Briefly, see Don Berwick’s 2021 National Forum Plenary on Ten Teams: Health Care’s Great Power and Great Responsibility He starts with a previous framing of the Moral Determinants of Health which include Ending hunger and homelessness in the US. His frame is that the healthcare system must become an active agent of change. He challenges every hospital and health system to create ten teams, each linked to key causes of ill health and disease not just to do good, but because these social determinants are core to their missions. He calls for engagement beyond the usual Community Benefit Program, to include a central daily strategic focus of the organization’s Board, senior executives, finance leaders, and accountability systems on the core systems that drive health and well-being. Why? Because healthcare is too big. It takes too much of the GDP (19.7% as of 2020) to stand on the sidelines.
For each team he suggests an aim, the connection to health, experts available for guidance and advice, and one or more exemplary organizations that have tackled the issue successfully. The teams should include:
- Senior Sponsor
- Board Sponsor
- Budget with ambitious quantitative goals
- Designated Leader with weekly reporting to the Senior Executive Group
- Resources and encouragement (license to learn)
- Active member of relevant regional or national learning collaboratives
One of these ten teams should be on Housing Security. Berwick calls out Rosanne Haggerty and the exemplary work of Community Solutions which this year won the $100m McArthur Foundation challenge grant to accelerate an end homelessness in America. Hospitals are challenged to commit to end chronic homelessness in the region served by the hospital and join the “Built for Zero” movement. Not every organization will have the scale to stand up all ten teams. As a simple heuristic, he suggests that a hospital stand up one team for every $100m in revenue. As an example, Concord (NH) Hospital had $555m in revenue in 2020 and thus might be challenged to charter five teams, one of which we propose would have a focus on housing security.
NH Collective Health Impact 