[1] The H1N11 influenza pandemic has created distinctive challenges and opportunities for healthcare providers. At Advocate Health Care, a large, dually affiliated faith-based system serving the Chicago area, planning for the epidemic’s resurgence this fall spurred recognition of both a need and an opportunity for vigorous, creative community outreach.2
[2] When the H1N1 outbreak surfaced last spring, Advocate mobilized resources to address a “surge” of patients. Many showed up at physician offices and hospital emergency rooms. A few were admitted as severely ill inpatients. While hospital resources were “stretched,” the situation proved manageable.
[3] But the spring surge was unlikely to mark the last impact of H1N1. Along with the rest of the country (and the world), Advocate began to prepare for the expected fall-winter surge, or surges, of patients affected by H1N1, seasonal flu, or perhaps both. Because Advocate’s Mission is to “serve the health needs of individuals, families and communities” in light of human beings’ creation in God’s image, Advocate’s care for health must extend beyond the walls of its facilities. Leaders in Advocate’s faith outreach,3 community health, and government relations areas realized that H1N1 preparations required new forms of outreach to Advocate’s faith partners, including congregations and judicatories, plus focused approaches to community partners such as government entities, schools, community organizations, and businesses. These leaders saw that compartmentalized approaches addressing faith communities and wider communities separately and without coordination could not meet the threat of widespread H1N1. Recognition of a need for concerted action reflected an awareness of organizational responsibility — Advocate’s “social responsibility as a corporate citizen,” recognized in its Philosophy and elaborated in a Board report on “Advocate’s citizenship.”
[4] It was also evident that timely, effective mobilization of community and faith community resources could prove vital. To reach this goal, more than the typical “dissemination” strategy of providing education and distributing resources through newsletters, email lists, and the like was called for. Engagement with multiple faith and community partners was critical if these partners were to be supported — and fully invested — in meeting the pandemic challenge.
[5] Dissemination. Nonetheless, dissemination was an indispensable first step. Because people look to Advocate as a trustworthy source of health information and expertise, it must be worthy of the public’s trust.4 Advocate was duty bound to ensure that any resources and education it offered conveyed current, reliable information —and all the better if it were readily accessible and appealingly packaged for the intended publics. Hence content and design input from both clinically knowledgeable and communication-savvy leaders in other departmental areas would be valuable, in fact necessary. Only so could optimal stewardship5 of the organization’s trustworthiness (a form of reputational stewardship) and of the human and financial resources devoted to these initiatives be assured.
[6] Ample information and pre-existing materials on H1N1 were available from multiple sources — for those who knew where to look. Making these materials readily accessible to the right constituencies was the key. It was determined that materials disseminated should consist primarily of resources available from the CDC (Centers for Disease Control and Prevention) and DHHS (the U.S. Department of Health and Human Services). Because the audiences represented diverse interests and multiple constituencies, it was important to tailor resources to the needs of a given constituency. Consistent with other efforts to expand and enhance access to health care, educational materials were produced in English and Spanish. In addition, some constituencies —congregations and their leaders, in particular — were recognized as strategic because of both internal and external impacts they had, or could have.
[7] Congregations were viewed as community assets, and potentially as a credible source of reliable pandemic information and guidance. Mutual collaboration could leverage existing relationships and communication channels, and help congregations and their leaders prepare to offer optimal support to internal and external constituencies. In a sense this use of Advocate resources functioned as indirect stewardship of congregational resources for the sake of community health.
[8] More broadly, it was deemed important that congregations and other small community organizations remain “open for business” as potential resources during a pandemic. They needed to devise strategies enabling continuity of operations and service if their leadership and staff were hit hard by the pandemic. A DHHS H1N1 resource guide for community organizations and congregations offered such strategies; for congregations, it even suggested infection control practices that could be implemented in worship settings. Advocate was able to offer limited print quantities of the resource guide, and made them electronically available to congregations as emailed PDFs or via web links to the text.
[9] For effective community dissemination, collaboration with appropriate partners was crucial. Those implementing Advocate’s community health outreach worked with health departments, school districts, elected officials, and park districts (placing posters in restrooms, for example) to distribute information about prevention, containment, and illness management. This approach reflected the Advocate value of Partnership. “Partnership” may seem nondescript as an organizational value (after all, who doesn’t value partnership?—even the Mafia does). But provide a worthy cause—and H1N1 has certainly been one—and Partnership comes alive in vital collaboration.
[10] Engagement. Beyond dissemination, efforts at relational outreach aimed to engage multiple constituencies listed above. Congregations, for example, were engaged through intensive seminars for faith community leaders, with infection control specialists from local health departments joining Advocate resource people to provide leadership. The aim was not just to inform, but to provide interactive guidance that helped leaders equip congregations to prevent and manage illness and offer potentially vital community support in a severe pandemic. In addition, Advocate parish nurses serving 28 congregations provided intensive education on H1N1 and often facilitated congregational planning for comprehensive response to H1N1. A high proportion of these congregations and their parish nurses participated in the intensive seminars.
[11] Coincidentally, fresh thinking about community health outreach among collaborating Advocate leaders had already convinced them it was important not only to reach out to identified constituencies, but also to track the effectiveness of community health interventions. This realization was driven by both clinical and public policy realities. It is no longer enough — whether in the eyes of those seeking to improve communities’ health or those who scrutinize “charitable” activities of not-for-profit healthcare providers — to offer health-related resources to communities and deem them “community benefits.” The demonstrated need a resource addresses, its actual use, and the impact it has (or doesn’t) need to be documented, monitored, reported. Those reaching out to communities and congregations tracked the use of H1N1 resources and proximate outcomes resulting from their use. (One such outcome: a suburban school district placed 5,000 CDC brochures on flu prevention and illness management in student backpacks; this meant a brochure went home with every K-8 student in the district.)
[12] One other instance of H1N1-generated collaboration deserves mention. Together with an academic institution and a public health institute, Advocate cosponsors a project, the Center for Faith and Community Health Transformation, which seeks to reduce health disparities through “faith-rooted” community partnerships.6 The Center was awarded a DHHS grant to provide H1N1-related resources and services to marginalized populations in the Chicago area. Funded services include education, consultation, and H1N1 vaccinations for populations such as homeless persons and undocumented immigrants — populations that might otherwise hesitate to seek, or not know how to access, these resources. While distinct from Advocate H1N1 efforts outlined above, this parallel initiative adds a dimension by extending access to H1N1 services to vulnerable populations in communities Advocate serves.7
[13] Two concluding comments seem appropriate. First, the approach to H1N1 described here reflects an ongoing organizational process of learning how to be an optimal community partner. It is part of Advocate’s evolving readiness and ability to collaborate with congregations and act as a partner in and with communities it serves. The H1N1 crisis has awakened greater awareness of the potential to leverage real, extensive benefit from such collaboration.
[14] Second, while this article seeks to make explicit some ethical and mission-related considerations informing Advocate’s response to H1N1, the reality “on the ground” is often implicit. Those who must decide and act—especially under circumstances perceived as urgent—may not always focus on particulars of the organization’s Mission, Values, and Philosophy (its “MVP”) as they choose a course of action. Nevertheless, committed people who have internalized key elements of the organization’s self-understanding can act effectively and indeed habitually on that foundation. Seen in this light, Advocate’s story of H1N1 outreach is a reminder that faith-based organizations rely significantly on formation as a source of real-time guidance to leaders faced with the need for timely action.
Endnotes
Early on H1N1 was called “swine flu” (the virus is traceable to pigs) or “novel H1N1” (other forms of H1N1 had previously been identified).
Created by a 1995 merger, Advocate is dually affiliated with the United Church of Christ and the Evangelical Lutheran Church in America. Presently, its primary sites of care include eight acute care hospitals, two children’s hospitals, and a specialty hospital, plus a home health and hospice agency and physician group practices and clinics. Advocate employs more than 28,000 people at over 200 locations. As a Lutheran social ministry organization, Advocate is a member of Lutheran Services in America. Early in 2010 the Advocate network will expand geographically by merging with another Illinois healthcare system a significant distance from Chicago.
As part of its faith-based identity, Advocate’s “faith outreach” function communicates regularly and collaborates widely with area faith communities. Its “congregational health partnerships” and “parish nurse ministries” areas played significant roles in H1N1 outreach.
See Philip J. Boyle, Edwin R. DuBose, Stephen J. Ellingson, David E. Guinn, and David B. McCurdy, Organizational Ethics in Health Care: Principles, Cases, and Practical Solutions (San Francisco: Jossey-Bass and American Hospital Publishing, 2001), 251.
Stewardship, Compassion, Equality, Excellence, and Partnership are Advocate’s core values.
The Center is a partnership between Advocate Health Care, the Public Health Institute of Metropolitan Chicago, and the Neighborhoods Initiative of the University of Illinois at Chicago. Although not a sponsor, the Chicago Department of Public Health also participates in this project.
In adopting a 2008 report on access to health care, the Advocate Board endorsed wide-ranging efforts to promote enhanced access, defined as “the ability of all individuals, families, and communities to secure appropriate health and wellness services in the right place, at the right time, and in the easiest manner possible.”