in                NAMI ED Connect:
  primary care health psychology: Duties, observations,                   • Navos Behavioral Health Consortium
  and recommendations. Professional Psychology:
  Research and Practice, 30(3), 283-290. http://dx.doi.                   • HOAG Memorial Hospital Presbyterian
  org/10.1037/0735-7028.30.3.283                                   Postdoctoral Fellow Training: Current relationships exist
  Larkin, K. T., Bridges, A. J., Fields, S. A., & Vogel, M. E.     between the Primary Care BH team and multiple local
  (2016). Acquiring competencies in integrated behavioral          universities.
  health care in doctoral, internship, and postdoctoral
  programs. Training and Education in Professional                 Resource Commitment
  Psychology, 10(1), 14-23.             NAMI ED Connect
                                                                          • Leader and staff time to research and plan the pilot
  Johnstone, B., Frank, R. G., Belar, C., Berk, S.,
  Bieliauskas, L. A., Bigler, E. D., . . . Sweet, J. J. (1995).           • Time for the peer counselors
  Psychology in health care: Future directions. Professional                 (dependent on pilot plan)
  Psychology: Research and Practice, 26(4), 341-365.               Postdoctoral Fellow Training: This program would                     require at least a 0.5 FTE to adequately provide support,
                                                                   supervision, leadership, recruitment, and program
  Other Sources                                                    development. Additional resource commitment would
                                                                   include clinic space and supplies.
  Health Care Blog:
  Hoag and NAMI:

11 |                                                                             CHIP First Hill and Cherry Hill Campus — 2019-2021


  Goal (Anticipated Impact): Initiate a pilot program at                           patients presenting with OUD with evidence-based
  the Ballard Emergency Department (ED) to transition                              guidelines for withdrawal management.
  patients with opioid use disorder (OUD) to a Suboxone                            Scope (Target Population): Initially, Ballard ED patients
  clinic for treatment. This pilot will be modeled off of the                      who present with OUD. After the Swedish-system rollout,
  Swedish Edmonds Suboxone program, which began                                    patients who present in any Swedish ED with OUD. Re-
  in January 2019. The goal is to address the identified                           ferral to a network of suboxone Medicaid waivered clinics
  community need through enhanced treatment of                                     (both Swedish and partners) will be offered to our patients.

   OUTCOME MEASURE                                                                  BASELINE         FY19 TARGET              FY21 TARGET

   Percent of patients that follow up from the ED
                                                                                        0%                50%*                    80%*
   to a Suboxone clinic
  *Targets modeled off of Swedish Edmond’s Suboxone program goals, although subject to change.

              STRATEGY(IES)                        STRATEGY MEASURE                 BASELINE         FY19 TARGET              FY21 TARGET

   Ballard pilot of best-practice
                                                                                                                             Continued full
   OUD screening, treatment,                      Full implementation of                          Full implementation
                                                                                        N/A                                 implementation
   and referral from the ED to a                        Ballard pilot                                   at Ballard
                                                                                                                              at Ballard
   Suboxone clinic
                                                                                                                           Seven EDs all with
   Swedish-wide implementation                                                                       One additional       Suboxone pathway
                                                  Number of campuses                                campus: Ballard
   of best-practice OUD screening,                                                  One ED -                              for OUD (Edmonds
                                                   with implemented
   treatment, and referral from the                                                 Edmonds        Plan full Swedish-     / Ballard / First Hill /
   ED to a Suboxone clinic                                                                            wide roll out         Cherry Hill / Red-
                                                                                                                           mond / Mill Creek)
                                                                                                  Full participation in
   Couple work with
                                                  Align with Community                            both North Sound      TBD based on ACH
   Accountable Communities of                                                           N/A
                                                 partners related to OUD                          and Healthier Here       partnership
   Health (ACH)
                                                                                                 ED related OUD work

  Evidence Based Sources                                                           Resource Commitment
  Multiple guidelines including the WA Bree Collaborative                          Ballard Operations sponsored by Kasia Konieczny
  Opioid Guidelines                                                                (Chief Operating Officer—Swedish Ballard), Quality                               Division resources, Nursing and Social Work resources,
   rent-topics/opioid/                                                             Addiction Recovery team, Swedish Family Practice
                                                                                   Clinic at Ballard, and Clinical Transformation and
  Key Community Partners                                                           Simulation Services.
  Initial community partner for the pilot include Swedish
  Ballard ED, Swedish Addiction Recovery Clinic at Ballard,
  and Swedish Ballard Family Practice Clinic. After the
  Swedish-wide roll out, partners will include multiple
  agencies such as Federally Qualified Health Centers,
  Behavioral Health Organizations, and others.

12 |                                                                                             CHIP First Hill and Cherry Hill Campus — 2019-2021


  Goal (Anticipated Impact):                                           risk of diabetes in diverse communities
       • Increase awareness on the importance of healthy         Scope (Target Population): Members of the community
          eating and exercise                                     contacted at public events, with focused outreach in low
       • Reduce the prevalence of childhood obesity and          income communities

   OUTCOME MEASURE                                              BASELINE                FY19 TARGET              FY21 TARGET

   Percentage of “at risk” community members (those
   who screen positive for diabetes, prediabetes, or
   with high glucose levels) who are given information              0%                       50%                      TBD
   for appropriate follow-up (Primary provider, Swedish
   diabetes center, YMCA, other community clinics)

        STRATEGY(IES)          STRATEGY MEASURE                 BASELINE                FY19 TARGET              FY21 TARGET

   Sponsor Urban
                           Funding: healthy living, well-
   Games (See                                             $5,000 in 2018           $20,000 in 2019             TBD
                           ness programs and outreach
   description below)
   Diabetes screening   Number diabetes screening           Hosted 4 tables in Host more than 4                TBD
   and health education and health education tables         2018 covering the tables covering the
   at Urban Games       hosted at Urban Games               following topics:  following topics:
                                                            1. Prediabetes        1. Diabetes resources
                                                                screening tool         and prediabetes
                                                                and education          screening
                                                            2. Blood pressure     2. Blood pressure
                                                                and CPR        3. Ask the Medical
                                                                education          Doctor or Registered
                                                            3. Swedish sports     Nurse (brief consult
                                                                medicine           on site)
                                                                                   4. Swedish Sports
                                                                                   5. Expanded outreach
   Prediabetes             Number of community              Glucose testing        At least one commu-         At least one
   screening at            events where Swedish             at three events        nity event for three        community
   community events        participates by administering    in 2018                Swedish campuses            event for all
                           prediabetes screenings and/      Prediabetes            during quarters three       five Swedish
                           or glucose testing. Events       screening              and four community          campuses
                           will include community           in 2018                outreach events 2019        during quarters
                           outreach events and health                                                          three and four
                           fairs, including Swedish                                                            community
                           sponsored events, walks/                                                            outreach events
                           runs, races, etc.
   Offer monthly online    # of views of monthly       745 views                   1,000+ views                TBD: Broaden
   cooking classes         Facebook Live cooking class (January                    Increase community          community
   through Facebook        videos which are open to    2019 video)                 partner outreach and        partner outreach
   Live, #SwedishEats      the community and promote                               awareness                   and awareness
                           healthy eating lifestyles
                                                                                                        Continued on the next page...

13 |                                                                             CHIP First Hill and Cherry Hill Campus — 2019-2021

  Evidence Based Sources                                      Resource Commitment
  Centers for Disease Control and Prevention:                 • Fiscal contribution $5000        • Hours to set-up and staff tables at Urban Games       • Hours to set-up and staff tables at campus
  tional-diabetes-statistics-report.pdf                          community events
  American Diabetes Association: https://professional.
                                                                 URBAN GAMES INFORMATION
                                                                 Urban Games’ vision is a bold community en-
  Taking Control of Your Diabetes Conference and Health
                                                                 gagement initiative that seeks to build community
                                                                 self-advocacy and individual self-agency centered
                                                                 on health and wellness. Partnering with Youth
  Other Sources
                                                                 Centric, a social purpose organization, Urban
  Swedish online cooking class videos (Swedish Eats):            Games proposes the following goals and outcomes:
                                                                    • Engage 1,000 Urban Games Youth
                                                                       Ambassadors in year round activities and
                                                                       programs who are committed healthy living
  Key Community Partners
                                                                       and wellness practices.
  • American Diabetes Association
                                                                    • Develop a data-informed wellness baseline
  • Garfield Community Center                                          for each of the Youth Ambassadors
  • Seattle Park and Recreation, City of Seattle                       for monitoring, coaching, and intervention,
                                                                       as appropriate.
  • Austin Foundation
                                                                    • Track over 10M activity hours (1,000 UG
  • Clean Greens and Fresh Bucks                                       Youth Ambassadors x 30 minutes per day
  • Seattle Chapter Jack n Jill, Inc.                                  x over 365 days).
  • Mary Mahoney Professional Nurses Association                    • Demonstrate through data analysis how a
  • iUrban Teen                                                        focused community based effort can improve
                                                                       health outcomes
  • Treehouse
  • Black Farmer Collaborative
  • Northwest Kidney Center
  • Asian Counseling Referral Services (ACRS)
     Community Farm

14 |                                                                     CHIP First Hill and Cherry Hill Campus — 2019-2021


  Goal (Anticipated Impact): Develop ongoing partnerships          Additionally, this consortium will work to address up-
  with community-based organizations and city and county           stream health needs, such as behavioral health, and
  entities whose focus is homelessness and providing               social determinants of health, such as employment.
  support for families experiencing homelessness in King           Scope (Target Population): Families experiencing
  and Snohomish Counties. Build collaborative relationships        homelessness or unstably housed (i.e. couch surfing)
  to identify and develop strategies and pathways to               in King and Snohomish Counties.
  reduce homelessness and provide supportive housing.

   OUTCOME MEASURE                                 BASELINE                            FY19 TARGET          FY21 TARGET

   Develop collaborative     782 family households (2,624 individuals) experiencing
   strategies focused on     homelessness in King County (2018)1                        House 10%
   moving a percent of                                                                                    House 10% + of
                             21 family households (60 individuals) experiencing         of homeless
   the homeless families                                                                                  homeless families
                             chronic homelessness in Snohomish County (2018)2              families
   to stable housing
                             Initial conversations with community partners
               STRATEGY(IES)                                           BASELINE        FY19 TARGET          FY21 TARGET

                                                # of partners
   Meet with housing advocates and                                   5 community      12 community
                                                 within the
   community partners in King and                                       partner          partner                 TBD
   Snohomish Counties                                                  meetings         meetings
                                               # of individuals                                         Fully funded housing
                                                in families with                                         strategies align with
   Fully integrated housing                      children in the                         Establish       housing advocates
   collaborative strategies with a            point in time count                         housing            and Swedish
                                                                  with community
   focus on unhoused families                     identified as                         collaborative     goals focused on
                                                  experiencing                                          families experiencing
                                                homelessness                                                homelessness
   Explore assets to invest in innovative
   ways to provide transitional housing
   to meet the needs of unhoused                     TBD                 TBD                TBD                  TBD
   families and partner with Providence
   Supportive Housing
   Administer behavioral health services                                                Establishing
   and training and education resources              TBD                   0             targets in              TBD
   to transition families to stable housing                                              6 months

  Evidence Based Sources                                           Key Community Partners
  All Home:             Plymouth Housing       YWCA
  time-pit-count/                                                  Capitol Hill Housing   Congregation for
  Seattle/King County Coalition on Homelessness:                   Wellsprings              the Homeless                                         West Seattle Help Link Vision House
                                                                   Ballard Help Line      Solid Ground
  City of Seattle:
                                                                   Mary’s Place           Seattle Chamber of Com-
                                                                   Seattle King County    merce – Housing Connector
  Resource Commitment                                                Public Health        Providence St. Joseph
                                                                   City of Seattle        Health
  Swedish Community Health Investment Division
                                                                   United Way             Others
  PSJH Housing Learning Collaborative
15 |                                                                            CHIP First Hill and Cherry Hill Campus — 2019-2021


  Goal (Anticipated Impact): Increase awareness of              See system wide goal for obesity and diabetes for
  individuals who are at risk for developing prediabetes        system outcomes.
  including screening (X) number of people. Identify            Scope (Target Population): King County residents -
  and acknowledge additional avenues for improving              % of those identified with prediabetes (compare with
  knowledge to reduce and prevent the risk of developing        WA State)
  type 2 diabetes.
                                                                                                    FY19          FY21
      OUTCOME MEASURE                                                               BASELINE
                                                                                                   TARGET        TARGET

      # of people tracked and referred to Swedish diabetes education classes,        0 (new
                                                                                                    TBD           TBD
      YMCA and Diabetes Prevention Programs (DPPs)                                  measure)
                                                                                     0 (new
      # of community health fair tabling events                                                     TBD           TBD

                                                               STRATEGY                             FY19          FY21
                        STRATEGY(IES)                                               BASELINE
                                                               MEASURE                             TARGET        TARGET

                                                         # of people who attend
      Employ American Diabetes Association
                                                          events (measure TBD
      prediabetes screening tool digitally or on paper
                                                           depending on ability         0           TBD           TBD
      questionnaires to people at Swedish sponsored
                                                          to track completion of
      events and health fairs
                                                              screening tool)
                                                         # of people connected
      Engagement results for referral to providers,
                                                         to providers, education,      50           TBD           TBD
      education, and resources
                                                              and resources

  Evidence Based Sources                                        Resource Commitment: Diabetes educators and
  Centers for Disease Control and Prevention:                   staff; Registered Dietitians; Swedish Bariatric, Metabolic,                   Endocrine Center staff

  American Diabetes Association:

  Key Community Partners
  American Diabetes Association, YMCA, Public Health—
  Seattle & King County (CHNA Report)

16 |                                                                        CHIP First Hill and Cherry Hill Campus — 2019-2021


  Goal (Anticipated Impact):                                        • Partner with Operation Night Watch/Point in
         educe the volume of patients currently taking                Time Program to address the health concerns of
        time in the Emergency Department (ED) that do                  individuals experiencing homelessness by providing
        not have acute needs, and help direct them to                  medical triage in an identified sanctioned homeless
        appropriate settings.                                          encampment in partnership with community based
         roactively support members in our community who
        have health care needs, increase access to preventive    Scope (Target Population): Partner with agencies/orga-
        care resources and address their health concerns in      nizations currently present in the community who have
        real time to decrease avoidable ED visits.               contact with individuals experiencing homelessness, and
                                                                 evaluate opportunities to provide clinic support at health
                                                                 fairs in partnership with those agencies’ interventions.

                                                                                                       FY19        FY21
   OUTCOME MEASURE                                                                        BASELINE
                                                                                                      TARGET      TARGET

   # of people treated at health fairs                                                       0          TBD         TBD
   Impact volume of ED visits by providing minor medical outreach efforts in identified
                                                                                            TBD         TBD         TBD
   locations supporting individuals experiencing homelessness

                                                                 STRATEGY                              FY19        FY21
                     STRATEGY(IES)                                                        BASELINE
                                                                 MEASURE                              TARGET      TARGET

   Partner with Operation Night Watch/Point in
   Time and Swedish providers. Hold a health fair
   twice a month and conduct health screens,            # of people who are treated          0          TBD         TBD
   wound care, minor treatment of ailments such
   as headaches, colds, coughs, etc.
   Elevate awareness and advocate option of               # of people who receive
   using the Swedish County Doctor After-Hours          information about the After-
                                                                                            Zero        TBD         TBD
   Clinic at Cherry Hill and other Federally           Hours Clinic or other Federally
   Qualified Health Centers                               Qualified Health Centers

  Evidence Based Sources                                         Resource Commitment
  Public Health—Seattle & King County CHNA, First Hill           Family practice residents and providers, nurses, certified
  and Cherry Hill data analytics - Tableau                       nursing assistants, ED techs, medical assistants, case
                                                                 managers or social workers
  Key Community Partners
  Operation Night Watch/Point in Time, Public Health—
  Seattle & King County

17 |                                                                         CHIP First Hill and Cherry Hill Campus — 2019-2021

  Goal (Anticipated Impact): Improve depression screening          Scope (Target Population): Swedish patients, caregivers,
  efforts using the Patient Health Questionnaire-2 (PHQ-2)         and community stakeholders
  and Patient Health Questionnaire-9 (PHQ-9). Increase
  number of Swedish caregivers and stakeholders who
  are trained in Mental Health First Aid.

                                                                   FY19                           FY21
   OUTCOME MEASURE                                 BASELINE
                                                                  TARGET                         TARGET

   # of Caregivers and community stakeholders      25 people        200      # of Caregivers and community stakeholders
   trained in Mental Health First Aid               by 4/19                  trained in Mental Health First Aid
   Improve % of patients who are screened             51.46%      54.46%     Improve % of patients who are screened for
   for depression at primary care clinics using                              depression at primary care clinics using the
   the PHQ-2 or PHQ-9 screenings:                                            PHQ-2 or PHQ-9 screenings:
        lign with current CEI Depression
       A                                                                        Align with current CEI Depression
       screening measure: Achieve 75%                                            screening measure: Achieve 75%
       percentile (63.4%) by 2022                                                percentile (63.4%) by 2022
        rimary care clinics include Central,
       P                                                                        Primary care clinics include Central,
       Cherry Hill Family Medicine, Downtown,                                    Cherry Hill Family Medicine, Downtown,
       First Hill Family Medicine, First Hill                                    First Hill Family Medicine, First Hill
   # of Caregivers and community stakeholders      25 people                 # of Caregivers and community stakeholders
   trained in Mental Health First Aid               by 4/19                  trained in Mental Health First Aid

                                        STRATEGY                                             FY19                       FY21
           STRATEGY(IES)                                       BASELINE
                                        MEASURE                                             TARGET                     TARGET

   Roll out plan to schedule         # of people who
   caregivers to attend Mental            attend                              Offer a monthly class with the goal
   Health First Aid Training                                   25 people
                                        John Bruels                          of engaging 200 Swedish caregivers
                                                               scheduled                                                TBD
   Promote Mental Health First        (Mental Health                           (clinical or non-clinical) to provide
                                                                on 4/19
   Aid training to our community     First Aid trainer)                         more mental health knowledge
   partners/“train the trainers”    offers classes of 10
                                                                                595 referrals. As the Behavioral
                                                           335 referrals to
                                       # of referrals                         Health resource site is established
                                                           Quartet Health
   Connect people to                  for psychiatry,                       it is anticipated that we will add 260
                                                             and various
   psychiatry, medication               medication                           more referrals per year because we
                                                           outside provid-                                              TBD
   management, and                    management,                            also will have more resources to give
                                                           ers for ongoing
   community resources               and community                          those who “cold call” for referrals and
                                                           psychiatric care
                                        resources                           cannot see our providers. Estimate is
                                                           and counseling
                                                                                  5 people a week X 52 weeks.
   Heighten participation in
   National Alliance on Mental
   Illness (NAMI) Walk (mental             # of
                                                                  40                         50-80                     100+
   health awareness) to generate       participants
   access to and awareness of
   mental health services.

18 |                                                                          CHIP First Hill and Cherry Hill Campus — 2019-2021

  Evidence Based Sources                              Resource Commitment
  NAMI:                                 Family practice residents and providers, nurses, certified
  Well Being Trust:                nursing assistants, ED techs, health navigators, patient
                                                      care coordinator, patient service representatives, care
                                                      managers, clinical educators, and behavioral health
  Key Community Partners
  Mental Health First Aid USA, NAMI

  Other Community Benefit Programs and Evaluation Plan

            NEED                PROGRAM NAME                 DESCRIPTION
                                                                                             (Low Income or
                                                                                           Broader Community)

                                Family Medicine
                                  Emergency                                                   Low Income/
   Access                                            Emergency Clothing & Sundries
                                Clothing Closet/                                               Homeless
                                 Supply Closet
   Education & Workforce              Year Up      Mentorship Training and Technology          Low Income
                                                    Clinical Support Care, Triage and
   Outreach                       Clean Sweep                                                  Low Income
                                                   Provision of Emergency Care Packs

19 |                                                              CHIP First Hill and Cherry Hill Campus — 2019-2021

  This community health improvement plan was adopted on May 14, 2019 by the authorized body of the hospital on
  May 14, 2019. The final report was made widely available1 on May 15, 2019.

  R. Guy Hudson, M.D., MBA 						Date
  Chief Executive Officer
  Swedish Health Services

  Kristen Swanson, MSN							Date
  Chair Board of Trustees
  Swedish Health Services

  Joel Gilbertson								Date
  Senior Vice President, Community Partnerships
  Providence St. Joseph Health

  Kevin Brooks 								Date
  Chief Operating Officer, First Hill
  Swedish Health Services

  Sherry Williams, MPA                                              Request a copy, provide comments or view electronic
  Regional Director Community Health Investment                     copies of current and previous community health needs
  Swedish Health Services                                           assessments:
  206-386-3407                                                      mission-outreach/community-engagement/communi-
  206-386-6000                                                      ty-needs-assessment/assessments-site-list

  1 Per § 1.501(r)-3 IRS Requirements, posted on hospital website

20 |                                                                           CHIP First Hill and Cherry Hill Campus — 2019-2021

  Definition of Terms                                         Initiative: An initiative is an umbrella category under
                                                              which a campus organizes its key priority efforts.
  Community Benefit: An initiative, program or activity
                                                              Each effort should be entered as a program in CBISA
  that provides treatment or promotes health and
                                                              Online (Lyon Software). Please be sure to report on
  healing as a response to identified community needs
                                                              all your Key Community Benefit initiatives. If a campus
  and meets at least one of the following community
                                                              reports at the initiative level, the goal (anticipated
  benefit objectives:
                                                              impact), outcome measure, strategy and strategy
      a. Improves access to health services;
                                                              measure are reported at the initiative level. Be sure to
      b. Enhances public health;
                                                              list all the programs that are under the initiative. Note:
      c. Advances increased general knowledge; and/or
                                                              All Community Benefit initiatives must submit financial
      d. Relieves government burden to improve health.
                                                              and programmatic data in CBISA Online.
  Community benefit includes both services to the poor
  and broader community.                                      Program: A program is defined as a program or service
                                                              provided to benefit the community (in alignment
  To be reported as a community benefit initiative or         with guidelines) and entered in CBISA Online (Lyon
  program, community need must be demonstrated.               Software). Please be sure to report on all community
  Community need can be demonstrated through                  benefit programs. Note: All community benefit
  the following:                                              programs, defined as “programs”, are required
      a. Community health needs assessment developed         to include financial and programmatic data into
          by the campus or in partnership with other          CBISA Online.
          community organizations;
      b. D  ocumentation that demonstrates community         Goal (Anticipated Impact): The goal is the desired
           need and/or a request from a public agency or      ultimate result for the initiative’s or program’s efforts.
           community group was the basis for initiating or    This result may take years to achieve and may
           continuing the activity or program; or             require other interventions as well as this program.
      c. The involvement of unrelated, collaborative tax-    (E.g. increase immunization rates; reduce obesity
          exempt or government organizations as partners      prevalence.).
          in the community benefit initiative or program.     Scope (Target Population): Definition of group being
  Health Equity: Healthy People 2020 defines health           addressed in this initiative: specific description of
  equity as the “attainment of the highest level of health    group or population included (or not included, if
  for all people. Achieving health equity requires valuing    relevant) for whom outcomes will be measured and
  everyone equally with focused and ongoing societal          work is focused. Identify if this initiative is primarily for
  efforts to address avoidable inequalities, historical and   persons living in poverty or primarily for the broader
  contemporary injustices, and the elimination of health      community.
  and health care disparities.”                               Outcome measure: An outcome measure is a
  Social Determinants of Health: Powerful, complex            quantitative statement of the goal and should answer
  relationships exist between health and biology, genetics,   the following question: “How will you know if you’re
  and individual behavior, and between health and             making progress on goal?” It should be quantitative,
  health services, socioeconomic status, the physical         objective, meaningful, and not yet a “target” level.
  environment, discrimination, racism, literacy levels,
  and legislative policies. These factors, which influence
  an individual’s or population’s health, are known as
  determinants of health. Social determinants of health
  are conditions in the environment in which people are
  born, live, learn, work, play, worship, and age that
  affect a wide range of health, functioning, and quality-
  of-life outcomes and risks.

21 |                                                                       CHIP First Hill and Cherry Hill Campus — 2019-2021
Cherry Hill
500 17th Ave.
Seattle, WA 98122
T 206-320-2000
First Hill
747 Broadway                                           We do not discriminate on the basis of race, color, national origin, sex, age, or
                                                       disability in our health programs and activities.
Seattle, WA 98122
T 206-386-6000

© 2019 SWEDISH HEALTH SERVICES. ALL RIGHTS RESERVED.                                                          COMM-19-0205-A 5/19
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