I believed in Detroit and I shared my feelings with anyone who would listen. I think that was the reason Detroiters gravitated toward me and asked me to lead on community boards as soon as I arrived. Over the years, I became involved in the community in a way that was unlike my peers. I was viewed as a leader—not just a health-care leader.
Of course, much of the speaking I did was on behalf of Henry Ford, in an attempt to change the way the community felt about our industry and its impact on the region. There was a strong belief in Michigan that health care was a liability rather than an asset. We heard the constant refrain: GM spends more on health care than it does on steel; lower health-care costs would have saved the auto industry.
In general, there was considerable criticism and negativity directed at health care. I couldn’t understand it and I refused to acquiesce. I knew about communities—like Durham, North Carolina, and Cleveland, Ohio—that viewed health care as a signature industry. They understood its presence to be a true strength because it attracted talent and created access to great health care for individuals and businesses alike. Great health care is an attraction. This became one of my mantras. I would talk about the strength of Henry Ford, but I’d also work to change the perception of health care in general.
Only later, when we went through the 2008–09 bankruptcies of two of our major automotive companies and ultimately the bankruptcy of the city, did it become abundantly clear that health care in Detroit was a major part of the solution for the economic challenges of the city and the state. The jobs would remain as long as health care did. Of course, numerous hospitals fled, but we remained fully committed to Detroit.
At last, we were all on the same page. The reality was that Detroit needed us, just as we needed Detroit in countless ways.
Detroit needed HFHS and other growing businesses in order to start to turn the tide back in the right direction. All told, the number of manufacturing jobs in Detroit proper fell from 296,000 in 1950 to just 27,000 in 2011;1 and, between 2000 and 2010, the city’s population fell by 25 percent, changing its ranking from the nation’s tenth-largest city to eighteenth.2 Following the shift of people and jobs to the suburbs, or to other states or nations, many of the city’s neighborhoods became distressed and heavily abandoned. High crime and political corruption were two further weights dragging the city down to the depths.
We couldn’t make up that deficit by any means, but we were clearly part of the solution. And as we gained momentum, we were able to help the city more and more. Our employment numbers increased from 12,000 in 1989 to 23,000 in 2015. We began attracting patients to Detroit from all over the world as breakthrough procedures and innovative care made headlines. We became a driver of social and economic revitalization in the region through community partnerships and initiatives, including incentives for Henry Ford employees to live in Midtown Detroit. In other words, we served as a stabilizing factor in the city and a bright light in the region’s hope for renewal.
We needed Detroit then and now because we are connected to the city in numerous crucial ways. As a health-care provider we are a community resource for the region we serve. Our greatest limiting factor would be the ongoing decline of the city. Our patients are largely from the region, as is the bulk of our employees. With uncompensated care one of our biggest challenges to profitability, a strong Detroit is essential to our long-term success. As health systems over the years have become more corporatized, many of them have of lost their way in terms of their community focus. That will never be the case with HFHS. We were created by Henry Ford to serve the community, and that emphasis is central to our mission, vision, and values. In fact, today we continue to look for better ways to connect ever more closely with the community. Our role as an employer and an economic force remains central to our strategy, as does our primary vision of transforming lives and communities through health and wellness, one person at a time.
Thinking Differently About Our Role
If the ongoing success of Henry Ford is linked to the stability of Detroit, then leading a coordinated charge to hasten the community’s recovery is fully within the scope of our interests. And given our mission and vision around community, the effort is even more appropriate. That said, economic development is not a core competency for most health systems. In fact, it’s unconventional for an organization like ours to attempt it in any meaningful way. In order for it to work, we’ve had to think very differently about our role and about investing in ventures that have nothing to do with health care.
One of the best examples of thinking outside of our usual frame of reference is our partnership with the Detroit Medical Center and Wayne State University to incentivize employees to reside in the city. Launched during the recession, amid automotive industry bankruptcies and massive job loss in Detroit, the program accumulated a pool of $1 million to get started. “Live Midtown” offers cash incentives to employees at any of the three organizations who elect to live in Midtown: it awards $25,000 to those who buy a home, $5,000 to those who renovate a home they already own, $2,000 in year one to those who rent, and $1,000 to those who rent the following year. The first Live Midtown program, launched in January 2011, was instantly successful. It exhausted its funding in seven months and attracted 220 new residents to Midtown Detroit during that time. The program is ongoing, and newer offshoots include incentives to “Live Downtown.”
There are a number of other major ways we at HFHS are boosting the local economy and redeveloping Detroit. One is by acquiring property in the neighborhoods around Henry Ford Hospital. As part of that effort, in 2012 we began a $500 million expansion of our Downtown Detroit campus. The vision over the next ten to fifteen years includes expansion of clinical facilities, green space, and commercial, retail, and residential development. As a key part of that effort, we worked with Cardinal Health in 2015 to open a sprawling, state-of-the-art health-care-supply distribution center in the neighborhood. The $30 million Cardinal Health Distribution Center marks a key development in the city’s revitalization, bringing 150 jobs to the neighborhood. Part of our contribution was acquiring the eighteen acres of property and performing the planning work, including conducting environmental testing and obtaining proper zoning approvals and development incentives. In order to ensure the success of the venture, we also shifted our entire distribution and warehousing business over to Cardinal Health. The beautiful 275,000-square-foot building transforms an area that, until recently, contained crumbling industrial structures and withering, desolate fields.
We are also part of a consortium that is developing a new light rail system that will run through Detroit, from Downtown to the boulevard where Henry Ford Hospital is located. In this case, we invested $3 million to add a station stop that will serve Henry Ford Hospital and the surrounding neighborhood. This, together with our other economic development efforts, will benefit us as well as the community. But in order to envision that mutual benefit we had to set aside the normal way that we thought about investments to determine what would really connect us to the community.
Beyond pure infrastructure development, we’ve used innovation and entrepreneurship as a means of fueling growth in Detroit. A community like Detroit, with its considerable grit and determination, is a fertile environment for innovation, and we’ve witnessed some inspiring successes as new ventures rise up from the ashes of shuttered businesses. In fact, in 1999 we played a leading role in one of the earliest attempts to sponsor start-up ventures in Detroit. In partnership with General Motors and Wayne State University, we incorporated TechTown, an incubator for innovation.
The concept mushroomed rapidly, and, in 2004, a 135,000-square-foot facility was opened in a landmark 1927 Albert Kahn building contributed by General Motors. Today, the building houses TechTown, its incubating enterprises, and other forward-facing Detroit businesses. Our former CFO and current CEO of our health plan, Jim Connelly, has served as treasurer of TechTown since its inception. Its recently renovated first floor is home to thriving bus
iness in the retail, wholesale, and technology sectors.3 TechTown is a dynamic place where talent, technologies, and capital converge. In fact, we put a couple of our major research activities into the building as well, including our genetics work and our drug discovery laboratory. With this move, we’re helping to create a space where people can collaborate to drive change. It is something that appeals to young professionals and it has already made a difference in the way Detroit defines itself and in the way it will evolve to succeed in the future.
TechTown is a great beginning, and there is much more to come. In 2014, for instance, I was asked by Detroit mayor Mike Duggan to chair a working group charged with creating an innovation district to accelerate job growth and entrepreneurship in the city. Our seventeen-member advisory committee—in partnership with anchor organizations in Detroit as well as private-sector companies, including those backed by Quicken Loans chairman Dan Gilbert—is examining ways to leverage the assets in Midtown and Downtown in order to tap into the knowledge economy. Our goal is to drive new growth and job creation, and to launch and attract new businesses to vital areas of Detroit. The 4.3-square-mile district under discussion already holds 55 percent of the city’s jobs, though it represents only 3.1 percent of its land mass.4
This is exciting. And this work lies at the intersection of several areas about which I am enormously passionate—Detroit, innovation, and turnarounds. I am excited to help move this concept forward because I firmly believe that it will support Detroit in evolving and becoming better than ever.
Caring for the Community
If economic development is somewhat new for HFHS, health care is not, and we are preemptive in how we approach serving the community. We need to be extremely disciplined in order to succeed at the job that we were founded to perform. After all, the complex social and economic conditions in Detroit mandate that we operate at peak performance. In addition, federal legislation and insurance reform are pushing health-care delivery organizations away from a fee-for-service model and toward one based on value—higher quality and lower cost. On top of that, altered demographics, from the vast aging population to young millennials with entirely different needs and expectations, put the onus on health systems to be nimble and open to change. Any way that you look at it, this is a perfect storm. And yet, HFHS is on solid ground because we have been paving this path in Detroit for a century. After all, Henry Ford Hospital was founded by a legendary stickler for efficiency—and we have followed his example closely.
We set our community health agenda using a seven-pillar approach to strategy—which in itself is not unusual. Most systems have a stated focus on finance, clinical care, and perhaps even education. But it is unconventional to have a strategic focus on the needs of the community. As part of that focus, our community pillar team analyzes multiple sources of health statistics, demographic data, and socioeconomic information to identify key communities. We use that information to prioritize specific needs and determine the focus of care for underserved and disadvantaged populations.
A specific tool the community pillar team uses to stake out a plan is our Community Health Needs Assessment. We use the triannual federally mandated assessment to help us improve the health of the people we serve through community programs and intervention strategies. The last assessment was completed in 2013, and we have used it to identify programs and services that will have the greatest measurable impact on the people we serve. The 2013 report pointed out areas on which we should focus, including poor access to care/lack of health coverage, obesity, lack of access to healthy food, diabetes, hypertension, and heart disease.
Using the information from the assessment and the anecdotal evidence we collect as a matter of course, we’ve developed ways to proactively attend to the health of the community and focus on preventive care as well as on reducing readmissions.
Infant Mortality—Creating a Safety Net
In 2007, we began to examine the high rate of infant deaths across the area. Despite the existence of high-quality health systems in metro Detroit, the appalling rates of death among the most vulnerable members of the community—infants—rivaled that of third-world countries. A major driver was the disproportionately high number of deaths among African American infants, who died at a rate that was nearly double the overall rate for the state, according to the Michigan Department of Community Health.5 The causes included the absence of a coordinated effort to link at-risk women with the necessary medical and social resources. Consequently, the safety net had gaping holes. Because a staggering problem like this requires a concerted effort, we collaborated with competing regional health-care providers to form the Detroit Regional Infant Mortality Reduction Task Force. Our goal was to improve the conditions that lead to infant survival through the first year of life.
The effort partners health systems with community organizations and local health departments to create a comprehensive approach that addresses both clinical and social factors associated with infant mortality. More specifically, the initiative connects at-risk women with “neighborhood navigators” who recruit women in three of the highest-risk neighborhoods in Detroit and connect them to an array of socially and economically appropriate health-care services, local neighborhood resources, and phone- and web-based sources of information to meet their needs. Pregnant women receive intensive intervention, including home visits and mentoring. The program results have reset the bar, and led to zero infant deaths among the enrolled women in at-risk neighborhoods.
The next iteration of this program, which is upcoming, uses the same techniques to connect women and their children with social services and health care, and also creates opportunities for group visits to doctors and counselors, whereby women and their peers join the program together to create a high level of peer support and reinforcement.
Obesity and Malnutrition—Generation with Promise
In 2007, our own Dr. Kimberlydawn Wisdom, the nation’s first state-level surgeon general, founded a program called Generation with Promise. Her commitment is to support Michigan’s young people, their families, faith-based organizations, and communities through knowledge and skills, to empower them to create communities in which healthy lifestyle choices are the default option. The program aims to help students and their families move more and eat better, changing lives in the process. Drawing on the expertise of registered dietitians, professional chefs, and health educators, local schools and physicians work together to improve healthy behaviors through nutrition education, including cooking demonstrations and food tastings for elementary, middle, and high school students and their families. The interactive approach includes a class on how to feed a family of six a healthy meal on a shoestring budget of $10, after which families receive recipes and $10 food vouchers redeemable at local markets.
Health Screening for Chronic Conditions
The African American Initiative for Male Health Improvement (AIMHI) is a joint effort of the U.S. Office of Minority Health and HFHS—started many years ago to provide screening and education for African American men at high risk for diabetes, hypertension, and other diseases, and to help them access care and improve their overall health. In support of the program, Dr. Wisdom went into the community on the weekends, visiting barbershops, churches, and community centers to enroll people. AIMHI transcends the conventional approach of public health screening programs by moving participants from disease recognition into treatment, and empowers them to manage their chronic conditions. After many years, it has become a signature program that underscores Henry Ford’s connection to the African American community of Detroit.
Finding Common Ground
Numerous programs, in addition to those above, are ongoing. From school-based health clinics and the Henry Ford Early College to health-care kiosks in churches and community centers, our community outreach and economic development efforts have partnership as their common denominator. For economic development, we partner with public and private organizations, including our competitors, a
s well as with entrepreneurs and small businesses. In our community, we partner with health-care and social service organizations and state and federal government, as well as thousands of members of the Detroit community.
I first started partnering with community organizations years ago in Akron when I was creating a program to reach out to the elderly in their homes. In this case, I partnered with a local community group so we didn’t have to fund all of the required infrastructure on our own. The group had a call center and other resources that I needed, and we had healthcare resources for seniors in the community.
Both in Akron and in Detroit I found that the key to effective partnering is finding common ground—of which there is plenty. If you find that common ground, you can transcend barriers such as competitive interests. To offer one example: for years I’ve met regularly with a group of fellow health-care CEOs from across southeast Michigan. We get together every few months to talk about ways to work together. These are our competitors and yet we share ideas and resources because our needs overlap in a multitude of ways. We always find common ground and a reason to collaborate.
It’s also important to create a partnership mentality within an organization. You need first to be aligned with your board, of course. Next, your leadership team must be aligned around a common vision regarding community needs. One of the biggest goals we are all aligned around at HFHS is reinvesting in our Detroit hospital and the Detroit community. We all agree that we need to take smart risks to encourage people to come to Detroit for care, and we need to work with other anchor organizations in Detroit to create a path to renewal.
Unconventional Leadership Page 14